Myths and Realities of Augmentative Communication

By:  Amanda Nagle, MA, CCC-SLP/L

Two-year-old Frank vocalizes the word “duck” while playing with a computer laptop and recorder. Frank attends weekly speech pathology sessions at Easter Seals DuPage & Fox Valley to help with issues that stemmed from food allergies and delayed truck core strength. After a year of therapy, Frank is now quite a talkative young boy!
Photo by: Nancy Kerner

Parents understandably worry when they hear the words “speech generating device”, “AAC” and  “augmentative communication”. Concerns are voiced such as:

• The Speech Language Pathologist (SLP) doesn’t think she will talk and is giving up on her speech
• My son talks, why is the SLP recommending a speech generating device? My son doesn’t fit this profile!
• Won’t that device stop her talking and make her too lazy to talk?

That is just not the case. The American Speech Language Hearing Association (ASHA) defines augmentative and alternative communication (AAC) as “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.”

There are many myths around the use of augmentative and alternative communication (AAC) in individuals of all ages but these myths are particularly prevalent with our young children. Below are the most common concerns (myths) that I continue to hear from families and professionals, especially those working with young children.  I want to dispel the myths with the realities surrounding the concerns.

MYTH:  The AAC system will become a crutch for my child.  Parents are frequently concerned that their child will use the device instead of learning to communicate verbally.

REALITY:  Many children’s verbalizations increase when they begin using a voice output AAC device.  Research and clinical practice continue to indicate that AAC does not interfere with verbal speech and actually encourages spoken language.   We frequently see increased imitation and spontaneous verbalizations when children use augmentative communication systems.  Children will communicate with the easiest and most flexible means available to them.  It is easier to use verbal speech when possible than it is to create a message on a communication device.

MYTH:  The term ‘augmentative communication’ refers only to devices with voice output.

REALITY:  There are many different types of augmentative communication with and without voice output.  Some types include using objects, photographs, picture symbols such as Boardmaker or SymbolStix, gestures and manual signs.  Other types are low tech battery operated single message voice output devices with as few as one message.  Mid tech devices are available with multiple message selections.  High tech devices are also available with robust language organization that can be modified for various stages in a child’s receptive and expressive language development. 

Tablet systems such as iPads have a variety of communication apps from single messages to full robust language organizations.  Frequently, children’s full communication systems include a combination of no tech, low-tech and high-tech AAC, in addition to their unaided communication including verbalizations.

MYTH:  Individuals must progress through a specific hierarchy of skills before they are ready to use augmentative communication or before moving to the ‘next level’ of augmentative communication.

REALITY:  There are no prerequisites for communication.  A child does not need to understand cause-effect before he/she can use AAC.  A child may actually learn cause-effect skills through the use of augmentative communication while she is learning new forms of communication.  A child does not need to know that a picture represents an object.  When a picture is attached to a voice output device or to a low tech surface, the child will begin to associate meaning between the picture and the object she receives when she selects the symbol.

For example, if you attach a picture symbol of ‘bubbles’ to a single message device, your child touches the picture and hears the message ‘bubbles’, then you blow bubbles for her, in time she will begin to associate the picture of bubbles with the actual bubbles.

MYTH:  AAC is a last resort and we are giving up on my child’s speech.

REALITY:  A child’s use of AAC can enhance speech, language and communication development while reducing frustration at the same time. Ideally, augmentative communication strategies should be introduced and implemented prior to communication failure in order to prevent communication failure.  When AAC is introduced early, before increased frustration and communication failure occur, a child may naturally incorporate the system into their typical communication repertoire.  Receptive and expressive language skills can be modeled using an AAC system.  It is never too early to begin to incorporate AAC strategies into a child’s communication development.  When introduced early, AAC can provide a strong foundation for a child’s receptive and expressive speech and language development.

MYTH:  My child speaks and AAC is only for people who are completely nonverbal.

REALITY:  AAC systems and strategies may be used as primary communication systems or as supplemental/augmentative systems for individuals.  Many children are verbal and have trouble being understood by unfamiliar listeners or become frustrated when a familiar listener doesn’t understand a spoken message when the context is not known.

The following are some, but not all of the additional ways that AAC can be used with children who are verbal but may be difficult to understand:

• repair communication breakdowns
• set topics
• word retrieval
• receptive language development
• expressive language development
• expansion

It is important to remember that individuals with complex communication needs should have the opportunity to use augmentative communication strategies if they are not able to say what they want or need, share an idea or story, offer their thoughts, ask questions, tell you that they are afraid and what they are afraid of, and tell you if they are in pain.  Augmentative communication can provide a means for them to share these types of messages to more people in more places more often.It is never too early to introduce AAC into communication intervention.  There are no prerequisites for communication.

For more information about Easter Seals DuPage & Fox Valley please visit EasterSealsDFVR.org.