Beyond Words: Communication Tools that Empower

Graphic and photo of celebration, confetti, speech bubbles, paper people in background overlayed with a photo of a man with down syndrome smiling and holding a communication device iPad.

Communication is not just about talking; it’s about making connections, expressing needs, sharing emotions, and asserting control over your life. Imagine how it would feel to live a life without being able to communicate. A life that doesn’t allow you to let the people you care about know how you feel. Being able to communicate is essential to human dignity and mental well-being. It allows people to have an active role in their everyday life.

Augmentative and Alternative Communication (AAC) was developed over time to assist people who, some or all of the time, cannot rely on their speech. The term Augmentative means to add to someone’s speech, while alternative means to be used instead of speech. AAC is comprised of multimodal systems that can supplement a person’s vocal impairment and is used all around the world.

Photo of diverse group of young people with different ethnic backgrounds, skin colors, and gender. The green background shows speech boxes "Everyone has a voice"

Early Usage

The term “Augmentative and Alternative Communication” has evolved over time, especially as technology has advanced. Since the early 1900s there has been a push to find other ways for people with severe expressive communication disorders to make their wants and needs known.

The history of AAC has grown drastically since it’s inception to the world in 1920. The “F.Hall Roe Communication Board” was the first known AAC device created. It allowed individuals to point to letters and words to form sentences. However, there was no option that existed on this board for people who were not yet literate. Many of the first devices created were heavy and bulky.

Today, there are estimated to be hundreds of thousands of augmentative and alternative communication systems available. With so many to choose from how does one decide which AAC system or device is appropriate for them? Let’s look at the different types of AAC systems we have at our fingertips.

Non Verbal Autism PEC Board with a graphic of a man wearing glasses pointing to one of the cue cards "drink"

Two Primary Categories

AAC systems can be broken down into two main categories; by technology and by the type of aid needed.

By Technology

The use of technology in AAC can be divided into three categories; no-tech, light-tech, and high-tech.

No-Tech examples:

Gestures
Facial expressions
Body language
Sign language

Photo of a young Caucasian woman demonstrating different facial expressions and hand gestures. The graphic icon in top left corner demonstrates successful communication by picturing two people, a speech bubble with puzzle pieces an a green check mark

Light-Tech examples:

Picture exchange communication systems (PECS)
Communication books
Simple word or picture cards

Photo of picture exchange communication system PECS or communication cards. The graphic icon in top left corner demonstrates successful communication by picturing two people, a speech bubble with puzzle pieces an a green check mark

High-Tech examples:

iPads with communication apps
Text-to-speech software
Speech-generating devices
Eye gaze technology

Photo shows elderly woman and man using an iPad which can have communication apps or other software to help. The graphic icon in top left corner demonstrates successful communication by picturing two people, a speech bubble with puzzle pieces an a green check mark

Using technology can assist the people we support to become more independent, have greater social engagement, and provide control over their lives. Unfortunately, as with many other things in life, there can be some drawbacks in using high-tech AAC systems. Sensory overload, cost of electronics, and accessibility to these devices have been known to put people at a disadvantage.

By Type of Aid

AAC includes unaided and aided methods of communication.

Unaided AAC relies on the person’s own body, without external support. This option may be difficult for people that lack fine motor skills.

Unaided examples:

Sign language
Gestures
Facial expressions
Body language

Photo of two people communicating through American Sign Language. The graphic icon in top left corner demonstrates successful communication by picturing two people, a speech bubble with puzzle pieces an a green check mark

Aided AAC requires some forms of external support. These external tools and supports include items that are no-tech, light-tech, or high-tech.

Aided examples:

Paper and pencil
Communication boards
Speech generating devices
Electronic devices

Photo of an iPad with lots of colorful apps. The graphic icon in top left corner demonstrates successful communication by picturing two people, a speech bubble with puzzle pieces an a green check mark

Having access and education on both types of aids can prove beneficial as people can use different systems in different contexts of their lives. For example, the individual may use facial expressions when communicating with their family or friends but may use a type of external aid with others they do not know well.

Deciding on an AAC Device

Choosing an AAC system or device involves the ongoing consideration of multiple factors.

Cognitive ability – If the person can communicate with speech or vocalizations, they may need a device that supplements their communication. While people who do not use vocal speech may need a different type of device to replace speech.
Physical ability – The person’s motor skills will determine how well they can use the AAC device.
Communication environment and lifestyle – Discuss where and how it will be used. The device should also have the pictures, words, and symbols they use on a typical day.
Consistent availability of the device – To be an effective means of communication for the person, the device or system needs to always be available to the person. Devices should be light enough for the individual or support person to carry and work in a variety of environments.

Summary

AAC devices can assist people of all abilities to live their lives to their fullest potential. It can be a powerful tool that leads to increased independence, stronger social relationships, and the ability to advocate for themselves.

Though finding the right AAC system may seem daunting, it is a crucial step in providing the people we support with a voice. The team (user included) should start by assessing the person’s cognitive and physical abilities. The person’s environment and lifestyle should also be considered. Once those factors are taken into account, the team can look at AAC systems by the type of technology they require and how much aid would be beneficial to them.

Don’t get discouraged if certain AAC systems do not progress the user’s communication abilities. Remember that communication is dynamic and the team might need to change or try different forms of AAC throughout a person’s life. Keep at it! Everyone deserves to be able to communicate and interact with each other.