Augmentative and Alternative Communication for Individuals on the Autism Spectrum

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If a person on the autism spectrum is not speaking, is only speaking a little, or is very difficult to understand, a speech language pathologist may recommend a form of augmentative or alternative communication (AAC). AAC consists of any type of communication other than oral speech which is used to express wants, needs, thoughts, or ideas. A system is augmentative if it is used to supplement existing speech, while a system is considered alternative if it is used for communication when speech has not developed or has been lost. AAC includes both unaided communication systems and aided communication systems.

Unaided Communication Systems

An unaided communication system is a form of communication that uses only the person’s body. People use unaided communication when they use facial expressions or body language. Sign language is another way people communicate with their bodies. A speech language pathologist (along with other professionals) may teach a child on the autism spectrum to use sign language in order to express him/herself.

Aided Communication Systems

Aided communication systems involve the use of additional tools or equipment outside of the user’s body. There are many different forms of aided communication systems which are commonly used by people on the autism spectrum. These include:

  • Communication boards/books: A person on the autism spectrum may learn to use a set of pictures and/or words to communicate. The pictures are usually organized into a page or book of pages. The child may have a book which he or she carries or there may be different “boards” for different activities or places. The child typically points to a picture to indicate what he or she wants. The child might learn to point to multiple pictures to make up a whole sentence; for example, “I want” + “red” + “car” + “please.”
  • The Picture Exchange Communication System™ (PECS) is a structured system in which a child learns to give a picture to another person in order to ask for something. The child learns how to pick a picture from a group of pictures and how to put the pictures together to make a sentence. This is different from other picture-based systems because the communicator has to give a picture to another person in exchange for an item.
  • Speech generating devices (SGDs) or voice output communication aids (VOCAs) are electronic AAC systems in which a person activates a symbol which is spoken out loud. Typically the communicator touches a picture or word to make the device speak, but a device may be programmed to be activated in many different ways depending on the abilities of the individual. There are many different types of SGDs, and they range from simple devices which only have a few pictures to very complex systems with thousands of words.
  • Facilitated communication is a highly controversial and unsupported process of communication. Facilitated communication is using a facilitator to help a non-speaking individual communicate. The arm of the non-speaking individual rests on the facilitator’s arm or hand to direct the facilitator to spell out words or point to pictures for communicative purposes. This is a not an evidence based treatment. The National Standards Project has gone to great lengths to caution against the use of facilitated communication.

Will AAC Keep My Child from Talking?

It is very important to know that if a child is introduced to an AAC system, it will not prevent him or her from using words. AAC systems are designed to enhance an individual’s ability to communicate, not take away speech or prevent the development of new skills. When a child is ready to speak and if able, he will. It is very powerful for children to learn that they can be in control of their environment by communicating, and this is often something that happens when a child begins to use an AAC system. Using AAC and speech is not an “either/or” situation – generally speech language pathologists continue to encourage speech development as AAC is introduced. No one has any way of knowing when or if a child will begin to talk, but it is often important to provide each child with a way to communicate before the spoken words come.

Important Considerations for Using AAC

If a child on the autism spectrum is not speaking, often the initial goal of speech language therapy is to determine what the best mode of communication is for the child. Many factors come into play, including how the child currently attempts to communicate and the child’s motor skills, ability to imitate, cognitive skills, and who the child will be communicating with.

Once a modality (or way of communicating) is chosen, it is very important that it is used consistently. If a child only uses an AAC system in one setting or situation, it will be very hard for those skills to generalize to other environments. This could lead to a child learning how to communicate in only one place or with one partner. We use our voices to communicate in many different places and with many different people, and a child using AAC should have the same opportunity. Your child’s speech language pathologist should give you suggestions for ways to incorporate the use of AAC in the home and in the community. In addition, it is generally not a good idea for a child to use one modality in one setting and a different one in another setting. For example, a child may have a hard time being successful if he or she is trained to use pictures to communicate at school but sign language is used at home.

There are many different types of AAC, and each may not work for every individual. If you are interested in learning more about AAC for your child, please contact his or her speech language pathologist.

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Last Updated: May 29, 2020

The Center for Autism Research and The Children's Hospital of Philadelphia do not endorse or recommend any specific person or organization or form of treatment. The information included within the CAR Autism Roadmap™ and CAR Resource Directory™ should not be considered medical advice and should serve only as a guide to resources publicly and privately available. Choosing a treatment, course of action, and/or a resource is a personal decision, which should take into account each individual's and family's particular circumstances.


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