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This article breaks down what AAC is and how it can be utilized.

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This article breaks down what AAC is and how it can be utilized.

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Multimodal communicators

Many people who cannot speak but use AAC are multimodal communicators. This means they have multiple ways to communicate their messages. As well as AAC, they might use vocalizations, word approximations, and maybe some gesture and sign language. Many people show photos from their camera roll to add to what they are saying. All different methods of communication should be valued and respected. Different communication still tells us something!

Even people with some spoken communication, may benefit from AAC. If speech is limited, AAC can help. It can give a person more words and language. They may communicate far more with AAC than they can with speech alone.

Benefits of AAC

Many people who cannot rely on speech, could benefit from AAC. And there are challenges when people do not have AAC.

People who use AAC describe benefits

These include:

stronger friendships and deeper relationships

richer, more frequent social interactions

deeper social roles: family member, friend, professional, student

increased autonomy and decision-making power over their own life

increased independence

more respect from others

greater participation in their family lives and communities

improved information sharing with physicians

improved personal safety in a variety of care settings, such as hospitals or long-term facilities

more employment and volunteer opportunities

improved physical and mental health

Challenges for people without AAC

There are often difficulties without AAC, when someone cannot talk reliably.

People who use AAC say that, prior to having a communication system, they experienced:

more social isolation and loneliness

increased frustration and acting out with loved ones

greater vulnerability, especially when alone in a care setting

feeling shut out of important decisions over their own life

inability to show what they know or can learn

The AAC journey

Communication is a fundamental human right. A person with speech impediments or disorders can communicate with AAC.

Before starting, you may still wonder whether AAC is really needed. Will AAC be beneficial? When should we consider AAC? If you need help answering these questions, please check the "Do we need AAC?" article.

If you are using symbols and wish to make plans that support change and progress, please use our Learn AAC Guide. This may help you to consider selecting the right AAC system for a person, getting set up for AAC and then helping to build language and real communication.

Good luck, please reach out to our support team if you need any help along the way!

Links & references

ASHA. Augmentative and Alternative Communication. [Article and references]

Ahern, Kate. (2014). Why "prove it with low tech first" doesn't work. [Blog post]

Beukelman, D., & Mirenda, P. (2013). Augmentative and Alternative Communication (4th Ed.). Baltimore: Paul H. Brookes.

Brady, N. C., Bruce, S., Goldman, A., Erickson, K., Mineo, B., Ogletree, B. T., Paul, D., Romski, M., Sevcik, R., Siegel, E., Schoonover, J., Snell, M., Sylvester, L., & Wilkinson, K. (2016). Communication services and supports for individuals with severe disabilities: Guidance for assessment and intervention. American Journal on Intellectual and Developmental Disabilities, 121(2), 121-138.

Farrall, Jane. (2015). AAC: Don't Demand Prerequisite Skills. [Blog post]

Kangas, Kathleen & Lloyd, Lyle. (2009). Early Cognitive Skills As Prerequisites to Augmentative and Alternative Communication Use: What Are We Waiting For?. Augmentative and Alternative Communication. 4. 211-221.

Light, J., & McNaughton, D. (2014). Communicative competence for individuals who require augmentative and alternative communication: A new definition for a new era of communication? Augmentative and Alternative Communication, 30, 1-18.

LoStracco, Heidi. (2014).The Myth of Augmentative and Alternative Communication (AAC) Pre-Requisite Skills. [Blog post]

National Joint Committee for the Communication Needs of Persons With Severe Disabilities. NJC on AAC. [Article]

Romski, M.A. & Sevcik, R.A. (2005). Augmentative communication and early intervention: myths and realities. Infants and Young Children 18 (3), 174.

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AAC stands for Augmentative and Alternative Communication. It describes methods, devices, or communication strategies for people who cannot use verbal speech.

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This article details many different types of AAC and how they can be used by a wide range of individuals.

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This article details many different types of AAC and how they can be used by a wide range of individuals.

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Augmentative and alternative communication (AAC) includes all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas. We all use AAC when we make facial expressions or gestures, use symbols or pictures, or write.

People with severe speech or language problems rely on AAC to supplement existing speech or replace speech that is not functional. Special augmentative aids, such as picture and symbol communication boards and electronic devices, are available to help people express themselves. This may increase social interaction, school performance, and feelings of self-worth.

