MODULE I
FOR TEACHERS

Foundations of Augmentative and Alternative Communication (AAC)

Augmentative and Alternative Communication technique for Inclusion (AAC-Inclusion)

1.    AAC-related concepts

AAC (Augmentative and Alternative Communication) refers to augmentative and alternative ways of communicating.

Alternative communication means forms of communication other than natural speech and/or writing. It substitutes natural speech when speech is not functional or is not available. In the AAC approach, this term is rarely used alone, because people with complex communication needs are often able to produce some vocalisations. It is usually used together with the concept of augmentative communication.

Augmentative communication refers to all means and actions used during communication in order to support, supplement or improve natural speech and/or writing. Unlike alternative communication, it supports rather than replaces natural speech. In a broader sense, it is an area of clinical and educational practice aimed at temporary or permanent compensation for serious communication difficulties through both specialised and standard supporting components.

An AAC user is a person with complex communication needs who already uses augmentative and alternative communication methods or will use them in the future. In 1991, the American Speech-Language-Hearing Association (ASHA) described an AAC user as a person with communication difficulties who cannot meet daily communication needs in a conventional way and can do so only with temporary or permanent AAC support.

A communication partner is any person involved in a communication interaction who actively cooperates with the learner, helping them transmit or understand a message. In AAC, the communication partner should know the user’s communication system and method in order to make the exchange more effective.

2. Facts and myths about AAC

MYTH 1. "AAC will stop speech development."

There is no evidence confirming a harmful effect of AAC on speech. On the contrary, research shows that AAC can support the development of spoken words and sentences. A meta-analysis by D. Millar, J. Light and R. Schlosser included people of different ages, from 2 to 60 years old, and with different diagnoses, such as Down syndrome, cerebral palsy, intellectual disability and autism. After AAC was introduced, no deterioration of verbal speech was observed in the participants. Improvement was recorded in 89% of the participants, including an increased number of spoken words. Similar results were obtained by R. W. Schlosser and O. Wendt in a study involving people with autism spectrum disorder. Decisions about introducing AAC should therefore be based on reliable research rather than unconfirmed beliefs or opinions.

MYTH 2. "The child must have adequate motor skills to point to symbols."

Modern technology offers many access options. A person can point or select using body parts other than fingers. Interfaces and switches allow scanning: the child may move a selection on a screen using the head, hand or another controlled body part and confirm the choice with a switch. Eye tracking has become a breakthrough in work with people with severe motor disabilities. It tracks eye movements and activates an action when the gaze remains on a button or symbol. There are also devices controlled by lip movement, eyelid movement or breath. Motor limitations are not a reason to delay or reject AAC; the task is to find a form of access adapted to the child.

MYTH 3. "The child must understand spoken language well enough before using AAC."

A child learns language through exposure and interaction. A newborn does not understand speech, but through contact with people who communicate verbally, the child gradually learns. In the same way, before a child uses AAC independently and appropriately, they need to experience AAC in everyday life. It is also important to remember that there are no simple tests that fully measure the passive language understanding of non-speaking people.

MYTH 4. "AAC is a last resort and should be introduced only after giving up hope for verbal speech."

Research and practice show that AAC should be treated as a first-line strategy for people with complex communication needs. Early access to many forms of AAC is essential in the initial development of communication, especially for young children at risk of delayed or limited expressive language. Early intervention in children aged 0-3 can significantly improve communication and language development and make functional utterances possible.

MYTH 5. "The child must reach a certain age before using AAC."

Communication begins at birth, so it is never too early or too late to communicate. Communication is a right, not a privilege. AAC should not be delayed until a child reaches a specific age. The longer a person is deprived of an accessible form of communication, the greater the risk of secondary difficulties such as reduced intellectual potential, withdrawal, challenging behaviours, frustration, passivity and increasing dependence on the environment and on other people.

3. Criteria for introduction: Who? When? How?

The communication partner is a key element in the process of developing communication competence. The partner’s behaviour, reactions, initiation of communication and organisation of communication situations are essential for the proper development of communication and for introducing an AAC system for a non-speaking person.

The role of the speech therapist or AAC therapist is not only to be a clear and active communication partner, but also to guide and instruct teachers, parents, therapists and caregivers. Parents are especially important because they can use AAC in everyday routines, natural family interactions and emotionally meaningful situations.

The skills of a good communication partner include the following:

Modelling

The first user of an AAC tool is not the child, but the people around the child. Adults should model the use of the communication tool constantly, in many situations and places. This does not mean modelling every spoken word. It means modelling key words and different communication functions, such as asking, naming, refusing, greeting, commenting and making choices.

Using an appropriate range of prompts and cues

The most common prompts are questions and physical guidance of the child’s hand to the correct symbol. These should not be the only or the most frequent prompts. Communication is not a simple physical action. It involves thinking, emotion, motivation and intention. Too many prompts may make the child dependent on the adult. A better strategy is to start with the most subtle cues and gradually offer more support only if needed.

