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A PRIMER ON AAC: ALTERNATIVE AND AUGMENTATIVE COMMUNICATION

Updated: May 12, 2021


WHAT IS AAC?

Alternative and augmentative communication (AAC) is any supportive system that helps a person use their communication more effectively. AAC includes any method we use to help express our ideas and feelings. This may include facial expressions, gestures, pictures, symbols, or writing. Young children often use AAC in their early years when their speech shows a delay. Using AAC lets little folks continue learning how to express themselves for all their social reasons. Many use the AAC until they are able to use speech to get their ideas across successfully—it augments their communication until they don’t need it any more. Some children become life-long users of AAC to successfully interact with the world.


Alternative means that the user does not use speech so needs a substitute method for expressing their ideas. Augmentative means that the user has speech but also uses the system to make their expression more clear or efficient.


Unaided AAC is any system where the person only uses their own body to communicate. This would include gestures, body language and sign language.

Aided AAC is any system that uses a tool to help the user express their idea. This may include low tech or high tech systems.


EXAMPLES OF LOW TECH AAC

Low tech means that no electronics or batteries are involved in the communication system. This might include sign language, or pointing to pictures or symbols.


Manual signs are easy and logical to use with children even before a child’s first birthday. Children naturally communicate with gestures before they start speaking words. Many parents choose to give their child a head start on expressing words by teaching them baby sign language.


Communication books are a collection of pictures or symbols that represent words. PECS (Picture Exchange Communication System) is a specific system that teaches a child to make requests by removing a symbol from their book and handing it to a person. PODD (Pragmatic Organization Dynamic Display) is another system that collects symbols in a book that teaches users to express a full variety of functions of communication (not just requesting).


Pencil and paper or a portable white board are AAC often used by adults when they lose their speech due to illness or injury. This is most useful for persons who already have a well-developed language system that includes literacy skills.

EXAMPLES OF HIGH TECH AAC

Speech generating devices (SGD) allow the user to select a button to have the word spoken aloud. These are also called Voice Output Communication Aids (VOCA). Families often call them their child’s “voice” or “talker.”


Static devices are simple types of high tech that use batteries. These can be a single button or a plastic case with two or more buttons. A helper records a word in each button for the user, who pushes the button to say the word. The Big Mack and Go Talk are examples of static devices.


Dynamic display devices have a touch screen that allows the user to use buttons to navigate to many screens of vocabulary and create sentences. They may also be used to type words on a keyboard and speak the words or sentences aloud.


Several companies produce full-featured dynamic display devices. For users with limited movement, the devices can be fitted with controls that use a switch, alternative pointer or eye gaze. Examples include PRC, Dynavox and AbleNet.


Other companies produce apps that can be used on a tablet or phone. Some apps, like Prologuo2Go, organize vocabulary according to categories. This requires navigating to many screens to make a full sentence. Others use a system based on the idea of motor memory, where vocabulary is organized based on frequency of use so navigation steps are reduced. Examples include LAMP Words for Life and Speak for Yourself.


Dedicated device is a term used when the system can only be used for communication—it is dedicated to that single purpose. Most insurance systems will only pay for a dedicated device.


It’s possible to purchase an iPad that is “locked down” to use as a dedicated device. When families buy an iPad with their own funds, though, they don’t usually pay for the dedicated feature. Instead, families can use the Guided Access setting to keep the iPad locked into the AAC app. In my opinion, it’s almost always a mistake to allow a child to use other apps on the same iPad they use for communication. Children prefer the entertainment option, which distracts from learning opportunities. It also makes their voice less accessible when they have to navigate between apps.


HOW TO TEACH A CHILD TO USE AAC

Children should start learning AAC as soon as a speech delay is noticed. This helps them keep up with developing their social communication and practice interacting with people for a variety of reasons. Having a way to express their ideas helps prevent frustration and tantrums that occur when children can’t make themselves understood.


Your child should start using a meaningful gesture before their first birthday. Model the common gestures and encourage their use. A list of 16 gestures all children should learn by 16 months is available from the First Words Project. You can add more vocabulary from the Baby Sign Language Dictionary.


Aided language stimulation is the speech-language pathology term for modeling AAC use. We’ve long used the term language stimulation to mean providing relevant words or narration during an activity. Adding the word aided to the phrase means AAC is being used in the model.


In my opinion, modeling is the best and most natural way to use AAC to support a child’s communication. Modeling teaches vocabulary in the context where it’s useful, which gives extra information to the learner. It also shows how we use our words for a whole range of purposes—to name, request, reject, comment, entertain, ask questions, start a conversation, etc. The video below illustrates the concept of aided language stimulation.


Core vocabulary is a method of organizing and teaching vocabulary to put the most useful words on the main screen of the device. Core words are those used most frequently in conversation When users have ready access to core words they can get their message across clearly and quickly in most situations. Less frequently used words, such as specific nouns, can be places on pages that require navigation. A demonstration of the power of learning core words is in the following video,


The Interaction Coach podcast has hundreds of ideas of how to support children’s communication development. Parents can model using sign language or an SGD while they are engaged in these daily activities.


AAC instruction should be started as early as possible. Sadly, too many children are denied access to AAC because they have a little speech or adults are “holding out” for speech. Having no effective means of communication slows a child’s development of cognitive and language skills.


WHAT IS THE COMMUNICATION BILL OF RIGHTS?

This statement came from the National Joint Committee for the Communication Needs of Persons with Severe Disabilities. It grew from concerns that children and adults are often not given access to communication tools when and where they need them. The statement is based on the belief that all people regardless of age or severity of disability have a basic right to use communication to affect their life and fully participate in communication interactions. The statement lists the following rights:

  • to interact socially, maintain social closeness, and build relationships

  • to request desired objects, actions, events, and people

  • to refuse or reject undesired objects, actions, events, or choices

  • to express personal preferences and feelings

  • to make choices from meaningful alternatives

  • to make comments and share opinions

  • to ask for and give information, including information about changes in routine and environment

  • to be informed about people and events in one’s life

  • to access interventions and supports that improve communication

  • to have communication acts acknowledged and responded to even when the desired outcome cannot be realized

  • to have access to functioning AAC (augmentative and alternative communication) and other AT (assistive technology) services and devices at all times

  • to access environmental contexts, interactions, and opportunities that promote participation as full communication partners with other people, including peers

  • to be treated with dignity and addressed with respect and courtesy

  • to be addressed directly and not be spoken for or talked about in the third person while present

  • to have clear, meaningful, and culturally and linguistically appropriate communications



WHERE CAN I LEARN MORE ABOUT AAC?

Facebook groups for families of AAC users

AAC through Motivate, Model, and Move Out of the Way Speak for Yourself

Websites

Common Sense Blog from parent of AAC user Project Core Praactical AAC


Videos

Gail VanTatenhove Presentation from parent Dana Nieder: Don’t Wait to Communicate: Why Your Child Needs AAC

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Joyce is very knowledgeable. Not only as a speech therapist but also on how the school system works. Which is very helpful going through the IEP process. She was able to engage with my daughter and was never hesitant to help in any way. I would definitely recommend Joyce to anyone that is looking for a trustworthy, caring and informed speech therapist.

- AUTUMN MARSHALL, PARENT