1. Augmentative/
Alternative
Communication
Cassandra M. Mariano, M.A., CCC-SLP
Jessica M. Antioco, M.S., CFY
2. Acknowledgements
• Students & Families
• Dr. Joanne Gerenser, Executive Director
• Jan Downey, M.A., CCC-SLP, Director of
Speech Services
• Eden II Speech Staff, past and present
3. What does AAC stand for?
• A – Augmentative
• A – Alternative
• C – Communication
4. Why do we need to talk about AAC?
• Because more than 50% of students at our
Granite Ave school alone use an AAC system.
• Because Autism significantly impairs a person’s
abilities particularly in the areas of language,
communication and social relations
5. What exactly is AAC?
• The American Speech, Language and Hearing
Association defines alternative and augmentative
communication (AAC) as an “area of clinical
practice that attempts to compensate, either
temporarily or permanently, for the impairment
and disability patterns of individuals with severe
expressive communication disorders.”
6. Why might a student require an AAC
system?
• They do not use verbal speech as a reliable
means of functional communication.
• They might require the system:
– To Augment their speech
– As an alternative to speech
7. Augmentative Communication
• Refers to “any approach designed to support, enhance,
or supplement the communication of individuals who
are not independent verbal communicators in all
situations” (Niciosi, Harryman, & Krescheck)
• An augmentative communication system supports
existing language and communication skills.
• Students using a system in an augmentative context
should be required to verbally approximate.
9. What’s the difference?
• Augmentative SUPPORTS verbal speech
• Alternative REPLACES verbal speech
• Important to note: Whether or not a system is
augmentative OR alternative depends on the
student not the system itself. Ex: For Johnny,
sign language may be an augmentative system.
For Billy, sign language may alternative.
10. Things to consider…
• Does the student have an effective
communication system?
• Is the system being used appropriately by the
student?
• Is the system being used appropriately by the
staff?
• Is there carry over between home and school?
12. Impact of Autism
Hallmarks are :
– A breakdown in all three communication components
(encoding, transmitting and decoding)
– Difficulty understanding language concepts
– Failure to comprehend gestures
– Lack of spontaneous use of language
– Lack of imagination
– Deficits in understanding and using appropriate language
– Restricted or limited knowledge of vocabulary
– Difficulty understanding spoken language
13. Impact of Autism on Speech
• 30 – 50 % of individuals with Autism may never
develop functional speech
• Functional speech is speech that can be understood by
people who are not familiar with the speaker under all
conditions.
• Many of those students who are verbal have articulation
and phonological errors, which makes their speech less
intelligible.
15. What are the modes of
communication?
• Verbal speech
• Body language
– Gestures
– Pointing
– Facial expressions
– Body posture
– Eye contact
• AAC systems (Augmentative/Alternative
Communication)
16. Benefits of AAC systems
• Enhances communicative competence
• Faciliates the development of language skills
• Research suggests that AAC systems may
increase speech production
• May increase speech intelligibility in some
individuals
• Evidence indicates that AAC interventions do
not have a negative impact on speech
production (Light, Millar, Schlosser 2006)
17. Benefits continued…
• Provides an effective and appropriate means of
communication in individuals who are unable to
meet their communication needs using speech
• Decreases inappropriate and maladaptive
behaviors that are a result of an inability to
communicate effectively
• May reduce the pressure from the demands of
speech production in order to focus on
communication
18. Misconceptions
• Inhibits speech production
• Negatively impacts the emergence of speech
• Individuals may prefer to use their AAC system
and not be motivated to learn to use speech
• Many clinicians perceive that they must make an
“either-or” decision; i.e. pursue speech
development or introduce an AAC system. (Light,
Millar, Schlosser 2006).
19. “No Tech” Systems
• “No Tech” systems – do not require an outside power
source.
– Picture Exchange Communication System (PECS) –
developed by Andy Bondy, PhD and Lori Frost, CCC-SLP in
the 80’s. This is a system where pictures on a board or in a
book initially represent desired items and activities and then
moves on to other language concepts. The student exchanges
the picture with a communicative partner.
– Sign language
– Picture boards
– Written scripts
21. PECS - Pros
• The picture exchange requires interaction with a
partner.
• You can use it to enhance eye contact.
• Portable
• Inexpensive – you can make your own pictures
either with Boardmaker (Mayer Johnson
pictures) or any digital image or photo (Google
Image is a great place to find some)
22. PECS - Cons
• Depending on how many pages a student has,
finding the desired picture can be slow.
• SO easy to lose pictures.
• Can be clumsy.
