Last updated 2026-07-11
A first then board is two pictures and nothing more complicated than that: one section labeled "First," one labeled "Then," each holding an image of an activity or item. First shoes, then outside. For a late talker, or a child with autism or a developmental delay, this small setup does something surprisingly useful: it turns time into something you can see instead of something you have to remember. "After lunch we'll go to the park" floats through the air and vanishes, but a picture sitting on a shelf stays put. Kids often struggle to hold spoken instructions like that in mind, and a board fixes that by making the sequence visible.
Children with autism spectrum disorder tend to process visual information more reliably than sound alone, which is why the National Research Council's report Educating Children with Autism named visual supports a core practice back in 2001 [1]. A first then board gives a child something to hold onto, and that predictability takes the edge off the uncertainty that drives a lot of meltdowns. It also gives them a reason to communicate: point to the "Then" picture, say "then park," and you're modeling two-word language at the exact moment the child is most motivated to listen. That motivation is the piece most home practice skips.
A full visual schedule might lay out eight or ten steps across a morning. This board shows two, and that gap matters more than it looks. Ten steps is a wall for a kid just meeting visual supports; two steps fit in one glance.
The American Speech-Language-Hearing Association groups tools like this under augmentative and alternative communication (AAC), the broad category covering anything that helps a person express or understand language [2]. A first then board sits at the simple end of that range, which is exactly why it's a good place to begin. No PECS binder, no speech-generating device, just two pictures. Once "first, then" clicks reliably, you expand: three steps, then a morning strip, then a full daily schedule. The board is the foundation, not the ceiling. Really, you're teaching one rule, that routines are predictable and the child can see what's coming, and that rule carries over to every visual support they meet later. The piece on AAC devices walks through where this fits into the bigger picture.
You don't need anything fancy to build one. The simplest version is a piece of cardstock folded in half, "First" written on one side, "Then" on the other, with real photos from your phone printed at home. It costs almost nothing and works as well as any store-bought board for most kids. A step up is a laminated board with velcro dots so pictures can be swapped; laminating pouches run about $15 to $20 for a 100-pack at any office supply store, and this is what most families end up with after the first week, since it survives being thrown and covers dozens of situations. Commercial boards, including ones tied to symbol systems like Boardmaker, run roughly $20 to $60. The symbol libraries cost more and are worth it if your child's speech-language pathologist already uses them, since matching symbols across home and therapy keeps things clear for the kid.
For pictures, real photos of your actual child doing the actual thing beat generic clip art early on: a photo of your child's specific bowl of crackers reads faster than a cartoon bowl. As symbolic understanding grows, shift toward line drawings, which travel better and swap easier. If you're already using PEC cards from therapy, use those exact symbols. Consistency beats novelty here.
Setting one up, step by step
Start with a routine your child already knows. Introducing a new tool during a brand-new situation stacks two learning demands at once, so pick something predictable: snack, bath, shoes on before heading outside. Choose the "First" activity first: something the child needs to do but might resist, or just the next required step. Shoes on. Three bites. Hands washed. Then choose the "Then" item, something the child genuinely wants. It doesn't have to be a treat; often it's a specific toy, a favorite show, going outside, a preferred food. "Then" has to feel worth it to the child, not to you. Load the board before you need it. Set it up at snack time before your child comes to the table, not mid-meltdown. A visual support introduced during a crisis rarely lands. When you're ready, get down to eye level and show it: point to "First," say "first shoes," point to "Then," say "then outside." Keep the words short. You're not explaining the system, you're using it, and the board explains itself. Follow through the second "First" is done. Point to "Then" and deliver it. Consistency is everything in the first two weeks: if "Then" doesn't reliably show up, the board stops meaning anything. Once it's delivered, some families flip the "First" picture over or pull it off to mark completion. That clean ending helps kids who struggle with transitions. The first try might take five minutes. After that, it's thirty seconds.
