What is AAC?
Augmentative and Alternative Communication (AAC) is an area of clinical practice that addresses the needs of individuals with significant and complex communication disorders characterized by impairments in speech-language production and comprehension, including spoken and written modes of communication.
Augmentative and Alternative Communication (AAC) describes multiple ways to communicate that can supplement or compensate (either temporarily or permanently) for impairments in speech-language production and/or comprehension, including spoken and written modes of communication. AAC is augmentative when used to supplement existing speech, and alternative when used in place of speech that is absent or not functional.
AAC uses a variety of techniques and tools, including picture communication boards, line drawings, speech-generating devices (SGDs), tangible objects, manual signs, gestures, and finger spelling, to help the individual express thoughts, wants and needs, feelings, and ideas.
The Big AAC Picture
Augmentative and Alternative Communication (AAC) is EVERYTHING an individual uses to communicate or to enhance communication.
Different strategies may be needed for different situations and communication partners.
Strategies and tools may be combined to meet a variety of communication needs.
It’s about Communication!
“The outcome of AAC is not the “tool”, it’s about whether an individual has access to “the power of communication – to interact with others, to have an influence on their environment, and to participate fully in society.”
(Beukelman & Mirenda, 2013 – Augmentative & Alternative Communication: Supporting children and adults with complex communication needs, 4th ed.).
“AAC interventions should always be MULTIMODAL in nature; that is they should utilize the individual’s full communication capabilities, including any residual speech or vocalizations, gestures, signs and aided communication.”
~American Speech Language Hearing Association (1991), ASHA, 33 (Supplement 5), 9-12.
There are a variety of naturally-occurring behaviors that may be combined in a multimodal repertoire.
Body Language refers to voluntary or involuntary movements of the body that serve as a form of communication. These movements can include:
whole body movements and/or proxemics (like moving towards something desired),
facial expressions, and
gestures (like waving “hi”, head nod, point).
Verbal Speech and Verbal Approximations (attempts at verbal speech that may be difficult to understand).
Eye-Gaze is the act of using one’s eyes to direct or redirect the attention of another person (like looking at the door to indicate they want to go out to recess).
Some things to think about…
With emerging communicators, body language can help give clues to a person’s “intent” (putting a head down might mean the child is sad that mom is leaving).
Body language can sometimes be shaped into a more formal communicative gesture (e.g. turning the head to the side can be shaped to a head shake for “no”).
Gestures are part of our earliest communication behaviors and remain an effective part of our repertoire throughout our lifespan. Some gestures are universal and are understood even across cultures. Some are “culturally relevant” (e.g. “dabbing”).
Even if difficult to understand, verbalizing is often a communicator’s first choice of a strategy.
Verbal approximations are often better understood by very familiar partners or at home.
Verbalization is the best way to communicate “what you want to say, how you want to say it” (don’t have to rely on what someone has “programmed” for you to say!) in as efficient way as possible (faster than looking for a symbol and touching a location or navigating to another page)…encourage any and all attempts!
For individuals who struggle to communicate, an AAC system can augment or support multimodal communication strategies. Natural ways of augmenting communication (e.g. body language, eye gaze, vocalizing or verbalizing, proxemics) provide important avenues for expressing thoughts and ideas, but cannot meet the wide range of communication needs that a communicator requires.
AAC Systems can be broken down into two types:
Unaided systems – you do not need anything but your own body to use an unaided system. Manual sign language and eye blink codes are examples of an unaided system.
Aided systems – require some sort of aid (like a tool or a device) to use. This could be a picture book, a spelling board or a speech-generating device.
An aided AAC system is an integrated group of three primary components that we’ll break down further:
Strategies, which are what WE do as facilitators and partners to support a student in developing or using aided forms of communication; or a novel method a student may use to convey a message;
the Tools themselves; and
Symbols, or how the system represents thoughts and ideas.
A strategy is a specific way of supporting the use of AAC tools, symbols and/or techniques (like how an individual accesses a system) more effectively for enhancing communication or building foundational skills. Strategies can lead towards more advanced expressive language development or increased proficiency with an access method. Strategies require partner and/communicator understanding and skill.
What are some common strategies we should be familiar with and comfortable using with our students?
Choice Making is a foundational skill from which we build competence with aided communication strategies! A communicator’s ability to make choices increases their options, allows them to control their environment, increases engagement and improves behavior! Present as many options as a communicator can (cognitively, physically and visually) handle. Go beyond choices of “things” (include things like who they want to sit next to, or what they want to tell mom when they get home). Choices can be presented via objects, environmental cues, pictures/icons, or verbally (with or without a physical or visual cue like touching a finger as you present a choice).
