The Ultimate Guide to Augmentative and Alternative Communication (AAC)

View Table of Contents

• What is AAC?
• Who Can Benefit From AAC?
• Types of AAC
• How to Implement AAC
• Challenges of AAC
• Cost
• Accessibility
• Lack of Awareness
• Social Stigma
• System Maintenance
• Limited Vocabulary
• 5 Benefits of AAC
• Improving Communication
• Enhancing Socialization
• Increasing Independence
• Supporting Academic Development
• Enhancing Quality of Life
• PECS
• Who is a candidate for PECS?
• How does PECS work?
• Benefits of PECS on ASD
• Communication benefits of PECS
• Social Communication benefits of PECS
• Benefits of PECS on Speech
• Benefits of PECS on Behavioral Issues
• Tips for parents & caregivers
• Tips for better communication
• Tips for teachers

AAC, which stands for Augmentative and Alternative Communication, is a system of tools and strategies that enhance or replace communication for people who have difficulty speaking or writing. AAC devices are electronic devices that allow individuals with communication difficulties to express themselves.

What is AAC?

Augmentative and Alternative Communication, or AAC, is a form of assistive technology designed to help people with communication challenges express themselves effectively. As a supplement or substitute for spoken language, AAC encompasses various methods, including gestures, symbols, images, and electronic devices.

The primary objective of AAC is to enable effective communication for individuals, irrespective of their physical or cognitive abilities. Those with disabilities like cerebral palsy, autism spectrum disorder, or Down syndrome, as well as people who have suffered strokes or brain injuries, may find AAC beneficial.

AAC can help users develop social skills, academic competence, independence, everyday functioning, attention, and the ability to convey their desires and needs. By providing the necessary tools for engaging in meaningful interactions, AAC can also improve their overall quality of life.

AAC devices come in two main categories: Unaided and Aided AAC. Unaided AAC doesn’t rely on external devices and consists of gestures, facial expressions, and sign language. Aided AAC, on the other hand, requires external tools like picture boards, communication books, and electronic devices.

Speech-related AAC devices can vary from basic picture boards to sophisticated electronic devices equipped with speech synthesizers. Augmentative therapy, a specific form of speech therapy, employs AAC devices to supplement or substitute communication.

Definition of AAC

Augmentative and Alternative Communication , commonly known as AAC, is a remarkable and versatile approach designed to support individuals who face challenges in speaking or writing. It’s like a friendly helping hand, offering numerous methods to enhance or replace conventional communication, ensuring that everyone has a chance to express themselves and be heard.

Gestures, for example, can be as simple as waving hello or pointing at an object. Symbols and pictures, on the other hand, are visual representations of words or ideas that can be easily understood, like a traffic sign or a menu with images of dishes. Electronic devices offer even more advanced options, with speech synthesizers and touchscreens enabling users to form sentences and convey complex thoughts.

The friendly and inclusive nature of AAC makes it a valuable resource for those with communication challenges. So, whether you’re a speech therapist, an educator, a family member, or someone who just wants to learn more, understanding AAC is a step towards a more connected and empathetic world. By embracing these alternative methods of communication, we can break down barriers and empower people to express themselves, building stronger connections and enriching lives.

What is an AAC device?

AAC devices are specifically designed to aid people who experience challenges with speech or communication, enabling them to communicate more effectively. These devices come in various forms and levels of complexity, from basic to advanced electronic devices equipped with speech synthesizers.

One of the simplest forms of AAC devices is the picture board. These boards utilize symbols or images to represent messages and are particularly useful for individuals with limited vocabulary or literacy skills. Communication books, another type of AAC device, employ symbols, images, or text to support those with communication challenges.

Electronic AAC devices are more intricate, utilizing technology to enhance communication. Operated by touch, switch, or eye gaze, these devices range from basic to highly sophisticated models. The simpler AAC devices rely on prerecorded messages or speech output buttons for conveying messages. In contrast, more advanced AAC devices can generate synthesized speech, offering customization options that allow individuals to create their messages and tailor their communication experience.

AAC devices for speech can be worn on the body or attached to a wheelchair, making communication accessible on the move. These devices can be programmed with specific phrases or vocabulary sets, enabling users to express themselves in a wide range of settings and situations.

AAC devices are tools that assist people with speech or communication challenges in communicating more effectively. They range from basic devices, such as picture boards and communication books, to more complex models that use synthesized speech and customization options. By providing numerous benefits for individuals with communication difficulties, AAC devices can greatly improve their quality of life.