Choosing pictures for non-speaking or minimally verbal kids
Start with photos of real objects and real people before line drawings or abstract symbols. Symbol-learning research points this direction, including Pat Mirenda's work on functional AAC for students with autism [3]. For a child without reliable symbolic understanding, a generic cartoon "outside" means less than a photo of your actual back door. Photos have one catch: they're specific. A photo of your child's red cup at home won't carry over to grandma's house. Line drawings and standardized symbols travel better. Most speech-language pathologists start with photos, pair them with a simple line drawing over time, then fade the photo once the symbol reads reliably on its own. For the "First" picture, pick things the child can actually finish on their own or with light help. If "First" needs a fight every time, the board isn't cutting conflict, it's just repackaging it, so it's worth asking whether the demand itself needs adjusting before blaming the tool. For "Then," be honest about whether your child actually wants this or you just think they should. Motivation is the engine, and if you're guessing, an SLP evaluation can pin down what genuinely moves your specific kid. The article on finding a speech therapist covers what to expect there. One practical move: keep five to ten "Then" pictures on hand so you can rotate and keep the reward fresh.
When to bring it out during the day
Not all day, that's the most common mistake. A first then board earns its keep at transition points: moments when you're asking a child to stop something preferred and start something less preferred, or to finish a non-preferred task before getting what they want. Bath time. Getting in the car. Ending screen time. Starting homework. Using it for every mundane moment waters down the signal. The board should mean one specific thing, that the child can see what's happening and what comes next, and if it's always out for low-stakes stuff, it loses that grounding effect. For kids with real transition anxiety, two to four uses a day is a sane starting target. Track which transitions are hardest and aim the board there first, then expand after a few weeks of wins. For late talkers, lean toward moments of high motivation, because that's where language is most likely to surface. If your child badly wants to go outside, the second before going outside is when they'll try "outside" or "go" or some approximation of it. The board concentrates that motivation into a predictable spot. Timing matters across settings too. A 2021 review in the Journal of Autism and Developmental Disorders reported that visual supports worked best when used consistently across home, school, and therapy rather than in just one place [4]. It's worth asking your child's SLP what they run in sessions so you can match it at home.
Using a first-then board to build language, not just manage behavior
The board does more good when you treat it as a language lesson rather than just a way to survive a hard transition. Show the picture, then model whatever language level you're working on. If your child is at the single-word stage, say the word as you point: "Shoes," then a pause. "Outside," then a pause. That pause is called a time delay, and it's a well-supported way to prompt a child with a language delay to communicate on their own [5].
If you're building toward two-word phrases, model two words instead: "First shoes." "Then outside." Don't expect your child to repeat it back right away. You're building an internal model over many, many exposures, not teaching a script.
Some kids start pointing to the "Then" picture on their own to ask for it. That's communication, with or without words, and it deserves a response: "Yes! Outside!" followed by actually doing it. Yoder and Stone, comparing two communication interventions for preschoolers with autism, found that responding consistently to these nonverbal bids is one of the best-documented ways to grow early language [6].
If your child uses AAC, pair the board with their device: after showing the board, prompt them to find the matching symbol on the device or PECS book. That ties the schedule to their main way of communicating. The Little Words app builds modeling prompts around exactly these daily moments, if you want more structure around the language side.
One thing to skip: using the board as an after-the-fact bribe. Saying "you should have done first then" once a meltdown is already underway teaches nothing. The board only works if it's shown before the transition starts, not explained in the middle of one.
When a child ignores or fights the board
This happens, and it doesn't mean the approach has failed. Start by checking the "Then": does your child actually want it right now? A favorite toy at 8am can be totally uninteresting by 4pm, so swap the picture before assuming the board itself is the problem.
Next, check the "First" demand. Can your child realistically finish what you're asking? A step that's too big or too long invites avoidance, so break it down: "first one bite" instead of "first eat your lunch."
Also worth checking is your own timing. If the board only ever comes out during hard moments, it starts carrying that emotional weight, and your child may end up reacting to the association rather than the board itself. Try introducing it during something easy and neutral first, like "first block, then puzzle," where both options are fine. Let your child succeed with the format before asking it to carry the hard stuff.
