Why AAC?

"Not being able to speak is not the same as not having anything to say".-unknown

Throughout my (still early) career as an SLP, I have worked with individuals who, due to a variety of developmental and neurological events, experienced profound difficulty with verbal expression. Individuals who are diagnosed with Childhood Apraxia of Speech (CAS), Autism Spectrum Disorder (ASD), Down Syndrome, Cerebral Palsy , Aphasia, Parkinson's Disease, Amyotrophic Lateral Sclerosis (ALS), and Multiple Sclerosis (MS) at some point may find themselves unable to verbally express themselves.

Today, I hope to provide insight in regards to an often feared and misunderstood communication tool: Augmentative and Alternative Communication (often referred to as AAC). The American Speech-Language Hearing Association (ASHA) describes AAC as "all of the ways we share our ideas and feelings without talking".

Let's break this down a little more. AAC systems are typically classified into two main categories: aided and unaided.

Simply put, aided AAC systems require an individual to utilize an external tool. The external "tool" can be further categorized into the categories of low-tech ( e.g. writing a note via paper and pen) or high-tech (e.g. speech-generating devices like the one you see on the TV show Speechless). Unaided AAC does not require any external mechanism, but it does require that the user have somewhat intact fine or gross motor skills in order to use gestures, manual signs, facial expressions, etc.

From my personal experiences, parents and caregivers of younger children are sometimes reluctant to implement AAC out of fear that they will be discouraging their child from using their voice. As a mother, I believe this is a valid fear; however, as an SLP, I can with full confidence say that research has found quite the contrary to be true. ASHA's AAC's Myths and Realities is a great page to check out, if you're interested in reading about the many benefits of incorporating AAC, such as decreasing challenging behaviors caused by frustration, and actually increasing natural speech and novel expanded utterances in some cases.

I digress. Now, back to that breakdown of what AAC is and what it isn't. Think of AAC as another tool in your toolbox which can be used to facilitate communication.

An AAC system can be used as augmentative, which means that it is used to help support existing speech production. For example, a child may be able to verbally say a few words (e.g. "yes", "no", "milk"), but is the child able to communicate their wants and needs? Is the child able to describe their feelings (e.g. sick, tired, etc.), likes and dislikes, protest (e.g. stop), and direct activities (e.g. go fast, put on, etc.)? Imagine the level of frustration you would experience if your understanding and knowledge of words remained the same, but suddenly your verbal output was limited to only a few words. This is where AAC can help bridge the gap as an augmentative tool.

AAC can also be utilized as an alternative means of communication for individuals who are nonverbal or do not have functional speech. Also is the key word. The introduction of AAC does not take the option of speech production off the table. Instead, it allows individuals to communicate their thoughts and ideas, to reduce frustration, to feel heard. Yes, some individuals may use AAC for a lifetime. Others may only need AAC for a season of their life. My goal as a speech-language pathologist is to help others functionally communicate through whichever mode is most successful for the individual. Speech is awesome! But communication is crucial, so if a child has difficulty speaking, let's try something different to help!

I recently read a quote that said "Your job is to lose your job", meaning if I do my job properly, my clients (at some point) should no longer need me because I have helped foster communicative independence. So, I will end this article with a little food for thought: if that child you (may) have in mind, suddenly found him or herself in a new place with all new people, could he or she effectively communicate without you? If not, we have work to do.

Please contact a speech-language pathologist if you have questions regarding how AAC may benefit your child.