AAC

Augmentative and Alternative Communication (AAC) can provide individuals with certain medical diagnoses, motor impairments, or speech and language disorders with a way to express their wants, needs, thoughts, and ideas with the world around them.

Speech-Language Pathologists (SLPs) are instrumental in providing assessments, implementation, and support needed to allow an individual to successfully use AAC, giving them a voice, a basic right.

Summary

• AAC (Augmentative and Alternative Communication) provides individuals with communication challenges a way to express their wants, needs, thoughts, and ideas.
• Both low-tech and high-tech AAC systems can improve communication, language development, social participation, and independence.
• AAC does not prevent speech development and may actually support language growth and communication skills.
• SLPs play a critical role in AAC assessment, device selection, intervention, training, documentation, and ongoing support. Using an EHR can help SLPs manage documentation in a secure environment.

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What is Augmentative and Alternative Communication?

Augmentative and Alternative Communication (AAC) refers to a range of communication methods that support or replace spoken communication for individuals with complex communication needs.

AAC, broken down, refers to:

• Augmentative: the various methods and tools that individuals may use to supplement verbal communication.
• Alternative: the modalities that are used to completely compensate for speech production difficulties.
• Both unaided and aided forms of communication are included within Augmentative and Alternative Communication.
• Unaided communication relies on the individual’s body, including use of facial expressions, sign language, and gestures.
• Aided communication requires the use of external support, which ranges from a picture communication system (such as PECS) to a high-tech speech-generating device.

Who benefits from using Augmentative and Alternative Communication?

According to the AAC guidelines outlined by the American Speech-Language-Hearing Association (ASHA), no individual should be denied access to communication support based on age, cognition, language level, or motor skills. ASHA also states that there are no prerequisites for getting started with AAC.

Whether an individual can benefit from AAC long-term or as a short-term support (such as post-surgery recovery), individuals of all ages can potentially benefit.

Common populations and diagnoses that may benefit from AAC include:

• Autism Spectrum Disorder (ASD)
• Cerebral Palsy
• Expressive Language Delays
• Childhood Apraxia of Speech
• Dysarthria
• Genetic Disorders (e.g., Down Syndrome)
• Traumatic Brain Injury (TBI)
• Stroke
• Articulation and Phonological Disorders
• Amyotrophic Lateral Sclerosis (ALS)
• Parkinson’s Disease

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Types of Augmentative and Alternative Communication

AAC systems generally fall into two categories:

Low tech: Low-tech AAC systems do not have electronic components and do not require batteries.

Examples include:

• Printed communication boards
• PECS (Picture Exchange Communication System)
• Choice boards
• Written communication
• Letter boards
• Choice boards

These systems are typically affordable, portable, and easily accessible.

While low-tech AAC systems can serve as excellent foundational tools, these tools can have limitations. They do not generate verbal output that can serve as a speech model for the user to hear. Low-tech AAC systems also require the SLP to dedicate significant preparation time for printing, laminating, and organizing materials.

High tech: High-tech AAC includes electronic devices or software that typically generate speech output or support communication through technology.

AAC devices that produce speech output, also referred to as Speech Generating Devices or SGDs, are typically highly engaging and dynamic. They often provide robust vocabulary and are customizable.

High-tech systems can be accessed through a variety of methods, depending on the individual’s physical, cognitive, and language needs.

Individuals can access high-tech AAC, including speech-generating devices through:

• Touch
• Eye gaze
• Head tracking
• Adaptive switches

Speech-generating devices dedicated strictly for communication include those made by companies such as PRC-Saltillo and Tobii Dynavox. Some individuals may also use a tablet such as an iPad that is equipped with an AAC app. Some of the commonly used AAC apps include TouchChat HD, TD Snap, LAMP Words for Life, and Proloquo2Go.

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Benefits of Augmentative and Alternative Communication

One common misconception is that using AAC will hinder a child’s speech development. On the contrary, research shows that AAC can actually enhance speech development, particularly for preschool-aged children with expressive language delays.

AAC can benefit individuals not just in the area of communication, but in several other ways.

Here are some of the key benefits:

• Improved communication: AAC provides individuals with a consistent, effective way to express their wants, needs, thoughts, feelings, and opinions.
• Enhanced expressive and receptive language skills: In addition to improving an individual’s expressive language skills, AAC can support receptive language development.

