Everything you need to know about AAC

What Is AAC?

Starting on your AAC journey can be a scary and daunting process, this article aims to cover everything you need to know about AAC and how to incorporate it into your daily life. AAC stands for Augmentative and Alternative Communication, it is a common tool used and recommended by speech pathologists that aims help people express themselves and understand those around them.

AAC can take many different forms, and chances are you’ve already used it in everyday life without even realising.  AAC includes any method of communication used to support or replace spoken language. Sometimes it’s as simple as writing a message on paper instead of saying it out loud, using gestures, or pointing to a picture. Other times, it may involve a high-tech communication device that helps a person express their thoughts, needs, and feelings. No matter the form it takes, AAC is all about helping people connect, communicate, and be understood.

Why use AAC?

Lots of people can benefit from using AAC and a speech pathologist will recommend it for a variety of different reasons, but the goal for is always the same, to support one’s ability to communicate, connect and express themselves.

• A young child with delayed language may be provided with a choice board or lanyard to support and build expressive language and prevent meltdowns.
• A person with cerebral palsy may use a robust communication device to communicate complex thoughts and ideas throughout the day.
• An adult who has lost their voice may write or draw messages out on a whiteboard to communicate with others.

Common types of AAC:

There is a wide variety of AAC options out there but some of the more common ones include:

• Lanyards with a picture and messages on them
• Cards that explain your needs or access requests
• A board of pictures that communicate short messages
• Buttons that play a specific message out loud
• An app that converts written words into spoken

AAC is also a system that can help people understand others was well as communicate with them. Lanyard systems or ‘Key Word Sign’ (KWS) where specific words in a sentence are signed, are designed as a way of supporting comprehension as well as expression. By providing a visual representation of words it gives people another way to understand what has been said.

Single AAC systems are rarely used alone, often systems are used in conjunction with each other and may be part of larger therapy goals. In the earlier examples the child with a language delay may also have people using key word sign around them, and the person with voice concerns may also text or type messages out. AAC can be a short term, long term or used periodically. Systems are determined by the needs of the user and it’s important that the AAC system is robust enough to meet the needs of the user.

AAC and communication functions

AAC aims to help and support people to communicate across all communication functions, this means that AAC is recommended to people with varying levels of language to support and develop their current abilities. Communication functions are the reasons or purpose of communicating a message. If you think about all the things, you’ve communicated today you can see there’s a range of reasons to communicate. Speech pathologists break communication functions into 8 groups.

What does it mean for AAC to be robust?

The idea of ‘robustness’ for AAC comes down to how much you can communicate or understand using the specific system. Something like a lanyard with a few messages is helpful in specific situations but would be unable to help communicate complex ideas. A communication device that has vocabulary for a variety of contexts and includes grammatical elements would be able to communicate thoughts and ideas across a variety of contexts and to a range of audiences.

Not every person needs a robust system, the type of system depends on the type of information that needs to be communicated (think of those communication functions) and what level of detail needs to be conveyed. A person who is unable to communicate any information using spoken words would need a very robust system while someone who needs AAC may require a less robust option.

High-Tech vs Low-Tech

AAC is a spectrum from low technology (low-tech) to high technology (high-tech). High-tech options involve computers and software to support and aid communication skills while low-tech are typically paper based. One benefit to high-tech is that it tends to be more robust and is usually designed to age with the client, but you have the downsides that it needs to be charged and is typically more expensive. Low-Tech is often cheap and you never need to worry about batter life but it tends to be less robust. If someone is a lifelong AAC user then a mix of high and low-tech can be useful to ensure that there’s always a backup if batteries go flat or systems stop working.

Will AAC Prevent Speech Development?

When AAC is first suggested to parents often a common concern is that it will prevent them or delay their talking, the short answer to this question is no AAC does not impact spoken language. In fact research suggests that augmented and alterative communication systems can support and help in the development in expressive and receptive language. Research shows that if a child is able to use their spoken voice they will, and AAC will not negatively impact this. Even people who have some words to express themselves can find benefit in AAC as a way to supplement and expand their language abilities.

