Let’s “talk” about AAC!

What does smiling at a neighbor, sending a text, and ordering food by pointing to menu pictures have in common? They are all examples of AAC. By writing this blog, I am utilizing AAC to convey this message to you. So, the question is…

 

What is AAC?

Augmentative or Alternative Communication (AAC) refers to all the ways that we convey our thoughts and feelings without talking. Our world is full of AAC and for good reason- AAC is essential for well-rounded and effective communication across all stages of life. 

Individuals with speech, language, or voice disorders especially benefit from use of AAC to help increase their functional communication skills (Drager et al., 2010). Research has shown that use of AAC can increase expressive language skills, increase language comprehension, increase positive behaviors, increase social competence, and even support verbal language skills (Light et al., 2003; Millar et al., 2006).

People with communication disorders may benefit from additional support to incorporate AAC into their daily lives. Speech-language pathologists are trained to assess, recommend, and implement AAC with clients, based on their strengths and needs. At PlayWorks, we empower clients by using various types of AAC throughout therapy, as well as encourage AAC in home carryover activities.

 

What are the types of AAC? 

There are two general categories of AAC: unaided and aided systems.

Unaided AAC refers to the use of the body to communicate. Examples of unaided AAC include:

  • facial expressions
  • gestures
  • body language
  • sign language
  • non-word vocalizations (i.e., laughing, crying, cooing)

Aided AAC refers to communication supported by supplemental tools or equipment. These tools can be categorized as either low-tech AAC and high-tech AAC. Low-tech AAC includes tools that do not involve electronics or use of batteries. Examples include:

  • Writing
  • Objects
  • Pictures and symbols
  • Picture Exchange Communication System (PECS)
  • Communication boards or books

High-tech AAC refers to tools that use electricity, electronics, or batteries to operate. Some examples include:

  • Speech-generating devices
  • Recorded or digitized buttons/devices (such as the Staples “easy” button)
  • Computers (e-mail, texts, etc.)
  • AAC software on tablets, computers, phones, and other devices

Many dedicated high-tech AAC systems have supplemental equipment available that makes communication access and transportation easier. For example, certain devices have external speakers to help others better hear the speech-generated message. Cameras may be attached to track eye movements for those people who use eye gaze to create their messages. Devices may have special stands or carrying cases to make them more accessible for those in wheelchairs.

At PlayWorks, we support the use of low-tech and high-tech AAC by creating custom communication boards, using props or objects, and utilizing AAC applications on speech-generating devices.

 

Determining AAC needs

Communication is most effective when it’s multi-modal, or occurs in a variety of ways. Therefore, in order to best support individuals with communication delays and disorders, it’s important to implement and teach both unaided and aided AAC. Research shows that no prerequisite skills are required before starting AAC (Light & McNaughton, 2012; Snell et. al, 2010). However, it is important to consider a variety of personal factors when starting, including:

  • Current profile (physical/motor, language, cognitive, sensory, etc.)
  • Strengths and areas of need
  • Available communication partners
  • Setting or contexts in which the person will need to communicate
  • Resources available to both the individual and the communication partners
  • Individual preferences

Your therapy team will then use this information to determine which AAC tools and strategies will be most appropriate to trial, implement, and possibly purchase!

No matter a person’s age or ability level, AAC is a fundamental part of increasing functional communication. In my upcoming AAC blog posts, I will address common misconceptions surrounding use of AAC and expand upon ways to support an individual in their AAC journey. 

 

Questions or Concerns?

If you have questions or concerns about your child’s development, please contact us at info@playworkschicago.com or 773-332-9493. The Speech-Language Pathology team and the Assistive Technology team are available to provide individualized AAC recommendations based on your child’s needs.

Nicole Sherlock, MA, CCC-SLP

Assistive Technology Co-Coordinator

 

Citations & References:

American Speech-Language-Hearing Association. (n.d.). Augmentative and Alternative Communication (AAC). https://www.asha.org/public/speech/disorders/aac/. 

American Speech-Language-Hearing Association. (n.d.). Augmentative and Alternative Communication (AAC). https://www.asha.org/practice-portal/professional-issues/augmentative-and-alternative-communication/#collapse_1

Crowe B, Machalicek W, Wei Q, Drew C, Ganz J. Augmentative and Alternative Communication for Children with Intellectual and Developmental Disability: A Mega-Review of the Literature. J Dev Phys Disabil. 2021 Mar 31:1-42. doi: 10.1007/s10882-021-09790-0. Epub ahead of print. PMID: 33814873; PMCID: PMC8009928.

