Augmentative and Alternative Communication (AAC)

Human beings are constantly communicating, whether it’s by making eye contact, pointing, nodding, or using words. Verbally or nonverbally, we humans need to share our wants, needs, thoughts, and opinions.

But for those who are unable to communicate using speech, trying to express themselves can be frustrating. For these people and their loved ones, an augmentative and alternative communication, or AAC, device can serve as their “voice box”--and it can be life-changing.

1What is augmentative and alternative communication (AAC)?

2How does an AAC device help you communicate?

3Who can use an AAC device?

4Types and examples of AAC devices

5What are the benefits of using an AAC device?

6How Expressable online speech therapy can support AAC users and their families

7How can you support your child or loved one if they use an AAC device?

What is augmentative and alternative communication (AAC)? 

AAC is an umbrella term that covers any way of communicating other than talking. Any method that can help a person communicate counts as AAC. That includes many systems and devices, such as communication boards, speech-generating devices, computer apps, and picture books. It also includes “no-technology” techniques such as gestures and facial expressions.

How does an AAC device help you communicate?

AAC is made up of two categories: augmentative and alternative communication.

Augmentative communication adds to someone’s speech. These are devices that support, supplement, or enhance your natural speech. One example: A portable amplifier that increases the volume of your speech when you’re in a loud place.

Alternative communication is used instead of speech. Alternative communication devices replace your natural speech. They are helpful for a person who is unable to communicate verbally. For example, a voice output communication aid (VOCA) is a computer program that will say words out loud for you. 

Who can use an AAC device?

People of all ages, from children to older adults, use AAC. They may be limited in their speech, have difficulty producing or understanding language, or be completely nonspeaking. 

Some people use AAC for a period of time after surgery or a medical event, such as a stroke or brain injury, until their communication skills return. Some people use AAC long-term because of a diagnosis such as cerebral palsy, multiple sclerosis, or autism.

It’s important to note that if a child is using AAC, that doesn’t mean they can no longer work toward a goal of using spoken language. AAC use supports language development overall. Using a device can help children communicate their thoughts, ideas, wants, and needs while they’re developing spoken language skills.

Types and examples of AAC devices

AAC devices are usually divided into three categories: high-tech, low-tech, and no-tech.

1 High-tech AAC

High-tech AAC devices are digital technologies. Some examples of high-tech AAC include: 

• Apps on a tablet, such as an iPad

• Computers with text-to-speech software 

• Devices with pre-recorded messages

• Speech-generating devices (SGDs), which are a computer or an app with a voice

• Amplifiers 

High-tech AAC devices are “dynamic.” Dynamic AAC devices can create on-the-spot messages to help the user immediately. They can be changed instantly as well.

2 Low-tech AAC

Low-tech AAC devices are “static” systems. This means they can’t be changed and only have so many displays. Examples of low-tech AAC systems include: 

• Communication boards 

• Picture books 

• Drawing tools

• Picture symbols 

3 No-tech AAC 

No-tech AAC techniques are likely familiar to you! Examples of no-tech AAC include:

• Sign language 

• Body language 

• Facial expressions

• Vocalizations  

What are the benefits of using an AAC device?

An AAC device is like someone’s voice box. That’s why the user should bring their AAC device with them wherever they go. The benefits of using augmentative and alternative communication include:

• Increased independence 

• Better mental health 

• Less frustration

• More participation with family and friends 

• More positive social interactions 

• More employment opportunities 

How Expressable online speech therapy can support AAC users and their families

The more an AAC user uses their device to communicate with others, and the more others engage with the AAC user, the better both parties will become at communicating. A speech-language pathologist, also known as a speech therapist, plays a key role in helping people use AAC. 

Expressable matches individuals and families with a licensed, certified speech therapist trained to evaluate and treat speech and language disorders that require an AAC device. All therapy is delivered online via face-to-face video conferencing. Based on the client’s age, communication difficulties, and goals, the speech therapist will develop a personalized treatment plan to meet their needs.

