Has your child’s speech therapist mentioned the term AAC or Augmentative Alternative Communication? Or recommended your child receive an evaluation for a communication device? If you’re not familiar with this area, it may seem a bit overwhelming at first. Read below for a better understanding of what AAC is and how your child may benefit from additional support to help them communicate.
What is AAC?
AAC or Augmentative Alternative Communication refers to systems or devices that facilitate communication when an individual is non-speaking or requires assistance to enhance their existing mode of communication. AAC can be used to support people of all ages for whom verbal speech is a challenge. This can include individuals who are non-speaking or impacted by certain disabilities. Children who are in the process of developing speech, and those who have lost their speech due to injury.
There are two modes of communication involved in AAC: aided and unaided. Unaided modes of communication include non-verbal means (such as gestures, facial expressions, and American Sign Language). Aided modes of communication require external support like communication boards with symbols, computers, or electronic devices.
What is the difference between Augmentative Communication and Alternative Communication?
Augmentative communication refers to systems or devices that supplement natural speech. Alternative communication refers to systems or devices that replace natural speech and are typically most useful for those who are not able to verbalize to communicate. A key feature to all Augmentative Alternative Communication systems, however, is access to vocabulary, which can be divided into two main categories: core vocabulary and fringe vocabulary.
Core vocabulary includes high-frequency words that makeup approximately 75-80% of the words we use in our daily communication. These include actions, prepositions, pronouns, and articles. Incorporating core vocabulary into an individual communication system is essential for maximizing access and accessibility as they are typically more generic words that can be used with more communication partners and within a variety of contexts.
Fringe vocabulary includes words that we use around 20-25% of the time and are lower-frequency in terms of our daily use. These can include words that are more context- or individual-specific, and while they are critical for rounding out a person’s communication system, they are usually treated as secondary to core vocabulary.
What is an AAC device?
AAC can come in many forms and can be used on a short-term basis (temporary) or long-term across a person’s lifetime. Temporary users may include individuals who experience an injury or onset of a particular condition and need a short-term solution to communicate their needs. Long-term users may include those with developmental or congenital conditions who have limited or no verbal speech and require additional support expressing themselves. There are three main categories of devices:
No tech – No tech AAC systems are ones that do not require the use of technology, such as gestures, sign language, and facial expressions.
Low tech – Low tech AAC systems are ones that employ a low level of technology. For example, picture communication systems where a child uses icons to request by pointing, giving, or arranging pictures in order to make a sentence. Other examples include communication boards, communication books, and symbol charts. Generally speaking, low-tech AAC systems are static and are unable to be manipulated in real-time while in use.
High tech – High tech AAC systems are typically computer-based, use dynamic displays and computer-generated speech. Some examples are iPads, symbol-based applications, and electronic devices controlled by switches or eye gaze. With technology developing at a rapid pace, there are many new directions AAC has taken over the past few years. (See below for descriptions of some of the more popular high-tech AAC devices.)
Why is AAC important?
Research indicates that 200-400 words make up 80% of the words we use every day. These are typically comprised of verbs, adjectives, and pronouns. A child who is non-speaking or struggling to identify and use these core words is significantly limited in their ability to express themselves and maybe frustrated that they are unable to indicate their wants and needs, socialize, and interact meaningfully with others around them. Providing these children access to core vocabulary is critical and offers them a powerful tool for communicating their thoughts and feelings.
Many parents are reluctant at first to venture into the world of AAC, fearing that picture symbols, sign language, or devices will limit their child’s desire or ability to use language verbally. Parents should rest assured that AAC systems are designed to enhance a child’s communication and if a child is able to verbalize, AAC will only help draw out additional skills. For other children for whom verbal skills do not emerge independently or within traditional therapy models, AAC can offer a significant boost to their communication skills and allow them the ability to express themselves more freely than they’ve been able to before.
How do I know if my child needs AAC?
Your child may benefit from AAC if:
They are showing difficulty fully communicating their wants and needs. This may appear frustrating to the child (crying, screaming, frequent tantrums, headbanging, etc), they may consistently try to retrieve items on their own without trying to communicate with others, or they may seem entirely uninterested in initiating or responding to communication attempts around them.
They are delayed in meeting expressive/receptive language milestones and don’t appear to be making adequate progress on their own or within traditional speech therapy.
They have limited verbal skills or demonstrate difficulty with aspects of expressive or receptive communication.
They demonstrate difficulty completing developmentally-appropriate daily activities on their own.
They are experiencing difficulty accessing their academic curriculum.
