Recursos en Español
Para encontrar recursos de ASERT que han sido traducidos al español, haga clic aquí.
To find ASERT resources that have been translated into Spanish, click here.
Augmentative and Alternative Communication (AAC)
You may have heard the word AAC when talking about individuals who have difficulty with spoken language. But what does it mean? AAC stands for augmentative and alternative communication. In simpler terms, it means all the ways we communicate without speaking. Some people use AAC for augmentative reasons because their speech may be hard to understand. Other people use AAC for alternative reasons because they do not speak or can only say very few words.
There are 3 different types of AAC no tech, low tech, and high tech.
NO TECH
For no tech AAC, you only need your body to communicate. Examples include nodding/shaking your head, waving, thumbs up/down, or sign language.
LOW TECH
For low tech AAC, you need material, but it doesn’t say anything when you use it. Examples include PECS, communication books, or writing your message.
HIGH TECH
For high tech AAC, you will use a system that is electronic, such as an iPad or a speech generating device. These systems use communication applications, such as Proloquo2Go, LAMP, or TouchChat.
- Common AAC Myths
- Wait Time
- Modeling
- Levels of Communicators
- FAQ's
- Core Words and Fringe
- AAC Competency
- Prompting Hierarchy
- Communicative Functions
Myth: AAC IS A “LAST RESORT” INTERVENTION
Research shows that early integration of AAC in speech language therapy is important because it helps with the development of language,communication, and social skills.
Myth: AAC WILL PREVENT SPOKEN LANGUAGE DEVELOPMENT
Research shows that AAC can increase natural speech when therapy uses a multimodal approach using both AAC and spoken communication. There is no evidence that AAC decreases or prevents speech from developing.
Myth: AAC IS ONLY WHO ARE FOR NON INDIVIDUALS SPEAKING
AAC is for any person who does not have reliable speech. If an individual is having trouble communicating using speech, AAC is a tool that can help them meet their communication needs.
Myth: AAC IS NOT APPROPRIATE FOR INDIVIDUALS WITH COGNITIVE DISABILITES
Depending on the needs of the individual, AAC systems range from simple switches to communication books to high tech speech generating devices (SGDs). Communication systems are developed based on the specific strengths and needs of the individual.
Myth: AAC WILL SOLVE ALL COMMUNICATION PROBLEMS
Success with AAC is based on many different factors, but it can help individuals with any level of expressive language needs by providing them a reliable means to communicate and fix communication breakdowns.
WHAT IS WAIT TIME?
Wait time is when we intentionally pause during interactions e.g., the communication partner is not speaking, not pointing to the device they are just waiting until the AAC user makes an attempt to communicate using their communication system.
IMPORTANT THINGS TO REMEMBER
Wait time is different for every AAC user. You will find the best wait time for through trial and error. Start with 5 seconds and increase as needed. The silence that comes with providing wait time may feel awkward for communication partners because we want to fill the silence, but it is very important that we give the AAC user that wait time and silence. Unlike spoken language, AAC requires additional time for AAC users to navigate their device or select the correct symbols or words. That is why waiting is very important. They need that extra time. Being patient is important. Don’t rush or pressure the AAC user. Giving wait time respects the pace of their communication.
Modeling is very important! We learned to speak by watching and listening to others speak, so it is important for our AAC users to see and hear other people talk using their communication system.
Below are some things to remember when modeling:
- GET THE COMMUNICATION SYSTEM The communication system should always be available.
- MODEL KEY WORDS Touch the buttons of the key words you are saying. You don’t need to model everything you say, but model the important words.
- MODEL – A LOT! The amount of times you model on the device is important. Model all day, every day, everywhere.
- EXPAND AND ADD ON Add to what they are saying. If they are using their device and only saying single words, model how to use two words. If they are using two words, model three. Help them grow their language by modeling.
- MODEL DIFFERENT COMMUNICATIVE FUNCTIONS We communicate for so many reasons. We ask for things, ask for help, make comments, and share information. There are so many things to talk about!
Level 1:
Emergent Communicators
An emergent communicator primarily uses non-symbolic communication, such as facial expressions, body language, gestures, and vocalizations. These communicators may not understand or use symbolic communication reliably (e.g., speech, sign language, pictures). Communication is limited to the ‘here and now’ and not about past or future events. Highly familiar communication partners often communicate for them. Language precursors of joint attention, imitating, and turn-taking may be delayed or impaired.
