In the early days of AAC, in the 1970s and 80s, most AAC practitioners believed that certain prerequisite skills were required before an AAC system could be recommended. These prerequisite skills included understanding of cause and effect, understanding that symbols represent actual things or actions, a minimum level of language understanding, and a mis-match between cognitive skills and the ability to communicate.

Much has changed in the past 40 years. We now have better AAC systems, more research, and better AAC teaching strategies. What we’ve found is that there are no prerequisite skills needed for AAC. In fact, the opposite is true. Implementing AAC along with good AAC teaching strategies are necessary in order for people with severe speech, physical, sensory, and/or cognitive disabilities to learn these “prerequisite” skills. 

This is not as surprising as it may seem. Typically developing children - those who can see, hear, physically access their environment, and have average thinking skills - require exposure to language.  They need thousands of hours of hearing spoken language models, practice with babbling, and getting natural feedback on their spoken language errors before they can express themselves using spoken language. Back-and-forth communication with others is also required for typically developing children to develop thinking skills and knowledge of the world. It makes sense, then, that people who have problems speaking, as well as sensory, physical, or cognitive issues, will also need lots of exposure and practice using a communication system they can understand and use, in order to develop basic skills.

The current best practice, based on years of study and experience, is that there are no prerequisite skills required for AAC.

But where to start?

There are many different types of AAC we can start with. The AAC system chosen can be something different for every AAC user. Ideally, it should be a balanced AAC system full of language. A balanced system lets you communicate about a lot more than making choices. There are many many reasons to communicate. Even if the AAC user isn’t communicating for all these reasons (yet), the people talking to him are - and they need a system they can use to model these conversations. We model a wide variety of language on our AAC system, so the AAC user can see words in action! This is why it is important not to start with what is often called a “Beginning AAC” system.  A “Beginning AAC” system may have very few buttons for the AAC user to chose from, and they must master this before given more words. When we start AAC this way, we are saying that the AAC user must first learn to make choices before they do anything else. We are also significantly limiting the AAC user’s language development. For more information, see Jane Farrall’s blog post What is “Beginning AAC”?

No prerequisite skills - everyone can learn

There are no prerequisite skills for AAC. You do not have to be a particular age to be eligible for AAC.  There are no behavioral or cognitive prerequisite skills that need to be demonstrated before AAC can be introduced. Any person with communication difficulties, regardless of age or diagnosis, should be given the chance to learn to communicate using AAC. They should be given access to a full balanced AAC system so they can communicate for all the different reasons that make us human. And they should be given access to the alphabet, so they can start their literacy journey.

We must presume competence. We must believe that all individuals with communication difficulties have the ability to learn to communicate, when given the right tools and supports. We must give them an AAC system that gives them the chance to develop language for real communication. We must give them time to see and learn this AAC system; all the time believing in their ability to learn to use it successfully. An AAC user can never truly “prove themselves” until we give them a full AAC system. We don’t know what someone who can’t speak wants to say, until they’re given a voice. When we presume competence and do not demand prerequisite skills, we are choosing the best path forward for potential AAC users. We show them that we believe in their ability to learn and communicate and we give them every opportunity for successful communication.

Overcome the Roadblock

Presume competence. There are no prerequisite skills to use AAC.  And there is so much to be achieved when we give a voice to AAC users!

Take the test: Check the Learn AAC Guide to see where you are in establishing AAC for an AAC user. This may help you overcome any roadblocks stopping you from success!

Links & References

  • Dos and Don’ts article by Jane Farrall about demanding prerequisite skills.
  • Powerful blog post about presuming competence.
  • 3 Responses to Programs that Make Kids ‘Prove Worthiness’ Prior to Providing Access to AAC, Carole Zangari, PrAACtical AAC.
  • The ‘Real’ Pre-requisites to AAC Device Use, by Carole Zangari, PrAACtical AAC.
  • What is “Beginning AAC”?, article by Jane Farrall.
  • American Speech-Language Hearing Association (ASHA) Position Statement and Technical Report on Access to Communication Services and Supports: Concerns Regarding the Application of Restrictive “Eligibility” Policies.
  • Beukelman, D., & Mirenda, P. (2013). Augmentative and Alternative Communication (4th Ed). Baltimore: Paul H. Brookes.
  • Brady, N., Bruce, S., Goldman, A., Erickson, K., Mineo, B., Ogletree, B., Paul, D., Romski, M., Sevcik, R., Siegel, E., Schoonover, J., Snell, M., Sylvester, L., & Wilkinson, K. (2016). Communication Services and Supports for Individuals With Severe Disabilities: Guidance for Assessment and Intervention. American Journal on Intellectual and Developmental Disabilities, 121(2), 121-138. doi: 10.1352/1944-7558-121.2.121.
  • Casby, M. (1992). The Cognitive Hypothesis and Its Influence on Speech-Language Services in Schools. Language, Speech, and Hearing Services in Schools, 23, 198-202.
  • Cole, K., Dale, P., & Mills, P. (1990). Defining language delay in young children by cognitive referencing: Are we saying more than we know? Applied Psycholinguistics, 11, 291-302.
  • Cole, K., Dale, P., & Mills, P. (1992). Stability of the intelligence quotient-language quotient relation: is discrepancy modeling based on a myth? American Journal of Mental Retardation, 97(2), 131-143. 
  • Cress, C., & Marvin, C. (2003). Common Questions about AAC Services in Early Intervention. Augmentative and Alternative Communication, 19 (4), 254–272. doi:10.1080/07434610310001598242.
  • Goossens’, C. (1989). Aided communication intervention before assessment: a case study of a child with cerebral palsy. Augmentative and Alternative Communication, 5(1), 14-26.
  • Kangas, K., & Lloyd, L. (1988). Early Cognitive Skills As Prerequisites to Augmentative and Alternative Communication Use: What Are We Waiting For? Augmentative and Alternative Communication, 4(4), 211-221.
  • Romski, M., & Sevcik, R. (2005). Augmentative Communication and Early Intervention: Myths and Realities. Infants and Young Children, 18(3), 174-185.