Augmentative and alternative communication (AAC)

Augmentative and alternative communication (AAC) encompasses a wide range of tools, equipment, and strategies that speech-language pathologists (SLPs) can use to enhance an individual’s ability to communicate effectively. 

While many people envision high-tech solutions like tablets and specialized apps when they think of AAC, alternative and augmentative communication systems actually cover everything from gestures to finger-spelling to speech-generating devices.

Summary

• Augmentative and alternative communication encompasses numerous tools and strategies that help individuals with speech and language impairments communicate effectively, from simple gestures to high-tech speech-generating devices.

• AAC for autism provides personalized communication solutions for autistic individuals who experience speech or language difficulties, requiring comprehensive assessment and individualized intervention approaches.

• Understanding aided vs. unaided augmentative and alternative communication systems is essential for practitioners, as clients often benefit from multimodal approaches combining both external tools and natural communication methods.

• AAC speech therapy involves collaborative implementation across multiple environments, training communication partners, and using evidence-based approaches like LAMP, PECS, and core vocabulary methods.

• Private practice therapists play crucial roles in AAC assessment, device selection, training, and ongoing support, requiring specialized knowledge of communication technologies and intervention strategies.

Understanding augmentative and alternative communication

For individuals facing significant barriers to communication, augmentative and alternative communication offers a lifeline. 

Speech-language pathologists help people access it.  

As an SLP, your role may involve assessing or providing consultation to determine the best augmentative and alternative communication solution for clients with significant speech-language production or comprehension challenges. 

Speech therapists may also need to educate family members who approach them wondering, “What is alternative augmentative communication?” It’s important to be informed about this aspect of the speech-language pathology field, even if it’s not your primary area of specialization. 

While research on augmentative and alternative communication is constantly evolving—with new tools and technologies expanding its reach—its purpose remains the same: to give individuals access to communication, which is a fundamental “human right” that should be “accessible and achievable for all,” according to the American-Speech-Language-Hearing Association (ASHA). 

This article covers aided vs. unaided AAC, provides AAC examples, and discusses the use of alternative and augmentative communication systems for a variety of diagnoses, including AAC for autism. 

While AAC speech therapy is just one segment of the vast scope of practice that SLPs cover, it’s critical work that has the potential to vastly improve individuals’ quality of life. 

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Aided vs. unaided AAC

The fundamental distinction between aided vs. unaided AAC systems forms the foundation for assessment and intervention planning.

Aided augmentative and alternative communication systems require the use of an external tool, while unaided augmentative communication systems do not.Understanding these categories helps practitioners match communication solutions to individual capabilities and needs.

Unaided AAC systems

Unaided AAC systems rely entirely on the individual's body and do not require external tools or equipment. 

These systems can be particularly valuable for individuals with intact motor control who need immediate communication options.

Common unaided AAC examples include:

• Manual signs and gestures: American Sign Language, signed English, or informal gesture systems

• Facial expressions: Intentional use of facial movements to convey emotions and basic messages

• Body language and positioning: Purposeful body movements to indicate preferences or needs

• Vocalizations: Non-speech sounds used intentionally for communication

• Finger-spelling: Manual alphabet for spelling words or names

Advantages of unaided systems:

• Always available and portable

• No equipment costs or maintenance requirements

• Can be used in any environment

• Promotes natural, face-to-face interaction

Limitations of unaided systems:

• Requires adequate motor control and coordination

• Limited vocabulary and message complexity

• Communication partners must understand the system

• May not be suitable for individuals with significant physical disabilities

Aided AAC systems

Aided AAC systems involve external tools, ranging from simple picture boards to sophisticated speech-generating devices. 

These systems often provide more extensive vocabulary and communication options.

