Pediatric Therapeutic Services

Augmentative and Alternative Communication 101

Get Answers to Five Common Questions About AAC Therapy and Resources

Have you ever felt frustrated because you couldn’t make your voice heard or your ideas known?

Odds are many of the students in your district feel that frustration at school every day. After all, 7.7% of U.S. children aged 3-17—nearly 1 in 12—has had a voice, speech, language, or swallowing disorder in the last year.

Fortunately, when children’s natural speech abilities alone don’t let them communicate functionally and effectively, augmentative and alternative communication (AAC) can help.

If you don’t know much about AAC, don’t worry. In the more than 20 years we’ve been providing related services, we at Pediatric Therapeutic Services (PTS) have found a lot of school administrators like you have questions about AAC services.

Here are the five we get asked most often. We hope our answers will help you feel you have a better handle on this complex but critical therapy intervention.

1. What Is AAC Therapy?

AAC therapy maximizes communication by supplementing or replacing a person’s natural speech with a system he or she can use unaided (with nothing but the body) or aided (with external equipment).

School-based AAC therapy’s goal is to help students develop the methods of communication they need to fully access and participate in their education.

2. How Do Students Qualify for AAC Therapy?

An AAC evaluation determines whether a child qualifies to trial or use an AAC system.

The evaluation assesses whether students have met various prerequisites:

  • Symbolic Understanding vs. Presymbolic Understanding
    If students can understand gestures that represent meaningful communication, they are presymbolic users, and will use little to no technology. If they can understand pictures or symbols that represent objects, actions, comments, they are symbolic users who can use low or high levels of technology.
  • Communicative Intent
    Students demonstrate communicative intent when they:

    • Perform a behavior only when they know another person is present.
    • Direct that behavior towards another person.
    • Wait for a response, persist if they don’t receive one, and stop when they do.
  • Joint Attention
    To qualify for AAC resources, students must be able to:

    • Maintain attention between her – or himself and another object (switch toys, music boxes, and so on) purposefully.
    • Turn toward an object or person that gains her or his attention.
    • Follow the object or communication partner’s direction for as long as the interaction lasts.
  • Behavioral Prerequisites
    The student’s behaviors need to be:

    • Purposeful
    • Directed toward and intended for an individual
    • Repeatable
    • Consistent for specific meanings

By consulting with teachers and reviewing their checklists, observing students in the classroom, and interacting directly with them, speech-language pathologists (SLPs) evaluate students’ mastery of these prerequisites.

3. What Levels of AAC Systems Are Available?

Smiling young girl in wheelchair in school library, using augmentative and alternative communication app on tablet computer.

Augmentative and alternative communication systems fall into three basic categories: no-tech, low- or light-tech, and high-tech.

  • No-Tech (Unaided)
    No-tech AAC systems use nothing more than the body to enhance students’ communication. These systems use:

    • Facial expressions (smiling, frowning, looking toward something)
    • Gestures (waving, pointing, pushing away)
    • Sign Language (ASL, Signed English)
    • Picture Symbols (Picture Exchange Communication System, picture communication boards, books)
  • Low-Tech or Light-Tech (Aided)
    These systems use battery-powered, simple to use, relatively affordable aids. They’re often easily programmed static display voice output devices capable of recording and playing back as many as 32 or more messages. Sometimes, device screens require paper overlays.Examples of such light-tech, AAC-dedicated devices include:

    • BIGmack and LITTLEmack
    • Step-by-Step Communicator
    • Go Talk (4, 9, 20, 32)
    • Tech Speak/Tech Talk
    • Super Talker
    • Quick Talker
  • High-Tech (Aided)
    The AAC devices in these systems use rechargeable battery packs to power their dynamic, lighted displays and synthesized voices. They allow for generative utterances and virtually unlimited vocabularies. They can also let students access environmental control units and the internet. Examples of high-tech devices dedicated to AAC include:

    • Dynavox T7, T10, T15
    • PRC ACCENT (800, 1000, 1400)
    • NovaChat (5, 8, 10, 12)
    • Tobii P10, P12, P15

    In addition, AAC language-providing apps are available for tablet computers such as the iPad.

4. How Do Therapists Select AAC Systems for Students?

Once you’ve established the student’s prerequisite levels, an SLP can start choosing and developing an AAC system for him or her to trial. 

When selecting a student’s AAC system, therapists must consider:

  • Sensory/perceptual factors such as the system’s size, type, and placement.
  • Positioning/access factors such as optimal seating, device mounting, and the student’s physical comfort.
  • Linguistic factors such as the level and type of language system and vocabulary the student needs based on his or her communicative functioning level.
  • Level of technology in the system—be it no-tech, low- or light-tech, or high-tech, it must correspond to the student’s symbolic or presymbolic understanding.
  • Symbol types used in the system—their sizes, styles (for example, Picture Communication Symbols or SymbolStix), and colors.
  • Grid size—the number of symbols in a field the student can discriminate between.
  • Display size, which is determined by a student’s vision, fine motor skills, and discrimination abilities.
  • Vocabulary type, whether predictive, category-based, generative, or text-based.
  • Portability, because some students will need to use their systems in a variety of settings.

Many AAC systems and devices have similar features, but matching those features to a student’s demonstrated educational needs is critical. If the system’s features don’t match a student’s needs and accessibility options, the system, through no fault of the student, won’t prove beneficial.

5. How Do Students Access AAC Systems?

Students must be able to access the AAC system freely in order to become more successful communicators. Their fine motor skills, vision, ambulatory abilities, and environmental needs all determine what access methods they will use.

AAC systems use various access methods, including:

  • Direct Select
    The student uses her or his finger to directly point to or press a button to pick the desired vocabulary message.
  • Keyguard
    A keyguard is a plastic grid placed on the device over the vocabulary in order to guide the student’s fingers to the desired message without activating undesired ones.
  • Switches
    Available in a wide variety of types and sizes, switches are single buttons that start scanning an AAC system for students with limited fine motor skills.
  • Joystick
    Some students can use a joystick to move the cursor on a screen or highlight the message they want to communicate.
  • Head Pointer
    In some systems, students use a stick worn on the head to access desired messages.
  • Head Mouse
    A head mouse is an infrared system the student controls by moving his or her head to highlight the desired message.
  • Eye Gaze
    High-tech, camera-based systems track students’ eye movements to move the cursor or highlight the desired message.

Make PTS a Key Player on Your District’s AAC Teams

As the many variables we’ve discussed suggest, no single, “canned” approach to augmentative and alternative communication exists.

Assessing students, selecting the appropriate AAC resources, and implementing them is an ongoing process requiring multidisciplinary, school-based teams work together.

PTS can be a key player on your district’s AAC teams.

Whether by sending you qualified and quality SLPs, providing AAC training for teachers in your schools, or working with you to make your AAC budget stretch farther without sacrificing positive outcomes, we can help your students communicate their needs, wants, ideas, and feelings more effectively, empowering them for greater educational success.

To find out more about how our AAC expertise can benefit your district’s program, call us at 610-941-7020 or contact us online.

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