Different Types of AAC

Let’s explore the fascinating world of AAC. Think of it as a friendly helper that comes in two main types: Unaided and Aided.

Unaided AAC is all about using your own body to communicate without any external devices. Examples include gestures, facial expressions, and sign language. These methods can be quite effective and versatile, but they do require some ability to control one’s body and a certain level of motor control.

Aided AAC, on the other hand, involves using external devices or tools to help with communication. These devices can range from simple to complex, depending on each person’s needs and abilities. Picture boards, communication books, and electronic devices are all examples of Aided AAC. The great thing about these devices is that they can be customized to meet individual communication needs and can be adjusted as those needs change over time.

When it comes to speech, AAC devices include augmentative communication devices, AAC communicators, and talking devices. Augmentative communication devices are electronic gadgets that enable communication through prerecorded messages or speech output buttons. AAC communicators offer more customizability, letting individuals create their own messages and personalize their communication experience. Talking devices are wearable AAC devices that can be attached to a wheelchair or worn on the body, allowing people to communicate on the go.

Augmentative therapy is a form of speech therapy that uses AAC devices to enhance or replace communication. This type of therapy can help individuals improve their communication skills, build confidence, and increase their independence.

AAC offers a wide range of benefits. It can help improve socialization, academic competency, self-sufficiency, everyday functioning, and attention. It can also increase independence and enhance the quality of life by allowing individuals to participate more fully in their communities and engage in meaningful interactions with others.

In a nutshell, AAC comes in two types: Unaided and Aided. Aided AAC devices can be customized to meet individual communication needs and vary from simple to complex. Examples of speech-focused AAC devices include augmentative communication devices, AAC communicators, and talking devices. Augmentative therapy is a speech therapy that uses AAC devices to enhance or replace communication, and the benefits of AAC span from improved socialization and academic competency to self-sufficiency, everyday functioning, and attention.

Common Modes of AAC

AAC offers a variety of options to cater to an individual’s communication needs and abilities. These options include speech generating devices (SGD), communication books, and mobile applications.

Speech generating devices are electronic tools that employ synthesized speech for communication. They are incredibly helpful for those who struggle with speaking or require a more advanced communication system. SGDs come in various models, from simple to complex, based on the user’s needs and capabilities.

Communication books serve as another form of AAC that utilize symbols, images, or text to convey messages. They can supplement or replace spoken language and can be tailored to fit the user’s communication requirements. Communication books are particularly beneficial for those who find reading or writing challenging.

Mobile applications represent a more recent addition to AAC options, available on smartphones or tablets to facilitate communication. These apps are advantageous for those seeking a portable communication system. Customizable to fit individual needs, mobile applications often include features like voice recognition and text-to-speech.

AAC encompasses an array of tools and strategies that enhance or replace communication for those who face difficulties with speaking or writing. It incorporates various techniques such as gestures, symbols, and electronic devices.

AAC devices range from basic to advanced electronic tools and can be employed in different modes like SGD, communication books, and mobile applications. By utilizing AAC, individuals can boost their social skills, academic competency, self-sufficiency, everyday functioning, and attention, ultimately improving their quality of life.

Who Can Benefit From AAC?

AAC devices can be used by people with a wide range of disabilities or conditions that affect communication. Some of the groups who can benefit from AAC include:

People with Speech and Language Impairments

People with speech and language impairments can benefit greatly from AAC devices. These individuals may have difficulty expressing themselves verbally due to a range of conditions, including aphasia, dysarthria, or developmental language disorders. AAC devices can be used to supplement or replace spoken language, providing individuals with alternative means of communication.

There are various types of AAC devices that can assist people with speech and language impairments. For example, speech generating devices (SGD) use synthesized speech to communicate, while communication books use symbols, pictures, or text to convey messages. Some AAC devices for speech include augmentative communication devices, AAC communicators, and talking devices. Augmentative therapy, a type of speech therapy that uses AAC devices to enhance or replace communication, can also be helpful for individuals with speech and language impairments.

By using AAC devices, people with speech and language impairments can improve their social skills, academic competency, self-sufficiency, everyday functioning, and attention. They can communicate more effectively with others, express their thoughts and emotions, and participate in everyday activities.