Aided AAC examples span a wide technology spectrum:

Low-tech options:

• Communication boards: Static displays with pictures, symbols, or words

• Picture books: Organized collections of photographs or symbols

• Written communication: Paper and pencil or typing

• Symbol cards: Portable sets of communication symbols

High-tech options:

• Speech-generating devices (SGDs): Dedicated communication devices with voice output

• Tablet applications: Apps designed for AAC use on consumer tablets

• Computer-based systems: Software programs for communication on laptops or desktops

• Smartphone apps: Mobile applications for on-the-go communication

Benefits of aided systems:

• Extensive vocabulary potential

• Voice output for distant communication

• Customizable organization and programming

• Can accommodate complex language structures

Challenges with aided systems:

• Equipment costs and insurance considerations

• Potential for device failure or damage

• Learning curve for operation and maintenance

• May require ongoing technical support

When deciding between aided vs. unaided AAC, it can be helpful for SLPs to remember that some individuals may benefit from the use of both. 

For example, a combination of gesturing and use of a speech-generating device may be the best choice for a client with relatively intact motor skills. 

Alternatively, the use of a communication board and vocalizations may be a combination that works well for a client with a different set of strengths and needs. 

Target populations for augmentative and alternative communication

Alternative and augmentative communication systems are utilized by a wide range of individuals across the lifespan who experience temporary or permanent communication difficulties.

Understanding which populations benefit from AAC helps practitioners identify appropriate candidates and intervention approaches.

Individuals with acquired or congenital disabilities such as apraxia, cerebral palsy, stroke, traumatic brain injury, and ALS are often good candidates for augmentative and alternative communication.

While not every autistic person experiences speech or language difficulties, those who do may benefit from AAC for autism. 

As a neurological difference, autism can sometimes impact an individual’s ability to communicate using spoken words, and augmentative and alternative communication can help compensate for or supplement spoken communication. 

AAC for autism requires personalized solutions—there is no one “right” device for autistic individuals or any other client facing communication challenges. 

Rather, identifying the best-fit system is an individualized process that involves a comprehensive assessment by an SLP.

An evaluation to determine if  augmentative and alternative communication is appropriate—and what type(s) of systems might be beneficial—should always include a thorough case history, ecological inventory, consideration of sensory and motor capacities, and self-report from the client, if possible. 

SLPs should also assess expressive and receptive language, written language, articulation and phonology, and cognitive and social communication skills. 

Specifically for aided AAC, evaluation of symbol and feature-matching is essential. This means determining a client’s capacity and preferences for using features and symbols. 

Trialing a device before committing to it is the best way to ensure that an AAC solution will be successful and sustainable in the long-term.

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AAC speech therapy

AAC speech therapy involves systematic instruction in device use, language development, and communication strategy implementation.

Successful intervention requires collaboration among multiple stakeholders and evidence-based treatment approaches.

Once an alternative or augmentative communication system (or systems) has been selected, SLPs can turn their attention to implementing treatment approaches that promote its use. 

This is often a collaborative process, with speech therapists working alongside clients, their families, and other healthcare, rehabilitation, and support professionals. 

The client’s communication partners must be trained on use of the device to help integrate it into a variety of environments and social contexts. 

When working directly with individuals who are learning to use AAC, speech therapists can draw from a number of evidence-based approaches such as: 

• Language Acquisition through Motor Planning (LAMP)

• Core vocabulary approach

• Picture Exchange Communication System (PECS)

• Total communication

• Milieu therapy

• Augmented input

Goals for AAC speech therapy may center on training clients and their caregivers on use of the system itself, while also targeting language, social communication, behavior, functional communication, and literacy. 

Augmentative and alternative communication represents a dynamic and essential field within rehabilitation and special education, offering life-changing opportunities for individuals with communication challenges. 

For mental health therapists, speech-language pathologists, and occupational therapists in private practice, developing competency in AAC assessment and intervention opens doors to serving diverse populations with complex communication needs.

The key to successful augmentative and alternative communication implementation lies in comprehensive assessment, individualized intervention planning, collaborative team approaches, and ongoing support for users and their communication partners. 

Whether working with AAC for autism, acquired communication disorders, or developmental delays, practitioners must remain current with technological advances while maintaining focus on evidence-based practice principles.

As the field continues evolving with advances in artificial intelligence, voice technology, and access methods, the future of augmentative and alternative communication holds tremendous promise for expanding communication opportunities for all individuals. 

By embracing these developments while maintaining person-centered approaches, clinicians can continue making meaningful differences in the lives of those they serve.

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