How to Choose AAC for an Autistic Person

Alternative and Augmentative Communication (AAC) is a way for nonspeaking or partially verbal people to communicate. If you're a parent, teacher, or mentor to an autistic person who has difficulty communicating, AAC may be a good way for them to tell you what they have to say. There are many kinds of AAC, both high tech and low tech, and knowing which one to choose takes a little research and experimentation.

Part 1

Part 1 of 2:

Knowing Whether to Use AAC

1
Consider the person's verbal skills. If an autistic person is completely nonspeaking, has significant nonverbal episodes, or doesn't have strong enough speech skills for reliable communication, then they can benefit from some form of AAC. AAC can supplement limited verbal abilities or be used as a sole means of communication.^{[1]XResearch source}
- AAC may be a stepping stone to verbal speech. It helps develop many of the principles of communication and exchange in interactions, and doesn't hinder the development of natural speech.
2
Think about how much the person can communicate. Language has to be functional; saying words because you've been "trained" to say them after a particular stimulus isn't functional. Language needs to be a tool for communicating wants, needs, ideas, thoughts, and feelings. If an autistic person is not able to reliably communicate their thoughts, then they need AAC.
3
Consider how frustrating communication is. If you or the autistic person regularly become stressed, agitated, or overwhelmed trying to communicate, then help is a good idea.
- Teaching AAC can help reduce meltdowns and "acting out" that stems from frustration at not being understood. It can also strengthen relationships, since the person can tell you about problems and reach out to you for help when they need it.
4
Think about how well strangers and acquaintances can understand them. Ideally, an autistic person should be able to be understood by acquaintances as well as close loved ones. If they speak with a strong disability accent or with mannerisms, then the option of AAC might be useful.
5
Recognize that several forms of AAC might be useful to have around. For example, an autistic person who is usually able to type may need PECS (Picture Exchange Communication System) if they are very stressed. Abilities vary from day to day, and it's good to have several tools available.
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Part 2

Part 2 of 2:

Choosing a Type of AAC

1
Use picture exchange communication systems (PECS) for young children or previously uncommunicative people. PECS is useful to communicate basic needs, wants, and learning concepts, and is easier to teach and learn.
- At the very simplest level, the use of PECS involves the communicator handing a communication partner a card with what they want on it, like a picture of a cookie or the word "cookie"; however, word cards can be chained together on sentence strips to form full phrases like, "I want a cookie, please".
- The ability to add more words to the chain as the communicator builds skills makes it ideal for newer communicators. PECS can be a useful stepping stone for speech or more advanced AAC.^{[2]XResearch source}^{[3]XResearch source}
- PECS is not sufficient for people ready to communicate more nuanced ideas like feelings, jokes, and complex thoughts.
2
Use switches or buttons. Switches are often used by people with physical disabilities who need an workable way to access a computer interface or communicate. However, they're also useful for beginning to build communication skills in someone who doesn't communicate clearly with others yet.
- These low-tech devices often take the form of a big button that can be programmed with an audio recording of a short word or phrase. When the communicator pushes the button, the device speaks the phrase for them, issuing a request or expressing a need. Because they need to be pre-programmed for use, buttons and switches are generally not used for very complicated communication but as a stepping stone to more complex, higher-tech communication devices.
3
Try communication board apps for more complex visual communication. The autistic person points to a pictures to identify a need or create an approximate sentence.
- Communication boards work for those who can't read or spell very well yet, since the icons can be presented as pictures or pictures and words.
- This may be difficult for autistic people who have severe motor skills issues. Boards are also not terribly dynamic, meaning that they need to be prepared ahead of time and generally contain a limited set of icons, thereby limiting the communication possibilities for the user. They're good in the early stages but don't always "move" as fast as the communicator's needs.
4
Try an AAC app or device. High-tech AAC devices can be very expensive, but the rise of smartphones and tablets has allowed developers to build apps that do the same thing. Very simple AAC apps work similar to PECS in that the communicator's device can be pre-programmed with a set of icons representing needs, wants, and familiar items from their day-to-day life. These icons can also have an audio recording or text-to-speech snippet associated with them so that when the communicator presses the icon, a voice says the word aloud. As the user develops more communication skills, they can transition to chaining words and phrases together, switch from picture icons to written words, and transition into typing full sentences through the app.
- High quality AAC apps are designed with the input of professional speech-language pathologists and therefore aren't as cheap as some of their lower quality counterparts. The price tags may be higher but it's worth keeping in mind that many of these apps and layouts have had the professional input necessary to make them as functional and useful as possible; because of muscle memory and the chaining of concepts, where buttons are located in the app makes a difference for both learning and everyday use, and there is a science to it. You may find it's worth, if possible, investing in a slightly higher quality app in order to encourage the building of communication skills; otherwise the user may end up plateauing at expressing wants/needs, rather than growing their skills to expressing more complex thoughts.
- Because most smartphones and tablets have built-in cameras, adding new icons is fairly quick and easy, meaning that parents, teachers, and mentors can update the AAC to expensive devices around all day, you may well end up dropping them eventually, and a good case can help prevent damage!
5
Teach typing to people who know how to read and spell. Typing is a versatile form of communication that can be used to communicate nuanced thought.
- Young children may not have the cognitive or motor skills necessary to type. They need to learn to spell before they can type.
- People with severe motor skills issues may not be able to move their fingers well enough to type.
6
Consider Baby Sign or regular sign language. Sign language can be a great way to communicate with loved ones and the deaf and autistic communities. Loved ones can learn sign language along with the autistic person.
- Sign language may not be a good option unless the family is willing and able to set aside time to learn.
- Keep in mind that many forms of sign language (including AS) involve facial expressions in addition to gestures to communicate ideas. This may make sign language harder for an autistic person who struggles to read faces or make facial expressions.
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Tips

Consider meeting with a Speech and Language Pathologist (SLP) to help you choose a good method and teach it to the person.
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Make an effort to understand what the autistic person is trying to tell you, even if it's difficult. Knowing that you care and want to understand is highly important to your autistic loved one, and it encourages them to keep trying.
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Always presume competence.
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Warnings

While correct use of facilitated communication is hypothetically possible, there are also many examples of it falsely appearing to work—meaning that the person's family gave up on other communication methods that may have given their family member a true voice. Experts do not recommend facilitated communication, even for people with significant fine motor skill impairments.
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