People with Cognitive Impairments

People with cognitive impairments can also benefit from AAC devices. These individuals may have difficulty with language comprehension, memory, or executive functioning, which can impact their ability to communicate effectively. AAC devices can be used to assist with communication and enable individuals to express themselves more effectively.

There are various types of AAC devices that can assist people with cognitive impairments. For example, communication books can be customized to meet the individual’s communication needs and may include pictures, symbols, or text. Picture exchange communication systems (PECS) use visual cues to help individuals communicate. Electronic devices with voice output, such as speech-generating devices, can also be helpful for people with cognitive impairments.

By using AAC devices, people with cognitive impairments can communicate more effectively with others, express their thoughts and emotions, and participate in everyday activities. They can also improve their social skills, academic competency, self-sufficiency, and everyday functioning.

People with Autism Spectrum Disorders

People with autism spectrum disorders (ASD) may have difficulty with social communication, including understanding and using language in social situations. AAC devices can be used to assist with communication and enable individuals with ASD to participate more fully in social interactions.

There are various types of AAC devices that can assist people with ASD. For example, visual schedules and picture-based communication boards can help individuals with ASD to understand routines and express their needs and wants. Social stories, which use pictures and text to describe social situations, can also be helpful for individuals with ASD. Speech-generating devices can be used to help individuals with ASD communicate more effectively with others.

By using AAC devices, people with ASD can improve their social skills, participate more fully in social interactions, and communicate more effectively with others.

Nonverbal People

Nonverbal people, such as those with cerebral palsy, ALS, or other conditions that affect speech, may require alternative means of communication. AAC devices can be used to enable nonverbal individuals to communicate effectively and participate in everyday activities.

There are various types of AAC devices that can assist nonverbal individuals. For example, communication boards with pictures, symbols, or text can be used to supplement or replace spoken language. Speech-generating devices use synthesized speech to communicate. Eye-gaze devices can also be used to enable individuals to communicate by tracking their eye movements.

By using AAC devices, nonverbal individuals can communicate more effectively with others, express their thoughts and emotions, and participate in everyday activities. They can also improve their social skills, academic competency, self-sufficiency, and everyday functioning.

People with Physical Disabilities

People with physical disabilities, such as those with cerebral palsy or spinal cord injuries, may also benefit from AAC devices. These individuals may have difficulty with speech, fine motor control, or using traditional communication methods. AAC devices can be used to enable individuals with physical disabilities to communicate effectively and participate in everyday activities.

There are various types of AAC devices that can assist people with physical disabilities. For example, communication boards with pictures, symbols, or text can be used to supplement or replace spoken language. Speech-generating devices use synthesized speech to communicate, and can be operated with switches or other assistive technology. Eye-gaze devices can also be used to enable individuals to communicate by tracking their eye movements.

By using AAC devices, people with physical disabilities can communicate more effectively with others, express their thoughts and emotions, and participate in everyday activities. They can also improve their social skills, academic competency, self-sufficiency, and everyday functioning.

People with Hearing Impairments

People with hearing impairments may also benefit from AAC devices. These individuals may have difficulty with spoken language or may rely on sign language as their primary means of communication. AAC devices can be used to supplement or replace spoken language, and can also be used to provide visual support for sign language.

There are various types of AAC devices that can assist people with hearing impairments. For example, communication boards with pictures, symbols, or text can be used to supplement or replace spoken language. Speech-generating devices can also be used to provide synthesized speech for individuals who are deaf or hard of hearing. Video phones, text messaging, and email can also be used as forms of AAC for people with hearing impairments.

By using AAC devices, people with hearing impairments can communicate more effectively with others, express their thoughts and emotions, and participate in everyday activities. They can also improve their social skills, academic competency, self-sufficiency, and everyday functioning.

Types of AAC

Various AAC systems can be employed to help individuals with communication challenges. These include:

1. Low-Tech AAC

Low-tech AAC systems are simple, cost-effective, and do not need electronic components. They encompass communication books, picture boards, and sign language. Communication books are paper-based books with pictures or symbols representing words or phrases. Picture boards display pictures or symbols to supplement or replace spoken language. Sign language is a visual language that relies on gestures and facial expressions for communication.

