Communication deficit is a key feature of autism, and we see children who have communication strengths and challenges of all types. Some children benefit from the use of alternative/augmentative communication, known as AAC. AAC includes any type of communication that is not speech in order to replace or supplement talking. Parents frequently and understandably have questions and concerns when a clinician starts talking about AAC for their child – it certainly is a new, different and unfamiliar way to communicate. Or is it? If you think about it, we all use AAC every day – we point, gesture, click on icons, text or email. This is all nonverbal communication! Not so unfamiliar after all.
Here are some of the top questions we hear about the use of AAC for children with autism:
What is AAC?
AAC can sound mysterious, but really it boils down to using visual (sight) or tactile (touch) means to help communicate. Since children with autism are typically visual learners, introducing them to a system that gives them visual as well as auditory input usually helps improve their language understanding and use.
AAC systems vary by the family’s needs. Some are no-tech like pointing or using manual signs. Some are low tech like written visual schedules for increasing language understanding or the Picture Exchange Communication System (PECS), which uses laminated photographs and symbols to help a child express him/herself. And some are higher tech, like using a program on the iPad that will speak when a button is pushed or allows the user to type and have the device read the typed text out loud. Your family might use any and all of the techniques depending on your child’s needs, preferences and challenges.
Why do we need AAC? We can understand our child already!
The answer to this question is different for every family. For children who don’t speak at all, it can be used as their voice. For children who may speak but are difficult to understand, it can help them be understood by unfamiliar listeners like peers, teachers, and even the cashier at the drive-through window. For children who use scripted language such as repeating lines from movies, it can help increase their functional communication and introduce them to new ways to put sentences together, or new ways to communicate such as having conversations, negotiating, or telling jokes.
The ultimate goal of any communication system is to allow the child to speak to anyone about anything at any time or place. Parents and families are usually the most savvy and compassionate listeners and can understand many of a child’s behaviors without blinking an eye. However, we also need to think bigger – how can we maximize communication for not only family members, but the bus driver, new friends and the waiter at the restaurant? Communication supports independence!
Does using AAC this mean we are giving up on talking?
Absolutely not! Our goal is always to provide the easiest, most accessible way for a child to communicate. Usually, speech is that option. However, even if a child can say one word at a time, there is still a lot we don’t know.
If a child says “shoes,” does he mean “I want my shoes” or “I like your shoes” or “My shoes hurt!” or “Look at those weird shoes”? We want to continue to nudge the child forward in terms of language development and understanding, because more specificity is more power.
In addition, many studies have shown that the use of AAC never decreases the child’s ability to talk; in fact, it may increase verbal output.
How do we know what AAC will work best for our child?
This is where the help of a good school or therapy team is crucial. There are many options out there and many considerations to make, such as thinking about your child’s motor, visual and hearing skills, as well as their ability to recognize photographs or symbols.
However, there are no prerequisite skills for starting AAC. We don’t need to wait until a child recognizes photographs – start teaching him/her how to point or hit a button that says “more.” We can use AAC support for every type of communicator.
Ok, we have some pictures and/or buttons and/or an iPad app, but our child isn’t using it at all. What do we do?
We want to establish the power of the AAC and make sure the child knows how to use it. It is not intuitive – there is a lot of teaching that goes into a successful AAC user. One of the most powerful techniques is called aided language stimulation which basically means we interact with the child using his/her AAC in addition to our own voice in order to communicate. So we might say “go” while simultaneously hitting a button with a symbol for “go” on it. Just like learning verbal communication, children are more likely to use visual communication if they see many examples of what to do. Start with activities or using objects that your child really enjoys to teach them how fun and enjoyable (and powerful) communication is.
We also need to work on changing our own expectations of communication. Everyone tends to use the easiest and fastest way to communicate, or the one they have developed a habit of using. For instance, a child may scream if he wants more food, and the parents recognize this signal and give him a fruit snack. If we continue to respond to that communication, we are teaching them that it is the best way to get something they want. If, instead, we help the child touch a symbol that says “more” and then give him the food, we are teaching a new, more sophisticated and understandable way to communicate.
While it takes effort to change our ways of thinking to include AAC, the eventual payoff is worth it – children who are more able to communicate what they need and want to the people in their world. What power we can give them!