• Christopher Lynch

Using Visual Supports to Help Manage Anxiety in Autism

Updated: Oct 10, 2018

Using Visual Supports to Help Manage Anxiety in Autism

Anxiety management for kids with autism is, in many ways, exactly the same as anxiety management for anyone else. Common elements of anxiety management for anyone include:

Identifying the source (s) of anxiety

> Increasing awareness of mind-body cues indicative of anxiety

>Developing strategies to relieve the intensity and duration of anxiety

>Incorporating strategies within an overall holistic anxiety management plan

However, there are some differences of emphasis that one should be aware of when applying anxiety management to children on the autism spectrum. One important point of emphasis is in the use of visual supports. Visual supports can make a crucial difference in anxiety management for children with autism.

People on the spectrum tend to be stronger in the visual modality and this can help with learning principles and techniques of anxiety management. Using visuals also holds appeal for children in general and can help maintain interest in the learning process.

“Visual supports can make a crucial difference in anxiety management for children with autism.”

What qualifies as a visual support?

A visual support is anything that can be seen that either enhances or replaces verbal instruction. A visual support can range from simple line drawings to fully immersed virtual reality experiences. Visual supports help the mind to break down large amounts of information into smaller, bite-sized pieces. This can be especially useful when the mind is under duress.

When to use visual supports in anxiety management for kids with autism?

Visual supports can be used at any stage of anxiety management training. For example, visual supports can be used to help a child with autism to understand how their level of anxiety can vary from a low range to extreme distress. For this purpose, I like to use a visual gauge such a ‘Fear Thermometer’:

In this case, the child I was working with chose colors to add to the visual support with Blue representing low anxiety, Green for medium, Yellow for high, and Red for highest. This coloring system not only helped him to describe anxiety but also became a way to decide what kind of approach to take depending upon the color level. In this case, the child began to use techniques (such as breathing, counting, and coping statements) as he transitioned from blue to green; began to seek supports from others if he transitioned into the yellow zone; and relied on support and grounding techniques if anxiety reached into the red zone.

Visual supports can also be used to compartmentalize issues. This is an important skill as anxiety can be overwhelming and make it seem as if sources of stress are coming from everywhere. By breaking sources of stress down into discrete areas, the child is beginning to gain some control over his or her anxiety.

In the example below, the child was feeling overwhelmed by stress and anxiety at school. Together we broke down the sources of stress and anxiety into discrete areas and he typed them up and then drew ‘clouds’ around them to keep them distinct:

After this step, I typically then ask the child to prioritize which area they would like to work on. It helps to use the child’s input in how they want to do this. Some children like to rank problem areas with numbers, others may use letters (e.g. level a, b, or c), still others may want to use another system (for example, number of stars or number of anxiety ‘hit points’). This exercise can help the child to move from feeling overwhelmed to feeling empowered and ready to problem solve.

Cues for techniques

Visual supports can be used as reminders for using various techniques. Breathing, muscle relaxation, imagery, coping statements, even a cue to meditate can be represented in a visual fashion. Any type of support can be useful but simple is usually best. A simple line drawing gets right to the heart of what you are trying to convey without any distracting background. For the child who reads, it can be helpful to have one word or short phrase descriptions accompanying these supports. For those children who enjoy drawing, I will often enlist their help in creating the visual support. One child, for example, clearly conveyed the cue to take a deep breath when anxious as follows:

These cues can be used discretely at school. For example, a student may have small visual cue cards in his or her desk that can be reviewed as needed. Some teachers may choose to employ these cues for the entire class (for example, having a sign for a designated “chill out” corner). This approach helps to destigmatize the need for anxiety management strategies and avoids singling out any particular student.

Key Take-Aways

  • Visual supports can greatly enhance anxiety management strategies for children on the autism spectrum.

  • Visual supports can range from simple line drawings to high tech platforms.

  • Visual supports can be used for all aspects of the anxiety management process from identifying anxiety to using and applying strategies.

For more examples of the use of visual supports please see the Stress and Anxiety Management manual that I have developed for kids with autism and related concerns. Totally Chill My Complete Guide to Staying Cool/AAPC Publishing


Christopher Lynch, Ph.D.


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