Types of alternative and augmentative communication (AAC)

Introduction

Communication is the key to so much in the world. Even those of us who have difficulty with social skills would acknowledge that interacting with other people in one way or another is an important part of our lives – we may just differ on how often we want to do it and the way we carry it out!

Denying someone the means to express their thoughts and communicate with others is a hugely damaging thing to do. While a significant number of autistic and other people are non-verbal or struggle with speech for a variety of reasons, this is no reason for them to be excluded from communication altogether.

Modern technology means that there is now a wealth of ways that we can and do communicate other than by speech, and we use many of them on a daily basis. It may be that humans communicated through signs and pointing before developing proper languages – babies certainly manage to communicate their needs without knowing any words!

This resource explores the types of alternative communication available to non-verbal people to help them participate more fully in everyday life.

What is AAC?

Alternative and augmentative communication (AAC) is any method of communicating something without speaking. If you are on the phone and someone in the room asks you where the TV remote is, you may point at it rather than telling them, so you are using AAC. In fact, we all use AAC all the time.

But if you are unable to speak for whatever reason, AAC can play a much more significant role in your life and become your primary way of communicating. In that case, it is vital that you choose and make use of the best method for you and your needs.

No equipment needed

The simplest forms of AAC need no equipment at all. They are made up of gestures, such as pointing or hugging yourself to show you are cold or could be a more formal sign language.

Gestures can be great for demonstrating basic needs and quite simple messages. Many of us may have gone shopping when on holiday and pointed to what we wanted to buy because we did not speak the local language. But conveying more complex ideas using simple gestures can be difficult. Imagine trying to explain how to bake a cake using only gestures that most people will understand without prior knowledge, or those games of charades where communicating even quite a simple film title without speaking turns out to be extremely difficult!

Sign language offers more options for communication and can certainly be used to convey complex messages and ideas. But there are 2 major drawbacks: firstly it has to be learned by the non-vocal person in the first place, and secondly, they can only use it to communicate with others who also know sign language. While the family and close friends of a sign language user will often learn to sign too, the non-verbal person will sometimes need to communicate with people who do not know sign language.

 

Traditional AAC equipment

An alternative to gestures and signs is to use some form of paper-based system. This could be a simple as paper and pen or a wipeable board for someone able to read and write, or some form of sheets with pictures or words on to which they can point.

These boards can work very well, particularly for younger children to communicate straightforward needs and thoughts. But there are some obvious drawbacks. The method is limited by the number of pictures or words on the boards available. Even if words are actually written as needed, this can be slow, and trying to write faster tends to make writing less legible! What is being said can only be received by whoever can see the board, so if trying to communicate with a group, this may slow things down further. If using preprepared boards, you are limited both in how many you can carry with you and by what pictures or words are on the boards.

Electronic AAC equipment

Perhaps the most versatile form of AAC is to use an electronic device, such as a mobile phone or tablet, equipped with an AAC app. This has an initial advantage in that these are highly portable and most of us carry one wherever we go already!

There are a large variety of different apps and systems available, and it is important that both the device and the app used meet the needs of the person concerned. A young child will need a robust device that can survive being dropped or knocked, and an interface which can be switched to use clear and simple pictures at first. Someone that will be using their device to communicate complex ideas will need something highly customisable that can be pre-programmed with key words and phrases for easy access.

Any good AAC device should be adaptable to meet the needs of the user and have a simple to use interface so that phrases and sentences can be pulled together and amended quickly and easily. Of course, you could just type everything but for most people this will be very slow and require knowledge of all the words they want to use, which is not great for a young child. A good AAC system will use intuitive systems of symbols that can be combined into more complex phrases and ideas as the user grows and learns. There are several different systems of symbols used, and it is worth researching the types of symbols used by the apps available to find the one best suited for the needs of the user.

The nature of an AAC app means that it is much easier to add new words and phrases as needed rather than having to prepare new physical boards or learn new signs, and so the usefulness of the app with increase the more it is used.

One further big advantage of an AAC app is the ability to have a voice then speak aloud what the user wants to say, literally giving them a voice. This is great for speaking to groups of people or when communicating with someone who may have difficulty seeing or reading a screen.

AAC apps are the most flexible and powerful types of AAC available, and a good AAC system will grow and learn with the user. The device it runs on should be chosen to suit their needs – do they need a large screen to point to because of movement or coordination issues, or is portability or a long battery life more important, for example? Then the app itself must be carefully researched to ensure that it meets the needs of the user not only today but next week, next month and next year. Selected and implemented with care, an AAC system of device and app can be literally life changing for a non-verbal person.

The price of access

One final important consideration is the price of both the device and the app itself. Some specialist devices and even some apps can cost large amounts of money. This raises two questions – can the user and their family afford the device and app in the first place, and how can you justify putting such a high price on a basic human right such as having a voice?

App2vox is a completely free AAC suitable for non-verbal children and adults. It is easy to use and offers a wide range of features to support communication and provide a text to speech facility. What’s more, it runs on an android phone or tablet so you may well already have a device that can be combined with this free app to provide an AAC solution for you or a loved one at no additional cost, because communication should not be a luxury that you have to pay for.

Conclusion

People can be non-verbal for a wide range of reasons, including autism. It is absolutely not the case that non-verbal people are of lower intelligence or that they do not want or need to communicate.

Fortunately, there are more AAC solutions available to meet all needs and circumstances than ever before. The most flexible, adaptable and portable are electronic solutions in the form of apps. App2vox is a free app that offers the ideal way to access the opportunities that communicating through an advanced AAC system offers. It truly does move non-verbal people closer to proper inclusion, at work, home, school and everywhere.

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