LINGUISTIC COMPETENCE
The linguistic goals for emergent communicators include:
- Identifying basic and high frequency vocabulary
- Requesting
- Rejecting/ Protesting
SOCIAL COMPETENCE
The social goals for emergent communicators include:
- Understanding cause/effect for communication
- Establishing joint attention
- Imitating actions
- Participating in routines
OPERATIONAL COMPETENCE
The operational goals for emergent communicators include:
- Reliably accessing symbols
- Selecting symbols intentionally
STRATEGIC COMPETENCE
The strategic goals for emergent communicators include:
- Recognizing the need to gain their communication partners attention
MAIN FOCUS
Work towards developing symbolic communication and receptive knowledge of symbols. Use vocabulary that is highly motivating. Focus on choice making and requests. Establish a positive relationship with their communication system.
Level 2:
Wants-Needs Communicators
A wants-needs communicator understands symbolic communication. These individuals communicate primarily to meet their basic wants and needs. Their vocabulary consist of highly motivating nouns and verbs. The generally only communicate for one function: requesting. There is little to no social intent for communication. They communicate at the one-word level. They do not recognize communication breakdowns, and if they do, they do not know how to repair them.
LINGUISTIC COMPETENCE
The linguistic goals for wants-needs communicators include:
- Expanding vocabulary to include nouns, verbs, and descriptors
- Answering simple routine WH questions
- Combining words to expand spontaneous utterance length
SOCIAL COMPETENCE
The social goals for wants-needs communicators include:
- Responds to greetings and farewells using a single word utterance
- Maintains attention to communication partner during conversation
- Replaces challenging behavior with messages
OPERATIONAL COMPETENCE
The operational goals for wants-needs communicators include:
- Transports and positions device
- Uses basic navigational symbols (e.g., home button)
- Opens communication application
- Turns device on/off
STRATEGIC COMPETENCE
The strategic goals for wants-needs communicators include:
- Asking for help
MAIN FOCUS
Remember that communication is more than requesting. Focus on increasing vocabulary and target different functions of communication. Model one level above their spontaneous productions.
Level 3:
Context Dependent Communicators
A context-dependent communicator has reliable symbolic communication that is limited to a person or context. These communicators rely on cues from familiar communication partner when using their AAC system. Their vocabulary is increasing to include pronouns. They are beginning to formulate routine short phrases. Strategic competency is beginning to develop, especially recognizing communication breakdowns and attempting to repair them.
LINGUISTIC COMPETENCE
The linguistic goals for context dependent communicators include:
- Expanding vocabulary to include pronouns
- Increasing length and complexity of utterances
- Asking pre-stored simple WH questions
SOCIAL COMPETENCE
The social goals for context dependent communicators include:
- Using greetings and farewells
- Using routine comments (e.g., fun, yuck)
- Using polite social forms (e.g., thank you)
OPERATIONAL COMPETENCE
The operational goals for context dependent communicators include:
- Adjusting volume based on surroundings
- Continue developing competence with navigating the system and accurately selecting symbols
STRATEGIC COMPETENCE
The strategic goals for context dependent communicators include:
- Recognizing communication breakdowns
- Using simple repair strategies, such as repeating the message
MAIN FOCUS
Communicators at this stage communicate very well with familiar individuals and contexts. They may not be as competent with unfamiliar individuals or different contexts and will most likely require more support. Start working towards building grammatically correct phrases and sentences.
Level 4:
Transitional Communicators
A transitional communicator communicates for a variety of purposes, appropriately asks and answers questions, and is formulating utterances of increased length and complexity. They communicate with a variety of different communication partners and are relying less on familiar contexts and partners. They participate in basic conversational exchanges and are beginning to repair communication breakdown. Spelling skills are beginning to emerge.
LINGUISTIC COMPETENCE
The linguistic goals for transitional communicators include:
- Expanding vocabulary to include abstract concepts
- Using plurals and verb tenses
- Improved sentence structures
- Answering higher level WH questions
- Asking more WH questions
SOCIAL COMPETENCE
The social goals for transitional communicators include:
- Engaging in 2-3 conversational turns
- Maintaining topic
- Asking partner focused questions
- Appropriately interrupts an interaction (e.g., excuse me)
OPERATIONAL COMPETENCE
The operational goals for transitional communicators include:
- Monitoring battery life
- Navigates between using symbol-based communication, pre-programmed messages, and keyboard
- Recognizes need for additional vocabulary or topics
STRATEGIC COMPETENCE
The strategic goals for transitional communicators include:
- Independently uses an introduction strategy with communication partner – tells partner they use AAC for communication, etc.
