Exploring Augmentative and Alternative Communication

by Dr. Karen Coulter

What is Augmentative and Alternative Communication (AAC)?  Simply put, it is a tool.  According to the Oxford online dictionary, a tool is ‘device or implement used to carry out a particular function.’  As a tool, the purpose or function of AAC is to augment a message or provide an alternative means for communicating when natural speech is not a functional option.  If a child or adult is unable to communicate using natural speech alone some form of AAC should be provided to support the most effective, interactive communication possible.   With this said, there are several of guidelines to bear in mind:

  • AAC is a process not a product
  • Everyone communicates and has a right to do so

In the process of sorting through the AAC toolbox you will need the help of a craftsman to pick the best tool and to learn how to use it.  That craftsman is a Speech Language Pathologist (SLP) with knowledge of AAC.

Tool selection by your SLP is one part matching needs and one part clinical skill.  When matching a tool within the diverse ASD population, each individual’s strengths and weaknesses must be taken into account.  Matching a tool to an individual takes clinical knowledge of how each strength and weakness lines up with any particular instrument.  The instrument isn’t as important as the individual’s needs.

Tool selection is a process not a product.  Within the selection process careful consideration must be given to what tools did or did not work before a final choice is made.  Perseverance can be as important to success as identifying barriers to AAC use. While this optimal system is being developed, an individual should never be without some a means of communication.  When an appropriate AAC system match is found for an individual, it will still need adjustments. Multimodal AAC systems are dynamic and must change as the needs of the individual change.

Other clinical skills a SLP provides include how to improve or shape an individual’s current communication into a more functional form.  Remember, learning to use AAC is learning how to use a new tool.  Changing the dynamic of communication expectations between individuals is the hardest step. In this process of change we are not only changing the AAC user’s behavior, we are changing our own.  Speech therapy offers accountability and coaching for this process.

Everyone communicates.  Everyone has a right to communicate.  These rights are summarized from the Communication Bill of Rightsput forth in 1992 by the National Joint Committee for the Communication Needs of Persons with Severe Disabilities. It states, ‘All people with a disability of any extent or severity have a basic right to affect, through communication, the conditions of their existence.’ How we communicate is the only difference.  Understanding how an individual with ASD currently communicates and identifying communication potential is part of the SLP’s clinical skill set.

Even though communication is a right for everyone, many times we turn on the mute button or take away a voice without knowing it.  For an individual with an AAC system self-expression can be obstructed or even stopped by a lack of access to appropriate vocabulary.  This issue can be addressed in part by the use of core and fringe vocabularies.  The AAC institute and Gail VanTatenhove elaborate on this topic.

AAC is an important to many individuals with an ASD diagnosis.  From 30 - 50% of these individuals are nonverbal and will remain so throughout their lifetime. Due to this need, the University of Louisville’s Autism Center will be continuing to provide further information about AAC in the upcoming months.  We have a previous webinar by Dr. Coulter, AAC 101 already available.  Future webinars will include the following titles: AAC Options –Different Technology Levels, AAC – the APPle of My iDevice and AAC Application – Developing Opportunities. She will also be hosting video podcasts covering the use of various AAC devices/ strategies.

Looking Further:

This list is not exhaustive and inclusion does not imply endorsement of the organization or the context of the Web site by Dr. Coulter.

Karen Coulter, Ph.D., C.C.C./S.L.P., A.T.P. is a Speech Language Pathologist and Assistive Technology Professional in the Department of Pediatrics at the University of Louisville’s Weisskopf Child Evaluation Center.  Dr. Coulter’s web site.


5 Things To Do Before You Choose an AAC App: Take A GULP. Zangari, C. January 11, 2012.  PrAACtical Thinking. March 12, 2012

Augmentative and Alternative Communication.1997. American Speech-Language-Hearing Association. October 17, 2012 Augmentative and Alternative Communication Decisions Adapted from a paper by Katya Hill, M.A., CCC-SLP, Assistant Professor, Speech-Language Pathology, Edinboro University of


AAC Institute. October 17, 2012 .

Baxter, S, Enderby, P, Judge, S,  & Evans, P. (2012). Barriers and facilitators to use of high technology augmentative and alternative communication devices: a systematic review and qualitative synthesis International Journal of Language Communication Disorders.  47(2), 115-129.

Guidelines for meeting the communication needs of persons with severe disabilities. (1992). ASHA, 34(Suppl. 7), 2–3.

Multimodal communication.  YAACK. 1999. October 17, 2012 .

Oxford Online Dictionary.  2012. October 17, 2012 .

KY Autism Training Center Fall 2012 Newsletter November 2012