How to use a first-then board at home

What is a first-then board?

A first-then board is a strip of cardstock with two spaces. One shows what your child is doing first. The other shows what comes next.

It is one of the simplest visual supports. AFIRM, a free training program from the University of North Carolina team that reviews autism research, describes a first/then schedule as "a type of visual support that includes the sequencing of two events to help a student understand what comes next" (AFIRM).

Two pictures keep things simple. Your child only has to hold on to one idea: after this, that. A picture also stays put after your words have gone, so your child can look again whenever they need to.

You may have seen first-then boards used in ABA (applied behavior analysis) sessions. AFIRM says visual supports can be used by teachers, therapists and early interventionists, and that "parents and family members also can use Visual Supports in the home". This guide is about the board itself, as a tool for home. You don't need a diagnosis, a referral or a program to use one.

When can a first-then board help?

Use it at the moments when your child has to stop one thing and start another, and before something new. A parent tool kit from the Vanderbilt Kennedy Center says visuals can help autistic children understand what to expect when routines change or a situation is new (Vanderbilt Kennedy Center). A good place to start is the moment that is hardest every day.

Use it for good moments too: "First lunch, then swings." That way, the board doesn't only appear before things your child dislikes.

How do I make a first-then board?

You need cardstock, photos or symbols, Velcro dots, an envelope or small box, and clear contact paper or a laminator if you have one. Paper, a pen and tape are enough to start tonight.

1. Make the board. Use a strip of stiff cardstock. Draw a line down the middle, and write "First" on the left and "Then" on the right. Or print the free first-then board, which prints on standard letter-size paper.
2. Choose the kind of picture. Use what your child understands: real objects, photos, symbols or written words. Photos of your child's own things are often easiest to start with. Research with minimally speaking autistic children suggests color photos can help children connect a picture with the real thing (Hartley and Allen 2015).
3. Take the photos. Photograph a handful of everyday things, such as their cup, the bath, the car seat, their jacket, the preschool door and their bed, plus a few favorite things.
4. Add the word. Write the word under each picture, so every adult says the same thing.
5. Make them last. Cover the board and pictures with clear contact paper or wide packing tape, or laminate them.
6. Add Velcro. Put a Velcro dot on each space on the board, and the matching half on the back of each picture.
7. Make a "finished" place. Tape an envelope or small box to the side of the board, labeled "finished" (or "all done"). Pictures go in here when an activity ends.
8. Store the spares. Keep the other pictures in a pouch, or on a strip of Velcro on the back of the board.

Make a second, smaller board for your bag, the car or a grandparent's house.

How do I use a first-then board every day?

Show the board before the change, say very little, and do what the board says. The Vanderbilt tool kit advises: "Try to use the least amount of words possible" (Vanderbilt Kennedy Center).

1. Set it up. Put the current activity under "First" and the next one under "Then".
2. Show it before the change. Get down to your child's level, point to each picture in turn, and say the same short words each time.
3. Wait. Give your child a moment to look and take it in before you say anything more.
4. Show it again at the change. Point to the "First" picture and say "finished".
5. Do the finished routine. Your child takes the "First" picture off and puts it in the finished envelope. If they don't want to, do it together, or do it yourself while they watch.
6. Move Then across. Move the "Then" picture into the "First" space, and add a new "Then".
7. Keep your word. Only put up what will really happen. If plans change, change the board and show your child.

How do I make it work for my child, not against them?

A first-then board works best when it feels helpful to your child, not like a list of orders.

In ABA and other behavior-based programs, the board is often set up with a less-liked task first and something the child enjoys second. The Vanderbilt tool kit describes a first-then board as "a visual display of something your child prefers that will happen after completing a task that is less preferred". The board can also simply show the order of things: "First bath, then story." Either way:

• Use it for good things too. If it only appears before bath time or leaving the park, it becomes a sign that something unwelcome is coming.
• Make sure the Then happens. If the board shows something your child enjoys, give it once the first step is done, even if you helped. The Vanderbilt tool kit warns that otherwise "your child may not trust the board the next time you use it."
• Never use it as a threat. Avoid "First shoes, then no tablet", and never take the "Then" picture away as a punishment.
• Keep it in the same place. Put it at your child's eye level, where the change usually happens, such as by the front door or on the bathroom wall.
• Use the same board at daycare, preschool and therapy if you can. AFIRM advises using visual supports "consistently and across settings". Share your photos, or ask for copies of the symbols your child's teacher or therapist uses.
• Offer a choice for "Then". Hold up two pictures: "Then swings or slide?" In a small study of three students with high support needs, being given choices reduced serious distressed behavior (Dyer, Dunlap and Winterling 1990).
• Listen to "no". If your child pushes the board away or points to "no", that is a message. Respond to it, even if the plan can't change.