MAIN FOCUS
Communicators at this stage are gaining greater independence across all competency levels. Grammar is a big focus at this stage along with answering and asking a variety of WH questions. They occasionally rely on context and cues for success.
Level 5:
Independent Communicators
An independent communicator has achieved mastery with all 4 competence levels. They use their communication system across all environments with familiar and unfamiliar communication partners with the same level of success. They recognize barriers that may impact their ability to communicate effectively and can use strategies to overcome them.
LINGUISTIC COMPETENCE
The linguistic goals for independent communicators include:
- Generates utterances of increased length and complexity
- Sequences information in a logical manner to tell or retell a story
- Uses morphological endings
SOCIAL COMPETENCE
The social goals for independent communicators include:
- Requests clarification
- Continues to maintain and demonstrate appropriate conversational skills
- Continues to ask partner focused questions
OPERATIONAL COMPETENCE
The operational goals for independent communicators include:
- Manages need for equipment upgrades and repairs
- Independently adds vocabulary
- Accesses external equipment (e.g., phone, email)
STRATEGIC COMPETENCE
The strategic goals for independent communicators include:
- Uses multiple strategies to repair breakdowns
- Plans ahead for specific communication, such as composing and pre storing messages for a doctor’s appointment
MAIN FOCUS
Communicators at this stage are independent and are meeting expectations for their age. They require no support to use their device. They communicate efficiently and effectively across settings with both familiar and unfamiliar communication partners.
WHAT IS AAC?
AAC stands for Augmentative and Alternative Communication. It encompasses a variety of tools, strategies, and devices that can help individuals who have difficulty using spoken language communicate effectively.
HOW DO I CHOOSE THE RIGHT AAC PROGRAM?
An AAC evaluation should be conducted by a speech language pathologist (SLP). They will identify the best system based on the individual’s communication needs, physical abilities, cognitive level, and preferences.
WHO CAN BENEFIT FROM AAC?
Anyone can use AAC, but it is especially helpful for individuals of all ages who have difficulty with spoken language, such as autism, cerebral palsy, stroke, ALS, or other neurological conditions.
IS AAC ONLY FOR PEOPLE WHO CANNOT SPEAK?
No, AAC is for anyone who has difficulty with spoken language. It can be used by individuals who have some speech but need more support to communicate effectively, as well as those who are non speaking.
WILL USING AAC STOP SPEECH FROM DEVELOPING?
No, research shows that using AAC does not impact speech development. In fact, AAC can help support spoken language development by providing a means of communication, reducing frustration, and encouraging language learning.
ARE SPEECH-GENERATING DEVICES (SGDs) COVERED BY INSURANCE?
The cost of AAC devices, also known as SGDs, are often covered by insurances, Medicaid, or other funding sources. An SLP can help with the process of obtaining funding.
HOW LONG WILL IT TAKE TO BECOME PROFICIENT WITH AAC?
It depends on the individual using the system. There is no specific timeline in which proficiency in AAC will develop. It’s important to provide consistent practice using the system, to frequently model on the device, and provide lots of support.
CAN AAC SYSTEMS BE PERSONALIZED?
Yes, it important to personalize the system to reflect an AAC user’s preferences and needs. This can include customizing vocabulary, symbols, and voice settings.
CORE WORDS
Core words are high frequency words that are used for a variety of reasons across many different settings. These words are typically verbs, adjectives, and pronouns. They are rarely nouns. Core words make up over 85% of what we say in our everyday speech. On a speech-generating device, core words show up repeatedly on many different pages. They generally remain in the same spot on each page. Their frequent presence in the communication system reflects their frequency of use in our daily communication.
Examples of CORE WORDS:
play more help different finished up
down again put in out want
look little my you
FRINGE VOCABULARY
Fringe vocabulary are very specific words for a specific activity or situation. They are mostly nouns.
On a speech-generating device, fringe vocabulary words do not show up repeatedly in the communication system. They are found on a specific page based on that topic.
ball bubbles movie song Elmo
book bag dog iPad car
shirt head toothbrush cookie flower
table Walmart
Linguistic Competency:
Understanding and using the words/symbols and vocabulary of their communication system. This area of competency is related to how well an AAC user can express themselves and understand others. It is more than just knowing the words/symbols; it’s about being able to use them to communicate.
