For children with ASD, errors often evoke disruptive behavior, with the result that instructional time is lost. Further, once errors are made, they are often repeated. The antecedent prompting procedure, manual guidance, faded to graduated guidance, spatial fading, shadowing, and decreased proximity to the learner, is a strategy for decreasing errors. In addition, the error-correction procedure—returning to the prior fading step until the learner makes several correct responses—helps to prevent repeated errors.

Although the most-to-least prompt sequence minimizes errors, error analyses are important. For example, is a particular photograph in the schedule associated with a high error rate? If we scrutinize those photographs, we sometimes note background stimuli (e.g., candy, a hat and coat) that have unintended salience for the learner. Do certain play materials (e.g., a top, a drum) depicted in the schedule evoke stereotypy? Error analysis helps to identify and prevent such problems. These error reduction procedures and error analyses, combined with a continuous schedule of reinforcement that gradually becomes intermittent, enable many young children to complete lengthy response chains that do not include high-rate vocal or motor stereotypy.

Parents of children with ASD often report their resistance to changes in routine . For example, the children may cry at birthday parties, attempt to isolate when grandparents visit, tantrum when a parent takes a different route to the grocery store, resist wearing new clothing or sampling new foods, or cry when a new baby brother or sister cries. Activity schedules can help children learn to adapt to changes in their environments and their usual activities.

Resequencing the photographs in children’s schedules, substituting original photographs for pictures taken from a different perspective, deleting photographs of previously mastered activities and adding new photographs and novel activities, lengthening activity schedules, and changing interaction partners—all of these procedures help youngsters learn to tolerate change. For children who have acquired basic schedule-following skills, it may be helpful to add a picture (for example, a photograph of a gift bag) that indicates a “surprise.” Initially, when a child arrives at the “surprise” picture, the instructor may produce the gift bag that contains a preferred snack. On future appearances of the “surprise” picture, the instructor may provide favorite toys or activities. Next, the “surprise” photograph is followed by a 1 min “party,” during which the instructor wears a party hat and produces a party plate containing a preferred snack. On a subsequent occasion, the “surprise” in the activity schedule is followed by a brief visit from an unfamiliar person, who delivers a preferred toy and then departs. Of course, the ratio of rewards to unanticipated events is adjusted to help preschoolers succeed when confronted with changes in routine, with the goal of gradually increasing the proportion of unanticipated change events that the child can tolerate without engaging in challenging behavior .

Sometimes, the activity schedule itself is sufficient to remediate resistance to change. A preschooler who was a skilled schedule follower, but who refused to sample new foods, was given an activity schedule that included pictures of a red bowl, a blue bowl, and a yellow bowl. Before each lunch, the contents of the bowls—a preferred food, a non-preferred food, and tokens—were non-systematically rotated across bowls. Pictures of the bowls controlled either eating a bite of a preferred or non-preferred food or taking a token. Tokens were frequently exchanged for preferred snacks. This young boy, who previously refused many foods, learned to sample new foods because the activity schedule controlled responding.

Similarly, an activity schedule proved useful for a 5-year-old with ASD who screamed and ran away whenever his infant brother cried. To address this problem, several pictures in his schedule showed his mother holding the baby while he brought her a diaper. When he encountered these pictures, a staff member who was holding a doll in a blanket said, “Tommy, could you please bring us a diaper?” and another instructor manually guided him to obtain and deliver the diaper, after which the pretend mother responded by thanking him and giving him a preferred toy or snack that was immediately used or consumed. When this response sequence was dependably exhibited, the photograph in the schedule was accompanied by a low-volume audiotape of a baby crying, and the boy continued to be rewarded for approaching with the diaper. The volume of the audiotape was gradually increased, until it was at or above the loudness of the infant’s crying, and the youngster continued to display the target responses in the early intervention setting, after which prompts were faded, the pictorial cues were added to his home activity schedule, and he assisted his mother and infant sibling at home .

After young children have learned to follow a first photographic activity schedule, it is time to begin preparations for the use of schedules at home. Although the first brief picture schedule may be taught in a quiet room, schedules are then introduced in busy classrooms, where there are many distractions. The goal is to help young children remain engaged when they follow schedules at home, where there may be disturbances such as ringing telephones, noisy siblings, and high-volume televisions. It may also be important to rotate instructors, in order to program generalization across adults.

Initially, parents are invited to visit the early intervention program, observe their child’s schedule following, collect data on the youngster’s performance, and then learn to use and fade manual guidance and deliver rewards. When a youngster consistently displays the desired responses in the treatment setting with a parent as prompter, the activity schedule is introduced at home. During this process, a staff member from the intervention program models the procedures, observes parents’ implementation, and provides feedback (McClannahan and Krantz 2001).

When new activities are introduced, they are typically taught first in the intervention setting and then transferred to home. Family activities and parents’ preferences are important in selecting next activities. Parents who have a special interest in music may want a young child to learn to hum or sing a song or pick out a few notes on the piano. Families who enjoy biking may want a young boy or girl to learn to ride a tricycle and later, a bike with training wheels. Parents who enjoy regular television watching may want a youngster to learn to play with toys on a rug near the sofa while family members watch a favorite program. Others may want a child to learn to play catch or kick a soccer ball. Activity schedules that acknowledge family preferences are more likely to be implemented at home .

Parents who are proficient with schedules learn to improvise and adjust schedules according to momentary needs and family members’ commitments. For example, if a quick trip to the grocery store is necessary, or a sibling needs a ride to an after-school event, a photograph of a car ride is inserted in a youngster’s schedule. If a young child appears tired, a picture of a nap is added. If an unexpected visitor arrives, independent play activities are added to a boy’s schedule. If a girl is off task while using the computer, the parent abbreviates the activity. If a youngster engages in stereotypy while moving from room to room, his parents may temporarily add sit-down activities to his schedule.

Over time, many children’s mastery of schedule-guided activities at home makes it possible to remove photographs from home schedules and create new schedules to be used at aunts and uncles’ or grandparents’ homes, during unexpected visits from relatives or friends, during car rides, in the barbershop or hair salon, or in doctors’ and dentists’ offices. Parents sometimes package these activity schedules and the accompanying materials in bags or backpacks, so that they are immediately available, even on short notice. Many children, ages 3–6 years, use activity schedules from the time they arrive home from the intervention setting until bedtime .

After a young child acquires a basic schedule-following repertoire, it is time to teach choice. Instruction often begins by presenting photographs of two preferred items on the last page of the schedule. Using graduated guidance, the instructor lightly holds the child’s hand above the page until he reaches for one of the pictures. Then he is guided to remove the picture he selected and obtain the corresponding item. If a learner does not reach for a picture after a few seconds, he is guided to take one, thus excluding the other. Most children quickly learn to make a choice. When a child regularly chooses one of two pictures without prompts, three choices are depicted on the schedule page. Subsequently, choices of rewards are presented on a nearby “choice board” or in a separate three-ring binder, and the number of items and activities is gradually expanded, until young children may make choices from a field of ten or more photographic stimuli.

Children are also taught to select the order of learning activities. Initially, pictures of two tasks appear on a page, and a child might select either counting or verbal imitation. Again, the number of choices gradually increases, until a preschooler may determine the sequence of nearly all of the activities in her schedule.

Learners often have separate schedules that teach play or gross motor skills. These schedules may contain no photographs; Velcro^© dots are centered on the otherwise blank pages. The number of accompanying photographs, on a nearby choice board or in a bin, is greater than the number of pages in the schedule book. Children not only learn to sequence these photographs and activities, but also to exclude certain photographs of toys or activities. Ultimately, the blank pages in the book are replaced by single photographs of play or exercise areas, which appear in youngsters’ daily schedules; then they independently make selections of play or exercise activities .