2. High-Tech AAC

High-tech AAC systems comprise electronic devices that utilize voice output for communication. They can vary from basic devices with a few buttons to advanced devices with touch screens and text-to-speech features.__ Examples of high-tech AAC devices include speech-generating devices, tablets, and smartphones.__

3. Symbol-Based AAC

Symbol-based AAC systems employ pictures, symbols, or icons to signify words or phrases. They are frequently used by individuals who struggle with language processing or literacy. Examples of symbol-based AAC systems include communication books and electronic devices that use symbol software.

4. Text-Based AAC

Text-based AAC systems use written language for communication. They are often used by individuals who have difficulty with speech or hearing. Examples of text-based AAC systems include electronic devices that use text-to-speech software and communication books that contain written words or phrases.

5. Picture and Video-Based AAC

Picture and video-based AAC systems use pictures, symbols, or videos to represent words or phrases. They are commonly used by individuals who have difficulty with language processing or literacy. Examples of picture and video-based AAC systems include electronic devices that use picture or video software and communication books that feature pictures or videos.

By employing different types of AAC systems, individuals with communication difficulties can effectively communicate with others, express their thoughts and emotions, and participate in everyday activities. They can also enhance their social skills, academic competency, self-sufficiency, and everyday functioning.

How to Implement AAC

Implementing AAC for individuals with communication challenges involves several crucial steps that call for meticulous planning, assessment, and training. These steps encompass:

Assessment of AAC Needs

The initial step in implementing AAC is to evaluate the individual’s communication requirements. This process usually involves a comprehensive assessment of the person’s communication abilities, including their capacity to speak, comprehend language, and utilize nonverbal communication. The evaluation may also encompass assessments of the individual’s cognitive skills, physical capabilities, and social abilities. The objective of this assessment is to pinpoint any communication barriers and determine the most suitable AAC system to employ.

Selecting the Right AAC System

Once the individual’s communication needs are assessed, the subsequent step is to choose the appropriate AAC system. Numerous AAC systems are available, ranging from uncomplicated, low-tech options such as communication boards and picture books to more sophisticated, high-tech alternatives like speech-generating devices and computer-based communication programs. The selection of the AAC system will depend on factors like the person’s communication abilities, preferences, and objectives, as well as the cost and accessibility of different AAC systems.

Establishing Goals for AAC Use

With the AAC system chosen, the next step is to establish goals for its use. This process involves setting specific, measurable, and attainable goals that correspond with the person’s communication needs and abilities. These objectives may include enhancing the individual’s self-expression, improving their language comprehension, or refining their social skills.

Developing a Plan for AAC Implementation

After defining goals, the next step is to devise a plan for AAC implementation. This plan should comprise a thorough description of how the AAC system will be incorporated into the person’s daily routine, as well as strategies for overcoming any potential barriers or challenges. The plan should also delineate the roles and responsibilities of caregivers, family members, and other members of the person’s support team in the implementation and backing of the AAC system.

Training for AAC Users and Caregivers

Achieving success with AAC necessitates providing training for both the individual using the AAC system and their caregivers. This includes training on operating the AAC system and strategies for supporting communication and maximizing the benefits of AAC. The training should be customized to the person’s needs and abilities and should be conducted in a supportive, positive environment.

Achieving Success with AAC

Ultimately, realizing success with AAC involves continuous monitoring and evaluation to ensure that the system meets the person’s communication needs and objectives. This may entail making adjustments to the AAC system, offering additional training or support, or considering alternative AAC systems if needed. It is also vital to celebrate successes and recognize progress along the journey, as this can help motivate and encourage continued use of the AAC system.

Challenges of AAC

While augmentative and alternative communication (AAC) can be a powerful tool for improving communication and enhancing the quality of life for individuals with communication difficulties, several challenges must be addressed to maximize its benefits. These challenges include:

Cost

One of the most significant challenges of AAC is the cost. Some AAC systems, particularly high-tech ones that require specialized equipment or software, can be quite expensive. This can make it difficult for individuals and families to access the AAC device they need. However, there are also lower-tech AAC devices for speech that can be more affordable and accessible for some individuals.

Accessibility

Another challenge of AAC is accessibility. For some individuals, especially those with physical disabilities, it can be difficult to access and use AAC devices effectively. This may require adaptations or modifications to the AAC system, such as adding switches or other assistive technology. Additionally, accessibility also refers to the availability of AAC systems in different languages and for different cultures.

Lack of Awareness

A lack of awareness about AAC is another challenge that can limit its effectiveness. Many people are not familiar with the different types of AAC systems available or how they can be used to support communication. This can lead to a lack of resources and support for individuals who could benefit from AAC. Education and training about AAC are crucial to increasing awareness and accessibility.

