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Suffolk Center for Speech



What is it?

“Augmentative and alternative communication (AAC) includes all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas. We all use AAC when we make facial expressions or gestures, use symbols or pictures, or write. People with severe speech or language problems rely on AAC to supplement existing speech or replace speech that is not functional. Special augmentative aids, such as picture and symbol communication boards and electronic devices, are available to help people express themselves. This may increase social interaction, school performance, and feelings of self‐worth. AAC users should not stop using speech if they are able to do so. The AAC aids and devices are used to enhance their communication” (ASHA 2017).

What is the Speech-Language Pathologists Role in AAC?

  • Collect background information
  • Determine communication needs
  • Determine communication barriers
  • Evaluation
  • Determine candidacy for communication system building
  • Development of system
  • Intervention
  • Educating team on use of system
  • Consulting

Breakdown of AAC Terms:

  • Alternative: instead of speech
  • Augmentative: as well as speech
  • Low tech: pictures, signs, boards etc.
  • Hi Tech: a range of electronic aids
    • Choice will depend on the individual’s level of both physical and mental ability, and on the environment they are in.

AAC is Not…

  • A last resort
  • “Giving up on” or “Replacing” verbal speech
  • Only for those that have a “low” IQ or a certain age
  • Only the job of the speech‐language pathologist
  • Something that keeps children from talking
  • Only for non‐verbal clients

Research to Support AAC use:

Millar, Light & Schlosser (2006) reviewed previously published studies that, among other criteria, presented data on “Speech production before during and after AAC intervention.” This review revealed that participants demonstrated the following:

  • 89% increase in speech production
  • 11% no change in speech production
  • 0% decrease in speech production

Schlosser & Wendt (2008) reviewed previously published studies describing the “Effects of AAC on speech production in children with autism and PDD‐ NOS”. They reported that a majority of studies revealed increases in speech production and “none…reported a decline”.

Hux et al. (2006) found that evidence supporting the use of AAC to enhance speech production for people with traumatic brain injury (TBI) exists. In addition to enhancing speech, AAC often supplemented it. That is, AAC was used in combination with natural speech

Hux et al. (2010) found that the best conversational outcome came when a person with aphasia used both her speech and AAC as opposed to either form of communication individually. It is important to note that the communication board used in this study was shared by the communication partner and the person with aphasia.

Who is a Candidate for AAC?

  • Anyone who needs help speaking and/or writing may need AAC
  • Lifelong because of a developmental disability (e.g. autism, cerebral palsy, Down syndrome)
  • At some point in life due to an acquired disability (e.g. Stroke, brain injury)
  • At some point in life due to a degenerative condition (e.g. ALS, Parkinson’s, MS)
  • Only occasionally to supplement speech (e.g. semi‐intelligible speech, laryngectomy)
  • Temporarily until speech returns (e.g. tracheostomy, mechanical ventilation)

Strategies to Promote Communication Using an AAC Device:

  • Engage (get at their level, eye contact)
  • Establish attention
  • Be in close proximity to the AAC user
  • Be in their line of vision
  • Watch for the AAC user to orient to you (attention shift)
  • Use visuals (present visual first)
  • Use meaningful gestures
  • Exaggerate movements to attract attention
  • Hold gestures (point long enough to mutual referent)
  • Less may be better
  • Match AAC user’s verbal output
  • Expand by one
  • Wait for responses
  • Count to 5, 10 after a command/question
  • Stay engaged
  • Increase opportunities for initiation
  • Be consistent with labels
  • Modify the environment to create active participation, communication
  • Make sure the individual has access to communication at ALL TIMES!
  • MODEL, speak as you normally would, using the device when applicable to reinforce spoken words



American Speech-Language-Hearing Association (2019). Augmentative and alternative communication (AAC). Retrieved from

https://www.asha.org/public/ speech/disorders /AAC.htm

Hux, K., Buechter ,M., Wallace, S., & Weissling, K. (2010). Using visual scene displays to create a shared communication space for a person with aphasia. Aphasiology. 2010 24:643–660

Millar, D. C., Light, J. C., & Schlosser, R. W. (2006). The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: A research review. Journal of Speech, Language, and Hearing Research, 49, 248-264.

Schlosser, R., & Wendt, O. (2008). Effects of augmentative and alternative communication intervention on speech production in children with autism: A systematic review. American Journal of Speech-Language Pathology, 17(3), 212–230.

Hux, K., Buechter ,M., Wallace, S., & Weissling, K. (2010). Using visual scene displays to create a shared communication space for a person with aphasia. Aphasiology. 2010 24:643–660

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