This question is increasingly asked as parents and caregivers become more aware of the benefits and positive outcomes of augmentative and alternative communication (AAC). My response to this question is that AAC is an appropriate consideration very early in intervention.
The American Speech-Language-Hearing Association defines AAC as … “a set of procedures and processes by which an individuals communication skills (i.e., production as well as comprehension) can be maximized for functional and effective communication. In other words, AAC includes any form of communication other than speech that allows the user to communicate in his or her surroundings.”
Light (1988) identified four primary functions, or purposes, of communication. These include:
- expression of wants and needs,
- exchange of information,
- social closeness, and
- social etiquette.
Typically-developing children use speech to function within these areas. When speech is not adequate to achieve the childs communicative purposes, it is necessary for the child to find a way to close any gaps. In terms of expressing wants and needs, AAC is a nice bridge between the need to communicate a message and actually getting your meaning across to another person. Children can use natural gestures, sign language, a communication book, a symbol (picture, photograph, line drawing, etc.), and/or a speech-generating device to convey their intents. Exchange of information becomes essential in a school setting. The teacher requires that the child interacts within the classroom by asking/answering questions, participating in collaborative learning groups, and using increasingly more complex language. This exchange of information demonstrates to the teacher that the child has achieved levels of knowledge expected at various stages in development. For example, a child that is unable to say an s is going to have a difficult time indicating that he/she has learned the concept of plurals. This same child would easily be able to demonstrate the use of plurals using AAC. As children mature, the requirements to communicate multiply with the opportunities. Social environments become more diverse and filled with more communication partners. Making communication interactions functional and effective takes on greater importance because of the addition of these social influences.
There is a chance that families will encounter speech-language pathologists who choose to focus on speech, while overlooking overall communication. A focus on speech is not wrong in and of itself. We all want our children to use natural speech. However, everyone on the childs team (including parents and peers) needs to step back and really look at that childs ability to communicate functionally within his/her various environments. Focus on what the child is currently able to communicate. Consider, if the progress in therapy is slow, how long are you willing to wait for the child to communicate? Is it ok to go through Kindergarten entirely without talking? First grade? There is a real difference between intelligibility (how understandable a child is using speech alone) and comprehensibility (which take speech into account along with context). Some AAC strategies put context into an interaction, and that may be sufficient to support the childs communication. These strategies might include alphabet (first letter) supplementation, indicating the topic being discussed, indicating a change in topic, etc. An evaluation to determine a particular childs needs is invaluable to determine the best AAC supports.
When discussing AAC, one of the first concerns voiced by parents and caregivers is that use of AAC might prevent the child from talking, or further delay development of natural speech. In response, I refer to the excellent Cumley (2001) article included on the Apraxia-KIDSSM web site. His research demonstrated that AAC does not deter a child from using speech to communicate, if and when it is effective for him/her. Moreover, as speech increasingly becomes the primary mode of communication (with development of functional natural speech), AAC tools and strategies will be gradually phased out of the childs communicative strategies. In fact, the child will phase out use of AAC on his/her own, when speech becomes more effective and efficient.
If you have decided to explore AAC as a means to help your child communicate for today, this is a specialized process that has many steps. Seek out a speech-language pathologist with expertise/knowledge in AAC. In the school system, these experts are often found on an Assistive Technology team, but may be identified by the district in many ways. Your childs current speech pathologist at school should assist you in this process. If you prefer to obtain this service in the community, it is important to contact various clinics to ensure that (1) the speech-language pathologist has expertise in AAC, and (2) during an evaluation your child will have an opportunity to interact with several different types of devices from different manufacturers. This will ensure that the device that best meets his/her needs is selected.
We do expect children with apraxia to use natural speech as a primary mode of communication someday. In the meantime, it makes sense to use AAC as a means of communication (or to supplement communication) to aid in language development and reduce your childs frustration. Using AAC does not alter the need for intensive and frequent speech treatment. It just provides a means to bridge the gap between effective and ineffective communicative interactions. Although we never lose sight of our final goal using natural speech we also need to think in terms of appropriate and functional communication today.
American Speech-Language-Hearing Association. “Augmentative and Alternative Communication: Knowledge and Skills for Service Delivery.” ASHA Supplement 22 (2002): 97-106.
Beukelman, David R., and Pat Mirenda, eds. Augmentative and Alternative Communication: Management of Severe Communication Disorders in Children and Adults. Baltimore, Maryland: Paul H. Brookes Publishing Co., 1998.
Caruso, Anthony A. and Edythe A. Strand, eds. Clinical Management of Motor Speech Disorders in Children. New York: Thieme Medical Publishers, Inc., 1999.
Cumley, Gary D. Children With Apraxia and the Use of Augmentative and Alternative Communication. Apraxia-KIDS. 2001
Dowden, P. “Augmentative and Alternative Communication Decision Making for Children with Severely Unintelligible Speech.” Augmentative and Alternative Communication 13 (1997): 48-58.
Light, J. “Interaction Involving Individuals Using Augmentative and Alternative Communication Systems: State of the Art and Future Directions.” Augmentative and Alternative Communication 4 (1988): 6-82.
[Dyann F. Rupp, M.S., CCC-SLP is a speech-language pathologist for the RiteCare Clinic of the Scottish Rite Masons in Lincoln, Nebraska. She received her M.S. from the University of Nebraska – Lincoln and has worked as a speech-language pathologist and assistive technology specialist in school and clinical settings. She can be reached at firstname.lastname@example.org.]