The ability to communicate is one of our most basic needs. Communication allows us to express our feelings, develop meaningful connections with loved ones, and share information with others.
While most people think of communication as talking, it's much more than that. From a very young age, babies communicate by gurgling, giggling and crying. They reach for objects and people. They babble simple to increasingly complex strings of sounds. Around one year of age, they start to use their first words. However, some children don't begin to talk—or communicate—as expected. Some children may be helped with
augmentative and alternative communication (AAC).
What is augmentative and alternative communication?
AAC is one way that a person may communicate without talking.
Augmentative means to add to someone's speech.
Alternative means to be used instead of speech. You may have seen someone in your life or on TV using a tablet or different device to type or even speak their words for them. These high-tech devices are methods of AAC. However, AAC can also involve little to no technology—such as providing a toddler or child with a paper or board with pictures that lets them point to what they want to say (more on that below)!
Not every tool works for every person, which is why it's important that families consult with a speech-language pathologist (SLP) who has experience with AAC. These professionals can help your child develop the language they need to reliably communicate with you, their friends, teachers and anyone else who they interact with in their daily lives.
Who should use AAC?
Children who can benefit from AAC include those with communication disorders or medical diagnoses that make it difficult to be understood by their family, caregivers, and peers. Some children have a diagnosis of autism spectrum disorder, cerebral palsy, childhood apraxia of speech, developmental language disorder, dysarthria, stroke, traumatic brain injury or voice disorder. However, anyone who has unreliable speech may benefit from the use of AAC. AAC can be used at any age, even during the infant and toddler years.
How can AAC help my child?
AAC offers many benefits, especially when it's introduced early in a child's life. Most importantly, AAC allows children who have difficulty communicating to effectively express their ideas, feelings, needs and wants.
Early introduction of AAC can positively impact:
Communication and language skills: Birth to three years is the most rapid period of brain development in a person's life. This is a time when children are developing the communication and language skills that are the foundation for later school and career success. When AAC is used during the early years, it can help children develop a strong language base and aid them in meeting their expected developmental milestones in language, communication and early reading and writing—similar to their peers who don't use AAC. This early use of AAC can also sometimes help to increase the amount of verbal speech.
Social interactions: AAC encourages social interactions between children and their peers, family members and caregivers. When a child can share their thoughts, this creates opportunities for bonding and helps them develop a sense of belonging. Children can express their unique personalities and even tell jokes using AAC.
Behavior: AAC can help reduce tantrums and other behavioral challenges that may occur when a child can't communicate their wants, needs and feelings. If a child is hungry, tired or in pain and unable to express that clearly, they understandably may become very frustrated and rely on other behaviors to alert loved ones to their situation.
School achievement: For school-age children, AAC is a tool that helps them to participate in school, making learning more accessible. AAC users can contribute to group activities and express to teachers what they have learned from academic lessons.
Myths & misconceptions about AAC
Parents and caregivers may have concerns about using AAC based on myths or misconceptions. Here are some myths and facts that anyone considering AAC for their child should know.
Myth: AAC interferes with verbal speech development, and it's better to work exclusively on oral speech.
Fact: AAC does NOT prevent or reduce verbal speech.
Research shows that using AAC actually supports verbal speech and language development. While some people use AAC their whole life, others use it temporarily (even for a few months). AAC can reduce frustration and set the foundation for improved communication skills. It also helps with learning language in infancy and toddlerhood, which are critical for later literacy skills.
Myth: AAC should only be considered when a child is older, or as a last resort after trying other methods.
Fact: AAC can be introduced very early, even before a child turns one.
Using AAC will not prevent your child from talking. If a child is having difficulty communicating, there's no need to wait. AAC can be considered in consultation with a pediatrician and SLP at any time, including as part of Early Intervention programs (available in all States and territories in the U.S.). AAC should not be seen as a last resort, but rather as an early tool to support communication. It's important for parents to know that some older children who may not have had success with AAC early may still benefit from trying AAC again.