27. Picture Boards - Pros
• Provides direct selection
• Visual and concrete
• Cost efficient
• Durable
• Portable
• Can be made specific to needs
• Easily understood
28. Picture Boards - Cons
• Exchange is not required
• No turn taking
• Requires a point
• May reduce eye contact
30. Written scripts - Pros
• Reduces prompt dependency (written prompts
are easier to fade than verbal prompting)
• Made specific to individual’s neds
• Can be easily updated
• Offers a variety of script fading and prompting
options tailored specifically to a student’s need
• Allows for consistency across instructors
31. Written scripts - Cons
• No verbal model
• Requires continuous changes while fading
• Does not promote eye contact (when first
introducing a script)
34. Voice output - Pros
• Direct selection
• Visual and concrete
• Can enhance syntax
• Verbal model remains constant
• The user can be responded to as a competent speaker
• Can be made specific to needs
• Easily understood
• Easily updated
• Can have unlimited vocabulary
35. Voice Output - Cons
• Devices can be very expensive
• Can break down
• Requires programming
• May promote stereotypy
• Can be heavy/bulky
36. What do our students currently use
their AAC systems for?
• Requesting
• Exchange of personal information
• There are SO many more opportunities for
language once the system is taught…
37. What COULD our students use their
AAC systems for?
• Requesting for preferred or needed items and activities.
• Requesting for the bathroom.
• Commenting – “I like this juice.”
• Denying – “No, I didn’t go to the park.”
• Labeling – “That’s a dog.”
• Initiating greetings
• Responding to social questions and exchanging of
personal information - “My name is Fred. I live in
Staten Island.”
38. Assessment, Referral and Evaluation
• Determine an individual’s communicative needs
• Evaluate components of their existing
communication system
• Assess prerequisite skills (fine motor, matching,
object/picture identification etc.)
39. Now what?
• Parents, speech therapists and teachers may
recommend that an individual be referred for an AAC
evaluation.
• An evaluation by a team of qualified professionals is an
important component in the selection of appropriate
systems
• It is essential that someone on the team has knowledge
of Autism and ABA.
• An understanding of the unique characteristics of the
individual student including learning styles and
maladaptive and stereotypical behaviors.
40. Resistance
• Sometimes we find that our students parents are
initially resistant to the idea of an AAC system.
• Why? Because they feel we are giving up on their
children becoming verbal communicators.
41. What do we say?
• There is no evidence that supports the assumption that
use of an AAC system decreases the likelihood of
speech development.
• Research has shown that when an AAC system is
introduced, many children actually demonstrate an
increase in speech, language and communication skills.
• At this time, there is insufficient evidence to indicate
the superiority of one system over another to promote
speech.
42. Issues to consider when teaching an
AAC system
• Identify goals
• Plan your targets beforehand
• Introduce systematically (For example, we may
want to start with one icon and add accordingly).
• Begin with highly preferred items – Initially,
these items should be “free access” and
immediately available.
43. And the survey says…
• A survey was recently conducted amongst Eden II and
Genesis school staff to gauge feelings and beliefs about
AAC systems.
• Of those that were invited to participate, respondents
included speech pathologists/therapists (40%), teachers
(28%), behavior specialists (8%) and teacher assistants
(24%).
• Of those that responded, 75% have been employed by
Eden II/Genesis for 5 years or less. 4.2% worked
between 5 and 10 years. 20.8% have been with the
agency less than 1 year.
44. Survey results
• Respondents 80
were asked to 70
rate how 60
familiar they are 50 Extremely
with various 40
familiar
Somewhat
systems. 30 familiar
20 Not familiar
10
0
Sign PECS Voice Picture
output boards
45. How important is it for a child with
limited speech to have an AAC system?
• For those that chose “it
80 depends” we got a variety
70
of explanations including -
Not “It depends if the child is
60 important educated or advanced
50 Somewhat enough to use it properly.”
important
40 “I feel if a child is somewhat
Crucial verbal we should be
30
prompting them more to
It
20
depends
talk. If a child has no
10 speech they should have
an AAC system.”
0
46. I work with students who use…
100
90
80
70
Verbal Speech
60
Sign language
50
PECS
40
Voice ouput
30
Picture Board
20
Combination of systems
10
0
types of
systems
47. Staff’s level of comfort with systems
90
80 Comfortable with
various systems
70
60 That I have been
50 instructed on systems
40
That I understand my
30 student without a
system
20
That my student truly
10 needs a system
0
Always Sometimes Never
49. Spontaneity continued
• 80% of staff feel that students need consistent
prompting to use their AAC system.
• Comments made on the survey indicate that
most staff feel as though students act mainly as
respondents with their systems.
