Should Augmentative and Alternative Communication (AAC) Be Considered?

ShouldAACbeConsideredflowchartSometimes this happens to me:  While talking to a speech-language pathologist (SLP) about one child using AAC, she’ll pause in the conversation, raise her eyebrows and say something along the lines of “You know, Johnny has been acting out a lot lately and he can say about 25 words, so he can talk, but do you think something like this would help him?”

I usually don’t know Johnny, but my answer is this: If you are asking the question, the answer is most likely “Yes.”

I’ve never had someone say, “Johnny tells me long stories and expresses his needs, wants, ideas, and thoughts.  He socializes and does great in school, but he has some issues with the /r/ sound.  Do you think something AAC would help him?” Well, then my answer would be no.

Parents and professionals know on some level when children need communication support.  We know that the verbal words they have are not enough to express their thoughts.  We feel the ache and panic of looking at a child who is using all of the tools he has – verbal words, gestures, facial expressions, signs – but we’re not able to figure out what he’s saying.  We watch the excitement fade from his face because he’s not able to share it.  We tried our best to understand. He certainly tried his best to explain, but despite our efforts, we’re left with a communication gap that we couldn’t fill.

So, the short answer is that if you’re asking the question, then yes, you should consider AAC.  If you have experienced that scenario with someone in your life, and you’re not investigating AAC as an option to bridge the gap in communication, please consider AAC.

I’ve created the visual above, but below is the text version for anyone who prefers that.

** As a side note, if you are considering AAC, consider high tech AAC for these reasons (and others):
1.Voice output provides a consistent model and helps increase verbal speech for some.
2. Independent exploration of vocabulary.
3. Access to a comprehensive vocabulary that allows students to build language beginning with a long term language system.**

AAC can be used for someone:

1. At any age
a. No one is too old or too young.
b. Consider AAC as soon as you have concerns. It will NOT hinder verbal speech development and has actually been shown to support it.

2. Regardless of perceived cognitive level
a. Accurate cognitive skills can not be expressed without language.
b. Consider AAC to provide a voice and a way for intelligence to be expressed.

3. Who has some verbal speech
a. Even with verbal speech, communication can be challenging, unreliable, and frustrating for some individuals.
b. Consider AAC to allow the individual to expand and clarify verbal speech, assist in word finding, and have access to communication during illness or high anxiety periods that may cause verbal abilities to be ineffective.

4. Who has physical limitations
a. For individuals who have fine motor issues, key guards prevent mis-hits more effectively than large buttons.
b. Consider AAC because individuals find ways to compensate when they are motivated to communicate, and fine motor skills often improve.  For severe physical impairments, consider scanning or eye gaze technology.

5. Regardless of previous AAC experience.
a. People and technology change rapidly.  If the individual still has complex communication needs, AAC could still be beneficial.
b. Consider AAC even if you “tried AAC 5 years ago and it didn’t work,” it’s time to try again.  It’s unlikely that you’re still using the same cell phone you had 5 years ago and the field of AAC has also changed significantly. Communication winds into every aspect of life, and success is crucial to quality of life.

6. With visual issues.
a. Even with thorough visual testing, perception is difficult to assess for an individual who is unable to communicate what is seen.
(1) Consider AAC  and allow the individual to explore and adjust positioning to compensate for vision.  Keep vocabulary in the same place. Motor planning  Try color coding or high contrast symbols and keep in mind that if individuals are not looking directly at the screen, it may be because peripheral vision gives them better visual acuity.

This is not to say that AAC is an immediate fix.  You are not able to hand a child a device and she grabs it to tell you her deepest thoughts.  It will, however, take the pressure off of the child.  It will provide a consistent steady voice that even unfamiliar people understand.  It will provide another tool in her communication repertoire that can give the listener context or clarify a word that pulls the message together and pushes it over the line and into intelligibility.  It gives the child security and confidence to continue to engage.

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Comments

2 responses to “Should Augmentative and Alternative Communication (AAC) Be Considered?”

  1. 1-A and 2-A and especially 5-B. So true! Thank you!

  2. Speaking as someone who outwardly presented like Johnny (oh my goodness I sounded SO VERBAL) but was actually still missing a good chunk of communication and just covering it by sounding fluent?

    Johnny should to know the option exists. Sure, most of the people who sound like Johnny will ignore the option, or maybe give it a shot and decide speech works better for them, but there will be some who realize that they can still say much more when typing. That’s what happened for me.

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