Our lives are full of transitions and tasks that need to be done daily; these could be things such as doing homework, getting paperwork done, or making dinner for your family. These may be simple tasks that everyone does, but some individuals may have a more challenging time than others. Individuals diagnosed with autism spectrum disorder may have difficulty transitioning from one task to another or doing the task itself. This is where the terms First-Then comes into play. You may be wondering what does this has to do with transitions and completing tasks? To understand, we need to identify what exactly the first-then board is?

There are many ways you can make First-Then boards for students, but in order to introduce them, you may want to start with something simple. A First-The Board is a visual strategy used to help children with language and/or behavior needs complete specific tasks (Dailey & Brooks 2019). The strategy occurs with two pictures, one in the “first” Column, which usually is a picture of a nonpreferred activity (Dailey & Brooks 2019). The other picture is placed in the “then” column with a preferred activity or preferred item. For this to work, the child must complete the nonpreferred task before doing a preferred activity (Dailey & Brooks 2019). For example, in the second picture, you see it is circle time first, then snack. This visual representation shows the child that in order to have a snack, we must first do circle time. The purpose of this visual board is to teach the child that we need to complete tasks.

How does this apply to speech therapy? 

The first-then board is very powerful in the speech world as the child is being taught schedules and receptive language. During the 1:1 session, speech therapists will utilize this visual strategy to have the child work on specific speech tasks, which may not seem fun. The child is then given a preferred activity or item to break up the tasks in-between. This provides the child with a better understanding of what is being asked of them. This is to get the child used to doing specific tasks and make that more normalized and functional in their everyday life. 

Can this be done at home?

In shorter terms, absolutely, and it is encouraged to be used at home as well as in the school setting. Children need consistency, and this is a very powerful tool to utilize with your child at home. There are many different handouts out there that can help use this at home with the child. Please contact the speech therapist that is working with your child before doing this at home to make sure you can be trained on how to do this. Things to consider are how you present this at home. The language used is different than everyday speech. For example, if your child wants to play at the park, they must finish their homework first. You would bring out the first then board and have a picture on homework followed by a picture of the park and say, “First homework, then park.” You also want to point to the pictures as you do this (Autism Circuit). Once the child has completed the task, you want to say, “homework all done, now the park!” This allows the child to understand that when they do the task, they can get something they prefer. This can be utilized in many different environments with the child. 

The power of first then has been a great tool that allows children to transition from one task to another and give them a visual representation of what needs to be done. Children strive to have visual representations, which assist in their ability to understand what the task is. The hope is that the child will no longer need a first then board over time and will be able to do these tasks on their own. 

Handouts:

https://childrensautism.ca/wp-content/uploads/2018/04/first-then.pdf

References:

Dailey, J. C., & Brooks, J. K. (2019). Autism Spectrum Disorder: Techniques for dental radiographic examinations. American Dental Hygienists’ Association, 93(6), 35-41.

Autism Circuit. (2021). First/then card. Autism Circuit. Retrieved October 4, 2021, from http://www.autismcircuit.net/tool/first-then-card.