Myth: If your child is using AAC, they should begin with non-tech options such as single paper pictures before trying any electronic tool.
FACT: There is no correct order for learning AAC.
The right tool is based on the individual child. Multiple types of AAC should be always available to support the child in case one option is ineffective (e.g., battery runs out, water ruins the paper, etc.). Just as anyone uses gestures, verbal speech, and written language to communicate, an AAC user can be effective using many types of low-, mid- and high-tech tools.
Myth: AAC is only for home or school.
Fact: AAC should accompany a child everywhere.
The need to communicate is not limited to home or school. Just as people who use verbal speech always have their voice with them, a child should always have their AAC tools available to express their wants and needs. For example, the AAC tools should always be brought with the child to any medical appointments.
Myth: AAC is only appropriate for children with autism spectrum disorder.
Fact: AAC is NOT limited to children with autism spectrum disorder.
Any child who experiences unreliable speech can benefit from AAC. This includes children with cerebral palsy, some chromosomal or genetic disorders, brain injury, dysarthria, speech/voice disorders, and various other developmental conditions.
Myth: AAC is limited to high-tech speech-generating devices that are very expensive.
Fact: AAC involves a wide range of options.
These include supports that require nothing but your own body (such as gestures, body posture, and manual signs); low-tech or no-tech options such as paper boards using pictures or words, writing, or drawing; and high-tech apps on tablets or specialized speech-generating devices. The choice of AAC depends on the child's needs, preferences, and abilities. Choices may vary frequently over time. More than one type of AAC is usually required to ensure that the child can always communicate. An AAC tool or tools are identified during an assessment with an experienced SLP. An SLP can help find ways to fund a device and many states have technology centers that can be a great resource for equipment.
How do I help my child get started with AAC?
As a parent or caregiver, you don't need to figure this out on your own! Speech-language pathologists are educated to help. The process may seem overwhelming, but these professionals will work with you and your pediatrician to help find an appropriate communication option or options. Here is how SLPs can assist:
Assessment and individualized intervention: An SLP will evaluate the specific communication needs of your child and recommend an AAC system/s that is appropriate for the child's abilities and preferences. They will work with other professionals including occupational therapists, physical therapists, or vision specialists to make sure that any accessories or equipment are tailored to any other sensory and physical needs the child has. SLPs will work with insurance companies, vendors, or local technology centers to help pay for technology as needed and help to complete any required paperwork.
Training and support: SLPs provide technology and communication training to important people in a child's life (family members, caregivers, teachers, support personnel) to help make sure AAC use is successful. They can show you how to operate, clean, store, and charge AAC equipment; demonstrate effective ways to use AAC; provide ideas for practice; and coach you on how to integrate AAC in all the places in a child's life (home, daycare, school, etc.). The SLP will develop goals with the family and provide communication intervention for your child to help them develop their speech and language with the aid of AAC. You will be an active participant in the learning process!
Ongoing progress monitoring: An SLP will regularly monitor your child's communication development and make necessary recommendations to support communication needs as your child grows into a teenager, college student, and adult. Your knowledge and input will continue to be crucial to making goals to match your child's needs.
You can find an SLP by asking your pediatrician for a recommendation, or by contacting your local early intervention program or school system. A database of private providers is also available from the American Speech-Language-Hearing Association (ASHA) at
www.asha.org/profind. It's important to ask the SLP about their level of experience with AAC and to choose a professional you feel comfortable with and is a good match for your child and family.
AAC is a powerful communication tool that can positively impact a child's life. Early access to AAC during later infancy and early toddler years can offer big benefits to a child's language development, social engagement, and overall well-being. Even if you haven't tried AAC before, your older child or teen may benefit from a comprehensive AAC evaluation. By working with an SLP to incorporate AAC, children and their families can improve and enrich their lives in every way.