50. Favorite device
• 68.2% of staff reported that their favorite system
to work with is a voice output device.
(Compared with 22.7% who preferred PECS
and 4.5% that preferred sign language).
• Respondents indicate that they have more
experience with a voice output device and see
more spontaneity in requests and initiations with
it.
51. Why do they like voice output
devices?
• Responses included:
– Provides a child with a voice
– Commands attention easily
– Gives students a large vocabulary
– Voice output provides a model for students to
imitate.
– Helps promote intelligibility and good articulation
52. Least favorite system
• Results of this survey indicated that staff found
picture boards to be least preferred.
• Only 8.3% feel that they have experience with it
and 4% feel that it leads to spontaneous
requesting and/or initiations.
53. Why don’t they like picture boards?
• Responses included:
– Not that familiar with picture boards
– Boards are very limited
– Boards reduce eye contact
– Boards are easily bent and lost
54. Challenges
• “The system is not send in from home or device
is not sent in charged.” (62.5%)
• “My student has a device that is always broken
and out for repair.” (54.2%)
• “Content on the system does not match what I
need in the classroom.” (41.7%)
• “The system or device is too bulky or takes up
too much room on the desk.”(29.2%)
55. Why aren’t systems out in the
classroom?
• We know how important it is to have the student’s
system available to them at all times. Why then do we
see students without their systems?
• 80% of respondents say its because the device was not
sent in from home or it was not sent in charged.
• 10% say they have not been properly trained on the
system.
• 10% say that they understand their student without
their system.
56. Staff need more training – what is
appropriate?
• 92% of staff 60
feel that they 50
would benefit 40
from Twice a month
Once a month
30
increased staff Quarterly
training. 20 Twice a year
• 58.3% stated 10
that quarterly 0
trainings
would suffice.
57. Training for Staff
• Training staff on AAC systems, especially voice
output device, should include:
– Basic device operation (on/off button, restart
button, recording and charging)
– Teaching methods (correct prompting procedures,
knowledge of whether the system is augmentative or
alternative and whether we are requiring a verbal
approximation)
– AAC systems should be with students at all times.
58. Training for parents/caregivers
• Are parents/caregivers aware of who to contact
regarding AAC system?
• Are parents/caregivers trained to use system?
• Are parents/caregivers aware that the system
must be sent to school daily? And if it’s a device,
that it must be charged?
59. Group Activity
• What skills do we look for?
• What system would YOU give a student?
60. Profile 1
• Male student, 4 years old
• Non-verbal communicator, will babble spontaneously
during play, indicates wants by reaching and grabbing.
• Can receptively identify 15+ objects and between 10-15
pictures.
• He can match identical objects, pictures and objects to
pictures.
• Poor eye contact
• Limited fine motor skills
61. Profile 1
• Would this student need an augmentative system
or an alternative system?
• What system would you pick for this child and
why?
• What “back up” system would you recommend?
62. Profile 2
• Female student, 13 years old
• She is a verbal student with multiple articulation errors, she
speaks in a low tone and exhibits rapid speech when frustrated
• Not easily understood by unfamiliar listeners
• Can receptively and expressively identify a multitude of objects
and pictures
• Is currently matching categories
• Previously used PECS until age 7 when she started using verbal
speech.
• Often requires prompting to make requests.
• Fine motor skills intact
• Exhibits hand flapping
63. Profile 2
• Would this student need an augmentative system
or an alternative system?
• What system would you pick for this child and
why?
• What “back up” system would you recommend?
64. Profile 3
• Male student, 3.5 years old
• He is a able to imitate one syllable words but does not use
speech to indicate wants and desires
• He reaches and grabs for desired items
• Excellent with non- verbal imitations
• Good fine motor skills
• Can match identical objects
• At present time, cannot receptively identify objects
• Behaviors include sweeping objects/materials off desk onto floor
• Has two one concept commands in discrimination
• Responds to name with head turn
65. Profile 3
• Would this student need an augmentative system
or an alternative system?
• What system would you pick for this child and
why?
• What “back up” system would you recommend?
66. Profile 4
• Female student, 8 years old
• Student is passive and often prompt-dependent
• Utilizes verbal speech to make wants and needs known
• Excellent fine motor abilities
• Is matching categories
• Is stronger receptively identifying pictures
• Will occasionally cry and/or laugh for unknown
reasons
• Parents requested for a system that would enable her to
be more independent/spontaneous
67. Profile 4
• Would this student need an augmentative system
or an alternative system?
• What system would you pick for this child and
why?
• What “back up” system would you recommend?
