Individuals with autism often experience heightened sensitivity to sensory input, difficulty with abstract concepts, and communication barriers, which can complicate emergency responses. Research indicates that children with autism have higher rates of emergency service utilization than their neurotypical peers (Dixon et al., 2010). The unpredictable nature of emergencies can result in increased anxiety, noncompliance, or maladaptive behaviors. Structured supports, such as visual schedules, facilitate understanding and reduce uncertainty by providing concrete, sequential representations of emergency procedures, allowing individuals to anticipate steps and respond more effectively.
Visual schedules are particularly effective because they leverage the visual learning strengths commonly observed in individuals with autism (Liang et al., 2024). By presenting information in a predictable, consistent format, these tools can decrease cognitive load, promote engagement, and reinforce appropriate behavioral responses. The integration of visual supports with behavioral rehearsal and social stories further enhances skill acquisition and generalization across settings.
Fire Drills
Fire drills are routine but often stressful events in schools and public facilities. Sudden loud noises and disruption of familiar routines can provoke anxiety or avoidance behaviors. Behavior skills training (BST), which combines modeling, rehearsal, and feedback, has been shown to improve fire drill responses in children with autism (Garcia et al., 2016). When visual schedules are incorporated into BST, individuals can preview each stage of the drill, such as hearing the alarm, following designated exit routes, and assembling at a safe location.
At home, caregivers can develop individualized visual schedules using photographs, icons, or written cues, supplemented with low-volume alarm rehearsals and social stories. Repeated exposure in a low-stress environment reduces anxiety and increases compliance with fire drill procedures (NASP, 2016). Studies suggest that pairing visual schedules with rehearsal not only improves immediate behavior but also supports long-term retention and generalization of emergency skills.
Natural Disasters
Natural disasters, including hurricanes, tornadoes, and earthquakes, present heightened unpredictability and risk. Unlike controlled fire drills, these events are difficult to simulate, complicating skill acquisition and generalization (Dixon et al., 2010). Visual schedules help by breaking complex procedures into sequential, manageable steps, making abstract concepts more concrete.
Child-friendly social stories paired with visual schedules enhance comprehension and engagement (Institute for Childhood Preparedness, 2020). Role-play exercises and repeated practice allow individuals to rehearse appropriate responses, supporting adaptive behavior under stress. Research indicates that these strategies improve predictability and reduce anxiety, enabling individuals with autism to remain calm and follow emergency protocols even in chaotic environments.
Hospital Visits and Emergency Departments
Medical emergencies often require visits to overstimulating and uncertain hospital environments, which can intensify sensory sensitivities and communication challenges (Malik-Soni et al., 2020). Visual schedules provide structured guidance, outlining steps such as arrival, waiting, interaction with staff, and medical procedures. When paired with familiar comfort items, simplified verbal instructions, and environmental modifications (such as dim lighting and noise reduction), visual schedules enhance understanding, cooperation, and adaptive behavior.
Evidence shows that structured visual supports reduce distress and improve compliance during medical procedures for children with autism (Chebuhar et al., 2013). Additionally, preparing personalized schedules for anticipated hospital experiences can increase predictability and mitigate anxiety associated with novel or complex medical environments.
Family, School, and Community Collaboration
Effective emergency preparedness requires collaboration across multiple systems. Caregivers should conduct regular practice drills, maintain accessible emergency materials, and create structured routines that mirror real-life scenarios. Schools can integrate emergency accommodations into individualized education plans (IEPs), such as noise-canceling headphones, staff support, or access to visual schedules during drills.
Community-level initiatives also play a critical role. Autism-specific first responder training and alert systems allow families to provide emergency personnel with individualized information, including preferred communication methods and responses to visual cues. Sensory emergency kits (containing visual schedules, comfort items, noise-canceling headphones, and communication supports) facilitate readiness during evacuations, hospital visits, or shelter-in-place situations.
Conclusion
Visual schedules represent a versatile, evidence-based intervention that supports emergency readiness across diverse contexts. When used consistently and paired with behavioral rehearsal, social stories, and environmental accommodations, these tools reduce anxiety, enhance predictability, and improve safety behaviors in individuals with autism (Chebuhar et al., 2013; Garcia et al., 2016; Malik-Soni et al., 2020). Their structured, sequential design is beneficial for learners who process information more effectively through visual rather than verbal instruction, promoting engagement and comprehension in high-stress situations. Emergency preparedness for individuals with autism requires proactive, individualized planning supported by collaboration among families, schools, and community responders. This coordination maximizes effectiveness and helps ensure that individuals with autism respond to emergencies with greater confidence, skill, and adaptive behavior.
Emily Germanis is a Registered Behavior Technician and MSABA student at Capella University.
References
Chebuhar, A., McCarthy, A. M., Bosch, J., & Baker, S. (2013). Using picture schedules in medical settings for patients with an autism spectrum disorder. Journal of Pediatric Nursing, 28(2), 125–134. https://doi.org/10.1016/j.pedn.2012.05.004
Dixon, D. R., Bergstrom, R., Smith, M. N., & Tarbox, J. (2010). A review of research on procedures for teaching safety skills to persons with developmental disabilities. Research in Developmental Disabilities, 31(5), 985–994. https://doi.org/10.1016/j.ridd.2010.03.007
Garcia, D., Dukes, C., Brady, M. P., Scott, J., & Wilson, C. L. (2016). Using modeling and rehearsal to teach fire safety to children with autism. Journal of Applied Behavior Analysis, 49(3), 699–704. https://doi.org/10.1002/jaba.331
Liang, Z., Lee, D., Zuo, J., & Liang, S. (2024). The use of visual schedules to increase academic-related on-task behaviors of individuals with autism: A literature review. International Journal of Developmental Disabilities, 1–14. https://doi.org/10.1080/20473869.2024.2402124
Malik-Soni, N., Shaker, A., Luck, H., Mullin, A. E., Wiley, R. E., Lewis, M. E., Fuentes, J., & Frazier, T. W. (2021). Tackling Healthcare Access Barriers for individuals with autism from diagnosis to adulthood. Pediatric Research, 91(5), 1028–1035. https://doi.org/10.1038/s41390-021-01465-y
School safety drills and exercises for students with autism spectrum disorder (ASD): Tips and resources for educators. National Association of School Psychologists (NASP). (2020). https://www.nasponline.org/
Using Social Stories to Introduce Concepts and Emergency Preparedness Drills to Children. Institute for Childhood Preparedness. (2020, June 24). https://www.childhoodpreparedness.org/post/using-social-stories-to-introduce-concepts-and-emergency-preparedness-drills-to-children
