What AAC Is
Augmentative and Alternative Communication (AAC) refers to any method used to supplement or replace natural speech for people who cannot rely on it as their primary communication form. It includes unaided methods (sign language, gestures, body language) and aided methods (picture boards, PECS, speech-generating devices, apps). AAC is not a last resort. It is a right.
AAC Does Not Prevent Speech
This is the most important myth to address. A 2008 systematic review of AAC for autistic children found that AAC interventions do not impede speech production, and most studies reported an increase in speech, although the gains were modest. An earlier 2006 review found none of the 27 best-evidence cases showed a decrease in speech, and 89 percent showed gains. Waiting for speech before offering AAC denies a person communication access in the meantime.
Types of AAC
Low-tech: picture boards, communication books, PECS (Picture Exchange Communication System), Makaton symbols. Mid-tech: recordable switches, simple voice output devices. High-tech: speech-generating devices (SGDs) and communication apps. Apps include Proloquo2Go (iOS), TouchChat (iOS/Android), Snap Core First, TD Snap, LAMP Words for Life, and LetMeTalk (free, Android). The right system depends on the individual's motor abilities, vision, and communication needs.
Presume Competence
Presume competence means assuming every person has the capacity to communicate, learn, and engage, until evidence demonstrates otherwise. It is the ethical default. When we do not presume competence, we offer inadequate communication systems, watered-down education, and reduced opportunities. Many nonspeaking autistic people communicate in remarkable ways when given robust AAC access.
How to Support an AAC User
Model AAC use yourself (aided language stimulation). Give the person time to respond without jumping in. Never talk over the person's AAC device. Respond to all communication attempts, including early and approximated ones. Include the AAC user in conversations about them. Protect the device, it is their voice. Follow the AAC user's lead about how they want to use it.
Funding AAC
Medicaid and private insurance may cover AAC devices, usually with an evaluation and documentation from a speech-language pathologist. Coverage rules vary by state and plan, so ask your SLP and insurer what they require. Under IDEA, schools must make assistive technology devices and services, which can include AAC, available when a child needs them as part of their special education, related services, or supplementary aids and services. Some nonprofit organizations provide AAC funding for uninsured individuals. ASHA (asha.org) has resources on funding and advocacy.
Myths About AAC
Myth: you have to exhaust all other options before trying AAC. Fact: there is no need to wait, AAC can be introduced as early as it is useful. Myth: AAC is only for people who cannot speak at all. Fact: many AAC users speak in some situations and use AAC in others. Myth: using AAC means giving up on speech. Fact: research reviews have found AAC does not impede speech, and many children show modest gains in speech. Myth: the device is too expensive. Fact: apps like LetMeTalk are free, and insurance or Medicaid may fund high-tech devices.