Social Stigma

Social stigma is another challenge that can impact the use of AAC. Some people may feel embarrassed or self-conscious about using an AAC device, particularly if it is visible or draws attention to their disability. This can make it difficult for individuals to use AAC in social situations or in public. Addressing social stigma requires efforts to increase awareness and promote acceptance of AAC devices.

System Maintenance

Maintaining and repairing AAC systems can also be a challenge, particularly for high-tech systems that require specialized equipment or software. This can lead to disruptions in communication and may limit the long-term effectiveness of the AAC device. Proper training and resources for maintenance and repair are crucial to ensure the continued use of AAC devices.

Limited Vocabulary

Finally, a challenge of AAC is the potential for limited vocabulary. Some AAC systems may have limited symbols or words available, which can make it difficult for individuals to express themselves fully or effectively. This can be particularly challenging for individuals who require specialized vocabulary related to their interests or occupations. Efforts to improve AAC systems by increasing vocabulary options are ongoing.

In conclusion, addressing the challenges of AAC requires a multifaceted approach that includes education, training, resources, and ongoing development of AAC devices and systems. By addressing these challenges, individuals with communication difficulties can experience greater success with AAC and improve their quality of life.

5 Benefits of AAC

AAC can have many benefits for individuals with speech or communication difficulties. Here are some of the key benefits of AAC:

1. Improving Communication

One of the primary benefits of AAC is the ability to improve communication for individuals with speech or communication difficulties. AAC can take many different forms, from low-tech options such as communication boards with symbols or pictures, to high-tech options such as speech-generating devices with synthesized speech output. With the use of AAC devices or strategies, individuals can express their thoughts, needs, and feelings, even if they have difficulty speaking or writing.

Effective communication is crucial for socialization, academic achievement, and overall quality of life. By improving communication, AAC can help individuals participate more fully in social interactions and educational activities, leading to greater independence and overall well-being. It is important to note that AAC is not intended to replace traditional forms of communication, but rather to supplement or enhance them.

2. Enhancing Socialization

AAC can also have a significant positive impact on socialization for individuals with communication difficulties. By enabling individuals to communicate more effectively, AAC devices and strategies can improve socialization skills and facilitate the development and maintenance of relationships with others. This can lead to a greater sense of community and connection, as well as improved mental health and well-being.

Effective communication also plays a critical role in accessing and participating in social activities, such as team sports or community events. By increasing the ability to participate in such activities, AAC can further support socialization and enhance overall quality of life. However, it is important to note that the use of AAC does not guarantee socialization, and individuals may require additional support or training to effectively utilize AAC for socialization purposes.

3. Increasing Independence

AAC can also promote greater independence for individuals with communication difficulties. By enabling individuals to complete tasks and activities on their own, AAC devices and strategies can reduce dependence on caregivers and enhance overall quality of life. For example, individuals can use AAC to make requests, ask for help, or perform self-care tasks, such as managing medication or making appointments.

However, it is important to note that the use of AAC for independence purposes may require additional training or support to ensure effective use. Additionally, the level of independence achieved may vary depending on the individual’s needs and the specific AAC strategies or devices used.

4. Supporting Academic Development

AAC can also support academic development for individuals with communication difficulties. By enabling individuals to participate more fully in educational activities, AAC can enhance learning and academic achievement. For example, AAC can be used to ask and answer questions, participate in classroom discussions, and complete assignments.

AAC can also facilitate greater participation in extracurricular activities, such as music or theater, further supporting academic development and enhancing overall quality of life. However, it is important to note that the use of AAC for academic purposes may require additional training or support to ensure effective use.

5. Enhancing Quality of Life

Finally, AAC can enhance the overall quality of life for individuals with communication difficulties. By improving the ability to participate in daily activities, connect with others, and express oneself, AAC can promote greater independence, socialization, and overall well-being. This can lead to increased confidence and self-esteem, as well as greater opportunities for personal growth and development.

It is important to note that the benefits of AAC may vary depending on the individual’s needs and the specific AAC strategies or devices used. Additionally, the use of AAC may require additional training or support to ensure effective use. However, overall, AAC can have a significant positive impact on the lives of individuals with communication difficulties, enhancing their ability to participate in daily activities, connect with others, and lead fulfilling lives.

