AAC Awareness Day 2018

When people talk about Augmentative and Alternative Communication (AAC), they could be talking about quite a few different things. At its most inclusive, AAC is an umbrella term for all the ways people communicate without, or in addition to, verbal speech. As people usually mean it, AAC is an umbrella term for the communication strategies and supports used by people with disabilities that affect communication.

Organizations like the National Joint Committee for the Communication Needs of Persons with Severe Disabilities (NJC) work on research and advocacy related to communication support. One important document the NJC created is the Communication Bill of Rights. This Bill of Rights asserts that everyone has the right to affect their own conditions through communication, and it gets into specifics. People have the right to ask for things, make meaningful choices (including rejecting all the offered choices), and share opinions, comments, and feelings. If someone needs AAC to make good on those rights, they have the right to functioning AAC, all the time.

This means a whole lot of neurodivergent people have the right to functioning AAC, but might not know it yet. Part of that is because AAC research frequently focuses on children and on nonspeaking people. People with some speech who also need communication supports tend to get less attention, as do adults. Part of it is a tendency for AAC services to be tied to diagnoses, while not every neurodivergent person who could benefit from AAC has (or wants) a professional diagnosis that would lead professionals to consider communication supports. And part of it relates to prioritizing speech over other forms of communication.

However, there are a variety of reasons neurodivergent people can benefit from AAC. Some neurodivergent people don’t speak at all, and rely on AAC all the time. Other neurodivergent people can sometimes speak, but not always, and use AAC when they can’t speak. It’s also possible to find some topics easier or harder to speak about. For a person with alexithymia (difficulty identifying and describing one’s own emotions), AAC supports may make it easier to communicate emotion in ways others understand. AAC can even be a way to save a useful script, then use it when it’s needed.

There are also a variety of tools people can use to support communication. Some, like dedicated communication devices (think Dynavox), are very expensive and probably out of reach unless insurance will cover them. Others are cheap, like pen and paper. Yet others depend on expensive platforms, like phones, tablets, or laptops. The additional costs of these options varies: built in text-to-speech options may not cost anything extra. Texting someone, even face to face, may be included in a cell plan. Typing out a message, then reading it aloud, is possible using a variety of applications, including free ones. Applications designed for communication support can cost a few hundred dollars, though, and seem to be more commonly made for Apple devices than for Android ones.

It’s useful to consider what skills, interests, and needs a person has when choosing communication supports. If space will be limited, cell phones or other platforms that fit in a pocket may be preferable.
A rapid typist may prefer a text-based system and put less priority on saved words or phrases. Visual thinkers may prefer picture symbols. Access to electrical outlets can determine the usability of technological solutions. (Backup battery packs keep phones running longer. Conference badges to let fellow attendees know how social we want to be don’t need batteries. Neither do T-shirts with text or pictures.)

One person may want several AAC options. I know I do – I’ve got FlipWriter (iOS) and Proloquo4Text (iOS) and eSpeak (Windows, Mac, or Linux) and whiteboard markers and T-shirts with text on them and a pocket full of index cards to write on and hand to people at need. Oh, and I talk too, most of the time. AAC isn’t just for people who never speak at all.

American Speech-Language-Hearing Association. Augmentative and alternative communication. https://www.asha.org/Practice-Portal/Professional-Issues/Augmentative-and-Alternative-Communication/.
American Speech-Language-Hearing Association. Augmentative and alternative communication (AAC). https://www.asha.org/public/speech/disorders/AAC/.
Brady NC, Bruce S, Goldman A, et al (2016). Communication services and supports for individuals with severe disabilities: Guidance for assessment and intervention. Am J Intellect Dev Disabil. 2016; 121(2): 121-138.
Hanson E. My client talks! Do I still need to consider AAC in my treatment planning? Speech supplementation strategies: AAC for clients who talk!. Perspectives on Augmentative and Alternative Communication. 2014; 23(3): 124-131.
Holyfield C, Drager KD, Kremkow JM, Light J. Systematic review of AAC intervention research for adolescents and adults with autism spectrum disorder. Augmentative and Alternative Communication. 2017; 33(4): 201-212.

Alyssa is an Autistic PhD student in the Interdisciplinary Neuroscience Program at the University of Rhode Island. Among other areas, they study Augmentative and Alternative Communication, both in the form of brain computer interfaces and as used by autistic adults. Alyssa hosted a United States Society for Augmentative and Alternative Communication chat (#ussaachat) on AAC in the workplace and uses AAC part time.