American Speech-Language-Hearing Association
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Information for AAC Users

Who uses AAC?

More than 2 million people in the United States have a severe communication disorder that impairs their ability to talk. This problem may be short or long and may be congenital (present at birth), acquired (occurring later in late), or degenerative (worsening throughout life). Common causes of severe expressive communication disorders that may require the use of AAC are shown in the following table:

Congenital Causes Acquired Causes Degenerative Causes
Cerebral palsy Stroke ALS
Autism Head injury Muscular dystrophy
Mental retardation Spinal cord injury AIDS
Physical disabilities Cancer Huntington's disease

For more information about individuals who use AAC systems, see ASHA's report "Communication Facts: Special Populations: Augmentative and Alternative Communication." Read a personal story from an AAC user and the story of Louis, the Trumpeter Swan

How do I know if AAC is for me or a loved one?

Selecting the best way to communicate is not as simple as getting a prescription for eyeglasses. It is important to obtain an evaluation by a group of professionals to develop the best communication system to meet your needs.

You can have an evaluation at a:

  • medical facility
  • private practice
  • school district
  • center-based program

An evaluation should involve a team of professionals working together. In addition to the AAC user and his or her family and caregivers, this team often includes the following:

  • Speech-language pathologist
  • Physician
  • Occupational therapist
  • Physical therapist
  • Social worker
  • Learning specialist
  • Rehabilitation engineer
  • Psychologist
  • Vision specialist
  • Vocational counselor
  • AAC user and family/caregivers

Team members evaluate the person's needs, current means of communication, and potential for using different kinds of AAC. Over time, team members may change as the person's needs change.

After a decision has been made to select an AAC system, it is important to have professional follow-up. This may simply be a one-time training or may require speech-language services that focus on the development of communication using the system over a period of time.

Professionals need to help the individual and communication partners learn a variety of skills and strategies (e.g., meaning of hand signs and operating a piece of electronic equipment)

How do people use AAC systems?

There are two primary ways that people access AAC. Access is the way an individual makes selections on a communication board or speech generating device. Direct selection and scanning are two forms of access.

  • Direct selection–includes pointing with a body part such as a finger, hand, or toe, or through the use of a pointing device such as a beam of light, headstick, or mouthstick. Those with severe physical impairments may need to access systems by using a switch. The switches can be turned on with a body part, puff of air, or wrinkle of an eyebrow.
  • Scanning–one type involves the use of lights on a system that pass over each choice and the user activates a switch to stop the light and pick a choice, other types are auditory scanning and scan patterns ( such as row/column, quadrant, step, and linear). Scanning requires less motor control but possibly more cognitive skill than direct selection access.

How language is represented in AAC systems

There are three basic ways to represent language in an AAC system: single-meaning pictures, alphabet-based systems, and semantic compaction.

  • Single-meaning picturesdo not require reading; the symbols are only one picture, but the group or symbol set is huge for a significant vocabulary (e.g., a 3-year-old would need a set of 1,100 pictures to represent his known vocabulary); some meaning to pictures must be taught since it is difficult to represent some words with pictures.This system is used the least compared with the others.
  • Alphabet-based systemsdo require reading; symbol sequences are long (systems that can predict words after the first several letters can reduce the number of letter selections).
  • Semantic compactiondoes not require reading; symbol sequences are short, typically between one and two symbols per word; symbol set is small (fitting on a single overlay to the AAC device). This system is used the most often.

Most people who rely on AAC may use more than one of these methods to communicate.

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What questions should I ask my speech-language pathologist?

The following are questions to ask a speech-language pathologist (SLP) before an AAC evaluation:

  • Do you typically provide services in the area of AAC?
  • How long have you worked in the area of AAC? Have you worked with anybody who has a similar problem?
  • Do you work as part of a team? What members are on the team?
  • After evaluation, what will you do to make the communication plan work? Will you do the follow-up treatment?
  • What specific kinds of communication options (e.g., additional treatment, gesture, sign language) do you recommend?
  • Where can I go to see and talk with people using AAC?
  • How soon can you schedule an evaluation? What will it cost? What kinds of payment do you accept?
  • If you recommend a particular device, will you help me find funding for its purchase?
  • Will I be able to see actual equipment that might be recommended? If not, where else could I go to see it?

The following are questions you should be able to answer after an AAC evaluation:

  • What communication approaches have been recommend?
  • Which approaches will be used for various modes of communication? Quick phrases? Expressing feelings? Giving and getting information? Conversation with family and friends? Written communication?
  • What symbols (e.g., letters, pictures, graphics, words, or phrases) will be used on boards or devices?
  • Is there enough flexibility in the recommended communication system so that communication is possible in a variety of settings?
  • Will special equipment or switches need to be bought or made?
  • What body positions can be used to increase communication and function?
  • Can the recommended system be modified as capabilities and needs change?
  • Why were the recommended techniques chosen?
  • Which professionals will be carrying out the recommended communication plan and how often must they be seen?
  • Can I talk with current users of the system I am thinking about?

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