Augmentative and Alternative Communication (AAC) Devices for Children and Adults with Developmental Disabilities

Augmentative and Alternative communication devices (AAC) are an evidence-based practice based on applied behavior analysis. Augmentative and alternative communication (AAC) incorporates a wide range of processes that augment, complement, or replace the speech of individuals with complex communication needs (Elsahar et al., 2019). Those with complex communication needs encompass approximately four million people within the United States. Due to the increasing prevalence of Autism Spectrum Disorder (ASD) and other disabilities that are impacting communication along with language skills, the exact number has increased over the years (Light&McNaughton, 2012). 

Augmentative and alternative communication (AAC) interventions for children and adults with intellectual developmental disabilities help increase those functional communication skills. Aided AAC refers to systems that require external or additional support outside of the speaker's body, and unaided systems include manual sign and gestures. These systems include high-tech speech-generating aided communication systems and low-tech systems, for example, symbols on a ring or in a book. AAC modalities refer to the different systems of AAC; for example, aided or unaided, high or low tech, along with different access methods (touch screen, eye gaze, head pointer).

At times, utilizing just a manualized system like the Picture Exchange Communication System (PECS) can lack sufficient support, making it harder for the one attempting to communicate (Crowe et al., 2021). Unaided AAC systems such as gestures and manual signs require gross and fine motor skills in their repertoire, functional use of hands and fingers, along with a trained communication partner familiar with gestures. 

AAC solutions can be classified further into three categories:

No-tech ,which is considered the oldest of the AAC categories, relies heavily on the  interpretation of facial expressions and voluntary motor movements to deliver non-verbal messages. 

Low-tech encompasses basic tools, for example, books and display boards with extended images and phrases that help to aid the communication process

High-tech refers to the use of electronic devices to achieve a target. Devices that fall into this category include smart devices and dedicated AAC devices, integrated hardware to support the user’s communication needs (Elsahar et al., 2019). 

The potential for AAC interventions has increased over the last thirty years, with solutions for those with a speech disability. However, although high-tech systems are evolving, low-tech systems are usually the first techniques tried as the usage of display boards and communication books is more cost-effective and easily obtainable to users (Elsahar et al, 2019). Along with the high cost associated with these high-tech devices, the training can be complicated, thus decreasing the usability. 

Strategies to help support the AAC user:

Ensure constant and easy access: Keep the device charged, near the user, and physically in sight at all times, including during meal time, outside, and anywhere the user might be. 

Personalize the device: Customize the device with the user's favorite themes, colors, and vocabulary to reflect the user's interests, hobbies, and cultural background to increase intrinsic motivation to use the device. 

Model using the AAC device: Demonstrate how to use the device by modeling the use of words and phrases in various contexts. This can include pointing at words on the device.

Create communication opportunities: Design activities that encourage spontaneous communication, and prompt the user to use their device. This is called a communication rich environment.

Engage in conversation: Ask open-ended questions that require more than a yes or no answer to encourage more thoughtful dialogue.

AAC users still use combinations of unaided low-tech methods together with an aided high-tech device, as suitable for the context of usage and the person they are conversing with. The ability to communicate effectively and efficiently your wants and needs, and actively participating in social exchange can improve quality of life, independence, social closeness, or relationships between individuals (Chan & Zoellick, 2011). These technologies are constantly evolving and incorporating the diverse needs and ever changing aspects with users with disabilities. 

References:

Chan, D.M., & Zoellick, M.R.B. (2011). World report on disability, 24. World Health Organization.

Crowe, B., Machalicek, W., Wei, Q., Drew, C., Ganz. J. (2021). Augmentative and Alternative Communication for Children with intellectual and developmental disabilities: A mega review of literature.

Elsahar Y., Bouazza-Marouf K., Kerr D., Gaur A., Kaushik V., Hu S. (2019). Augmentative and Alternative Communication (AAC) Advances: A Review of Configurations for Individuals with a Speech Disability. 

Light J, McNaughton D. The changing face of augmentative and alternative communication: Past, present, and future challenges. Augmentative and Alternative Communication. 2012;28(4):197–204.

De Spiller-Smith, Miren Behavior, Behavior Specialist