PECS

Picture Exchange Communication System (PECS) is a one of the most used method of augmentative and alternative communication. The aim is the same; to enable functional communication.

PECS have cards with objects, actions, symbols, words or pictures printed on them and individuals give, show or exchange these cards when they want something. It’s also possible to use the cards to make comments, choices, requests and to ask or answer questions. Basically, these cards mediate the communication between individuals who use them and the world.

Who is a candidate for PECS?

People who cannot communicate traditionally, with no age restriction, can use PECS. Non-verbal individuals, people who cannot initiate conversations or who can benefit from increasing vocabulary or communicating more efficiently create the target group for the system. In other words, people with no verbal communication can utilize the system to interact, while people who can talk may use the system to improve interaction skills. To be more specific, individuals that struggle with verbal communication due to having ASD or other developmental disorders can benefit from the system.

How does PECS work?

There is a specific training program that requires participation of parents, teachers, other specialists and of course the children. It’s advised that all steps are implemented in correct order in a similar manner across people and situations. The duration of this training process differs for each individual.

• Phase 1: How to communicate

The goal of the first phase is to learn to give the visual of the desired object or activity to the other person. For instance, the child wants a toy car. There is a picture of a toy car in front of them. One person guides the child to pick the picture and give it to another person. In this phase, there are two people other than the child. When the guided exchange is completed, the communicative partner immediately reinforces the behavior by praising. Reinforcement is key in the learning process. It gives the message that the activity was welcomed, approved and should be repeated in the future.

• Phase 2: Distance and persistence

In this phase, children learn to use this new way of communication in several settings (i.e., home, school etc.) with different people. Reinforcement should continue but any prompts should be eliminated gradually. This enables using the system independently to communicate.

• Phase 3: Picture discrimination

This time, two pictures are presented and the child must select the desired one and give to the other person. Initially the second picture is something the child does not prefer. For instance, if the child wants a toy car, the second picture can be a food item which is from an unrelated category. One by one, the child understands to distinguish pictures.

• Phase 4: Sentence structure

Learning to form simple sentences is the aim of this phase. There is a picture that represents the phrase “I want”. The child is expected to combine “I want” picture with another one to state what they desire. Also, pictures of adjectives (i.e., red, big), prepositions (i.e., on, in) and other words are added to further expand vocabulary and enrich sentences.

• Phase 5: Responsive requesting

The goal is to answer questions such as “What do you want?”. The child opens the book with pictures and gives the answer using them.

• Phase 6: Commenting

Other questions are asked in this phase such as “what do you see, what do you hear, what is it?”. Children then learn to answer those in correct forms like “I see or hear this” or “it is a…”.

Benefits of PECS on ASD

PECS is a well-studied method. Many scientific studies were conducted to understand and support the effectiveness of the system. The results indicate substantial benefits in several different areas. It is important to say that benefits of AAC are parallel to those of PECS. Specific findings are discussed in this section.

It is important to mention that at first, PECS was developed for ASD exclusively and later expanded to different populations. So, there are many studies conducted to demonstrate the effects of the system for people on the spectrum.

Communication benefits of PECS

Individuals with ASD may possess communicative impairments. They may be non-verbal or may have developed speech but struggle with social components of communication. PECS teaches people an effective but relatively easier means for communication. Actually, the system helps the child to interact but also assists parents, caregivers, teachers and peers to communicate with the child in a simpler and more understandable level.

Initiating interactions is a great benefit that the system provides, regardless of the age (Ganz et al., 2012). Even children who seem indifferent to their surroundings learn to start a conversation spontaneously. Requesting something is the primary objective of PECS. Children are taught to request for their needs or wants which also requires them to initiate communication.

Overall, from two different meta-analysis articles (a method of statistical analysis that combines findings from different studies to understand any general effect) with more than 24 studies incorporated, it can be said that PECS is an effective modality for improving communication skills (Flippin et al., 2010; Ganz et al., 2012).

Social Communication benefits of PECS

The nature of PECS is physically exchanging a visual aid with another person. So, the context is always reciprocal. Initiating, requesting and joint attention are all interactive and reciprocal elements of social communication that are also embedded in PECS training objectives. In short, PECS benefits social side of communication as well (Lerna et al., 2012).