If your child keeps throwing, destroying, or refusing to even look at the board after two or three weeks of real, consistent effort, bring it up with an SLP. They may suggest a different visual format, a different modality, or a different way of easing the demand. Some kids need object-based schedules, real objects standing in for activities, before they're ready to read two-dimensional pictures. For autistic kids with significant anxiety or sensory sensitivities, resistance might be telling you something about the transition itself rather than the tool, and an SLP experienced in autism spectrum speech therapy can help you sort out which it is.
Is this just for autistic kids, or for any late talker?
First-then boards came out of applied behavior analysis and special education, and most of the research base is with children on the autism spectrum. But visual supports help any child who thinks visually, gets anxious around transitions, needs predictability, or is still building language comprehension.
Plenty of late talkers without an autism diagnosis do well with them. A child who doesn't yet reliably follow spoken directions is exactly the kind of kid who benefits from a visual cue bridging the gap while spoken language catches up. Kids with childhood apraxia of speech often find visual supports useful too, for a related reason: spoken instructions are hard to hold onto when motor planning for speech is the main struggle.
The American Academy of Pediatrics recommends evaluation and early support for any child with a language delay, without waiting for a formal diagnosis [7]. A first-then board doesn't require a diagnosis to try. It costs nothing and carries no real risk: worst case, your child just ignores it. For kids hitting typical milestones who are simply late talkers with no other concerns, a board isn't strictly necessary, but it never hurts, and plenty of families use one just to smooth over toddler transitions in general.
How early intervention uses these boards
Early intervention is a federally mandated program under Part C of IDEA, covering children under three with developmental delays or disabilities [8]. From age three to five, Part B of IDEA covers services through the school district.
Inside EI and preschool special education, visual supports like first-then boards are among the most commonly recommended evidence-based practices. The National Professional Development Center on Autism Spectrum Disorder lists visual supports as one of 28 evidence-based practices for children with ASD, based on their systematic review of the research [9].
If your child's EI SLP or developmental specialist already uses a first-then board in sessions, ask them to walk you through exactly how: which pictures they've chosen, and how they prompt language around it. Asking for a home version of the same board is a completely reasonable request and usually simple to set up.
If you're not yet getting EI and you're worried about your child's language, the piece on early intervention walks through how to request an evaluation, which is free and in most states doesn't require a doctor's referral. Consistency between EI or preschool and home is one of the strongest predictors of whether a child actually uses a skill in new places, so ask the team what they're using and mirror it as closely as you can.
Knowing when to fade the board
The goal is always independence, including independence from the board itself. Start fading when your child completes "First" tasks consistently without much distress, starts anticipating transitions before you even show the board, and shows enough comprehension that a spoken reminder sometimes works on its own.
Fading is a slow dial-down, not a sudden removal. One approach: leave the board visible but stop pointing to it during easy, familiar transitions. If your child handles it fine anyway, the board wasn't doing much work there anymore, so you can step back further.
Some kids keep using the board in specific situations (high anxiety, new places, unfamiliar demands) long after it's dropped out of daily routines. That's a fine outcome. A tool doesn't have to disappear completely to count as a success.
For kids ready for more, a full visual schedule is often the next step: a picture-based morning strip, then a simple written list, then no external support at all. That path can take months or years and looks different for every child. Nobody has clean data on exactly when the average child with a language delay stops needing visual supports, so the honest answer is to watch the child, not the calendar. When they can hold a two-step sequence in mind without the board, fade it. When they can't, keep it.
What the research actually shows
The evidence for visual supports in general is solid. For first-then boards specifically as a named format, the research is thinner and tends to live inside larger studies of visual support systems or behavior intervention packages.
A 2020 systematic review in Focus on Autism and Other Developmental Disabilities looked at visual schedule research across 23 studies and found consistent positive effects on transition behavior, task completion, and independence in children with ASD and intellectual disabilities [10]. Most of those studies used formats with first-then or two-step components built in. The National Autism Center's National Standards Project classifies visual supports as an "established" treatment for individuals with ASD, the top rating in their framework [11].
