Augmentative and Alternative Communication (AAC)

“Communication is life. It is the only vehicle we have for connecting meaningfully with others.”

  • Joseph Grenny, author

Background 

The ability to communicate is possibly the most important thing we can give our children. It means they can: 

  • connect with other people
  • show what they understand
  • make their thoughts known
  • be meaningfully occupied and productive

On the most basic level, communication is necessary for safety and wellness.

Defining AAC

AAC can be aided or unaided. Unaided AAC is any system that doesn’t require any materials or devices. It might be as simple as gestures and facial expressions, or as complex as American Sign Language (ASL). Aided AAC is communication using materials of some kind. It could be drawing pictures on a scrap of paper, typing, or a communication system like PECS or Proloquo2Go.

In practice, using unaided AAC can be limiting because not everyone understands. However, it’s best for a person to be able to use some unaided AAC strategies so that they can communicate at times when their aided device isn’t available or convenient.

Choosing a Device or Strategy

The best starting point is an assessment with the help of a speech-language pathologist (SLP). They will assess your child’s: 

  • strengths
  • communication style
  • needs 

An SLP will also help you think about what your child might need in the future as their abilities grow, and  can help your child begin to use the chosen strategies, and provide some training for you and the school team.

To begin communicating, a child must learn how to use the device and what the symbols mean. If they are new to social interaction, they will also need to learn how to put ideas together, and how to engage with people in communication, such as:

  • getting people’s attention
  • when and how to share an idea
  • how to take turns
  • how to communicate for different purposes

Communicating for different purposes is especially important, as sometimes people using an AAC device tend to stick with just refusing or requesting and labeling things. They might not be used to communicating to share ideas or information, or speaking in social ways to build relationships. That’s why it’s helpful to have therapists supporting the child, family and school through this process.

The person using AAC also needs communication partners (family, friends, classmates, teachers) who will need to learn how to use the communication system and how to encourage the user so that the child has someone to talk with.

Who Should Use AAC

AAC is helpful for anyone whose ability to use speech is not the same as their potential for communication. Some people with autism are quite verbal, but find they can sometimes write more easily than they can speak. 

At the other end of the continuum are people who do not speak and may appear to have no interest in communicating. However, appearances can be deceiving. There is no one who would not benefit from greater access to communication. 

People sometimes believe that using AAC might slow down the development of verbal speech. However, the research is clear that the opposite is true. Using alternative communication helps people communicate better, both nonverbally and verbally, if they have the capability.

Another misconception is that a person must be ready, cognitively or developmentally, before using AAC. The way a person currently communicates might affect what strategies are used, or the kind of system to use, but not whether they should use AAC at all. 

For example, a person who throws things might not be a great candidate for a tablet, but there are many other, low-tech ways to support communication. If a child is at the initial stages of social communication, it is important to give them a way to refuse, or get attention, or request what they want. 

Speech-Language & Audiology Canada has affirmed that there are no minimum linguistic or other prerequisites to introducing AAC tools or strategies. Everyone can learn to communicate better than they already do.

Overcoming Barriers to AAC

AAC is not a magical tool that unlocks the ability to communicate instantly. Implementing a system is a lot of work and takes time, practice, and thought for both teacher and student.

Sometimes people underestimate the potential of nonspeaking people. There is also a lack of awareness of options that are available to work around communication barriers. Another difficulty is making sure that devices and systems are user-friendly in complex home and school environments.

Expert help can also be hard to find. In the United States, the Individuals with Disabilities Education Act (IDEA) requires that assistive technology be considered as part of planning for all children with disabilities. If it’s determined that AAC is required, the school must purchase devices or materials and train staff. There is no similar requirement here in Canada, although Manitoba’s Accessibility Act has a requirement for businesses and organizations (including schools) to consider communication needs of clients. The document specifically mentions print versions of information, text to speech, captions and ASL. Assistive devices must be supported.

However, the clinicians in the school system have limited time to spend on a single child. If we were to follow a guideline like IDEA, they would be swamped beyond managing. We must consider how we use our existing resources to manage communication support for all who would benefit. Missing opportunities to help students whose quality of life could be changed because of a lack of resources is not acceptable.

“…there is a growing body of science that suggests that we might have gotten it wrong, at least some of the time, for some individuals. I think that it is not okay to get it wrong for even one person; when we talk about communication, we are talking about peoples’ lives, no less than that…” (Mirenda, 2008)

Getting Started with AAC

If you think your child could benefit from communication support, look for resources in your school and community. It can make an enormous difference to your child’s quality of life.

AccessATCanada allows you to search for programs related to assistive technology in your province. There are a range of programs related to AAC, including potential funding sources and programs that may have loaner devices.

In Winnipeg, the Open Access Resource Centre (OARC) is a helpful organization that provides training and loans out devices for people to try. To access their services, the OARC ask for a referral through an SLP, usually connected to the child’s school, but a private SLP could also help you get started. According to them, the really necessary factor is one adult who is willing to learn about AAC and do the consistent work to support its implementation for a child. 

Further Reading