Emily Higgins-Walsh is a Specialist Speech and Language Therapist working in the NHS to support chidren with speech language and communication needs (SLCN) across Lancashire and South Cumbria. Here, Emily discusses the advantages of flexible and person-centred communication tools for autistic people.

What is AAC?

Human communication is a complex process that uses a variety of methods. Lots of people use speech as their primary form of self-expression. However, we all use some alternative communicative methods such as waving, frowning, pointing, giving a ‘thumbs up’ or gesturing in countries which do not speak our home language. These communicative methods are all forms of AAC (ISAAC, 2023).
 
AAC stands for Augmentative and Alternative Communication (RCSLT, 2023). It refers to using communicative systems which augment a message and may be alternative to speech. Whilst the above forms of AAC are used by lots of people around the world, there are other forms of AAC such as visual communication books and electronic communication devices which are used less commonly. These should be personalised to meet the individual needs of a person and designed to reduce the unique communicative challenges they may face. AAC therefore enables people to communicate as effectively as possible, in as many situations as possible (Communication Matters, 2023).

What does AAC look like?

AAC is commonly categorised in the following ways:

1. Non-aided AAC. This includes communicative methods such as facial expression, body language, gesture and pointing. No additional tools or equipment are used beyond the human body. 
2. Aided AAC. This is generally organised into two further subcategories:

• Electronic AAC. This involves the use of electronic Assistive Technology equipment involving dedicated hardware and software options.  
• Paper-based AAC. This involves the use of paper-based communication tools such as PODD (Pragmatic Organisation Dynamic Display) books, spelling boards, auditory scanning books, e-tran frames etc.

Why use AAC?

The extent to which a person might use AAC depends on the ease with which they are able to use spoken language expressively.   AAC can be useful for many reasons:

• AAC enables individuals with unclear speech to reliably express themselves in alternative ways. 
• AAC can be versatile and bespoke; accessible via touch, switches, eye gaze and head pointing.
• It enables individuals with clear speech to augment their spoken message and add clarification or additional meaning. 
• AAC makes it possible to ensure the voices of non-speaking communicators are heard and acknowledged. 
• AAC empowers people with learning disabilities to communicate with as much independence as possible, with or without spoken language. 
• AAC can be used fluidly and interchangeably. During one communicative exchange, a person might use non-aided AAC as well as a variety of aided AAC, depending on what works best for them or what feels most comfortable. 

How can AAC benefit autistic people?

No two autistic people are the same and it is not advisable to approach the use of AAC within the autistic population with the view that one system works best for all. 

The ways different people with different communicative preferences and challenges might use AAC vary greatly.  

Some forms of AAC which have been researched specifically in relation to the autistic community, include: 

• PECS (Picture Exchange Communication System). PECS is typically used to teach autistic children with a speech and language delay how to initiate a request with a familiar adult by using picture cards. PECS is becoming an increasingly debated topic amongst speech and language therapists internationally (Alzayrer et al, 2021; Ganz et al, 2009). This is because PECS is based on the principles of Applied Behaviour Analysis (ABA). 
• LAMP (Language Acquisition through Motor Planning). LAMP is a therapeutic approach based on neurological and motor learning principles (Centre for AAC and Autism, 2023). Designed specifically with the autistic community in mind, LAMP works on the principle that there is one unique ‘rule’ (or motor plan) to express a specific word, like that of typical speech production. LAMP principles can be applied within both paper-based and electronic AAC systems to ensure maximum success. 
• Aided AAC can be beneficial in unique ways (Logan et al, 2017). Electronic AAC can support autistic adults without a learning disability to use communication methods (including text-based apps) to reduce social demand and anxiety in social situations. In addition, symbol-based software options (such as Proloquo2go / Grid 3 / TD Snap) can be used to empower autistic people with learning disabilities to express their thoughts, ideas and preferences independently (Light and McNaughton, 2014). 

Advice for professionals

It is important to liaise with a speech and language therapist to support you to access a thorough and robust AAC assessment (Dietz et al, 2012). There are many important factors which must be taken into account for each individual (Light and McNaughton, 2014). For example, medical needs, culture and individual strengths. 

Modelling how to use any AAC and working with the user to develop successful communication via a new means is essential (Binger and Light, 2009). Just as you wouldn’t expect someone to know how to play the piano by simply sitting in front of it once, new AAC users require time and support to learn how to use an aided AAC system expressively.
 
When supporting a person to use an AAC it is important to remember that communication is made up of a range of functions, including commenting, greeting, refusing, joking, asking and directing and not just requesting. 

The reference list below is full of resources for professionals to learn more about the uses, benefits and advice on the “do’s and don’ts” of AAC.

Conclusion

AAC arguably brings its own kind of magic to the boundaries of communication. It allows us to express ourselves more freely, flexibly and break limitations. Perhaps the most wonderful thing about it, is the creativity available within the field which makes it possible to meet the very individual needs of any one person (often using a multitude of systems, simultaneously!). In the words of the late Dr David Beukelman; one of the principle founders of AAC, [it] ‘is all about communication – connecting people with each other’ (Dietz et al, 2022).  

For further information, please explore the below useful websites list and article sources. 

Useful websites

• PECS 
• Liberator
• AssistiveWare
• AceCentre