Augmentative and alternative communication

AAC is multimodal

People often combine speech, vocalizations, facial expression, body movement, gesture, sign, writing, pictures, and devices. One form may work well at home and another in a noisy community setting. Communication partners should recognize the person's reliable forms instead of requiring a single “correct” mode.

“Augmentative” describes support that adds to speech. “Alternative” describes another route. A person can use AAC while continuing to speak, and speech development should not become a gate to communication access.

A system includes more than a device

An AAC system can include vocabulary, symbols, access method, positioning, mounting, charging, carrying, partner strategies, backups, and repair support. A technically capable device may fail in daily life if it is unavailable, uncharged, out of reach, too slow, or unfamiliar to partners.

The current ASHA AAC practice portal describes aided and unaided AAC and says users should always have access to their communication tools or devices.

Presume communicative potential

Communication access should not depend on proving a list of cognitive, motor, imitation, or speech prerequisites. Assessment can identify effective access, language, vocabulary, symbol, motor, sensory, and partner supports while the person continues to communicate.

Treat behavior, gesture, body movement, and existing communication as information. Avoid interpreting every movement for the person. Offer direct opportunities, wait time, familiar partners, and a way to correct misunderstanding.

Assessment belongs to qualified roles

An SLP with AAC expertise evaluates communication and language needs within scope. Occupational therapy, physical therapy, vision, hearing, medical, educational, behavioral, technology, and family expertise may be relevant. The AAC user remains central.

Behavior analysts can support functional assessment, teaching, partner response, generalization, and measurement within competence and collaboration. A behavior-analytic label does not replace speech-language assessment or authorize device selection outside scope.

Vocabulary should support a full life

The system should enable requests, refusals, comments, questions, opinions, humor, relationships, pain reports, privacy, consent, assent, emergencies, and self-advocacy. Vocabulary limited to preferred items gives the person a narrow role.

Plan how new words are added and who may edit them. Preserve the person's established organization when possible. Discuss privacy for stored messages, history, contacts, and cloud features.

Partners need practical skills

Partners should keep the system available, model its use without demanding imitation, wait for communication, recognize multiple forms, respond to the message, and repair misunderstandings respectfully. They also need to know the backup route.

Measure partner access and response separately from the person's communication. A missing device or ignored message is a system failure, not a failed client opportunity.

Run an access audit across a full day

Choose a representative day and map waking, travel, school or work, care, recreation, meals, privacy, and emergencies. For each period, record the communication forms available, device position, charge, vocabulary, backup, partner competence, and any delay before the person can communicate.

Include transitions, bathrooms, outdoor activity, quiet time, and moments when a primary partner is absent. Ask the AAC user which gaps matter most and whether the system feels easy to use. Turn every gap into an owned action with a due date. Repeat the audit after a new device, schedule, setting, access method, or support person. Report system availability and partner response separately from the person's message frequency. Audit evening and weekend routines too.

A fictional museum example

Pilar uses speech, gesture, a tablet-based SGD, and a laminated backup board during science-museum visits. Across 14 planned visits, the primary system is charged and within reach in 12 of 14. The backup is available in 14 of 14.

Pilar communicates a choice, comment, question, or pause in several forms. Report message types without ranking speech above AAC. The two primary-device misses remain access failures with an owner. These counts do not measure Pilar's language ability or prove an intervention effect.

Protect ownership and continuous access

Clarify who owns the device, funds service, manages passwords, approves repairs, and receives it during transitions. Never use device removal as punishment, a motivator, or a way to force speech. If an immediate hazard requires moving hardware, provide an accessible backup and restore access promptly.

The current BACB Ethics Code addresses competence, collaboration, client involvement, consent and assent when applicable, communication, risk, and evaluation for covered professionals. The BACB Test Content Outline is examination content and does not create AAC authority.