Modeling/Prompting are two different things, yet two critical strategies to have in your toolbox and to use! Modeling is a “less intrusive” teaching strategy that can help a communicator learn how to communicate in a new or novel way or learn how to use a communication strategy to more actively participate and engage (like showing them how to touch pictures to say “my” “turn” while playing a game). Prompting usually follows a hierarchy (most-to-least or least-to-most), and is a systematic way of scaffolding students in acquiring new skills.
Social Scripts are a set of sequenced steps that move a communicator through a conversation. They can be plugged into a routine (like greeting my classmates every morning) or used for a more spontaneous interaction (like asking a friend to the movies). Scripts usually involve both the communicator and their partner, and can be used to expose a communicator to using more varied communication functions.
Aided Language Modeling is how we take modeling to the “next level” when supporting our communicators! We can’t expect our communicators to learn to use communication symbols without seeing/hearing those symbols used in meaningful ways. In this strategy, partners model the words we are targeting for our learners and use them in as many natural environments or contexts as we can. As you are modeling, the communicator is building a connection between the symbol and the meaning behind that symbol. Modeling the same word in different contexts allows the communicator to learn that words can be used in different ways. Open Access encourages teams to use Aided Language Modeling in conjunction with providing students with access to a Universal Core vocabulary.
For more information, explore the Project Core website, or the Universal Core Vocabulary [Technical Report] from the Center for Literacy & Disability Studies at the University of North Carolina at Chapel Hill.
Partner-Assisted Scanning is a strategy that allows a communicator with physical and/or visual impairments to communicate more actively by participating in conversations using choices presented by a skilled partner. This strategy provides communicators with the language they need to interact with partners and participate in activities without having to independently access a system. Choices can be visual, auditory or a combination of both. Using a “smart partner” allows for flexibility and scaffolded support that would not be available in a technology based system (while the student is developing those critical access skills), giving the student access to communication opportunities that might not otherwise be available.
Check out this video from Practical AAC to familiarize yourself with this strategy.
Spelling is the ultimate strategy for generating novel messages! Spelling-based systems can be no-tech (a spelling board) or high-tech (an alphabet layout in a speech generating device). Using these supports is NOT just for proficient spellers. Even communicators with more rudimentary spelling skills can make very good use of spelling layouts to communicate (e.g. the first letter of a word) and/or repair breakdowns. Many more proficient communicators prefer spelling because it allows them to say what they want to say exactly how they want to say it!
Encoding is any technique in which a communicator gives multiple signals that together specify a desired message. For example, picking a letter and a color determines a specific message.
Tools are the physical object or device used to transmit or receive messages. We can break down these tools with the following descriptions:
No-Tech or Technology
They can be no-tech (e.g. a communication book, flipbook, eye gaze board) or technology based (a single message communicator up to a robust speech generating device). No-tech does not necessarily mean less sophisticated, however! Some no-tech systems can be quite robust language systems. No-tech systems can be used in conjunction with technology based systems; they are not mutually exclusive.
Static or Dynamic Displays
For a technology-based system, we can also categorize tools as having either “static” displays (meaning that the symbols on the overlay are fixed or static; the symbols on the display don’t change, unless you physically change the overlay) or “dynamic” (meaning that locations on the display can be programmed to link to another page set with a new display of symbols).
Digitized or Synthesized Speech
Tools can also have different output features. A tool with “digitized” (recorded) speech stores a real person’s actual words, phrases or sentences in the form of digitized sounds. A tool with “synthesized” speech (often referred to as text to speech) produces sounds similar to human speech and is needed to translate spelling into speech output.
Dedicated or Integrated
And finally, we can categorize tools by whether they are a device made specifically for use by individuals with communication needs (a dedicated tool), or a commercially available tool that can be used for multiple purposes, but with the right app or software can be used as a speech-generating device (an integrated tool).
To explore examples of tools, navigate to the AAC Resource FlipKit.
A symbol is how a word or concept or message is “represented” so that a communicator can select it in order to send a message to his or her partner. Symbols can be tactile (like objects or parts of objects), visual (like a picture, drawing, letter or word) or auditory representations of concepts or ideas.
Symbols can be sequenced to build sentences from separate parts.
Not all symbols are alike! Some are what we call “representational” (or more concrete). They look like what they are trying to convey. Sometimes these are referred to as “picture producers”. For example, all of these are symbols for “cat”.
But not all words or ideas are so easy to represent. Some are more “abstract” (symbols that will require some explanation, teaching, or modeling in order for them to be understood and used by the communicator). These are sometimes referred to as “non-picture producers”. For example, all of these are symbols for “on”.