An experienced speech therapist plays a key role in helping people use AAC. 

Before a person can receive an AAC device, they must have an AAC assessment. Your speech therapist can collaborate with other professionals, including physical therapists and occupational therapists, to help determine the best AAC device for you or your loved one.

Once the AAC device or system is chosen, the speech therapist can: 

• Teach the person how to use their AAC device

• Teach family and friends how to best communicate with the AAC user

• Program the device so the AAC user can communicate effectively

• Teach the AAC user and/or caregiver how to change the words on the device

Adult clients can choose to attend sessions by themselves, but are welcome to bring caregivers or family members to the sessions as well. For children, we recommend that a parent or caregiver attend sessions with their child so they can learn at-home strategies from the speech therapist. This way they can confidently practice with their child outside the session and improve their child's communication. With an AAC device, there are a few other specific reasons for a caregiver to attend sessions:

• Family members should learn how to use the AAC device. When a child is first learning an AAC system, one of the main ways the therapist and caregiver can support that is by modeling use of the device themselves. Here’s an example. If the adult and child are blowing bubbles and the adult wants to model language, they may say, "Wow, it's bubbles! Pop pop pop!" and click on the icon for "bubbles," so the device says "bubbles” at the same time. This helps the child make the association between the actual physical bubbles and the bubbles icon on the device. 

• The caregiver can tell the speech therapist about the most important concepts, items, and people in the child’s life. The speech therapist can then show them how to program the device to prioritize those things and put them in easy-to-find places. For example, if the child loves playing with cars, the therapist would program "cars" on one of the main screens.

• It’s also helpful to learn the technical side of using the AAC device, since the caregiver is likely the one charging, updating, and otherwise managing the device throughout the week.

How can you support your child or loved one if they use an AAC device?

Below are some tips to help you support the AAC user in your life. You’ll find even more helpful tips here.

1 Know how to use the AAC device

It’s important to understand how to use your loved one’s AAC system or device. If you don’t understand it, you won’t be able to respond to them, which will hurt communication between the two of you. 

2 Show your child or loved one how to use the device

Demonstrating how to use the AAC device is the best way for your loved one to learn how to use it themselves. 

3 Use the AAC device everywhere and with everyone

The AAC device is your loved one’s “voice box.” Bring it everywhere with you, so the device becomes a familiar, common practice of communication for everyone involved. Remember, the goal of having an AAC device is to help the AAC user communicate as independently as possible. 

4 Reward your loved one for using their AAC device

It takes time to adjust to using an AAC device. To keep your child or loved one motivated and help them build the habit, try using reinforcements or small rewards, especially at the beginning. Try to keep communication fun and interesting!

For example, when your loved one attempts to use the device, turn your attention to them. Acknowledge their attempt, even if the actual message isn’t accurate. You can also provide a small physical reward, such as a toy or an activity. When your loved one is learning to use their AAC device, you may need to reward them immediately, any time they reach for their device. Once your loved one is used to the device, you can fade away the rewards. 

5 Remember the purpose of the AAC device

At the beginning, focus on using the device during activities that are already fun for your child, rather than in a high-pressure situation. If your child or loved one is acting out or seems confused or frustrated whenever they use the device, stop using it for a while and try something else. It’s important to remember that the AAC device is meant to help the user, not cause harm. 

6 As a communication partner, be patient and go slow

When you’re speaking to your loved one, take your time. Repeat yourself as needed and pause after sentences. This helps the AAC user process what you’re saying, which will make it easier for them to respond. Also, wait for them to be done communicating before taking your turn to speak.

Remember that many AAC users do have strong receptive language, which means they understand what's being said to them. The device helps them communicate the thoughts, ideas, and feelings that are in their brain. They may know exactly what message they want to convey, but they need some time to use the device to get the message out. So be patient as they respond. The rhythm of the conversation may be a little different from what you’re used to, and that’s OK!