Augmentative and Alternative Communication (AAC) 101

Communication is an essential part of life. We rely on communication to express our wants and needs, form friendships, exchange ideas, and engage in our communities. For the many people with disabilities who have difficulties with spoken communication, augmentative and alternative communication (AAC) devices and programs can bring language alive and make communication possible.

So, what is AAC, and what kinds of AAC devices are out there? How do you know if your child could benefit from one? What kinds of support and funding are available? To learn more, we sat down with speech-language pathologist (SLP) and AAC specialist Ali Steers as well as Undivided’s Head of Health Plan Advocacy Services, Leslie Lobel.

“AAC looks like so many things,” Steers says, “so it can be really hard for someone to wrap their brain around what exactly AAC is.” Functionally speaking, AAC can be anything from an iPad app to a computer with text-to-speech software to a dedicated, portable device or low-tech systems like communication boards, a picture exchange communication system (PECS), and signing. “We can all kind of think of ourselves as AAC users,” Steers says. “All of us are sending text messages. All of us are writing emails. All of us are using emojis.”

Steers adds that it’s important to recognize that all children already communicate in some way, whether it’s verbal, with their eyes, or vocalizations, and that AAC devices are used to augment or add to a child’s communication.

For more on what AAC is from Ali Steers, watch this clip:

A child could benefit from an AAC device if they:

• have difficulties speaking verbally
• are speaking verbally unreliably
• are unable to speak verbally

“If your child is not developing intelligible speech with their mouth on par with their typically developing peers, then, in theory, you should be talking with a speech therapist, and that speech therapist should be giving you good advice about whether or not your child has the ability to develop intelligible speech without augmenting their communication,” Steers explains.

Note that it's never too early or too late to start with AAC, according to Steers:

Steers suggests that parents think about AAC in the same way they think about German or French — it really is “a language that we use all day to communicate.” So it’s crucial that the right device and system are chosen for your child’s unique needs.

An essential first step is speaking with a professional who is knowledgeable about AAC programs and devices and who will take many variables into account when helping you determine what system is going to work best for your child.

An evaluator will look at the following:

• Access: Can the child use this device? For example, a child who does not have the fine motor control to use an iPad shouldn’t be given one for communication. In that case, other options should be considered.

• Environment: Who is the child going to be communicating with?

• Language organization: How is the child going to be communicating? What words do they need access to, and how should these words be organized?

  • Steers tells us that a language system should be set up for durability and longevity because the system will need to grow with the child. The way the system is set up is essential to whether your child will be able to communicate effectively with their device. Are high-frequency words easily accessible? Are there enough words available to them? Steers suggests trying the device out for yourself. Can you talk to your child using the system? If not, the layout may need to be redesigned, because if you are not able to communicate with the device, they will likely struggle as well.

• Portability: How will the device move around with the child? For example, a child can use a cross-body strap to carry the device, or it can be mounted on their wheelchair. Whether a mount or strap will work well depends on the needs of the child and the device itself.

Steers suggests testing a program or device before committing to it whenever possible to ensure it will work for your child. Working with a knowledgeable SLP will help you start narrowing down the best AAC system (such as apps or speech-generating devices), as there are many options currently available on the market, including:

• Direct selection programs and devices, where the child will directly point to, press, gaze at an image or word they wish to select
• Dedicated devices for AAC
• Tactile or auditory devices for children who are visually impaired
• Standard USB joystick or mouse
• Head pointing devices
• Eye-gaze devices
• Switch scanning

For a deeper look at the most common programs and devices in the above categories, as well as insights about using them, see our article Top AAC Programs and Devices to Know About.

As Steers points out, communication is a medical necessity. “Everyone needs to be able to communicate, to speak to their doctors and their health team,” she says. “We need to be able to build relationships with those in our environment. Communication is absolutely a medically necessary function, in the same way that a wheelchair is.”

Some dedicated devices can be costly, and Steers never recommends families attempt to pay for them out of pocket. There are several funding sources you may have access to:

• Private insurance
• Public insurance like Medicaid
• School district
• State disability organizations or programs
• Grants and scholarships

Learn more about each of these in our full article about funding AAC devices and programs.

For your child to get the most from their AAC program or device, everyone who interacts with them will need to receive proper training, including family members, teachers, and peers.

In most cases, an SLP will provide initial training on using the system for a child’s family members, teachers, aides, peers, and any other person they interact with on a regular basis. Parents can also request that group time with their child’s classmates be written into their IEP, so the SLP can help other students learn to use the device alongside their child.

Once a person is thoroughly trained and proficient, they can then train others. Steers tells us she has had great success with parents teaching other family members and teachers instructing a child’s peers and friends.

Learning to work with AAC programs and devices will take time and practice and can be an overwhelming experience. If you feel like you need more support, you can:

• Speak with an SLP who is knowledgeable about AAC. Steers tells us that not all SLPs are fully trained in AAC, and parents should ask detailed questions. Here are some example questions to ask an AAC specialist:

  • What systems do you have experience with? What is your comfort level with different AAC systems/equipment?
  • How long have you been providing AAC services? What do you do to stay current in the field?
  • What is your process for determining a good AAC fit?
  • How do you measure progress?
  • How will you collaborate with or support teachers, doctors and other members of my child's care team?

• Visit the company website of your child's AAC device or program. Many of them offer articles, webinars, or training to help you learn more. Chris Rigby from Tobii Dynavox tells us that, like many AAC companies and organizations, the Tobii Dynavox website offers a number of guides to help parents with the funding process. Other companies and organizations offer similar funding support, including:

  • LoganTech (for the ProxTalker, ProxPAD, MegaBee Eye Pointing Communication Tablet, and 6dot Braille Labeling and Learning)
  • Prentrom (for the PCR Accent series, the PRiO-mini, and LAMP Words for Life)
  • The Center for AAC and Autism (for LAMP)
  • TouchChat’s user-based Facebook group
  • Enabling Devices’ resource page
  • California DOR’s Voice Options Playlist on YouTube

• Reach out to your state's department of developmental services to find out about local organizations that offer support and training, such as Regional Center in California.

• Stepping into AAC is a free 20-week course for families who are new to AAC, featuring videos, activities, and other resources.

Remember that it's a journey and a process that requires patience, practice, and perseverance. Watch this clip of parent Lelah Coppedge, whose son Jack works with Steers: