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Augmentative and Alternative Communication (AAC)

Description: Refers to methods of communication to either enhance or replace conventional forms of communication (spoken language). Individuals with significant impairment in communication skills may rely on augmentative communication systems to express their needs, wants, and feelings. There are a variety of augmentative communication systems that are available including gestures, sign language, picture exchange (such as PECS), pointing to pictures, and electronic devices that include voice output. Each system has unique advantages and disadvantages so the ultimate choose of a system should be predicated on a complete evaluation. Such an evaluation should consider the individual’s existing skills, his/her communication needs, and the skills needed to interact with others.

Research Summary: Studies indicate that AAC may improve communication skills for children with autism spectrum disorders who have limited or no verbal communication skills when ABA teaching methods are used to teach AAC. However, benefits appear to be limited. “Children with good verbal imitation skills demonstrate better speech production than those with poor verbal imitation skills, with or without AAC” (National Research Council, 2001, p. 58). Regarding sign language, “It is important to note that simple signs may be a support for children learning to speak or an additional mode of communication for children who have no speech or limited speech. However, it is very rare to find a child with autism spectrum disorder who learns to sign fluently (in sentences) and flexibly. Signing is not generally an entry point into a complex, flexible system” (National Research Council, 2001, p. 58). Similar findings have been reported for the Picture Exchange Communication System (see the research summary for PECS). There are case reports of children with autism spectrum disorders becoming proficient with electronic voice-output devices, but studies with strong scientific design have not been conducted on the use of such devices for children with autism spectrum disorders.

(See also the section on the Picture Exchange Communication System)

Recommendations: The application of ABA methods to teach AAC is an appropriate intervention for children with autism who have limited or no communication skills. Because of the scientific support for AAC, professionals and families may wish to obtain additional information about this approach; resources are listed in the references below.

To increase the utility of this intervention, an important area for future research is to investigate AAC methods for promoting initiation of communication and acquisition of complex, flexible language.

Selected References:

Systematic reviews of scientific studies:

• Hourcade, J., Pilotte, T. E., West, E., & Parette, P. (2004). A history of augmentative and alternative communication for individuals with severe and profound disabilities. Focus on Autism and Other Developmental Disabilities, 19, 235-244.
• National Research Council (2001). Educating Children with Autism. Washington DC: National Academy Press.

For additional information:

• Beukelman, D. R., & Mirenda, P. (2005). Augmentative and alternative communication: Supporting children and adults with complex communication needs (3rd ed.). Baltimore: Paul H. Brookes.