What is AAC?

Alternative & augmentative communication (AAC) refers to all forms of communication other than oral speech that are used to express thoughts, needs, wants, and ideas. It is usually multimodal, meaning that people will use multiple and at times overlapping methods of communication when interacting with others.

There are two major types of AAC: aided and unaided.

  1.  Aided systems involve some type of equipment outside of the person’s body, ranging from low-tech devices (such as paper and pencil) to high-tech devices (such as speech generating devices). Aided systems differ in terms of the vocabulary/symbols used, modes of access (direct select, switch activation, eye gaze), output modes (speech, text), whether or not the device requires a battery/charger, whether the device is able to communicate with other devices (laptop computers, phones), and many other characteristics.
  2.  Unaided systems do not involve external equipment that individuals have to carry with them. These include manual sign languages such as ASL, fingerspelling, and Amer-Ind. Many AAC consumers use some verbal speech and/or sign approximations in addition to their aided system, because they may not have access to their device at all times.

Who uses AAC?

Approximately four million people in the U.S. cannot or do not rely exclusively on oral speech in order to express themselves (Beukelman & Mirenda, 2013). The majority of AAC consumers have complex communication needs related to developmental disorders, brain damage or disease, and/or physical damage to speech structures (such as the mouth and throat). There is no “typical” person who uses AAC — everyone is different!

What is the goal of AAC therapy?

To provide person-centered, context-sensitive interventions that create opportunities for versatile, meaningful communication with multiple communication partners across multiple settings. Ultimately, the AAC consumer should feel empowered to communicate in all situations.

How do people figure out which AAC system is right for them?

When evaluating a candidate for AAC, speech-language pathologists (SLPs) assess various areas of competency and other factors that can impact success (Light & McNaughton, 2014):

  1.  Linguistic competence → receptive/expressive language ability, including the ability to interpret and use symbols
    • How much can the person understand and how much can they express?
    • What are the person’s strengths and weaknesses in the areas of vocabulary and grammar?
    • What kinds of things does the person want to be able to communicate?
  2.  Operational competence → ability to manipulate the AAC device: turning it on and off, flipping switches, programming new vocabulary, changing a recorded message, changing a voice setting, managing malfunctions, etc.
    • Does the person have significant motor, sensory, and/or cognitive impairments?
    • Is it difficult for the person to inspect or handle the device?
    • Is it difficult for the person to learn how the device works and use it independently?
  3.  Social competence → how well a person is able to manage the social aspects of communication, such as turn-taking, topic maintenance, reciprocity, balance
    • Is the system acceptable to the user and to potential communication partners?
    • Can the person use AAC to communicate spontaneously in family interactions and in everyday settings?
    • All AAC vocabularies should be highly individualized and functional, in that they reflect the user’s needs, desires, likes, and preferences.
  4.  Strategic competence → person’s ability to solve problems, esp. recovering from and repairing communication breakdowns
    • Can the person identify instances of communication breakdown? Can s/he revise or clarify the message in order to communicate more effectively?
  5. Psychosocial factors → person’s motivation to communicate, their attitude (and other’s attitudes) toward AAC, communication confidence and resilience.

The SLP, client, and their family assess these factors and daily communication needs to determine a good fit for an AAC system.

Citations:

Beukelman, D., & Light, J. (2020). Augmentative & alternative communication: Supporting children and adults with complex communication needs (5th ed.). Brookes Publishing.

Light, J. & McNaughton, D. (2014). Communicative competence for individuals who require augmentative and alternative communication: A new definition for a new era of communication? Augmentative and Alternative Communication, 30(1), 1-18. DOI: 10.3109/07434618.2014.885080.