On language specifically, the connection is more indirect. Visual supports seem to reduce the meltdowns, avoidance, and shutdown that get in the way of learning, which opens up more room for language practice. The idea that a first-then board speeds up language growth directly isn't backed by controlled research. The idea that it lowers conflict around transitions and creates more motivated moments for communication is well supported. ASHA frames visual supports as a bridge between where a child's communication is now and the language goals they're working toward [2], and that's the right way to think about it: a bridge, not a cure.
If you want structured support alongside visual tools, the Little Words app helps you practice language modeling during real daily moments, built around how late talkers actually learn.
Frequently asked questions
At what age can you start using a first then board?
You can introduce one as early as 18 months, though most kids aren't ready to use it consistently until around age two. What matters isn't the age on the calendar but whether the child can look at a picture and understand it stands for something real. Start with photos of actual objects and people from your own home, and keep the "First" demand small, just one brief action.
Can a first then board replace speech therapy?
No. It's a support tool, not a treatment. Speech therapy works on the underlying mechanisms of language, comprehension, motor planning, and expressive vocabulary among them, through individual assessment and hands-on intervention. A first then board can complement that work by creating structured moments at home, but it doesn't stand in for what a licensed SLP provides. If your child has a language delay, an SLP evaluation is where to start.
What if my child can't recognize pictures yet?
Use real objects instead. A physical shoe in the "First" spot and a cracker in the "Then" spot gets the same sequence across without asking for symbolic understanding the child doesn't have yet. This is called an object schedule, and it's common for kids at very early developmental levels. Once the child starts pairing the object with the activity reliably, add a photo of that same object next to it, then fade the object out over time.
How many pictures should be in my "Then" rotation?
Five to ten works for most families. A small library lets you match the reward to whatever the child actually wants that day, which shifts more than you'd think. Keep them somewhere visible so you can swap fast. If your child keeps reaching for the same two or three, those are your highest-value motivators: save them for the hardest transitions and spend the lower-preference items on easier asks.
Should "Then" always be a reward?
Not necessarily. It can be a preferred activity, a preferred person, a break, or just the next step in a routine the child enjoys. What matters is that the child understands what's coming and wants it enough to outweigh whatever's hard about "First." "First shoes, then go outside" works because going outside is motivating, not because it's a formal prize. The question is simply whether the child is motivated to get through "First."
How do I use a first then board if my child has echolalia?
Kids with echolalia often have strong rote memory, so they may parrot "first" and "then" without actually grasping the sequence behind it. Watch whether your child is connecting the words to the pictures and activities, or just repeating a phrase. If it looks like repetition without comprehension, pull back your own talking and let the board carry more of the message: point silently, or use just one word. More on this in the article on echolalia.
Can I use a first then board on a phone or tablet?
Yes, and a digital version travels better for a lot of families. Apps like Choiceworks and First-Then Visual Schedule HD offer this format. The catch is that some kids associate tablets with screen time and get dysregulated the moment they see the device, before the "Then" item even shows up. If screens are already a high-preference item in your house, a physical board often works better since it doesn't trigger screen-seeking as soon as it appears.
What's the difference between a first then board and PECS?
PECS (Picture Exchange Communication System) is a structured protocol that teaches a child to initiate communication by handing a picture card to a partner in exchange for something wanted. It has six phases and needs training to run properly. A first then board is a much simpler visual support for sequencing and transitions. The two work well together: plenty of kids use PECS to request and a first then board to understand what's coming next. Different jobs entirely.
How do I explain the first then board to grandparents and other caregivers?
Show them, don't explain it. Hand them the board, run one full cycle (first this, then that, follow through right away), and let them try it once while you watch. Written instructions rarely stick, but a ten-minute live demo where they see the child actually respond does far more. Consistency across caregivers really does matter for the tool to work, so the time spent showing everyone pays off.
Is a first then board the same as a token board?
No. A token board is a system where a child earns tokens (stickers, chips, checkmarks) toward a bigger reward after several behaviors. A first then board shows just one immediate sequence, with no accumulation involved. Token boards ask for more cognitive steps and generally suit older kids, or ones who already handle first-then reliably. Start with first-then, and bring in a token board later if your child needs more structure for longer tasks.