Incorporating choice has a variety of benefits. For example, research with children and adults with ASD indicates that engagement is higher in choice versus no choice conditions (Ulke-Kurkcuoglu and Kircaali-Iftar 2010; Watanabe and Sturmey 2003), and that opportunity to choose task sequence is associated with higher on-task scores, more rapid task completion, and decreased problem behavior (Smeltzer et al. 2009).

As noted earlier, the most-to-least prompt hierarchy was selected for the purpose of promoting independent engagement and minimizing prompt dependence. But in our experience, the final fading step—decreasing adult proximity to a child—is the step least often implemented. Perhaps teachers and parents are fearful of separating from 2–6-year-old children with ASD. But for children in this age group, decreased proximity may mean stepping behind a bookcase or room divider, or moving just outside a play area or classroom, so that the adult is no longer visible to the child. If the goal is to enable children to remain productively engaged in the absence of immediate supervision, adults must fade proximity.

In a study by Pelios et al. (2003), independent work skills were established in three boys with autism, ages 5, 9, and 9 years, who had a history of remaining on task when instructors were present, but engaged in stereotypy in their absence. Throughout the investigation, the boys followed activity schedules that displayed on alternate pages either a single, previously learned word (e.g., “math,” “coloring”), or a penny, which was self-delivered; at the end of the session, pennies were exchanged for preferred items. Manual prompts were faded to graduated guidance, spatial fading, shadowing, and then proximity decreased until the teacher was outside the room . Subsequently, the teacher entered the classroom for 2 s every 2 min, then 3 min, then randomly every 2–5 min and then every 3–5 min. During treatment, if a boy took a penny without completing a task, the teacher manually guided him to return the token and follow the schedule, and if stereotypy or other off-task behavior occurred for 3 s or more, the teacher removed all previously earned coins and manually guided the participant to begin the schedule again. The on-task and on-schedule behavior of all three boys generalized to a novel setting and to novel materials, in the absence of adult supervision. This investigation underlines the independence that can be achieved by children with ASD when adults’ proximity is faded and supervision is unpredictable.

At first glance, it may seem unusual and unnecessary to fade adults’ proximity and promote the independent behavior of very young children. Staff members in early intervention programs sometimes resist moving beyond a young child’s line of sight or stepping outside the classroom, perhaps because it may appear that they are doing nothing. But parents are often aware of the difficulties of continuous supervision. At home, parents must attend to other children, prepare meals, answer telephone calls and e-mails, receive guests, and pursue housekeeping tasks, and these tasks are difficult to complete if a young child with autism has not learned to remain appropriately engaged, at least for a few minutes. Teaching young children to use photographic activity schedules and deliver their own tokens not only promotes independent performance, but also helps to reduce parents’ response cost .

As noted earlier, activity schedules are gradually extended from a few photographs to many photographs that guide youngsters through the day, including time spent in the intervention program as well as time spent at home. As new activities are added, it is important to evaluate their age appropriateness. A 3-year-old with ASD who identifies alphabet letters and reads a few sight words may receive a good deal of positive attention, but a 6-year-old who plays with stacking cups and teething rings will be viewed quite differently by others. For children with severe disabilities, activities can (and should) be modified to reflect chronological age. For example, a 5-year-old who cannot yet match pictures and corresponding objects can learn to match identical objects on a computer, and can be taught to follow an activity schedule that enables him to match photographs in the schedule with photographs mounted on bins that contain the corresponding materials.

Typically, activity schedules lengthen because children master longer response chains. After response sequences such as washing hands, brushing teeth, or setting the table have been mastered, single photographs in the main schedule may depict other schedule books with pictures of hand washing, toothbrushing, or table setting on the covers. Learners then obtain sub-schedules, go to the relevant locations, complete the depicted responses, and return to their main schedules.