What if my child throws it, ignores it or gets upset?

Most problems have a simple cause. Change one thing at a time, and give each change a few days.

My child throws the board or pulls the pictures off

Throwing a board is often a way of saying "no" or "I don't want that". That is communication, not misbehavior.

• Check what usually goes on the board. If it is often something your child dislikes, add more things they enjoy.
• Start again with easy steps. The Vanderbilt tool kit suggests beginning with "a task that your child usually completes willingly and successfully".
• Make taking the picture off part of the routine, so your child has a job to do.
• Fix the board to the wall or fridge, and give your child a separate "no" or "break" card to use instead.
• If the board has become a sign of bad news, put it away for a few days. Bring it back with only enjoyable things for a while.

My child ignores it

• Try an easier kind of picture: real objects, or photos of their own things.
• Take the board to your child, at their eye level, rather than pointing from across the room.
• Show it at the moment of change, rather than leaving it up all day and hoping they notice.
• Use fewer words.
• Check the board has been reliable. If what it showed often didn't happen, rebuild trust with simple, sure things.

My child gets upset when they see what comes next

Being upset can mean your child has understood what is coming and doesn't like it. The board is getting its message across; the next step is to make the change itself easier.

• Show the next picture earlier, so your child has time to get used to the idea.
• Give something worth moving to, such as a favorite toy to carry or something nice straight after.
• Offer a way back later: pause the show, take a photo of the block tower or put the toy on a "later" shelf.
• Add a finishing ritual, such as "one more turn, then finished".
• If one activity always causes upset, look at the activity itself. It may be noisy, uncomfortable or too long.

See meltdown, tantrum or shutdown if upset turns into overwhelm, and feelings and calm for ways to help your child settle.

What does the research say about first-then boards?

We did not find any studies that test first-then boards on their own with young autistic children. The support for them comes from wider research on visual supports, and from professional guidance.

• A large review by the National Clearinghouse on Autism Evidence and Practice (NCAEP), at the University of North Carolina, classed visual supports as an evidence-based practice for autistic children and young people, based on 65 studies (NCAEP 2020).
• A review of 31 studies of picture schedules concluded they can be considered evidence-based, "especially when used in combination with systematic instructional procedures". In plain terms, they worked best when adults taught children how to use them, step by step (Knight, Sartini and Spriggs 2015).
• Autism centers such as OCALI and the Vanderbilt Kennedy Center publish how-to guides on first-then boards.
• They don't make every change easy. In a small study of two autistic children, picture schedules on their own did not reduce distressed behavior when the children had to move from a liked activity to a less-liked one (Waters, Lerman and Hovanetz 2009). A 2026 review of 19 small experiments found that warnings on their own often did not reduce distress at transitions (Kim et al. 2026).

When is my child ready for a visual schedule?

When your child uses the two-picture board easily and starts looking for what comes after "Then", try adding a third picture: "First breakfast, then shoes, then car." Build up slowly to a short strip for one part of the day, such as the morning. OCALI describes the first-then board as a support for someone "not yet ready for a more complex visual schedule". The gradual build-up is common practice rather than something research has tested, so go at your child's pace.

The free visual schedule printable and the guide to visual schedules show how. You can keep using the first-then board for hard moments, even once your child has a visual schedule.

Where can I get more help?

Ask for advice if you are not sure which pictures suit your child, or if the board still isn't helping after a few weeks of steady use.

• A speech-language pathologist (SLP) can advise on the right kind of picture and how to use it. Your child's pediatrician can help you find one.
• If your child is under 3, your state's early intervention program can help, and you can call it yourself. CDC's early intervention page (reviewed February 17, 2026) says "A doctor's referral is not necessary" (CDC). Find your program on the list of state programs.
• If your child is 3 or older, CDC suggests calling any local public elementary school and asking for an evaluation through the school system (CDC). If your child has an IEP, ask the school team to use the same board, pictures and words as you do at home.
• Parent Centers give free help with early intervention and IEPs, and the Autism Society National Helpline offers information and referral.