When to consider Augmentative and Alternative Communication (AAC) for children with communication disorders

Proven Behavior Solution’s Director of Speech and Language Therapy, Paul Simeone, specializes in working with children with ASD and complex communication needs and their families. He is also an Augmentative and Alternative Communication (AAC) specialist and is certified as an Assistive Technology Professional. Please read on for an excellent article written by Paul for parents or caregivers who are considering AAC for their children. 

Augmentative and alternative communication (AAC), using low and high-tech strategies to support or replace speech, is an intervention that is useful for many children with communication disorders. AAC systems include low-tech strategies such as PECS or communication books as well as high-tech systems such as tablet-based speech-generating applications. AAC can be particularly helpful for children with autism spectrum disorders (ASD) with moderate to severe communication deficits.

The use of AAC has wide benefits and applications for children with ASD. In addition to serving as a primary communication mode, AAC has a range of uses including enriching and building language, supporting language comprehension, and repairing spoken communication. The type of AAC system and implementation strategy should be based on each communicator’s specific strengths and needs. AAC assessment requires knowledge of ever-changing technologies, proficiency in system selection and programming, and clinical expertise in language intervention. While AAC tools have become more widely accessible over the last decade due to the availability of tablets, the over-abundance of options can actually make the process more difficult for families. Many parents and providers face difficulty when deciding whether to try an AAC strategy for their child.

Here are some cases in which getting an AAC evaluation might be appropriate:

• Early language development: If your young child with autism is not speaking, an AAC intervention may be appropriate. Whether used as a primary communication mode or simply as a visual support for language, young children with ASD and communication deficits benefit from AAC. The use of AAC has been demonstrated to support reciprocal language for minimally verbal children by giving them a means to engage in turn-taking.[1] This increase in reciprocal communication is widely accepted to support overall speech and language growth. Many parents and providers hesitate to use AAC strategies with young children because they are concerned that it will impede speech production. In fact, current research supports AAC intervention as early as possible for children with ASDs who have speech and language delays and has been shown to support speech development.[2]
• Unintelligible speech: Many children with ASD experience co-occurring motor-speech deficits. While these children may speak, they may be extremely difficult to understand. In addition to therapy for speech production, AAC is an excellent way to help repair communication breakdowns. Either as a primary mode of communication or used augmentatively for communication repair, an AAC system may provide a quick, reliable, and understandable means of communication.
• Receptive language: Language is more than speaking. To participate in conversations, answer questions, or even navigate many environments, the ability to comprehend is vital. Many children with ASD also have deficits in language comprehension. Understanding new vocabulary, following directions, or understanding communication partners in conversation may be difficult. Using AAC as a visual support to build receptive language skills is an effective, evidence-based approach. Visual schedules, Visual Scene Displays, and video modeling are all forms of AAC that have been demonstrated to be effective for kids with ASD.

AAC has a wide range of social, receptive, and expressive applications. AAC intervention should be a team-based process that includes parents, AAC specialists, SLPs, BCBAs, teachers, and other therapists on the team. Collaboration and coordination of services can mean the difference between success and failure. If you suspect your child could benefit from an AAC intervention, please contact us to set up an appointment. 

[1]DiStefano, C., Shih, W., Kaiser, A., Landa, R., & Kasari, C. (2016) Communication Growth in Minimally Verbal Children with ASD: The Importance of Interaction. Autism Research,  9: 1093–1102

[2] Ganz, J.B. (2015) AAC Interventions for Individuals with Autism Spectrum Disorders:

State of the Science and Future Research Directions. Augmentative and Alternative Communication, 31(3): 203–214

Paul is the Director of Speech & Language Therapy at Proven Behavior Solutions. He has worked extensively in home, school, and clinical settings. Most recently, he was Director of Rehabilitation Services for a private special education school.

He specializes in working with children with ASD and complex communication needs and their families. Paul is also an Augmentative and Alternative Communication (AAC) specialist and is certified as an Assistive Technology Professional. Licensed in the state of Massachusetts, he is a member of the Massachusetts Speech-Language Hearing Association (MSHA) and the American Speech-Language-Hearing Association (ASHA). Paul has been a presenter at ASHA’s Annual Conference and presented at the 2019 National Convention for the Association for Behavior Analysis International (ABAI). Currently, he is completing a PhD in Rehabilitation Sciences at Mass General Hospital’s Institute of Health Professions and conducts research on interdisciplinary communication interventions for children with ASD. At Proven Behavior Solutions, Paul provides direct and consult speech and language services as well as supervision for graduate-level clinical interns.

Education:
BA in Human Services, Empire State College
MA in Speech-Language Pathology, Lehman College
PhD Candidate in Rehabilitation Sciences, MGH Institute of Health Professions