AAC for SLPs – Child Apraxia Treatment

Augmentative and Alternative Communication (AAC)

Information for Speech-Language Pathologists

AAC and CAS

Selecting an AAC System

When to Refer

AAC Myths

Benefits of Using AAC

AAC and CAS

Augmentative and alternative communication (AAC) is any form of communication that helps someone who has trouble speaking to communicate. It can take a variety of forms including sign language, gestures, pictures, and speech generating devices, which now include tablets, such as iPads, with specific apps.

Many children with CAS use some form of AAC at some point in their communication journey. For most children with CAS, AAC is a bridge to speech, a temporary means to increase communication abilities and decrease frustration while working to improve speech. For a small number of children with severe CAS, AAC may be their primary form of communication long-term.

Selecting an AAC System

There is not one particular form of AAC that is best for every child with CAS. The most important thing is that the method of communicating works for the child and the people around them. It is also vital to remember that AAC should not be used silently. Regardless of the system, speech is still modeled and encouraged.

See the table below for different examples of AAC systems, including some of their pros and cons.

Method	Benefits	Drawbacks
Naturalistic gestures/signs	child may already use some can be effective for getting wants/needs met learning can be embedded in daily routines may provide opportunities to practice language skills, like building sentences	may not be recognized by others unfamiliar with child motor skills may be difficult for some children
“Low-tech” (low-technology) picture communication systems	usually easy for child to learn allows child combine pictures and make sentences (like “want milk”) which helps build language skills easier for people unfamiliar with child to recognize than signs	keeping track of lots of picture boards or notebooks can be difficult can be taxing to add new pictures as child’s vocabulary grows no voice output
“Mid-tech” (mid-technology) systems, like simple apps with voice output	easy to add new vocabulary allows child to combine symbols to make sentences and practice language	can be difficult for children to understand and find symbols, requiring lots of teaching time
“High-tech” (high-technology) systems/apps with expanded vocabulary and features that facilitate language development	provides the child with limitless vocabulary can be programmed to meet an individual child’s needs most provide a platform that encourages language skills including different grammar forms many interface with other technology	requires time and expertise to learn to use effectively expensive

When to Refer to an AAC Specialist?

Probably the most important question to consider when selecting an AAC system for a child is how long the child is expected to use it as a primary means of communication. This is important because committing to learn a high-tech AAC system can be a big investment of time and resources, so it may be most appropriate for a child who is going to rely on that system for an extended period of time. Most children with CAS who do not have other disorders impacting speech/language development are able to use simple signs and low or mid-tech communication systems for a period of time while working intensively on speech production. For these children, the focus of the speech therapy should be remediating the CAS by improving motor speech planning and programming, not on teaching a complicated AAC system.

However, children with CAS who have other speech/language disorders may rely on AAC methods for a longer period of time and therefore finding the best “fit” for the child is important and a full AAC evaluation is in order. If you are not comfortable and qualified to provide a full AAC evaluation, a referral to an SLP with this expertise is recommended. The following are factors to consider when selecting an AAC system for longer-term use:

Motor Skills
If a child has other motor deficits, such as difficulty with fine motor tasks involving their hands, this should be considered when selecting an AAC system. For example, sign language might not be the best choice for a child who has trouble imitating movements with their hands.
Vision
If a child has significant visual deficits, this needs to be considered if the AAC system utilizes visuals, such as pictures (either hard copies or digital). Adjustments to visuals, such as increasing contrast, can be made to help accommodate for visual deficits.
Portability
It is important for the child to have their AAC system with them at all times. After all, we communicate in many different situations! Consider how portable or easy to carry the system is for the child. Some systems, such as sign language, don't require anything to be carried. Other systems, such as pictures or a device, have to be transported with or by the child.
Ease of Learning
Ease of learning is specific to each child. A full AAC evaluation involves trying a few different systems to see which one the child responds to most readily. Another factor to consider is teacher availability. Even if the child responds well to a system, it might not be the best approach if there is no one available to teach the child that system. For example, if the child learns sign language easily, but there is not a person fluent in sign language available to teach the child and family, it might not be the best fit.
Availability of Communication Partners
Communication only works if there is both a sender and a receiver using the same system. The communication partners that interact or will be interacting regularly with the child matter. For example, if the child is using sign language but goes to school where no one understands sign language, the child will not be able to communicate effectively.

AAC Myths

The following are common misconceptions about AAC.

My child won't talk (or talk as much) if they use AAC
Research studies have shown that children who have access to AAC methods actually develop speech at an equivalent or even faster rate, likely because AAC encourages children to make more communication attempts since they have a "fallback" method.
My child is to young to use AAC
Children as young as 12 months of age can successfully use simple AAC methods to communicate wants/needs much like similarly aged children may use single words.
Using AAC means giving up on my child talking
Absolutely not! Using AAC means giving your child a voice and a way to express themselves while they are working on developing (more) speech. Clinical experience and research indicates that using AAC facilitates, not hinders, speech development.

Benefits of Using AAC

There are many benefits to using AAC while continuing to work on speech.

Builds the child's language
Language, both receptive and expressive, are the foundation for communication. AAC provides an additional method for learning language that typically includes not just a verbal model but also includes a visual support. For example, including a gesture while talking can aid comprehension.
Decreases frustration for the child and their communication partners
AAC can help children to communicate more clearly, resulting in less frustration for them and for you. Even for a child who is talking, AAC can provide clarification when their speech is not understood.
Increases the child's confidence as a communicator
Children with CAS often have poor speech intelligibility. When children are able to communicate successfully with more people, their confidence and self-esteem in social situations often improves.
Decreases the child's anxiety
Children with CAS who are pre-verbal or who have poor speech intelligibility often experience anxiety, especially in new situations. AAC can help decrease this anxiety by giving them another method to communicate.
Provides a foundation for speech
In addition to building language, when a child uses AAC their message is communicated. This is affirming for the child and often increases a child's motivation to speak.