When a speech-language pathologist first mentions AAC, many parents feel a mix of hope and worry. Will a picture board or talking app help my child communicate right now? Or will it mean they stop trying to talk? These are fair questions, and there's published research on them. Here's what AAC is and what the guidance says about some of the most common worries.
What is AAC?
AAC stands for augmentative and alternative communication. ASHA's Practice Portal describes it as an area of clinical practice that supplements or compensates for difficulties with producing and/or understanding language, in both spoken and written forms.[1] ASHA explains that AAC can be:[1]
- Augmentative, when it adds to speech a person already has
- Alternative, when it's used in place of speech that is absent or not functional
- Temporary, such as for patients recovering after surgery
AAC is used across the lifespan, including by people with developmental disabilities, acquired conditions, and neurological differences such as autism.[1] ASHA cites an estimate that approximately 5 million Americans may benefit from AAC.[1]
Myth 1: "AAC will stop my child from learning to talk"
ASHA addresses this worry directly. It notes that some people believe AAC reduces motivation to speak and delays language development. However, ASHA states that "AAC use may help improve natural speech when used in a multimodal approach."[1] Several research reviews have looked at this question:
- A 2006 research review of studies from 1975 to 2003 found no cases among the most rigorous studies in which speech decreased after AAC intervention. Most participants showed gains in speech, though the gains were usually modest.[3]
- A 2008 systematic review focused on autistic children concluded that AAC interventions "do not appear to impede speech production and may result in increased speech production." The authors also noted that the gains were modest and that expectations should be realistic.[4]
- A 2021 review that updated and extended the 2008 review found that, overall, AAC resulted in improved speech production for autistic individuals, but speech gains did not surpass AAC use.[6]
In other words, research to date does not show that AAC holds back speech, and many children in these studies used more speech over time. The same reviews also describe the speech gains as modest and call for realistic expectations.[4, 6]
Myth 2: "My child is too young" or "needs certain skills first"
ASHA notes that both families and professionals sometimes assume young children aren't ready for AAC until they reach school age.[1] ASHA's position is clear: "There are no prerequisites for AAC intervention."[1] ASHA also addresses the belief that skills like showing communicative intent or understanding cause and effect must come first, noting that impaired cognition does not rule out communication.[1]
On age, ASHA reports that early AAC use can help develop speech and language, and that AAC can increase vocabulary for children with developmental delays who are 3 years old and younger.[1] In one randomized study of 68 toddlers with developmental delays who were speaking fewer than 10 words, the children in parent-coached interventions that included AAC developed larger vocabularies than the children in a spoken-only intervention. The authors concluded that augmented communication "does not hinder, and actually aids, speech production abilities" in the young children they studied.[5] ASHA's consumer affiliate puts it simply: "It's never too early or too late to use AAC."[2]
Myth 3: "AAC is only for children who can't talk at all"
ASHA considers anyone a candidate for AAC if their communication abilities don't meet their communication needs.[1] Some people use AAC all the time, some use it only sometimes to help others understand their speech, and some need it only for a short period.[2] People who use AAC can use both speech and AAC to talk with others.[2] The Practice Portal lists improving speech production and intelligibility as one possible focus of AAC intervention.[1]
Myth 4: "AAC means an expensive tablet"
AAC comes in many forms. ASHA separates it into two broad types:[1]
| Type | What it includes |
|---|---|
| Unaided AAC (no external tool) | Body language, facial expressions, gestures, manual signs, finger spelling, and vocalizations[1] |
| Aided AAC, no-tech and low-tech | Communication boards and books, pictures, photographs, objects, visual schedules, drawing, spelling, and writing[1, 2] |
| Aided AAC, high-tech | Apps on tablets or smartphones, computers with artificial voices, and speech-generating devices[2] |
Many people use a combination of tools throughout the day.[2] Coverage varies: some AAC tools are covered by insurance and some are not, and an SLP can help families understand their options.[2]
Myth 5: "Once my child has a device, they'll figure it out"
Families often wonder how children actually learn to use an AAC system. ASHA describes an approach called augmented input, also known as aided language stimulation or aided language modeling. In this approach, a communication partner says words while also pointing to the matching symbols on the child's AAC system.[1] SLPs also help find the right tools, teach the child how to use them, and teach family members and other people in the child's life how to communicate with them.[2] If you'd like support using AAC at home, our parent training page explains how coaching works.
A note on respect: ASHA supports a "zero-exclusion" policy for AAC services, and states that the time and effort involved in setting up AAC should not be a reason to exclude someone from intervention.[1] AAC isn't a sign of giving up on a child. It's one more way to make sure they can be heard.
The bottom line
The research reviewed here does not support the fear that AAC stops children from talking, and ASHA is clear that children don't need to earn access to it. AAC can be as simple as gestures and pictures or as complex as a speech-generating device, and the right fit depends on the child. If you're wondering whether AAC could help your child, a speech-language pathologist can assess their communication needs and talk through options with you. You can learn more on our speech therapy and autism support pages, or read our guide to echolalia and gestalt language processing.
Sources
- American Speech-Language-Hearing Association (n.d.). Augmentative and Alternative Communication (Practice Portal). ASHA.
- Communication Health Support Association (n.d.). Augmentative and Alternative Communication (AAC). CHSA, the consumer affiliate of ASHA.
- Millar, D. C., Light, J. C., & Schlosser, R. W. (2006). The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: A research review. Journal of Speech, Language, and Hearing Research.
- Schlosser, R. W., & Wendt, O. (2008). Effects of augmentative and alternative communication intervention on speech production in children with autism: A systematic review. American Journal of Speech-Language Pathology.
- Romski, M., Sevcik, R. A., Adamson, L. B., Cheslock, M., Smith, A., Barker, R. M., & Bakeman, R. (2010). Randomized comparison of augmented and nonaugmented language interventions for toddlers with developmental delays and their parents. Journal of Speech, Language, and Hearing Research.
- White, E. N., Ayres, K. M., Snyder, S. K., Cagliani, R. R., & Ledford, J. R. (2021). Augmentative and Alternative Communication and Speech Production for Individuals with ASD: A Systematic Review. Journal of Autism and Developmental Disorders.
Articles from Speech Me Therapy, a pediatric speech-language therapy practice in North Phoenix serving Scottsdale, Paradise Valley, and families across Arizona by telehealth. Our posts summarize published guidance from professional and public health organizations; sources are listed at the end of every article.