Augmentative and alternative communication (AAC) refers to all the different ways we communicate besides speaking. This can include gestures, pointing, pictures, communication boards, communication tablets and other technological devices with communication features.
These ways of communicating are considered augmentative when they are used to add to or support existing speech. They are alternative when used instead of speech.
AAC is for everyone! We all use AAC in our daily lives, such as when we send a text message on our phones or use a gesture (e.g., waving your hand) to say hello to a friend. For children, AAC is especially helpful if they are not yet talking, have limited speech or if their speech is difficult for others to understand. Some children may only need AAC for a short time, such as during illness or while recovering from a procedure.
Types of AAC
There are two main categories of AAC tools:
- Unaided AAC: This type of AAC relies only on the body to communicate. Some examples include baby signs, sign language, facial expressions and gestures. No external material, such as paper or technology, is used.
- Aided AAC: This type of AAC uses external tools, ranging from low-tech options such as a paper communication board to high-tech options such as electronic speech-generating devices (e.g., tablets or phones with special communication apps).
What are core boards?
While there are hundreds of thousands of words in our languages, we actually use a small group of about 200 words for 80 per cent of what we say every day. These are called "core words". A “core board” is a communication board made up of mainly core words.
Core words are powerful because they are very flexible and can be used in a variety of contexts. For example, you can use “go” to mean “go outside”, “go away” or “ready, set, go!”
Unlike "fringe" words (specific, context-dependent nouns such as "rhinoceros"), core words allow AAC users to express a wide variety of needs and thoughts with just a few symbols.
Because many core words are abstract and harder to picture, it is important to teach your child these words through consistent modeling in daily life. For example, you can use core words during routines such as eating breakfast or going to the grocery store.
What is aided language stimulation?
Children learn spoken language by hearing others talk every day. Similarly, a child using AAC needs to see their system being used by others many times before they can start using it effectively. This modelling strategy is called aided language stimulation.
When using aided language stimulation, you simply point to one or two symbols on the AAC system while you are talking to your child. For example, if you say, "Let’s go to the mall," you might point to the "go" symbol on their communication board.
For a visual guide on aided language stimulation, watch this video: Aided Language Stimulation Explained.
How can speech-language pathologists (SLPs) support your family in using AAC?
After assessing your child's communication needs and talking with your family, an SLP can help create and personalize various AAC types and/or devices to meet your child’s language level and needs. SLPs also work closely with occupational therapists (OTs) to support a child’s access (i.e., how a person can visually, physically and cognitively interact with an object) to their AAC system if needed. There are a few different ways to access AACs:
- Direct selection: Choosing a word or symbol from a set of options using:
- direct physical touch or by pointing with a body part or an object
- a movement or signal generated with a joystick, eye gaze, trackball or traditional mouse
- Indirect selection: Presenting a group of items to your child until the target item is reached. This can be done electronically or with help from a communication partner by:
- presenting items in a linear sequence (i.e., going through each symbol one by one)
- presenting items using a “row-column” sequence (i.e., going through each row of symbols until your child chooses a row and then going through each symbol in that row one by one)
- switch scanning (i.e., using one or more switches, such as buttons or track pads, to select items either linearly or in a row-column sequence)
Once an AAC system is selected, an SLP can help teach you and your child how to use that system.
Common AAC misconceptions
- “Will AAC delay or stop my child from ever speaking?” No. Research shows that AAC does not hinder or prevent a child from using spoken language. In fact, AAC has been proven to help develop and improve speech and language skills.
- “If my child can speak, will AAC be useful to them?” AAC can be useful for many types of communicators, whether they use spoken language or not. Everyone augments their spoken language with AAC, for example with facial expressions and gestures. AAC can be especially helpful for children if their speech is delayed, limited or hard to understand. Moreover, some children may be able to speak in certain situations but prefer to rely on their AAC in other contexts.
- “If my child understands spoken language, do I have to use their AAC when communicating with them?” It is very helpful for a new AAC user to see familiar communication partners using their AAC in everyday situations. Children learn spoken language by being immersed in a rich language environment, and that applies to AAC as well!
Tips for using AAC
- Keep things low pressure: Do not force your child to point to symbols or repeat you. Focus on having fun and naturally showing them how the tool works.
- Follow your child’s lead: Use the AAC during activities your child already enjoys, such as playing with favourite toys or games.
- Pause and listen: Always give your child plenty of time to process what you said and to get their message out.
- Acknowledge all types of communication: If your child uses a gesture, a sound or a look to tell you something, treat that as a meaningful message.