Using Augmentative & Alternative (AAC) Communication for Autism

by Shea Brogren, MOT, OTR/L November 10, 2020

AAC for Autism Blog Post

If you’re a parent or caregiver of a child with autism, chances are you’ve heard of the term augmentative and alternative communication, commonly referred to as AAC.

What exactly does augmentative and alternative communication mean?

AAC refers to any form of assistive technology for communication (tool, strategy, program, etc) that allows a child with autism to express their needs and thoughts effectively.

In this article, we will review the different types of AAC available for children with autism. First, let’s consider how communication, language, and speech can be affected for a child with autism.

Communication and Autism

One of the major criteria for an autism diagnosis is a deficit in communication and/or social skills. In many situations, communication skill deficits are one of the earliest identifiable signs related to autism spectrum disorder.

Children with autism may experience difficulty in the following areas related to communication and speech:

  • Difficulty with social-emotional communication, such as understanding the flow of conversation, interpreting emotions and intentions of others, engaging in play with peers, adjusting behaviors to different social environments, and initiating social interactions
  • Non-verbal communication difficulties such as avoiding eye contact, not understanding others’ body language or non-verbal gestures
  • Engaging in repetitive or rigid language, which may include using different pitches when speaking, providing extreme detail about a topic when asked a question, difficulty continuing on a conversation or engaging in two-way communication

It is always important to note that each child is unique and will have their own strengths and areas for growth in regards to communication and speech. Some children with autism are completely non-verbal (approximately 50%), while some may have only social communication difficulties.

No matter where a child falls on the communication spectrum, a thorough assessment by a speech-language pathologist that considers the whole child is recommended before seeking out any form of AAC.

The big myth about AAC

There is typically one big misconception about using AAC for children with autism, and that is using a form of AAC will prevent a child from speaking or in some way delay a child’s communication skills because they are using alternative forms of communication.

The bottom line is that research has found this to be incorrect and inaccurate. In fact, the opposite has been found to be true.

Research has shown that using the most appropriate form of AAC for a child can actually improve speech, communication, and social-emotional communication.

Most importantly, no risks have been found from trying or using AAC, making them a safe, effective option for many children and families.

What different types of AAC are there?

In this section, we'll break down the types of AAC into three major categories:

  • Low-tech options
  • Picture Exchange Communication System (PECS)
  • High-tech options

Please remember that it is essential to have a child assessed by a qualified speech-language pathologist or a professional certified in assistive technology, as they will be able to provide the best recommendations for AAC for your child.

Low-tech options

1. Sign language

    Sign language is a form of communication that uses signs from American Sign Language (ASL). This may be an option for some children with autism, especially those who have very strong visual skills.

    2. Visuals

      There are several low-tech options to support a child with autism by visually identifying and communicating their needs. A visual board is the most common, where a routine or specific choices are visually presented in images on a board, allowing the child with autism to select or point to an object or image as a way to communicate. This tool is also a common way many therapists teach reinforcement, such as offering a preferred activity after a routine has been completed. A speech-language pathologist and occupational therapist can work together to help develop effective visuals for a child.

      Picture Exchange Communication System (PECS)

        Picture exchange communication system, commonly referred to as PECS, is another type of AAC that can be used with children with autism. PECS differs from a visual board in that it requires a professional trained in PECS to assist the child with learning the systematic process. The process involves teaching a child how to communicate with another individual by handing them a picture of what they want.

        PECS

        PECS follows a six-step process to teach children with autism how to communicate. It begins with teaching the child about using individual pictures as a way to communicate and progresses to more complex skills, such as producing short sentences, making requests, and making commands. PECS is generally used for children who are non-verbal or unable to produce speech. Research has shown that PECS is effective at improving functional communication skills in children with autism, as it provides them with a way to have their needs communicated and met. Again, it is necessary to find a professional with advanced training in PECS to ensure safe and effective outcomes.

        High-tech options

        There are several different types of high-tech AAC options available, depending upon each child’s unique speech and language needs. High-tech communication devices look similar to a tablet, as they have a screen and some include buttons.

        AAC

        A Dynavox is one example of a high-tech AAC device. These types of devices can be used to communicate words, phrases, and sentences, by pushing a certain button or combination of buttons. These types of devices can be simplistic (one or a few buttons on the screen) or complex (multiple buttons or commands). This type of AAC requires the appropriate training from a qualified professional and often, are expensive.

        A newer alternative is to use an iPad, tablet, or smartphone to install a dedicated AAC app. Many of the companies that sell AAC devices have also started to develop apps that are similar or completely comparable to those on their standalone devices.

        Two of the more common apps include Proloquo2go and CommBoards Lite, however, there are several additional options as well. Again, these range from simplistic to complex and require training before use.

        Speech therapy, AAC, and autism

        A speech language pathologist (SLP) is a professional trained in assessing and treating communication problems or disorders. If you think AAC could benefit your child, it is best to first consult the opinion of an SLP, as they will perform a complete diagnostic evaluation in order to recommend the best treatment options for your child.

        They may also consult with an individual certified in Assistive Technology (AT), however that is dependent upon the state you reside in and the SLP’s background with using AAC.

        If using AAC is a treatment option for your child, an SLP will implement a teaching process to help your child learn how to use and implement their AAC device or strategy.

        Family involvement is imperative during all parts of learning and using AAC. An SLP will introduce the form of AAC to the child by modeling its use and then will let the child explore the device on their own, when they are ready.

        The SLP will also fully teach the child how to use their specific AAC device or communication tool (ex: sign language) and provide family education on how to promote its use in the home setting. This process will take a variable amount of time, depending upon the needs of the child and family.

        Conclusion

        The use of AAC for autism can be highly beneficial if it is determined that this type of assistive technology is appropriate for your child. There are no known risks of using AAC and the overarching benefit is that it will provide a way for your child to communicate his or her needs and thoughts.

        There are several options available, including low-tech and high-tech, and it's easy to become overwhelmed when researching these options. To ensure the best, safest, most effective outcome for your child, it is crucial to work with an SLP to determine the best path for treatment.

        We hope this article provided clarity in terms of AAC and the potential options available for your child! If you've had success with using AAC, we'd love to hear about it!


        References

        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).

        Nunes, D.R. (2008). AAC intervention for autism: A research summary. International Journal of Special Education, 23 (2).

        Shea Brogren, MOT, OTR/L
        Shea Brogren, MOT, OTR/L

        Shea Brogren, MOT, OTR/L, is an occupational therapist with over three years of experience in pediatrics and child/adolescent mental health and has also worked as an adjunct lecturer at the University of North Dakota. Shea has a special interest in program development and developed and implemented occupational therapy programming at a residential treatment center for children. She now practices in an outpatient setting.

        Her primary area of interest involves working with children who have experienced developmental trauma. Shea has advanced training in SMART treatment (Sensorimotor Arousal Regulation Treatment), the Zones of Regulation, using sensory-based interventions to address trauma, infant mental health, attachment, and arousal regulation related to trauma disorders.


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