What is augmentative and alternative communication (AAC)?

No matter their age, children are always communicating. Whether it's with words, gestures or even just a look. When they can't communicate like they usually can, or aren't developing at a typical pace, it can feel frustrating for both you and them. Augmentative and alternative communication may be able to help.

Augmentative and alternative communication refers to methods and tools that help children communicate by supporting or substituting speech. AAC is personalized for each child based on their needs and abilities. It can be used for a short time or a long time, depending on how your child communicates and what their needs are. 

AAC can include many methods and tools, such as the following: 

• Symbols and pictures
• Speech-generating devices
• Computer programs
• Text
• Sign language
• Eye gaze
• Shared glances
• Touch
• Gestures
• Facial expressions 

Augmentative and alternative communication could help your child in the following instances: 

• To help with early communication development, if your child is not meeting communication milestones at the typical pace
• To replace speech that was lost or never developed
• To help them communicate when language skills are limited or nonfunctional (for example, if your child is intubated)
• To clarify their speech when it is difficult to understand 

Who might benefit from AAC? 

Children with complex communication needs may benefit from AAC. These conditions include (but are not limited to): 

• Motor speech disorders, such as apraxia, dysarthria or anarthria
• Speech sound production disorders, such as reduced intelligibility of speech (or speech that is hard to understand)
• Surgery performed to create an opening into your child's windpipe to help them breathe (tracheostomy)
• Language disorders or delays
• An acquired language disorder following a medical incident or injury (aphasia)
• Nonspeaking
• Difficulty speaking 

Children with physical access needs may benefit from AAC. These conditions include (but are not limited to): 

• Upper extremity differences
• Disorders of tone, such as spasticity, dystonia or hypotonia
• Delayed gross and fine motor development
• Motor planning and coordination difficulties
• Neurologic and movement disorders 

Children with both complex communication and physical access needs may benefit from AAC. These conditions include (but are not limited to): 

• Angelman syndrome
• Autism spectrum disorders
• Cerebral palsy
• Cornelia de Lange syndrome (CdLS)
• CHARGE syndrome
• Developmental delay
• Genetic syndromes
• Intellectual disability
• Landau-Kleffner syndrome
• Leigh syndrome
• Lennox-Gastaut syndrome
• Leukodystrophies
• Leukomalacia
• Mitochondrial diseases
• Muscular dystrophy
• Neurological/neurodegenerative conditions
• Rett syndrome
• Temporary medical conditions (for example, a tracheostomy or intubation)
• Trisomy 21 

Our specialized assistive technology (AT) therapists work with our speech-language pathologists (SLPs) to find and solve any problems your child might have with using their communication tools. 

AAC evaluation

In an AAC evaluation, our SLPs use “feature matching” to find the best communication system for your child based on their unique strengths, needs and preferences. Your child’s new device will help them communicate more easily and comfortably throughout the day. 

The evaluation considers how your child moves their body as well as how they process (see or hear), understand and interact with technology. Other considerations include: 

• Speech and language skills
• Physical access, seating and positioning
• Vision, hearing and sensory needs
• Medical status
• Literacy skills
• Cognitive abilities
• Communication environments
• School and work considerations
• Caregivers’ priorities and goals
• Patient and family preferences 

AAC treatment

The goal of treatment is to provide personalized, effective solutions for each child’s unique communication and physical access needs to enhance their communication abilities and quality of life. 

We’re here to help support your child and match them with the right AAC system. We do this through several important steps:  

• Trials of AAC devices or systems are conducted to determine the best fit for your child.
• Therapy focuses on supporting your child’s ability to use AAC to communicate for a variety of reasons.
• Visits are scheduled for the setup and customization of the chosen AAC system.
• Caregivers receive training to ensure effective use and support of the AAC system and are connected to local device representatives for additional support.

Frequently asked questions

Is AAC only for non-speaking children? 
No. AAC can benefit children with partial speech abilities as well, helping bridge the gap in communication. 

Should AAC only happen after traditional therapy? 
No. AAC can be introduced alongside traditional therapy to meet immediate communication needs. 

Will AAC prevent verbal speech improvement? 
No. Research shows that using AAC can help improve language skills by making it easier to speak through methods like prompting and repetition. Many users see their verbal speech improve after starting AAC. 

Should my child try low-tech AAC before high-tech? 
Not necessarily. Success with low-tech AAC, like communication boards or paper and pencil, does not guarantee success with high-tech AAC, like speech-generating devices. Many users find high-tech devices, which provide voice output and resemble smartphones or tablets, to be more engaging and effective, offering a more motivating and functional communication solution. 

Does my child need to be independent for AAC to be successful? 
No. Many children need support to use AAC, and success is measured by improved communication. 

Does my child need to have any skills mastered before they can use AAC?  
No. AAC can benefit children of all ages and abilities, focusing on tailored support rather than specific skills.