Communication systems, strategies and tools that replace or supplement natural speech are known as augmentative and alternative communication (AAC). These tools support a person who has difficulties communicating. How do we decide who needs AAC? When should AAC be started? How can we best determine if the person needs, or would benefit, from alternative tools and strategies to support communication?
Who is AAC for?
There are a wide range of reasons, disorders, and disabilities that can result in a person not being able to speak. They may have a developmental disability or acquired disorder that has affected his or her ability to speak. Or they may have lost the ability to speak temporarily due to stress, anxiety, or even a medical emergency.
When can we start using AAC?
Many people who cannot speak may benefit from some form of AAC to support communication. But when do we start? When is the right time?
First and most importantly, there are no age prerequisites to using AAC. You cannot be too young or too old to use AAC. Starting AAC can happen at any age. And once someone has started with AAC, they may not have to use their system forever or all the time.
AAC would be recommended in these cases:
- As speech is developing
- To support speech that is hard to understand
- When no speech has developed
- If speech is lost or is deteriorating
- When speech is temporarily not possible
Just because a person has some spoken communication in the form of words or vocalizations, it does not mean that they would not benefit from AAC. Providing an AAC system to a person with limited speech will give them more words and language, and the possibility of communicating far more than they can with speech alone.
Assessing for AAC - Which AAC system should be used?
In your AAC assessment process, you may hear that certain “prerequisite skills” are needed before AAC can be started. This idea was state-of-the-art in the 1980’s when ASHA first recognized AAC as an area of practice, but research has since shown that it is not the case. In fact, anyone who cannot use speech to meet his or her communication needs can benefit from some form of AAC. For example, many people with a developmental disability that has impacted their language development benefit from others using AAC first for receptive input, long before the person can use it independently. Communication is a human right that should be available to all. See the reference and links section at the end of this article for information about the lack of support for the prerequisite skills requirement.
Who can help with AAC?
Speech-Language Pathologists/Therapists, generally, should have received training in the area of AAC. But not all “Speechies” have had the same training or experience using AAC. Similarly in schools and hospitals, other support staff (such as teachers, other therapists, nurses, or social workers) will have had different experience levels with people who use AAC. So much knowledge is gained when you work in the area of AAC, so if you need support with AAC, always seek a professional who has worked in the field of AAC.
You can also go online. There are many many supportive communities, with experienced families and professionals, all offering advice and support.
Our Facebook communities are: AssistiveWare's Family members AAC community, and AssistiveWare's Teachers and therapists AAC community.
What AAC do we need?
AAC incorporates all the tools and strategies a person can use to communicate when they are not able to speak.
Would the potential AAC user prefer or benefit from an Unaided forms of AAC, such as gestures, facial expression or sign language?
Or would they benefit from an Aided form of AAC such as choice cards, symbol boards, or high-tech tools (eg. Speech generating devices, AAC app on an iPad, etc.)?
A potential AAC user can also use a symbol-based AAC system or a text-based AAC system.
An AAC system may be a text-based system with a keyboard. This is generally for a person who cannot speak, but has developed or retained effective literacy skills.