KEY ASPECTS OF LINGUISTIC COMPETENCE
Vocabulary Knowledge
- Receptive language: understanding language and understanding the different words on their communication system
- Expressive language: Using words on their communication system to communicate and express themselves
Syntax and Grammar – arranging words to follow the rules of the language
Morphology – changing parts of the word to change their meaning
Semantic Understanding – understanding the meaning of words and how they related to one another in sentences
Symbol Knowledge – AAC systems use symbols, pictures, or icons instead of (or alongside) written words. Some symbols are concrete and are easily recognizable, but others may be abstract and not as recognizable
Cultural and Social Language Use – Language use can vary depending on the cultural or social contexts. It also includes informal versus formal language.
ACTIVITIES TO DEVELOP LINGUISTIC COMPETENCE
Modeling – use the communication system yourself when talking with the AAC user
Reading – use the communication system to read together and talk about the story
Daily Routines – use the communication system to label items and actions
Play – use the communication system during fun activities
The key thing to remember is to use it the communication system every day so the AAC user can learn their system and develop their language skills.
Operational Competency:
The skills an AAC user needs to use and maintain their communication system.
KEY ASPECTS OF OPERATIONAL COMPETENCE
Basic Device Use – turning on/off a high-tech device, charging a device, and adjusting settings such as volume and brightness.
Navigation Skills – many communication applications require have many different pages and folders that an AAC user will need to learn how to navigate.
Access Method – knowing how to access their communication system based on their physical abilities. This can include touching the screen, activating a switch, using eye gaze, or other input methods.
Maintenance – updating the communication application and device software, troubleshooting problems, backing up the system, and cleaning the device.
Communication Application Use – knowing how to add words, change/modify buttons, add/modify pages, and changing the appearance of symbols. These customizations help improve use of the system for the AAC user.
Emergency Procedures – knowing who to contact for technical support and having a back-up communication system if their system needs to go out for repair or is not working.
ACTIVITIES TO DEVELOP OPERATIONAL COMPETENCE
Daily Routines – create daily routines where they learn to charge their device, to wear it when transitioning, and cleaning when dirty
Guided Exploration – Explore the device together to learn how to navigate the system, discover different functions, and explore different categories
Daily Routines – use the communication system to label items and actions
The key thing to remember is to teach the skills necessary to use and maintain their communication system. This will help develop responsibility and give them a sense of ownership of their system.
Social Competency:
The skills and abilities that an AAC user needs to effectively participate in social interactions. It includes the rules of conversation and how to develop and maintain social relationships.
KEY ASPECTS OF SOCIAL COMPETENCE
Initiating and Maintaining Conversations – knowing how to start a conversation, greet others, ask/answer questions, make comments, and stay on topic. AAC systems might have specific phrases to help with conversations, such as the AAC users name and prestored questions to ask.
Understanding Social Cues – understanding nonverbal cues such as body language, tone of voice, and facial expressions.
Expressing Emotions – being able to share how we feel, such as happy, sad, or frustrated. It is also important to be able to read other people’s emotions and respond appropriately.
Communicating in Different Social Contexts – knowing when to use formal language and informal language, such as talking with a teacher or boss versus talking with friends and family.
Repairing Communication Breakdowns – recognizing when a message hasn’t been understood and taking steps to clarify or rephrase a message.
Building Relationships – using their communication system to develop and maintain friendships
ACTIVITIES TO DEVELOP SOCIAL COMPETENCE
Games – play games to learn turn taking and how to interact with others
Video Modeling – use videos to learn how to engage in positive social interactions
Peer Interactions – real life interactions with peers will provide opportunities to learn, practice, and problem solve social skills
The key thing to remember is to participate in activities that encourage interacting with other people to learn and practice these skills.
Strategic Competency:
The skills and abilities that an AAC user needs to overcome limitations of their communication system and overcome communication challenges.
KEY ASPECTS OF STRATEGIC COMPETENCE
Repairing Communication Breakdowns – recognizing when a message hasn’t been heard or was not understood. Learning when to repeat a message versus taking steps to clarify the message by rephrasing.
Using Different Modalities of Communication – knowing how to switch to other modalities of communication if their communication system is not available, such as using gestures, facial expressions, sign language, or writing.
Overcoming Device Limitations – developing ways to work around limitations of the communication system, such as when a word is not on the device. This can involve finding other way to say the words, either using synonyms or by describing.
Timing and Pacing – have preprogrammed message or using text prediction to increase to speed up communication, especially in fast paced conversations
Self Advocacy – having preprogrammed phrases in the device to let a communication partner know about their communication skills and needs. For example, having a preprogrammed message that says: “I understand what you are saying. I use this device to communicate. Please give me time to write my message.”