When a child’s schedule is lengthy and has been frequently practiced, it is often possible to delete cues that are no longer needed. For example, at snack time, when a boy correctly obtains napkin, cup, and paper plate without looking at the corresponding photographs, it is time to remove those cues and replace them with a single photograph of paper plate, napkin, and cup, near a bottle of juice and cookies. If he then makes errors, prompting resumes and in some cases, photographs may be temporarily replaced. But it is essential to remove pictures that children no longer reference, because failure to do so may teach them that they need not use their schedules .

Activities change and schedules are updated as children acquire new skills. The discrete-trial verbal imitation of phonemes depicted in a 2-year-old’s schedule later becomes imitation of words, and then imitation of phrases and short sentences. Photographs of dressing skills, such as putting on shoes, are replaced by photographs of shoe tying and pictures that show steps in getting dressed.

Similarly, social activities depicted in children’s schedules become increasingly complex. A schedule for a nonverbal 2-year-old may include a picture of a child standing in front of an adult with arms raised to request a toss in the air. Subsequently, the photograph may be accompanied by a magnetic card or button-activated voice recorder that plays the sound/uh/, an approximation of the word “up.” Later, as speech is acquired, recorded scripts may include “up,” “want up,” “I want up,” and “I want up, please” (McClannahan and Krantz 2005). Next, scripted conversation moves beyond mands to more typical interaction with teachers and peers (Krantz and McClannahan 1993; Wichnick et al. 2010) .

As activity schedules evolve to reflect children’s developing repertoires, an issue of primary importance is making them similar to others’ to-do lists, daily planners, appointment books, and calendars. Often, a first step in this direction is teaching children to read sight words that represent activities in their schedules. In our experience, some young children who use the carefully programed Edmark Reading Program (1992) to learn to read sight words may readily learn to use written activity schedules when sight words are superimposed on photographs for some time, after which photographic backgrounds are abruptly removed. Other children, however, do not benefit from these procedures .

Birkan et al. (2007) used superimposition and background fading to teach a young boy with ASD to read 15 target words that represented the activities in his physical education schedule. The 6-year-old was selected as a participant because he had used the Edmark Reading Program for 5 months, but had learned only 16 sight words.

Prior to the study, he was taught to label the 15 photographs in his schedule (e.g., slide, swing, basketball, Pogo stick). During intervention, Adobe Photo Shop^© was used to superimpose the target words on photographs of corresponding activities; then portions of the photographs were gradually removed, until only the text remained. After background fading was completed, the boy correctly read 14 of the 15 target words in his schedule, and his reading skills transferred to different text size and color. During the 24 days of the study, he learned 14 sight words.

Miguel et al. (2009) used match-to-sample conditional discrimination training to teach two preschoolers with ASD to select pictures and printed words when the names of these stimuli were dictated. After they learned to match dictated words to pictures and dictated words to printed words, stimulus control transferred from pictures to printed words. Although neither of the boys could consistently follow a textual activity schedule during baseline, they could do so after training. Other investigators have shown that written lists that remain available mediate delays and promote correct responding (Stromer et al. 1998) .

Activity schedules not only evolve from pictures to text, but also to video applications and stimuli presented on desktop and pocket computers. Rehfeldt et al. (2004) described the use of PowerPoint® software to create schedules that included photographs, sounds, text, and videos, and that contained both close-ended (or completion-based), and open-ended (or time-based) activities. It is evident when completion-based activities are over—the last piece has been placed in the puzzle, the worksheet is finished, or all dressing tasks have been completed. In contrast, open-ended activities (such as reading books, playing with wheel toys, listening to music) have no obvious conclusion and therefore end with a signal indicating that it is time to put materials away and return to the schedule. When children use schedule books, they learn to set digital kitchen timers by matching color photographs of timers with colored buttons on the timers. When using PowerPoint® schedules, a slide displays a clock that is programed to chime after a designated amount of time has elapsed.