People outside your home/immediate family are unable to understand what your child is communicating. Family members are often able to guess or predict what a child wants or needs; but is the child able to communicate those needs on their own?
Top AAC devices
There are many high-tech AAC devices on the market. Read below for information on some of the big names in AAC.
GoTalk 9+: The GoTalk 9+ is a recorded speech output device that is sized similarly to an iPad. It allows users to record messages to corresponding picture icons and then use these buttons to request, respond, comment, and engage in social interactions. Users are able to record up to 9 messages on 5 different levels (for a total of 45 messages). Features include volume control, core vocabulary buttons at the top for easy access, sequential recording, built-in overlay storage, and standard AA batteries. The GoTalk series is a particularly good fit for individuals who struggle with dexterity. The GoTalk 9+ is durable, portable, lightweight, and ideal for choice-making, relaying needs, initiating conversations, and supporting daily activities.
Tobii Dynavox: Systems that are part of the Tobii Dynavox family are speech generating devices that come pre-loaded with AAC software. Some of their devices (like the T-series) look like a traditional tablet and offer pages geared toward establishing core vocabulary, generating sentences, and accessing quick phrases and topics. Pages are organized in a cohesive and systematic manner that makes identifying vocabulary and building sentences intuitive and allows the user to advance in complexity as they go. Others (such as the i-Series) come with eye gaze capabilities for individuals with more complex access methods who are not able to use or not comfortable using touch. For older users, these devices can also include email and social media applications to be built in. For all its systems, Tobii Dynavox emphasizes the importance of portability and maintaining the ability to interact socially with others using their devices. Features include pre-stored phrases, choice of screen size, Gorilla Glass on screens for durability, and the ability to be customized per individual user.
Proloquo2Go: The Proloquo2Go system is an AAC symbol-based app that is compatible with iPhones, iPads, and iPod Touch devices. Once purchased and downloaded, it provides an inventory of 25,000 pre-loaded symbols with the ability for the user to add their own photos. Core words are the basis for this assistive technology and depict common emotions, requests, and responses. Single words or phrases generated by the individual can be read aloud by a pre-programmed voice. Once a user is comfortable with their personalized configuration, frequently used phrases, verbal commands and requests can be filed in customizable folders. The Proloquo2Go includes over 100 voices to choose from (including regional vocabulary and accents), 23 pre-programmed grid sizes, and a Progressive Language feature that helps users gradually acquire new vocabulary.
The Megabee Assisted Communication and Writing Tablet: The Megabee Assisted Communication and Writing Tablet is an AAC device that uses eye gaze and blinking as the method for selecting letters or phrases. The user communicates selections with assistance from a partner or caregiver sitting across from them ready to interpret. The user’s selections are ‘read’ by the caregiver who types them into the device and registers them on a digital screen. For individuals with low literacy skills or cognitive deficits, picture symbols can also be used in place of letters and written phrases (up to 36 images). Features include a custom carrying case, rechargeable batteries, and all necessary software. The Megabee Assisted Communication and Writing Tablet can be linked via Bluetooth wireless for displaying onto a larger screen or to input text into a personal computer.
DIY AAC for Toddlers
AAC systems can be used for all ages, including very young children. There are a number of ways parents can support their early learners using AAC tools and strategies, including do-it-yourself visuals. Some examples include:
Creating a choice board for your child’s favorite songs. Have your child select the song they want to sing together by pointing or using a label if they’re able.
Print out picture icons of your child’s favorite foods and offer 2 choices to start. You can add additional icons as they become more familiar with this process. You can model how to make a choice by pointing and then immediately offering the food to your child. If you don’t have a printer handy, you can also cut out labels from food boxes (e.g. cereal, crackers) and tape/velcro those to a board so your child can see their options.
You can use a similar process for offering choices of toys/activities to your child. Print out simple pictures of the most motivating and preferred toys for your child and show them how to point to make an activity choice. Use hand-over-hand assistance if needed at the beginning.
Verbs are a great way to build core vocabulary. Using the above icons, you could also emphasize the associated action words, like “jump!”, “splash”, “ride” or “color”.
Research is revealing more and more about how children communicate and how augmentative and alternative systems can be beneficial to learning, expressing thoughts, boosting confidence, supporting social interaction, and navigating the world around them. If you think your child may benefit from AAC support, connect with a Speech-Language Pathologist (SLP) for ways you can get started.
If you need more information about AAC and which devices may be beneficial for your child, the American Speech, Hearing, and Language Association (ASHA) is another great resource.