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Visual Supports - Using Symbol Communication

Wong-Baker FACES Pain Rating Scale. From Pam Harris/USING AAC AS A FAMILY provides this back ground to this visual support:
My son is functionally nonverbal and uses AAC strategies to express himself. He has a rare genetic disorder, Rubinstein-Taybi syndrome and like most with RTS, is intellectually impaired and endures myriad medical challenges.

Before we found out that Josh's knee was intermittently subluxing, it was too easy to attribute his reluctance to walk up the stairs to his 3rd grade classroom as avoidance. Before we found out that Josh was hypoglycemic, it was too easy to attribute his unwillingness to get out of bed in the morning as avoidance. Before we found out that Josh had eosinophilic esophagitis, it was too easy to attribute his picky, pokey eating as sensory. Before we found out that Josh had an impacted wisdom tooth, it was too easy to attribute his refusal to brush his teeth as sensory or avoidance. Everyone was sure it was "behavior" and needed to be extinguished.

How many people with special needs are really experiencing pain and discomfort only to get social stories, visual schedules, time-outs, fav activities restricted or other punishments?

We all must do better and work harder to address pain - expressing pain - its location and its intensity. Pain and discomfort is a part of the human condition and people with communication challenges - regardless of age or skill level - must receive instruction in communicating about pain.

Waiting until a medical crisis arises is too late. I have attached a one-page handout that I use. It describes the Wong-Baker FACES Pain Rating Scale. I hope this sparks discussions.
Pam Harris

This was posted on the QIAT listserv 5/22/08. Go to to join.

More discussion on the use of this scale can be found at:

Abbott, C., Detheridge, T., & Detheridge, C. (2006). Symbols, Literacy and Social Justice. Cambridge, UK: Widgit Software.
Abbott, C., & Lucey, H. (2005). Symbol communication in special schools in England: the current position and some key issues. British Journal of Special Education, 32(4).
Buti, M. (2005). Let's get organised. Closing the Gap, 23(5).
Buti, M. (2007). Let's get visual. Closing the Gap, 26(1).
Cohen, S. R. (2004). Boardmaker... visual supports for all students. Closing the Gap, 23(4).
Frost, LA & Bondy, A. (1994). The Picture Exchange Communication System. Cherry Hill, NJ: Pyramid Educational Consultants.
Hartmann, A.(2007) Speech-Generating Devices - Will they stop my child from talking? Paper presented at the 2007 National Biennial Autism Conference, Gold Coast, Queensland. Retrieved from
Hodgdon, L. A. (2002). Visual Strategies for Improving Communication - Practical Supports for Home and School. Michigan: QuirkRoberts Publishing.

Writing with Symbols 2000, Communicate: In Print 2, Communicate: By Choice, Communicate: SymWriter, Communicate: Webwide.
Boardmaker, Boardmaker Plus
Clicker 5. Clicker Paint, ClozePro.

Online Resources, Classroom Resources and Practical Ideas
PictureSET is a collection of downloadable visual supports that can be used by students for both receptive and expressive communication in the classroom, at home, and in the community. This searchable database allows you to find a wide range of useful visual supports for different curriculum areas, activities, and events.
Linda Hodgdon's webpage - using visual strategies for supporting communication. Sign up her e-newsletter.
Visual support material, print material, online learning activities, and teacher and parent information.
Web based activities using visual supports.
An interactive forum for speech/language pathologists and teachers to exchanging ideas, techniques, and lessons that work; find out about materials before buying, seeking and giving advice, and exploring helpful resource links.
Free on-line resources for symbol readers.
Symbol web sites, information about symbols, symbol publications, guides and how to's and free Software
Widgit resources. Free and low cost packs for Communicate: In Print 2, Writing with Symbols and in PDF format.
Mayer-Johnson downloads page.
Mayer-Johnson forums for user discussion and sharing of resources.
Learning Grids is a resource sharing site for free resources for Clicker, ClozePro, Jigworks and Wordbar. Use them as they are or modify them to suit your needs.
Web Activity Exchange with a collection of free downloadable activities for a variety of software programs - suitable for a wide range of needs and age ranges.
The Therapy Friends Kits are ready made symbol activities using PCS. Each Therapy Friends Kit is centred around a theme area and can provids a whole unit of activities for the classroom. All activities can be used with students of differing ability levels.
Weekly on-line newspaper using symbol support.
'book-in-hand' bookshop catalogue.
KLIK Books website link to the Communication Series Books.
1. Communication for All Kids:Using an Exchange Communication System in Your Classroom, Second Edition
2. Communication in All Curriculum Areas: Embedding an Exchange Communication System in Learning Activities
Autism Spectrum Australia (Aspect) publications including:
Visual Strategies: Developing Visual Supports
Discusses visual learning style of people with autism; what are visual supports; practical examples of visual supports; how visual supports can facilitate communication, support behaviour and assist the development of functional skills; making visual supports effective (symbol & format selection; accessibility & information content); and practical hints for making visual supports. 34pp handbook, published 2001.
Savner, J. L., & Myles, B. S. (2000). Making Visual Supports Work in the Home and Community. Shawnee Mission, Kansas: Autism Asperger Publishing Co.
Contains step-by-step directions and pictures to help create visual supports that can be geared to the individual child and family across many settings.
Google Images - download photos, images and free symbols for use in visual support resources.
Listing of PSC Books and resources.