Drager, K., Light, J., & McNaughton, D. Effects of AAC interventions on communication and language for young children with complex communication needs. Journal of Pediatric Rehabilitation Medicine. 2010;3(4):303–310. doi: 10.3233/PRM-2010-0141.

Picture Exchange Communication System: Is PECS appropriate for my child?

When people think of communication, they often think of verbal communication. However, communication is not limited to one modality. In fact, communication can occur through a variety of modalities: verbal exchanges, written exchanges, facial expressions, gestures, sign language, etc. Picture exchange is another modality through which people can communicate. To capitalize upon this modality, Picture Exchange Communication System, or PECS, was created as a leading therapeutic technique for children who cannot yet verbally communicate.

As a pediatric speech-language pathologist, I often come across the question from parents, “Is PECS appropriate for my child?” Let’s dive into what PECS is, how it works, and for whom it may be appropriate.

What is PECS?

Picture Exchange Communication System (PECS) is a form of augmentative and alternative communication (AAC) that allows people to communicate using pictures. Although PECS contains a formal protocol that systematically moves through six phases of communicative exchanges, the method of picture exchange can be modified to meet the needs and skill level of the child.

How does PECS work?

  • Children using PECS are first taught a cause-effect relationship between pictures and communication. In other words, they learn that when you give a picture, you receive something in exchange.
  • Children are then taught to use pictures to communicate with different people across a variety of environments.
  • After the basic communicative exchange is established, the child learns to discriminate between multiple pictures in order to request specific objects or activities.
  • Pictures can then be combined to communicate phrases and sentences of increasing complexity, such as “I want ___.”

Who benefits from PECS?

PECS is often recommended for children who do not yet have a means of verbal communication. For PECS to be effective, however, the child must be motivated to communicate, as PECS relies upon the child initiating communication exchanges by giving pictures to another person. PECS also requires that child must have the cognitive skills to understand the cause-effect relationship between giving a picture and getting something in return. Therefore, a child who does not yet understand the cause-effect nature of a basic communicative exchange would be an inappropriate candidate for PECS until this skill emerges.

Myths Debunked

  • PECS is only for people who won’t learn to talk: The use of PECS does not imply that the child will never learn to use verbal language. In fact, the use of PECS can facilitate verbal communication by providing children with an outlet to reduce frustration and establish early communication skills.
  • PECS is only for people with Autism: PECS is frequently recommended for children with Autism Spectrum Disorder due to deficits in expressive language and social communication. However, recommendations of PECS should be child-specific and may or may not be appropriate for any child who does not have a means of verbal communication.
  • PECS only targets requesting: As a child moves through the PECS hierarchy, they can learn to use pictures for different functions, including requesting, answering questions, and ultimately, commenting independently. PECS involves high priority vocabulary to teach children that they can expand their expressive vocabulary to meet their wants and needs.

Questions or concerns?

If you have questions or concerns about whether PECS is appropriate for your child, please contact us at info@playworkschicago.com or 773-332-9439.

Jill Teitelbaum, MS, CF-SLP
Speech-Language Pathologist

References:

Bondy, A. (2001). PECS: Potential benefits and risks. The Behavior Analyst Today2(2), 127.

Vicker, B. (2002). What is the Picture Exchange communication System or PECS?.

Photo Credit: sitemaker.umich.edu

Frequently Asked Questions about Augmentative and Alternative Communication (AAC)

What is AAC?

AAC is a term used to describe any method of communication that adds to or “augments” speech. This can include anything from signs and gestures, to picture symbols or even high-tech devices involving computer technology.

Will AAC impact language development?

The use of AAC will not delay or impede language development, and often can help improve spoken language. It also allows for many individuals to express themselves fully when spoken language may be difficult.

Who uses AAC?

Anyone who has difficulty expressing themselves via spoken language may benefit from AAC. AAC users may have limited spoken language, unclear speech, or find spoken language difficult in social settings. The cause of the communication impairment may be present at birth (autism or cerebral palsy), occurring later in life due to injury or illness (stroke or head injury), or may worsen throughout the person’s life.

How do I know if AAC is right for my child?

Your child’s speech-language pathologist (SLP) can help guide you through the decision process. You may notice that your child is already using simple AAC such as signs and gestures in his therapy sessions. If a more robust system would be beneficial for your child, your child’s SLP may recommend a more comprehensive evaluation in which various professionals can help select the most appropriate system.

Meryl Schnapp M.A., CCC-SLP
Speech-Language Pathologist