The Twirly Little Unicorn
Position words, WH-questions and story sequencing, with a session report on the digital edition.
Are Adapted Books Evidence-Based?
Not as a finished product, but the visual supports they are built on are. Here is what that does and does not tell you.
The short answer
Not as a whole: we did not find research that tests adapted books themselves, but the visual supports an adapted book is built on are a recognized evidence-based practice for autistic learners from birth to age 22. That is a real strength, and it is also the edge of what we can honestly claim.
An adapted book bundles several things: pictures that carry meaning, short repeated text, pieces the student moves or matches, and the same page layout again and again. Research has looked hard at the first of those. We did not find research on the bundle, so this page does not say adapted books are proven.
What the research does support
The National Clearinghouse on Autism Evidence and Practice (NCAEP) reviews intervention research and sorts practices into evidence-based or not. Its 2020 report covers studies published from 1990 to 2017. A practice counts as evidence-based when it has at least one of these: two randomized or quasi-experimental group studies, five single-case studies, or one group study plus three single-case studies.
According to the University of North Carolina's AFIRM team, which summarizes that report for teachers, visual supports meet that bar with 104 single-case studies and 2 group studies. The studies span early intervention through young adults, and they cover outcomes such as communication, academics, behavior, play, school readiness and social skills.
The AFIRM summary describes a visual support as a concrete cue paired with, or used in place of, a spoken cue. Pictures, photographs, symbols, written words and objects all count. The picture on an adapted book page is a visual support in exactly that sense.
The list of preschool studies in the AFIRM summary also includes a 2014 study on getting preschoolers with autism to take an active part in book reading (Fleury and colleagues, in Child Language Teaching and Therapy). We have not read that paper, so we cannot say how close its materials were to an adapted book.
Where the evidence stops
- It is about autistic learners. The review does not speak to students with Down syndrome, language delays, intellectual disabilities or other needs, even though teachers use adapted books with all of them.
- It is about visual supports, not the whole book. The AFIRM summary itself says individual types of visual supports may not all be equally effective. Hand-matching pieces, rereading the same book and WH-question prompts are things adapted books add on top, and we did not open research on any of them.
- It is a review of studies up to 2017. Newer work may exist that we did not look at.
- Most of the studies are single-case designs. They show a practice working for the individuals studied, which is how this field often builds evidence, but it is different from large group trials.
- We read a summary, not the full report. We opened the AFIRM summary and the NCAEP overview pages. We did not open the full 2020 report.
How to talk about this with your team
If a parent, administrator or IEP team asks whether adapted books are evidence-based, a fair answer is: "They use visual supports, which are an evidence-based practice for autistic learners, and we are collecting data on this student to see whether it is working for them." That is accurate, and it keeps the decision where it belongs, with the student's own data.
Adapted books make the data part easier because every page asks for the same kind of response. For the digital books, the end-of-session report shows how many responses were independent, how many needed a visual prompt and how many needed a verbal prompt. For the printable books, you can tally the same three levels by hand. Goal language belongs to the IEP team, and you will find example wording in the guides for special education, autism and speech therapy.
The same standard applies to any materials claim, ours included. Ask what the claim rests on, and whether the research was about the product or about something the product contains.
Try one with a student and take data
The most useful evidence is your own student's. Two books are free, each as a printable PDF and as a digital book, so you can run a few sessions before you decide on anything.
What Do You See At School?
A peek-and-guess book with real photos and the core words what, you, I and see.
Details are on the free adapted books page. When you want more, a membership covers 800+ printable books and over 300 digital books for $10 a month (40 printable downloads a month) or $99 a year (no monthly download limit), with unlimited use of the digital library on both. See the membership options.
Sources
- Sam, A., & AFIRM Team (2024). Visual Supports: EBP Brief Packet (Updated). UNC Frank Porter Graham Child Development Institute. afirm.fpg.unc.edu
- NCAEP, Executive Summary: Evidence-Based Practices for Children, Youth, and Young Adults with Autism. fpg.unc.edu
- NCAEP home page, which describes the 2020 report. ncaep.fpg.unc.edu
Frequently asked questions
Are adapted books an evidence-based practice?
Not as a finished product. We did not find a body of research that tests adapted books themselves. The visual supports they are built on are a recognized evidence-based practice for autistic learners, so the honest claim is that adapted books use an evidence-based ingredient, not that adapted books have been proven.
What is the evidence for visual supports?
A 2020 systematic review by the National Clearinghouse on Autism Evidence and Practice (NCAEP) found that visual supports meet its evidence-based practice criteria, with 104 single-case design studies and 2 group design studies, covering autistic learners from birth to age 22.
Does the research cover students who are not autistic?
That review covers autistic learners. It does not tell you what is true for students with Down syndrome, language delays or intellectual disabilities. Many teachers use adapted books with those students, but this page does not claim research support for that.
Can I write adapted books into an IEP?
Your IEP team decides what goes in an IEP. Goals are usually written about the skill, such as answering WH-questions, and the materials are the teacher's choice. An adapted book is one way to practice the skill and to collect data on it. See adapted books for special education for example goal language.
How do I know if an adapted book is working for my student?
Watch the same skill across several sessions. Count independent responses, responses after a visual prompt and responses after a verbal prompt, and look for the independent count to rise. The digital adapted books print a one-page report with those three levels for each session.
More guides: questions to ask before you buy, adapted books vs Social Stories and adapted books vs Boom Cards.