Augmentative and Alternative Communication (AAC) Overview

Definition: AAC refers to methods of communication that enhance or replace expressive language.
Types: Includes both augmentative (to supplement) and alternative (instead of spoken language) communication.

User-Centric Approach: Always prioritize what the individual with AAC wants to communicate.
- Example: Implementing Land Graphica for an older adult recovering from a stroke diverges from systems used in preschool settings.
Family Expectations: Consider what families desire for their AAC users but recognize these may not align with the needs of the user.
- Example: Parents wanting detailed reports about daily activities from children compared to the children’s own narrative needs.
Communication Within Family: Address the importance of relaying messages such as pain or emotions to family members.
- Quote: “Most parents want their child to share about their day.”

Unaided AAC: Communication methods that rely solely on the body, including:
- Facial Expressions: Indicate emotions (sad, mad, happy).
- Gesturing: Using hand signs like thumbs up or down.
- Sign Language: A fully developed language.
Aided AAC: Any devices or tools that assist communication, including:
- Low-tech methods like symbol boards.
- High-tech devices like speech-generating devices (SGDs).

Low Tech: Devices that do not require batteries.
- Example: Basic communication boards.
Mid Tech: Battery-operated devices, such as Big Macs, which provide single messages.
- Example: Big button devices for simple messages or commands.
High Tech: Most advanced devices requiring batteries that provide dynamic output and include:
- Dedicated speech-generating devices (SGDs).
- iPads equipped with communication apps, often requiring insurance for purchases.

Overview: A method where users exchange pictures to communicate wants/needs.
- Developed initially as a behavior modification and data-driven tool.
- Each phase requires users to reach certain criteria before advancing to high-tech options.
Challenges: Issues with individual abilities; some may lack motor skills to manipulate PECS effectively, leading to a need for alternative methods.
Recommendation: Movements away from PECS toward more dynamic communication methods.

Diversity of AAC Systems: Each manufacturer has unique vocabulary systems:
- Examples: Unity, TD Snap, and super core systems.
- Emphasis on language acquisition through motor planning vs. mere identification of symbols.
Vocabularies: Select vocabulary relevant to user’s interests and context, e.g., core vs. fringe vocabulary.

Access Methods: Various modes for using AAC:
- Direct Selection: Using fingers or eyes to select symbols.
- Switch Scanning: Scanning icons where the user selects their choice by input.
User Evidence-Based Practices: Model vocabulary and provide ample opportunity to communicate.
Multi-Modal Communication: Individuals may use a combination of AAC methods, including gestures or vocalizations alongside devices.

Misconceptions: AAC does not inhibit verbal speech development.
- Statistical Insight: 89% of AAC users enhance speech production through visual support from AAC.
Developmental Disabilities: Consideration for individuals with various conditions like autism or cerebral palsy who require AAC to enhance communication abilities.

Stakeholder Perspectives: Differences in perspectives regarding AAC from family, providers, and users create a nuanced environment for implementation.
Presuming Potential: Shift from presuming competence as a baseline to presuming potential regarding user capabilities with appropriate support.
Correct Terminology: Movement from deficit-based labels (nonverbal, impaired) towards strength-based interpretations (AAC user, multimodal communicator).

Real-World Examples: Instances of users adapting various systems show the fluidity and necessity of tailoring AAC to fit the evolving needs of the individual, such as tech upgrades or switches from high tech to more user-friendly options over time.
User Engagement: Involvement in choosing device skins or voice types demonstrates user agency, encouraging proper buy-in and usability.

Comprehensive Approach: Providers need to address all aspects of communication for AAC users, from individual choices in device aesthetics to the alignment of core vocabulary with personal interests and needs.
Continuous Support and Modeling: Emphasizes the need for ongoing modeling and user-friendly methods, ensuring that AAC users can engage meaningfully with those around them and cultivate successful communication patterns.