Understanding augmentative and alternative communication
Augmentative and alternative communication brings together every means that replaces or supplements speech when speech is missing. A single term covers very different realities, from a simple gesture to a device that produces a voice on the person’s behalf.
Speaking does not come naturally to everyone. An autistic person, a person with cerebral palsy, a person with aphasia after a stroke or a person with a neurodegenerative disease may have reduced, absent or unstable access to speech. Augmentative and alternative communication, often shortened to AAC, brings together all the means that replace speech or supplement it so that a message can be understood. It depends on no particular diagnosis: it answers a need, the need to say something to someone.
Two words for a single field
The word alternative refers to means of communication other than speech, for a person who does not speak or no longer speaks. The word augmentative refers to means that supplement speech already present and make it clearer, for a person whose message remains hard for those around them to understand. The American Speech-Language-Hearing Association, ASHA, accordingly defines AAC as an area of practice that supplements or compensates for difficulties in the production or comprehension of spoken and written language.
In France, the Haute Autorité de Santé draws a similar distinction in its recommendations on autism spectrum disorder: AAC appears there among the means of communication to be offered, without waiting for any prerequisite to be acquired. The wording above is our summary and not a quotation: the reference text is linked at the foot of the page, and it is that text which is authoritative.
Who it is for
AAC concerns people whose histories are very different. Some live with a condition present from birth or early childhood, such as autism or cerebral palsy. Others lose part of their speech during their life, following a stroke, a head injury or a neurodegenerative disease. Others again lose the use of speech only for a limited time. A symbol requires no reading: that is what makes this family of tools useful in situations that are nonetheless very far apart.
- A condition present since childhood, such as autism or cerebral palsy.
- A condition acquired in adulthood, such as aphasia after a stroke.
- A neurodegenerative disease that gradually reduces access to speech.
- A loss of speech limited in time, during a hospital stay for instance.
- A situation where the language of the country differs from the person’s first language.
An American paediatric hospital, the Children’s Hospital of Philadelphia, distinguishes three situations that call for AAC: a complex communication disorder, such as aphasia, dysarthria or mutism; a need for physical access linked to motor or neurological difficulties; or the combination of the two, for example in autism, cerebral palsy or a neurodegenerative disease. Success with a simple tool does not automatically announce success with a more elaborate device: each situation calls for its own choice of tools, made with the person concerned.
Unaided, aided
The body alone, with no tool
Part of AAC draws on the person’s body alone: gestures, facial expressions, gaze directed towards an object or a person, or a full sign language. These forms, described as unaided, call for no object. They do assume sufficient motor control and shared points of reference with those around, in order to be understood, and they are often the first resource families draw on, before any tool is introduced at all.
A tool in addition to the body
The other part of AAC goes through a tool outside the body: a picture pointed to, a board of symbols, a book, a keyboard, or a device that produces synthetic speech. These forms, described as aided, range from plain paper to the most elaborate device. Most people who use AAC combine several of these tools according to the situation and the person they are talking to, rather than keeping to a single one.
From paper to screen
Aided tools also divide according to their technology. Non-digital tools, such as a book of symbols or a printed board, depend on no battery and work in all circumstances. Digital tools, such as an app or a dedicated speech-generating device, add a voice and a greater vocabulary capacity, but depend on a screen, a battery and sometimes on being set up in advance. The reference organisations in AAC recommend not relying on a single one of these modes, precisely because none of them covers every situation of daily life.
None of these situations comes down to a diagnosis: each one calls for tools chosen with the person, never on their behalf.
This article describes a communication tool and what verified sources report. It constitutes neither medical advice, nor advice on treatment, nor a diagnostic tool. Any question about an individual’s health is a matter for a health professional, the only person qualified to assess a particular situation.
The real cost of dedicated devices and the practices specific to hospitals are each the subject of a separate article on this blog. Words Within Reach belongs to the family of aided, digital tools, completed by a printable board for the moments without a screen: free of charge, with no account, and with no data leaving the device.
Sources
- Augmentative and Alternative Communication (AAC), American Speech-Language-Hearing Association (ASHA).
- Augmentative and Alternative Communication (AAC), Children’s Hospital of Philadelphia.
- Trouble du spectre de l’autisme : interventions et parcours de vie du nourrisson, de l’enfant et de l’adolescent, Haute Autorité de Santé.
- What is AAC?, ISAAC Canada.
This article is published under the CC BY 4.0 licence: copy it, translate it, republish it, crediting ODERSA.