AAC users should not stop using speech if they are able to do so. The AAC aids and devices are used to enhance their communication.

Glossary of Communication Terms
Who uses AAC:

Individuals who are born with the types of congenital disability that cause an inability to speak (i.e., autism, cerebral palsy, various syndromes, hearing loss)

Individuals with certain types of traumatic brain injury (any age)

In adulthood: stroke, ALS, cancer, MS

Primary Types of AAC:

Facial Expressions

Gestures

Sign Language

Pictures, Symbols

Writing

Speech Generating Devices (SGDs)

Types of AAC Systems:

Unaided communication systems rely on the user's body to convey messages. Examples include gestures, body language, and/or sign language.

Aided communication systems require the use of tools or equipment in addition to the user's body. Aided communication methods can range from paper and pencil to communication books or boards to devices that produce voice output (speech generating devices or SGDs)/and/or written output.

Electronic communication aids allow the user to use picture symbols, letters, and/or words and phrases to create messages. Some devices can be programmed to produce different spoken languages.

Glossary of Terms

Alphabet-Based Methods - These include spelling, word prediction, letter codes, and whole words. Literacy is required.

Core Vocabulary - The small number of words that are used for the majority of communication. For most people, about 85% of communication is accomplished using just a few hundred words.

Extended Vocabulary - The words that are used for the 15% of communication not covered by core vocabulary.

Fingerspelling - Letters are formed by different shapes of the hand and fingers. Each word is then spelled out. Fingerspelling often is used with sign language for spelling of proper names, technical terms, and the like.

Gestures - Some gestures, such as shaking or nodding the head or shrugging the shoulders, are so common that they are generally understood by everyone. Other less obvious, but still easily recognizable, gestures can also be used for communication. For example, the American Indians made up a group of hand signals that they could use for basic communication at their intertribal meetings. These gesture systems are easy to use, but detailed conversation is not possible.

Language Activity Monitoring - This is the automatic recording of the content and time of language events. The information is then analyzed to produce a report of various quantitative summary measures of communication performance.

Language Representation Methods - Speech output AAC systems use one or a combination of three basic language representation methods: single meaning pictures, alphabet-based methods, and semantic compaction. An understanding of the performance differences and appropriate choices of method(s) are very important to the effectiveness of the communication system.

Sign Languages - These are languages composed of different hand shapes originally developed for people with severe hearing loss or deafness. They require a certain amount of manual dexterity and are not understood well by people who do not know the system. Different sign languages have developed in different countries.

Single Meaning Pictures - Each word in the vocabulary is represented by a different picture. Thousands of pictures are needed for a modest vocabulary size. Meanings must be taught since most words are not naturally represented by pictures.

Speech - Oral symbols/speech can be spoken by a person or generated by computer.

Semantic Compaction - This method uses sequences of multi-meaning icons to represent vocabulary items.

Transmission Techniques

There are a variety of different ways to send messages. With good motor control, an individual can produce communication symbols by using speech, gestures, sign language, fingerspelling, writing, head shaking, eye blinks, and other facial and body movements. When an electronic AAC device is used, the device transmits the communication in response to input from the user.

Selection Techniques

Without adequate motor control, an individual must be taught how to indicate those symbols he or she wants to use. Selection techniques include direct selection, scanning, and encoding. The selection rate has direct impact on the rate of communication. Selection rate can be measured, and the fastest technique should be used.
Direct Selection
The individual directly indicates the desired symbol, usually by pointing with a body part, such as the finger, thumb, fist, elbow, eyes, foot, or knee. Often, a pointing aid is needed. It can be a pointer held in a closed fist, a stick held in the mouth, or a light beam mounted in a headband. If motor control is not good enough for pointing, a number of electronic devices are available to help with selection. One such device uses a very good camera and a high-speed microprocessor to find even very small eye movements. For people who can speak but not write, desired words can be spoken, decoded by computer, and then printed out. Direct selection generally is faster than other approaches.
Scanning
In scanning, symbol choices are presented to the user one at a time. The user chooses the symbol, or group of symbols, wanted by signaling at the appropriate time. Scanning can be done with or without electronic equipment. In one of the simplest forms, the user has a chart of pictures representing various personal needs and interests. The communication partner points to each picture one at a time and asks a yes/no question (e.g., "Is this what you want?"). The user answers the question with a head nod or eye blink, and the process is repeated until the correct choice is found. By using an electronic device, an individual can produce messages independently. A special switch is used to stop a moving light when it comes to the desired symbol. Many different kinds of switches are available that can be used by people who have very limited motor control. Basic scanning is slow, and is useful only when no more than 15 choices are available. When more choices are needed, other types of scanning have to be used. Choices may be arranged in rows and columns. The user locates the desired symbol, and allows the light to move from column to column until it reaches the right one and then from row to row until the desired symbol is lit. For even more choices, the user may have a number of different charts with different rows and columns. Through self-selection or answering yes-no questions, the user chooses the chart with the desired symbol on it, and the communication then proceeds just as it did for row and column scanning.