When AAC is implemented with aided language input/modeling (communication partners using the AAC system while they talk), the individual may also show improvements in vocabulary acquisition and symbol comprehension.

• Increased social participation skills: When provided with access to communication, individuals are able to more actively participate in school, social interactions, work, and activities within their community.
• Reduced frustration: Difficulties communicating often lead to breakdowns that can cause frustration and challenging behaviors. By providing an alternate means of expression, AAC can help reduce these difficulties.
• Greater independence: With access to AAC, individuals often gain increased independence as they are able to make choices, communicate their preferences, and advocate for themselves.

Role of speech-language pathologists in Augmentative and Alternative Communication

Speech-Language Pathologists (SLPs) play a key role in the AAC process. Their responsibilities include:

• Conducting a comprehensive assessment: SLPs must consider the client’s motor skills, cognitive abilities, visual impairments, sensory needs, and behavior when evaluating an individual for AAC. This assessment is sometimes completed in collaboration with other professionals, such as an Occupational Therapist (OT).
• System selection: Rather than selecting a device first, the SLP uses “feature matching”, which involves considering the client’s communication needs, language abilities, cognitive skills, motor abilities, and other characteristics to identify AAC features that best support successful communication.
• Intervention and training: Ongoing intervention is necessary for successful implementation of an AAC system. SLPs work with clients in speech therapy to improve their ability to use AAC effectively. They also provide training for family members, caregivers, educators, and support staff.
• Collaboration: SLPs collaborate with a client’s communication partners, such as families, teachers, physicians, OTs, PTs, and other team members to ensure positive AAC outcomes.
• Ongoing support: SLPs monitor a client’s progress with the AAC system, update the vocabulary (personalizing it over time), modify access methods as needed, and adjust treatment plans when indicated.

Documentation and treatment planning when using AAC

Thorough documentation is required when it comes to AAC.

Assessment documentation: High-tech AAC devices can be funded through insurance, grants, or school districts, and detailed clinical justification within an SLP’s evaluation and treatment notes is required.

AAC evaluations should include the following information:

• Current communication methods
• Communication strengths and difficulties
• Receptive and expressive language skills
• Access considerations (vision, hearing, motor, etc.)
• Trial data from AAC systems if available
• Functional communication needs
• Recommendations and rationale

The SLP typically documents consideration of at least 3 different AAC systems and provides the rationale for recommending the selected system.

Goal development

AAC goals must be tailored specifically to the client’s functional communication needs. This could mean making simple requests or participating in complex conversational turn-taking.

The SLP may generate AAC goals that target requesting and rejecting, making choices, answering questions, participating in conversations, or self-advocacy. Regularly collecting and analyzing data from goals helps the SLP engage in ongoing monitoring to ensure the AAC system continues to meet the individual’s needs over time.

Augmentative and Alternative Communication (AAC) allows individuals with communication challenges to express themselves, connect with the world around them, and participate in daily routines.

From low-tech picture boards to advanced speech-generating devices, AAC can significantly improve the quality of an individual’s life.

While selecting and implementing AAC systems is a key part of the SLP’s role, delivering ongoing AAC intervention and support requires efficient tools for documentation, scheduling, communicating with clients, and conducting teletherapy.

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• Template library
• Billing & payments

• Insurance claims
• Client portal
• Telehealth
• E-fax

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References

Dada, S., Flores, C., Bastable, K., & Schlosser, R. W. (2021). The effects of augmentative and alternative communication interventions on the receptive language skills of children with developmental disabilities: A scoping review. International journal of speech-language pathology, 23(3), 247-257. https://pubmed.ncbi.nlm.nih.gov/32893695

Gómez-Asencio, D., Gago-Valiente, F. J., Arana-Álvarez, C., Mendoza-Sierra, M. I., López-López, M. J., & Moreno-Sánchez, E. (2025). Pedagogical interventions in augmentative and alternative communication (AAC): therapeutic benefits in healthcare and quality of life. A systematic review. Frontiers in Communication, 10, 1584169. https://www.frontiersin.org/journals/communication/articles/10.3389/fcomm.2025.1584169/full

Iacono, T., Goldbart, J., Douglas, S. N., & Garcia-Melgar, A. (2022). A scoping review and appraisal of AAC research in inclusive school settings. Journal of Developmental and Physical Disabilities, 34(6), 963-985. https://link.springer.com/article/10.1007/s10882-022-09835-y