Structuring and visualisation in practice

Principles of the guideline

According to the guideline, helpful in interaction are, among other things: non-verbal initiation of contact, concrete and direct communication suited to developmental age, structuring of the environment and routines, maintaining physical distance and avoiding strong sensory stimuli. In addition, a discrepancy between cognitive and social or daily-living skills should be taken into account and over- as well as under-demand avoided. ^{[1, Rec. 3]}

In nursery and school

For nursery, the guideline named clearly worded instructions for action, a visualised daily structure and small-step guidance, where needed a low-stimulus separate room and hearing protection. In school: simplified work instructions, worksheets and task wording as well as individual reasonable adjustments. ^{[1, Rec. 109]} More: Autism in nursery: notes for professionals and Pupils with autism in lessons.

In work and housing

• Work (in the guideline’s section for people without intellectual disability who do not obtain training on the open labour market): consistent workplace, consistent routines and working hours, well-structured workplace, breaks for recovery. ^{[1, Rec. 114]} More: Employees with autism: notes for employers.
• Housing: daily structure and continuity of staff, where appropriate guidance through structured programmes with individual choices conveyed in visualised form. ^{[1, Rec. 117]}

Phasing out prompts and aids

For therapy in the preschool years, the guideline named using prompts and reinforcers in a differentiated way and fading them out quickly. ^{[1, Rec. 10]} For school support too, the following applies: the child’s independence should always be promoted. ^{[1, Rec. 109]} Applied to visual aids, this means (suggestion from the editorial team): check whether a plan is still needed or whether it can be simplified, and involve the person themselves.

What we know about effectiveness

• The recommendation on structure and visualisation rests on expert consensus. The guideline named no study that had tested the effect of visual plans in people with autism. ^{[1, Rec. 3]}
• The guideline named pure structuring measures without special training of interactive, communicative and daily-living skills in toddlers up to primary school children among the methods that should not be used for the goal “social interaction”. ^{[1, Rec. 12]} For a low-frequency parent programme in the preschool years based on the TEACCH approach (called FITT in the guideline), it reported no effect on blind-assessed measures of social interaction. ^{[1, Ch. C.4.2.2]} This does not mean that structure in everyday life is worthless, but that it does not count as a substitute for targeted support.
• For employment, the guideline reported from a study of 50 people that support by a tablet (iPod Touch) reduced job-coach hours without performance falling. The study has not been checked by the editorial team. ^{[1, Ch. C.10.3.2]}

What else you should know

• Check individually: Not every person on the spectrum needs or likes visual plans. The person’s wishes should be asked about regularly. ^{[1, Rec. 4]}
• Daily structure in detail: Routines, structure and predictability in everyday life.
• Not covered: concrete formats (daily plans, symbols, timers), choice of aids and training in methods such as TEACCH. The editorial team has read no checked source on this.

Sources and literature

1. DGKJP, DGPPN et al. Autismus-Spektrum-Störungen im Kindes-, Jugend- und Erwachsenenalter. Teil 2: Therapie. S3-Leitlinie, AWMF-Reg.-Nr. 028-047, Stand Text 02.05.2021 (Empf. 3, 4, 10, 109, 114, 117; Kap. C.4.2.2, C.10.3.2). – Guideline (in German); expired on 23 March 2026 (see no. 2)
2. DGKJP. Aktuelle Leitlinien (Eintrag 028-047: „Gültig bis 23.03.2026“). https://www.dgkjp.de/wissen/aktuelle-leitlinien/ – Professional society (website in German)