Encoding - With encoding, the user learns to use specific codes for each message. Numerical codes (1 = "Can I talk with you a minute," 2 = "I'd like to have pizza for lunch," 3 = "Let's pick a movie to see," etc.) are the most common, but sequences of letters and shapes also have been used. Encoding can be a very rapid way of expressing lengthy messages. If mental abilities are better than motor abilities, encoding can provide a greater range of vocabulary options. For example, a vocabulary display may only have room for ten choices. However, by combining numbers, many more messages can be expressed. For example, I + 3 = "Please leave me alone!" Usually, both users and communication partners must know the code or have a chart of the codes available. However, some communication devices work by pressing a number code that generates computer speech.

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Augmentative and Alternative Communication (AAC)

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First Responders Disability Awareness Training | We are the nation's premier training program and resource for first responders to best serve & respond to individuals with disabilities

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One kind of AAC device that is utilized by many individuals is an eye gaze device. Eye gaze devices allow users to communicate without using any bodily movement other than their eyes. This type of AAC is commonly used by individuals with Cerebral Palsy, ALS, or Multiple Sclerosis. There are many different versions of eye gaze technology and each has its own specific functions. The website linked above discusses an AAC device called the Eyegaze Edge and the different functions and capabilities that this device has.

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The world's most advanced eye-driven communication device. Internationally trusted and locally loved

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Another important type of AAC are the many AAC apps on mobile devices that help people communicate. Many of these apps utilize symbols or pictures that individuals can press to communicate with others. Some apps, like Proloquo2Go have over 25,000 symbols to choose from and even provide the option to use personal pictures as symbols. These apps largely do not have any limits to language as they have a vocabulary of over 10,000 words with the option to add your own words as well. These apps are extremely important in helping many individuals communicate effectively. Individuals with Down syndrome, autism, or largely anyone who has speech difficulties can utilize these apps to help them communicate. The link above is an informational overview on Proloquo2Go that lists a number of highlights and features of the program itself.

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Our AAC app family has two new members supporting children and parents on their AAC journey.

Built from the ground up with an easy-to-use layout, step-by-step guidance and support, you can easily make communication with AAC a part of your everyday life.

Try AssistiveWare Proloquo and Proloquo Coach free of charge for one month.

You'll love how this symbol-based app helps users learn how to express themselves. Proloquo2Go puts the user's development first, with innovative features based on clinical knowledge and user research.

It's also one of the few AAC apps designed to support all users, from beginning to advanced. Completely customizable and designed for a range of fine-motor and visual skills, the app's versatility makes it useful for non-speaking people with autism, Down syndrome, cerebral palsy, and a range of other diagnoses or speech impediments like apraxia and dysarthria.

Grow and develop

Communicate with ease

Core words stay in the same place throughout the vocabulary to aid motor planning.

Customizable folder organization. You can also create your own folders easily, based on thematic templates.

Designed for a range of fine-motor and visual skills with options like 23 pre-programmed grid sizes and accessibility settings which support scanning and Apple's VoiceOver.

Use it your way

"
The app continues to grow with us, and each update brings only greater utility and reward. Rupert is seventeen now, and I can't see us ever using any other communication format.

Proloquo2Go lets you be you. Choose from 100 voices, ranging from friendly adult voices to genuine children's voices and bilingual voices. The voices are created using real recorded speech, making them feel surprisingly natural. For some languages, you even have multiple options.