What should I do if my child completes "First" but melts down when "Then" ends?
That's a transition problem at the end of the "Then" activity, not a flaw in the board. Add a third step: "First shoes, then outside, then snack," so there's something to look forward to once "Then" is over. Some families run a visual timer during "Then" so the ending isn't a surprise. Predictability is what brings meltdowns down. If the end of "Then" is unpredictable, the anxiety around it makes sense.
Does a first then board work for kids with apraxia of speech?
Yes, especially for managing transitions and easing the frustration that comes with communication difficulty. Kids with apraxia of speech often understand far more than they can say, and a visual support honors that gap instead of fighting it. It also lowers the verbal demand of transition moments, which helps when speaking itself is effortful. Pair the board with modeling of short target words during motivated moments. More in the article on apraxia of speech.
How long does it usually take for a child to understand the first then board?
Most children with some symbolic understanding show recognition within one to two weeks of consistent daily use. Full generalization, meaning the child applies the expectation flexibly across settings and people, usually takes four to eight weeks. There's no clean clinical trial behind that timeline; it comes from practitioner experience and small observational studies. If understanding still isn't showing up after a month of genuine, consistent use, talk to an SLP about trying a different format.
Can a first then board help with picky eating or mealtime routines?
Yes, and mealtime is one of the most common places families put it to use. A typical structure: "First three bites of [non-preferred food], then [preferred food or end of meal]." The key is making "First" achievable. One bite beats "eat your dinner." Start with a quantity your child can manage without much stress and build up from there, pairing it with simple language modeling around the foods to open up vocabulary along the way.
Sources
- National Research Council, Educating Children with Autism (2001), National Academies Press: Children with autism spectrum disorder process visual information more reliably than auditory-only information, supporting use of visual supports.
- American Speech-Language-Hearing Association, Augmentative and Alternative Communication overview: ASHA describes visual supports as a category of AAC that includes any tool helping a person express or understand language, and frames them as a bridge between a child's current communication level and language goals.
- Mirenda, P. (2003). Toward functional augmentative and alternative communication for students with autism. Language, Speech, and Hearing Services in Schools, 34(3), 203-216.: Symbol learning research supports starting with photographs of real objects before moving to line drawings or abstract symbols for children with autism and language delays.
- Journal of Autism and Developmental Disorders, visual supports review (2021): Visual supports were most effective when introduced consistently across settings (home, school, therapy) rather than in only one environment.
- Snyder-McLean, L., & McLean, J. (1987). Effectiveness of early intervention for children with language delays. Topics in Early Childhood Special Education, 7(2), 1-24; also ASHA technical reports on time delay as an evidence-based strategy.: Time delay is a well-supported strategy for prompting spontaneous communication in children with language delays.
- Yoder, P., & Stone, W. L. (2006). Randomized comparison of two communication interventions for preschoolers with ASD. Journal of Consulting and Clinical Psychology, 74(3), 426-435.: Responding consistently to nonverbal communication is one of the most well-documented strategies for encouraging early language development.
- American Academy of Pediatrics, Developmental Surveillance and Screening policy: AAP guidance recommends that any child with a language delay receive evaluation and early support without waiting for a formal diagnosis.
- U.S. Department of Education, Individuals with Disabilities Education Act (IDEA), Part C and Part B: IDEA Part C mandates early intervention services for children under age three with developmental delays or disabilities; Part B covers ages three to five through school districts.
- National Professional Development Center on Autism Spectrum Disorder, Evidence-Based Practices Report: The NPDC lists visual supports as one of 28 evidence-based practices for children with ASD, based on systematic review of the research literature.
- Knight, V., et al. (2020). Visual schedules for students with autism: A systematic review. Focus on Autism and Other Developmental Disabilities.: A 2020 systematic review of 23 studies found consistent positive effects of visual schedule interventions on transition behavior, task completion, and independence in children with ASD.
- National Autism Center, National Standards Project, Phase 2 (2015): The National Standards Project classifies visual supports as an 'established' treatment for individuals with ASD, the highest rating category in their framework.