Augmentative and Alternative Communication
May 18, 2022
You may have heard the acronym AAC used by speech-language pathologists, assistive technology specialists, or other healthcare professionals. AAC stands for “augmentative and alternative communication” and refers to all the things a person could do to augment or modify mainstream styles of communication to fit their needs. It also refers to the plethora of alternatives to mainstream communication. “Mainstream communication,” in this context, refers to speech that is produced using one’s oral structures (like the tongue, lips, soft palate, etc.).
AAC is for everyone! Everyone utilizes AAC in some capacity throughout their typical day, even if they’re neurotypical. As I write this blog post, for example, I’m using an alternative communication method by typing, and I’m augmenting my communication experience by using a raised keyboard (to address some growing symptoms of carpal tunnel).
When we hear speech-language pathologists talking about AAC, they’re usually referring to high-tech methods of communication that use electricity. The most common high-tech AAC tools are speech-generating devices (SGDs). SGDs include tablets with language programs or apps that the user utilizes for communication. There are even some apps marketed specifically to autistic individuals, including the Language Acquisition through Motor Planning (LAMP) Words for Life program.
Low-tech methods of communication are those that do not use electricity. Written communication is a low-tech form of AAC, but within the autism community, more common forms of low-tech AAC include pictures/symbols (such as those used by the Picture Exchange Communication System or PECS), communication books/binders, and American Sign Language (ASL).
Research indicates high-tech and low-tech forms of AAC benefit child language development and increase an individual’s overall participation in communication-related activities (e.g., school, work, social events). In the case of children, AAC is another tool by which a child can learn and use their developing language skills. While some parents/caregivers may want a child to use spoken language only, it’s important to focus on overall communication development.
In the case of other prospective users, AAC helps improve access and participation in communication-related activities such as school, work, social events, etc. In my experience as a speech-language pathologist, I’ve had the pleasure of working with autistic adults who may not use AAC all the time, but who may use high-tech and low-tech AAC when they’re experiencing increased levels of social anxiety. I’ve also worked with individuals who use AAC at school, but because their family members understand their gestures well, don’t use AAC at home. It’s not a one-size-fits-all type of prescription. The key is, individuals should be able to choose when and how they use AAC!
If the prospective AAC user receives special education services at a public school, they likely have an individualized education program (IEP). When the school’s IEP team (which can include the student and/or their parent) is creating this document, there’s usually a section for listing assistive technology supports. If your child requires assistive technology in order to access the general education curriculum, this is where you’d list low-tech and high-tech AAC. And if it’s listed in the IEP, the school is required to provide those supports, not the parent/caregiver.
When seeking AAC tools via a public school, the first step is usually an evaluation by the school’s assistive technology team. This evaluation usually allows the student to experiment with a few different AAC options while the evaluator tries to determine whether one of those options may benefit the student. If it looks like the student may benefit from AAC, the student trials the AAC tool for several weeks or months. During this trial period, data is collected to determine whether the tool actually is benefitting the student. And if indeed the student is making academic progress with the AAC tool, the school will give the student the tool to use in the classroom and, usually, at home. The only issue in this scenario is that the AAC tool, even if it’s an SGD, remains the property of the school. So if the student switches school districts, the AAC tool will need to be returned.
The process for acquiring AAC tools outside of the public school system is a little bit different and depends on what exactly you’re seeking. Of course, many low-tech tools are things you can create yourself and/or purchase for relatively low costs online. But other tools, and especially SGDs, carry a huge price tag. Thankfully, most SGDs and other high-tech tools are covered in part or in full by insurance/Medicare/Medicaid/etc. If you’re seeking an SGD, I recommend finding a speech-language pathologist in your area with AAC experience—they’ll typically conduct an evaluation and help you acquire a trial device. After trialing a device for a period of time, the speech-language pathologist usually writes a “letter of medical necessity” to justify insurance/Medicare/Medicaid coverage. And once your payer approves the device, it’s yours!
Madison Brumbaugh is a speech-language pathologist with a passion for augmentative and alternative communication (AAC) and serving clients with complex communication needs, including clients who may be nonspeaking. Madison has previously worked in the public school, private practice, and home healthcare settings and has experience navigating the AAC acquisition and funding process, collaborating with manufacturing representatives to ensure minimal out-of-pocket costs to clients and families. In her free time, Madison enjoys hiking, playing with her dogs, and trying new hobbies – recent favorites include stained glass making and rock climbing.