Exploring insurance options for Proloquo2Go? We've got you covered.

Our partner, AbleNet, specializes in guiding people through the insurance process for AAC apps and devices. AbleNet works with ALL speech-language pathologists, regardless of their experience with speech devices.

Visit AbleNet's site or contact our support team and get Proloquo2Go the hassle-free way.

Proloquo2Go

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Join the community

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Make every environment set up for quick access to AAC. These printable communication boards are handy to use across different environments. This is very helpful when the device is not available. Using core word boards means you can make AAC always available.
Quick communication boards (new!)
More words to communicate with. Read how to use the Quick communication boards.
Core word boards

Gateway to Language & Learning is an efficient core word vocabulary offering user vocabularies for children, teens, and adults.

Proloquo2Go has the CrescendoTM core word vocabulary built-in. The Gateway to Language and Learning© vocabulary is available as an in-app purchase.

Learn more about Crescendo and Gateway

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Proloquo2Go - AAC app with symbols - AssistiveWare

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You'll love how this symbol-based app helps users learn how to express themselves. Proloquo2Go puts the user's development first, with innovative features based on clinical knowledge and user research.

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This image demonstrates a type of application where the individual can manipulate letters on a screen to communicate. This image shows an adult guiding the child to specific letters to help learn the foundations of using a communicative device.

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The image above is a communication device called a GoTalk 20. This device has about 20 different symbols that can be used for communication with 5 specific symbols at the top that are used most frequently. This type of AAC is not as expansive as other forms, but it may work for certain individuals. The pictures and vocal recordings are both personalized in this device, and it works through physical touch.

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This video shows a young boy with apraxia utilizing his speech device. This demonstrates an AAC app in function. This device is crucial for this young boy's communication as it helps him best express himself through speech.

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This video shows a Ted Talk given by disability advocate Chris Klein. Klein is disabled himself and speaks upon his experiences as an individual with a disability. While this video is fairly old, I feel it is still important because it demonstrates that people use AAC in so many different ways. Not all people communicate in the same way, so this video really captures that idea through Klein's words and his actual usage of his communication device

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TEDxMacatawa - Chris Klein - seeing unique abilities

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While this specific link is not to a direct assistive technology or AAC device, it can be used to find more information about both of those topics. Parents, educators, or AT users can use a type of search engine on the website to put in what their circumstances are and what they are looking to find more support in. This is a great resource for individuals who are looking to use more AT or more AAC in their classrooms or daily life.

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There are a wide variety of low-tech options for those who still want to utilize AAC. High-tech AAC can be very expensive and not suitable for everyone. Many individuals may prefer to utilize a picture board where they can just point to symbols to make words and phrases. The example linked above combines picture boards and more high tech AAC. This device utilizes small pictures that the individual can manipulate by placing down on the small pads. These pads then read the symbol selected aloud. Though this may be a more expensive option, I think it is important to highlight that AAC can take many forms and is not always a high-tech form of communication.

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Simply place a tag on any open location and press down for voice output. Use the speak all tag (the green circle) to have the device speak all tags from left to right.

We give you blank sticker sheets so you can label, print, and record specific things in the user's environment to help make communication more meaningful to them. Our favorite is when users print out a picture of their dog so they can use their device to call over their best friend.

We built this with the most destructive communicators in mind. To test its durability, we ran it over with a full size dodge pick up truck.

Our speech generating devices can be covered by insurance. Not sure of where to start? Contact us for more information.

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I feel that AAC is an extremely powerful tool that can help so many different people and give them a voice. AAC can take a number of forms and can be extremely helpful in implementing UDL principles. I also have an interest in AAC as I am also an ASL student at Temple. Using sign as a form of communication has greatly expanded my vocabulary and ability to communicate with others which has inspired me to learn more about AAC in general. AAC allows all students to access material because of the many options that AAC has. Because of the many formats AAC has, this meets the UDL goal of action and because communication can be presented in many different ways with ways to interact with material. AAC also helps student meet the principle of representation because of the many ways in which AAC can be presented as discussed on this page. AAC helps accomplish engagement by providing different ways to motivate students who AAC.