If you want to find out more about how AAC can support speech you can find more information here

How to use AAC

Once a speech pathologist practices an AAC system in session they will then ask users and their support team to incorporate it into their activities of daily living but knowing precisely how to do this can be difficult, and each type of AAC will present its own challenge. Across AAC types there are some key ideas that can be implemented.

1. Ensure availability
2. Model across context
3. Model without expectation
4. Presume competence

Ensure availability

Regardless of the system you are using make sure that there is always the ability to use and gain access to it.

• Lanyards can be worn at all times by users and their carers, you can practice looking at the cards and using them with other people or toys but you want to make sure that the lanyard is always in arms reach.
• Choice/core boards can be specific to different activities so make sure that the board is readily available near the activity. If the board is about food, you may have it set at the dining table or tucked into a lunchbox. Sometimes coreboards are kept in a book that can be carried around.
• Whiteboards being used to communicate a message may need to have a strap so it can easily be carried, and a marker and eraser must be kept with them.
• Robust systems like LAMP, PODD and Proloquo need to be downloaded onto a dedicated communication device that is always kept with the individual. The user must have access to their device at all times meaning that the programme does not need a password and the volume is not changed without the users consent.

Model across contexts

AAC should be able to be incorporated throughout the day and into daily activities this helps build generalisation of the AAC, generalisation means that the user does not just associate the word/system with only one specific task or prompt but throughout out the day and with different meanings. For example think of the word ‘turn’, we can model this word in a variety of contexts:

• “My turn” and “your turn” for turn taking
• “Turn the car” for a car turning a corner
• “Turn it over” to turn an object over

If we just modelled ‘turn’ in one of these context we miss a lot of what the word can do, more than that we want to make sure that the word isn’t just modelled during a 20 minute speech practice session we want to model it throughout the day. If we think of the words “more”, “help” and “stop” we want to make sure the AAC user understands

Model without expectation

While this idea is particularly for introducing high-tech systems to people using a robust system it can be applicable to all AAC. When people introduce a system it can be tempting to ask the user to find specific words or to prompt them to copy what you do, however we want to always be modelling without expectation.

When we model without expectation it means that we’re showing and using the AAC system in a fun and comprehensible way and not ‘quizzing’ the user. This helps ensure that we’re modelling beyond requesting, we’re ensuring that modelling is more likely to be generalised and you’ll also find that as you model without expectation it becomes easier to model throughout the day rather than just during ‘practice time’.

Presume competence

Presuming competence means that we make the assumption that all people have something to communicate and that all people can adapt/learn ways to communicate their message. If we assume these things we ensure that we are setting AAC users up for success.

This idea not only impacts the choice of AAC we’re using but also the way we use it, if we assume someone is not competent or can never learn we’re less likely to keep the device available at all time, we may not include all vocabulary items, we may not even be modelling it correctly because if we presume they can’t then more then likely they won’t think they’re competent either. By presuming competence we’re giving a person every opportunity to not only communicate but to also communicate about things important to them.

What words should I model?

What needs to be modelled on AAC goes back to what the goal of the system, some AAC is used for a specific communication function like communicating access needs, if this is the case modelling in these specific contexts would be appropriate.

For people with broader communication goals the models need to be done across the communication functions discussed earlier.  When starting to model language it can be tempting to only use ‘I want’ phrases however it’s important to keep in mind those communication functions and model across them.

On a more robust system communicating these messages will be easier, but when lanyards or core boards are used it may become tricky to ensure we’re modelling all communication functions and not just requests. This then goes back to the design and selection of words being used and modelled.

When using these systems, it may be useful to think ahead of time of what words you can select and model, if using key word sign or a high-tech device you may want to search these words up ahead of time so you don’t have to look them up on the spot.

What’s next?

AA can be both long term and short-term meaning you may find yourself working with AAC systems for weeks or years, either way it’s important that you keep your short term goals clear and achievable with direct steps to long term speech and language goals. If you ever have questions or concerns about your AAC system, it’s important to bring it up to your speech pathologist to support you.

You can find out more about AAC with Moi Clinic here.