AAC = Independence!

Stacey Ramirez M.S., CCC-SLP
Stacey Ramirez M.S., CCC-SLP

LKS & Associates
Speech-Language Pathologist

“I think it’s time we start exploring A-A-C!” says your trusted language professional. Whether you’re hearing this from your child’s teacher or your child’s speech therapist, you can definitely sense the excitement. But you’re finding it hard to match their energy. You might begin asking yourself, “What is AAC? And why would I be interested in this if I thought we were working on speech?”

AAC stands for Augmentative & Alternative Communication and is a very broad term to refer to any and all the ways that someone may communicate without the use of verbal speech. In fact, you may already be familiar with the uses of AAC. American Sign Language, through use of hand symbols and motions, is a form of AAC, as well as Stephen Hawking’s speech-generating program, ACAT, which he controlled by cheek twitches. AAC methods are generally divided into two categories: no-tech/low-tech systems, like writing and paper-based “core boards,” and high-tech systems, like speech-generating applications on tablets or eye-gaze computers. Both have their merits in reaching the main goal of AAC systems: to bridge expression and understanding between two communicators for INDEPENDENT communication. 

Pattenden, A. (2015). Professor Hawking outside the Department of Applied Mathematics and Theoretical Physics, University of Cambridge. Stephen Hawking. Retrieved March 2022, 8AD, from https://www.hawking.org.uk/in-pictures/24?position=20.

The speech mechanism involves a complex pathway of signals from the brain to other parts of the body. Some of these pathways include signals to make sure we breathe at the right time, move our tongue and lips at the right time, and come up with the right things to say in the right order at, you guessed it, the right time. And on top of that, we have to be able to read our communication partners to be sure we got our message across. With such complexity comes the possibility that verbal speech may not always be accessible to use as a tool to communicate. When a communicator is unable to rely on speech as communication, either temporarily or indefinitely, AAC is there to save the day! 

Some factors that can impact speech reliability:

  • Motor movement difficulties (impacting breath support or oral muscles in the tongue, jaw, and lips)
  • Decreased speech intelligibility (or the ability to be understood by others)
  • A smaller repertoire of spoken words  
  • Arousal (being extra sleepy or extra frustrated, examples of low and high arousal)
  • And the reverse! Difficulty understanding messages delivered verbally will also interfere with relying on spoken language 

Any combination of these factors can occur alongside any complex neurodevelopmental differences, such as Autism Spectrum Disorder or a genetic syndrome. These factors may also become prevalent later in life with an acquired condition such as a neurodegenerative condition, like ALS (amyotrophic lateral sclerosis), or following brain trauma, like a stroke.

But my child has some speech, shouldn’t we focus on that? 

Although turning to AAC means introducing another tool to someone’s toolbox of communication, it doesn’t mean abandoning speech. Researchers have conducted numerous studies investigating the impact of AAC use on development of speech and language. Many found the use of AAC does not hinder verbal speech production at all (Romski et al., 2015; Gevarter et al., 2013; Schlosser & Wendt, 2007)! For individuals with Autism specifically, it was found to enhance language holistically, which looked like improvement of understanding of spoken language and encouraging speech by increasing expressive vocabulary (Allen et al., 2017; Schlosser & Wendt, 2008). At the very least, use of AAC will make no impact upon verbal speech (Gevarter et al., 2013). When an SLP introduces AAC, it is with the intent that AAC will act as a supplement to verbal speech attempts, and any other modes of communication. 

Here is an example of AAC at work…

Someone in a coffee shop with their caregiver may verbally produce the word “tea” as a request. But they can’t say the word that names what kind of tea they want. They do remember the word they used to talk about it another time and the picture it had on their AAC device. So, this individual may then press “iced tea” under the “drinks” tab on their speech application. In an example like this, we see someone’s message has been made more clear and, perhaps the most important, this person was able to make the message clear all on their own! Someone did not give them the words to say, their choice of tea wasn’t limited by the frantic guesses their communication partner was making, and they weren’t imitating anyone. Imagine how empowered this person felt being able to work their way through a serious moment waiting in line at the coffee shop trying to tell their caregiver what they really wanted. And imagine the relief the caregiver had felt when they realized that they may be at a coffee shop, but iced tea is still on the menu and definitely an option. A moment of communication and a moment for a caregiver and their loved one to connect was salvaged. And in this instance, this individual used both verbal speech and AAC. Being able to rely on different modes of communication makes use of “multimodal communication”, which has positive implications for communication and language development all around! 

Project Core Team, C. for L. and D. S. (2022). 9 Location Universal Core Communication Book. Project Core. Retrieved March 8, 2022, from http://www.project-core.com/9-location/

So what does all this information mean for me?

It means ANYONE can use AAC! Anyone with difficulties understanding language or expressing language can benefit from it, and it also means that any lingual skillset can be met with the right communication system. Therapy sessions for AAC will look different from a verbal language session because the SLP will be teaching how to use a physical system, and will also use the system itself to improve language. It might mean more instances of quiet as the SLP waits to see if someone remembers where an icon was, or it might mean working with language goals that someone is confident in so that they can just focus on finding buttons. AAC and language at the same time might look like using buttons someone already knows to then stop and think, and then using that helpful information to go back and find an actual response.

Speech & Language Kids, T. S. L. P. S. (2022). Child using digital speech application. Parents’ and Teachers’ Guide to Getting Started with AAC. Retrieved March 8, 2022, from https://www.speechandlanguagekids.com/teach-your-child-to-use-an-aac-device/

AAC is all about empowering individuals to speak for themselves, relieving caregivers of the burden of figuring out what someone wants or needs, and eventually, helping people connect through one moment of mutual understanding at a time. AAC devices can hold jokes too, you know! Just like the questions in this article, you should know you’re welcome to ask any questions about AAC, its purpose, and its goals. Your SLP would be happy to help!

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