October is AAC Awareness month, so let this SLP prattle on a bit about it! Credentials: I am an ASHA certified and state licensed Speech Language Pathologist who has been working in pediatrics for the past three years, I have a Master's of Science in Communication Sciences and Disorders. I prescribe, program, and perform therapy with a variety of AAC devices.
AAC stands for Alternative Augmentative Communication - it basically refers to any communication mode other than verbal speech. Lost your voice from laryngitis so now you're using texting to communicate? AAC. You're ordering in a restaurant and don't know how to say the name of the dish you want so you point to a picture in the menu? AAC. You meet your friend's eyes and make a face to express "the guy near me is a creep" - AAC.
So what are those tablets? That is referred to as high tech AAC because...it uses more advanced technology! Thanks to tablets, most high tech AAC is housed in software rather than hardware - but hardware can still be very necessary for who needs access to the device.
Who uses AAC? Lots of people! It's most often associated with Autism right now, but there are many people - Autistic and not - who use AAC. A famous example is Stephen Hawking
Here we see Dr. Hawking using a high-tech speech generating device that is mounted to his wheelchair. How is accessing it? Eye gaze! There is a special camera in that device that tracks his eye movement.
4. Do kids use these? What about screen time? Kids do use these devices and it's honestly so great. These devices are used only for communication - when I introduce high tech AAC to a child, there are no games on the device to clearly separate it from being a toy. Toys are great and we can have fun with the device, but the device's purpose is communication. Kids, Autistic and not, can and do learn this distinction! I am currently working with a 2 year old with suspected ASD and he gets it! He's with it and he's so excited he gets to repeatedly tell me he wants to play with the animal toys.
5. Okay...but does using AAC hinder speech and language development and using "words"? NO. There is no data to suggest that AAC access and use hinders speech and language development or verbal productions. In fact, in a 2024 meta-analysis, it was found that around 80% of children who are exposed to the use of AAC actually INCREASED their vocal productions. AAC is another pathway to communication by definition but there is now emerging evidence to see it as a therapeutic intervention in itself. I've actually had wonderful success introducing and using AAC with clients who I suspect can learn to verbally communicate, but it's going to take a long time using traditional methods alone. One client now has increased her vocal vocabulary AND her device vocabulary and uses BOTH to form messages - she recently told me "No, fine" with a vocal "no" and with the "fine" using her device. And it was 100% contextually appropriate! AAC by design is to create access - NOT STOP IT.
6. AAC users not CAN be bilingual - they are!! Most of my AAC using clients are Spanish and English bilingual speakers. I create both Spanish and English grids and provide the client access to them. I will link them together so the client can learn to code-switch - and don't you know, they do it! I have a client who has the names of her school friends in her English grid but not in her Spanish grid so she will say the name, switch over to Spanish then tell the device to say it again in a Spanish accent because she knows she is Hispanic! The cultural identity and interaction she has now because of her device is priceless, and it was deeply meaningful to create that grid with her family to create that connection.
7. Okay but are non-verbal kids even cognitively - Stop it right there. I am tired of people who do not know any non-speaking people or work with them literally trying to speak for them. That girl who is navigating between the Spanish and English boards for accent purposes? She'd be considered "non-verbal". Another "non-verbal" client told me "6-7" last week using his device and it was completely age expected! One of the most beautiful moments in my career is when I learned that my client's favorite color was purple because he finally had access to words and he asked "Is it purple?"
Part of why I wrote this is because there is not enough discussion about it. AAC is incredible, particularly high-tech AAC. And I also want there to be more awareness of it for anyone who needs it. When I was an intern, I met a woman who had her tongue removed due to cancer and for ten years she had to get by with just writing little notes on her notepad. Her doctor never brought it up! We have the technology!