Avoiding too many questions

Parents and teachers should avoid turning every interaction into a test. In everyday conversation, adults can first answer their own questions and model symbols. For example: "I wonder what weather you like. I like the sun, but sometimes I like walking in the rain too." This creates a natural conversation instead of pressure to perform.

Noticing and appreciating every attempt to communicate

Every communication attempt should be noticed and valued, especially at the beginning. The attempt may be a look, smile, movement, vocalisation, gesture, pointing, picture selection or use of a device. The adult should always respond, even if the response is refusal.

Interpretation is important because the adult may misunderstand the child’s intention. If this happens, the child has an opportunity to correct the misunderstanding.

Accepting the child’s chosen communication mode

If a child points to a bottle of juice instead of using a symbol, a good communication partner gives the juice and models the symbol "juice" without criticising the child. The adult should not say: "Show the symbol first, then you will get it." AAC should support communication, not become an obstacle to communication.

Attitude and motivation of the adult

The adult’s motivation is as important as the child’s motivation. Non-speaking children are often very sensitive to non-verbal signals and can sense when a communication partner is not truly interested. If the child feels ignored or underestimated, especially when their understanding is questioned, they may withdraw from interaction. This can be misread as lack of ability and may deepen isolation.

The beginning of communication competence development is a key period. Small early successes are essential because they motivate the child and the family, build trust in the method and show the environment that communication with the child is possible and meaningful.

Diagnosis of communication skills

AAC diagnosis, or assessment, is a complex and long-term process that usually involves several meetings with an AAC specialist. To understand a child’s communication skills, parents, therapists and teachers need a reference scale. Observation should cover four areas of communication:

transmission of information;

building utterances;

functional cooperation with a communication partner, including conversational interaction;

general attitude and motivation to communicate.

Parents can support the assessment process by observing the child in everyday situations: meals, play, dressing, going outside, bath time, shopping, family visits and moments of frustration. These everyday situations often show the child’s real communication needs more clearly than formal assessment tasks.

4. Conditions for effective support of speech through a communication tool

The following conditions should be met so that the use of a communication tool is effective and supports the development of speech and communication. These principles apply both to high-tech tools, such as a tablet with AAC software, and to low-tech tools, such as a communication book.

Quick access to the communication tool at all times

A common mistake when introducing AAC is using the communication tool only during selected activities. Communication takes place throughout the whole day, so every daily opportunity should be used to teach communication through aided language stimulation and to develop speech and communication.

The child should have quick access to the whole vocabulary in the communication tool at all times, not only to selected boards in selected situations. AAC should be available during walks, shopping, play, meals, dressing and family routines, not only during table-top activities.

The communication tool must be literally within the child’s reach. It should not be kept in a backpack, left in another room, stored in a locker or placed on a shelf. A speaking person has their "communication tool" available all the time through speech organs. AAC should be treated in the same way. Parents and teachers should also organise safe and practical ways of carrying the tool, for example using a strap, a protective case or a communication book that travels with the child.

Individualisation of vocabulary

The communication tool must include vocabulary that is important from the child’s perspective: family members, favourite activities, toys, food, places, people and routines. This is especially important for autistic children, for whom learning functional communication may be particularly difficult. Vocabulary should be connected with the child’s everyday life and with things that truly matter to the child.

A common mistake is focusing on vocabulary that is neutral or unimportant for the child. Motivation grows when the child can communicate about things they like, need, dislike, want to stop or want to repeat.

Different communication functions

Learning to communicate cannot be limited to naming objects or describing pictures. Communication is much broader. It includes requesting, refusing, asking questions, commenting, greeting, sharing information, making choices, protesting, telling stories and expressing feelings.

An individual communication tool should therefore contain vocabulary that allows the child to express many different communication functions. These functions should be developed in parallel, not in a rigid linear hierarchy.

Variety of parts of speech

In the vocabulary of a young child learning their first language, different parts of speech appear from the beginning. Verbs are necessary for building sentences and for further language development. For this reason, AAC vocabulary should include different parts of speech even for beginning users.

The key word is variety. AAC should help the child develop different communication functions and different types of vocabulary at the same time. This makes it possible to build meaningful communication, not only isolated naming.

Practical guidance for parents

Keep the communication tool available all day.

Use the same symbols in daily routines.

Model the tool yourself before expecting the child to use it independently.

Wait long enough for the child to respond.

Accept all forms of communication: looking, pointing, gesture, vocalisation, symbol, object or device.

Respond to the child’s message immediately when possible.

Include vocabulary that is motivating and meaningful for the child.

Do not use AAC only for testing or naming pictures.

Use AAC for real purposes: asking, refusing, choosing, commenting, greeting and expressing feelings.

Cooperate with teachers and therapists so the child uses similar tools at home and at school.

Short parent checklist