The ABCs of AAC: Opening the Door to Communication
If you’re exploring AAC for your child, you’re not alone—and you’re doing a great thing by learning more. Rest assured, AAC is not giving up on speech—it’s providing tools for your child to communicate effectively as their skills grow!
My interest in AAC began over 10 years ago on my journey to become a speech-language pathologist. I observed a teacher assume that their student didn’t understand anything that was said to them yet when the student was provided with an AAC device the student could answer questions and label items. It brought me such joy to see the pride in the child’s face when they were able to effectively communicate! Thus, sparked my interest in AAC!
What is AAC?
AAC is an acronym for Augmentative and Alternative Communication. AAC is meant to allow a nonverbal child to express themselves while learning verbal language. It can be used for many types of children (apraxia, autism, etc). It can be used as both a replacement for verbal communication or as a supplement to verbal communication. AAC is not a one size fits all approach as the first step is to complete a thorough evaluation of the child and their family dynamic to determine the best choice for each specific child. Both verbal and non-verbal children can benefit from use of an AAC device as there is a vast array of AAC types. Low-tech AAC may consist of a picture board (a grid with symbols and words on it), a communication book (book that contains pictures of familiar people/places/things) or even a pen and paper. High-tech AAC may consist of an iPad with an AAC app on it, an eye gaze machine that tracks movement of the users eyes to make selections, or even a modified typing app. You may see a high-tech AAC device referred to as a Speech Generating Device or SGD.
Who benefits from AAC?
Children with a range of different diagnoses and learning styles can benefit from AAC. For example, a child with cerebral palsy who struggles with speech and motor skills could use an AAC device, a child with autism that is not yet or minimally verbal could use an AAC device, a gestalt language learner who benefits from modeling to produce functional language could use an AAC device, a child with Down Syndrome who is hard to understand due to low muscle tone could use an AAC device. These are just some examples! An AAC device can be helpful for anyone that struggles to communicate with others and can be a useful tool for other’s to better understand your child! It’s important to remember that use of an AAC device can be temporary. In many cases, it is a helpful device as your child’s skills develop!
What does an AAC assessment at Creative Speech Therapy look like?
An AAC evaluation consists of various steps as we pride ourselves on proving a well-rounded and thorough evaluation. We conduct a speech assessment (if applicable), a language assessment and an oral motor exam. Next, we look at gross and fine motor needs (e.g. can the child isolate a single finger) and evaluate if the child can scan multiple pictures on the device and if they are interested in a device. After, we trial multiple different AAC apps to get a sense of which app best fits your child’s needs. We match your child with an app that provides the best technology features, selection method and vocabulary for your child. Then, we build out your child’s unique board. We target functional words for your child, family names, and favorite foods, toys, items, etc.
At what age can my child start to use an AAC device?
People of all ages can use an AAC device! Research shows that children with communication challenges can benefit from AAC as early as 12 months. (Davidoff, B.E. 2017)
What are some Commonly Used Apps?
There are a variety of AAC apps that can be used to best fit your child’s needs. As a speech/language pathologist trained in AAC, it’s my job to determine which app would be the best fit for your child. Four commonly used apps are:
1.Proloquo2go-
-Provides a vast field of icons that are grouped based on their part of speech (e.g. verb, preposition, noun).
-Options for progressive vocabulary to build language as the child becomes more successful
-Extensive fringe vocabulary (words about topic/individual/environment) and vast customization
2.TouchChat HD w/Wordpower-
-Provides options for icons to be one word utterances (car) or phrases (Let’s play cars) and uses predictive phrases for easy sentence creation.
– Has a vast field of icons that are grouped based on their part of speech (e.g. verb, preposition, noun).
-Can access visual scenes (e.g. integrates with media)
3.LAMP words for life-
-Uses principles of motor planning to aide in language acquisition. (Think about how when we type on a keyboard it is fairly automatic and with enough practice we don’t need to think about where each letter is. This is because of motor planning.)
-Can work well if child has trouble scanning to look at all the icons on the AAC device
-Each icon is always in the same place
4.TD Snap-
-Offers a variety of access methods (e.g. touch, eye gaze, scanning, etc.)
-Provides users with open for Core word template options or motor planning options
-Provides ‘Quickfires’ on all pages which gives the user an easy way to use commonly used phrases (e.g. greeting, yes/no, etc.)
But will using an AAC device hinder verbal language?
A common misconception is that if a child uses an AAC device they will start to rely on it and not develop their verbal language skills. Current research and my clinical expertise and experience shows that use of an AAC device can help to promote and grow verbal language as using an AAC device taps into the expressive language center of the brain. For example, if a child cannot speak due to having Cerebral Palsy, using an AAC and building sentences on a device allows kids to practice expressive language skills despite not being able to produce language verbally.
So, what makes Creative Speech Therapy NYC different?
Three important pillars of picking and using an AAC device to me are functionality, customization and training. Love this!
Functionality: I prioritize making the device as functional as possible for the child. This means that I think flexibly and am able to alter devices to guarantee that a child is able to use the device in a functional way. This may look like:
-Adding in a key guard for children with limited dexterity
-Changing the grid size to best fit the child’s vision and processing skills
-Selecting a program with fewer selections needed to produce a message
Customization: Many apps offer a variety of customization features and it is important that a child’s device be customized to best fit them.
Customizations might look like:
-Adding in real pictures of preferred toys
-Replacing generic symbols for people with real photos
-Programming in your child’s favorite foods for ease of access
-Limiting or expanding the grid size as your child becomes more proficient
-Providing access to words in multiple languages for bilingual children
-Rearranging icon placement to fit your child’s fine motor needs
-Creating folders for easy access to frequently used vocabulary
Training: Here at CST we value collaboration highly. For children to become proficient AAC users they need extensive modeling outside of their speech therapy sessions. I frequently provide training to children’s parents, caregivers and teachers. More so, it is important to me that all people that interact with your child be trained in using the AAC device so this may include occupational therapists, extended family or even gymnastics coaches!
Summary
AAC (Augmentative and Alternative Communication) provides tools to help children with speech or communication challenges express themselves, whether as a supplement or alternative to verbal speech. It includes both low-tech options like picture boards and high-tech devices like iPads with specialized apps. Children as young as 12 months can benefit, and AAC can support the development of verbal language rather than hindering it. At Creative Speech Therapy NYC, evaluations are thorough and personalized, with a focus on functionality, customization, and training for families and caregivers to ensure successful use across all settings.
Resources
Davidoff, B. E. (2017). AAC With Energy—Earlier. The ASHA Leader, 22(1), 48–53. https://doi.org/10.1044/leader.ftr2.22012017.48
Written by Dani Edelstein
Speech/Language Pathologist