ACTIVITIES TO DEVELOP STRATEGIC COMPETENCE
Practice repairing communication breakdowns – using scenarios or role playing
Synonym Description Game – learn how to describe words
Practice Different Modalities of Communication – practice different ways to communicate that don’t involve the communication system
Text Prediction – develop literacy skills and learn how to use text prediction to speed up communication
The key thing to remember is that developing these skills will help the AAC user develop independency, self-advocacy, and engage in effective communication.
The prompting hierarchy is a step-by-step approach and starts at the least restrictive manner and increases to the most restrictive. The goal is to stay as close to least restrictive as possible.
NATURAL CUEING
The AAC user is given the opportunity to communicate independently without any prompts. This is the goal where the individual initiates and uses the communication system on their own.
EXPECTANT PAUSE
Use of wait time. This brief, intentional pause is used to encourage the individual to use their communication system independently
INDIRECT VERBAL PROMPT
Asking an open-ended question to encourage use of their communication system. It’s a subtle cue to use their communication system without directly telling them to use it.
DIRECT VERBAL PROMPT
Explicitly telling the individual to use their communication system. This can include telling them where to go to formulate their message.
GESTURAL PROMPT
Pointing to the specific button the individual needs to select to navigate their system and to create their message.
MODELING
The communication partner shows the individual how to use the communication system by showing them exactly what to do and how to say it.
PHYSICAL PROMPT
Physical assistance is provided. This includes partial hand over hand assistance (e.g., supporting them at their elbow) and direct hand over hand assistance (e.g., guiding their hand). We should avoid this type of prompting.
Below are some of the different reasons why we communicate:
REQUESTING
Asking for things, actions, or help
Examples: I want cookies, blow bubbles, I need help
REJECTING/REFUSING
Saying that one does not want something or does not agree
Examples: no, stop, all done, no like
COMMENTING
Sharing thoughts, feelings, or what we see
Examples: I like that, I feel mad, I see a dog, yummy
GREETINGS
Saying hello, goodbye, or other social niceties
Examples: hi, bye, please, thank you
ASKING QUESTIONS
Seeking information from others
Examples: What is your name? Where is my iPad?
GIVING INFORMATION
Providing information, answering questions, or telling stories
Examples: My name is, I am going to the park
EXPRESSING EMOTIONS
Sharing feelings like happiness, sadness, or frustration
Examples: I feel mad, I am happy
SOCIAL INTERACTIONS
Engaging in conversation, making jokes, or participating in social activities
Examples: Your turn, Do you want to play a game?
Other downloads
| Name | Description | Type | File |
|---|---|---|---|
| What is AAC? | You may have heard the word AAC when talking about individuals who have difficulty with spoken language. But what does it mean? AAC stands for augmentative and alternative communication. | Download file: What is AAC? | |
| Common AAC Myths | This resource deals with some of the common myths about AAC, and explains what the truth is. | Download file: Common AAC Myths | |
| Wait Time | Wait time is when we intentionally pause during interactions e.g., the communication partner is not speaking, not pointing to the device they are just waiting until the AAC user makes an attempt to communicate using their communication system. | Download file: Wait Time | |
| Modeling | Modeling is very important! We learned to speak by watching and listening to others speak, so it is important for our AAC users to see and hear other people talk using their communication system. | Download file: Modeling | |
| Levels of Communicators | This resource explains elements of different communicators, like: Emergent Communicators, Wants-needs Communicators, Context Dependent Communicators, Transitional Communicators, Independent Communicators. | Download file: Levels of Communicators | |
| FAQs about AAC | This resource answers some of the most common questions about AAC. | Download file: FAQs about AAC | |
| Core Words and Fringe Vocabulary | This resource explains the difference between Core words and Fringe vocabulary words and provides examples of each. | Download file: Core Words and Fringe Vocabulary | |
| AAC Competencies | Understanding and using the words/symbols and vocabulary of their communication system. This area of competency is related to how well an AAC user can express themselves and understand others. | Download file: AAC Competencies | |
| Promoting Hierarchy | The prompting hierarchy is a step-by-step approach and starts at the least restrictive manner and increases to the most restrictive. The goal is to stay as close to least restrictive as possible. | Download file: Promoting Hierarchy | |
| Communicative Functions | This article lays out some of the common reasons why we communicate with each other. | Download file: Communicative Functions |