One study investigated communication with peers using the system and found out that when the peers understood how PECS work, their interactions improved (Thiemann-Bourque et al., 2016). This enabled people on the spectrum to play and socialize more with individuals their age. In most of the interactions, children with ASD requested and peers responded but some of the children shared their toys or made small comments as well, even though commenting is not yet a skill they acquired during PECS training. This shows the room for improvement when the system is used in various setting with different people.

Benefits of PECS on Speech

Teaching speech was never an actual objective of PECS however, some children using the system developed skills to use speech in an instinctive manner. In other words, PECS is a method of communication and learning it may make it convenient for individuals to learn another way to communicate such as speaking. Still, this is not a main goal of the system but an added gain. It is important to say that individuals may not develop speech and use speech generating devices (SGDs) instead.

Different articles reported that vocabulary and length of utterances increased after learning to use PECS. In other words, some children started forming longer phrases, clauses or sentences than before. Also, vocalizations that are not recognized as words decreased in the process. However, it is important to emphasize that the findings related with speech outcomes are mixed and not equally effective across participants of studies (Ganz & Simpson, 2004; Jurgens et al., 2009; Flippin et al., 2010).

Benefits of PECS on Behavioral Issues

Disruptive behaviors such as throwing, destroying or hitting and tantrums including behaviors like yelling, crying are not targeted outcome variables for PECS. This means, the use of PECS was not hypothesized to decrease these problematic behaviors. However, there are both anecdotal and research-based evidence that shows effects as such. In short, there is a supplementary gain of declined behavioral issues in children using the system (Charlop‐Christy et al., 2002; Ganz et al., 2012).

The reason this consequence can be explained with a simple logic. Behavioral issues mostly stem from the frustration of inability to communicate. So, when children began communicating functionally, problematic behaviors could be reduced. Especially when children are adjusted to the system and use it most of the time, the results can be maintained. In this way, children can feel understood and related. Being less frustrated brings emotional stability that is the gateway for less behavioral issues.

Tips for parents & caregivers

Before discussing tips and considerations for parents or caregivers, it is important to note that parent training is vital in the process of adjusting and using new communicative modalities. After the assessment procedure, it is basically up to the parents to introduce the system properly and create opportunities to incorporate AAC into everyday activities. In other words, parents play a crucial role in improving their child’s communication capabilities.

How to introduce the AAC system?

After a comprehensive assessment process and finding the suitable device, the first question every parent or caregiver has in their mind is “How do I introduce this system to my child?”. Here we summarize the steps and considerations in doing so.

Understanding how the AAC system works

Before showing the system to the child, it is important for parents to get a grasp of the device. Simply by pushing buttons, using switches and trying to communicate using the device can be helpful. For instance, if it is a speech generating device, how can it vocalize your intended message? Can other people understand and give their response in return? Questions similar to these should be answered.

The main purpose is learning about this new means of communication that your child will be using. Ultimately the parents will be on the receiving end of this interaction. This is just like learning another language, if you cannot understand it, you cannot respond to it and the communication suffers. Also, having familiarity helps in solving any future problems related with the device or the communication itself.

Last but not least, it can encourage parents to empathize with the individual who will be using the system. As it is known, a little empathy goes a long way. Trying to interact with another person using the AAC system can enable appreciating the frustration, anger and other emotions your child might be feeling. This experience itself is valuable for the relationship between the child and the parents. So, as it can be seen, it is crucial to comprehend the use of the system before introducing it to your child.

Demonstrating how to use the system to the child

After completely understanding the general way of functioning of the system, parents can introduce the child with this new method of communication. Starting slow is a good strategy. Maybe at this level, just handing the individual the device and allowing some exploration is more than enough.

Then, using it to communicate is the next step. For example, the chosen AAC system uses visuals that represent words, and the child is asking the parent to give the toy car. You can find the picture of the object and show it to the child while saying its name (“A toy car”) and then you can give the object to the child. Another example can be an SGD vocalizing the name of the object after the parent pushes its buttons, followed by receiving the object.

This is called “modeling” and it is an important method of learning for all children. With repetition, children connect an action (showing picture or pushing button) to its consequence (receiving the object). And in the future when they need something, they just mimic the action.

Using the AAC device everywhere and with everyone

Modeling the use of the system is essential in teaching the child how to operate the system to communicate. The key in this is to do this repeatedly in every occurrence of interaction. In order to do so, the child must always have the system nearby so that it is ready to use. Also, parents should use the AAC while talking to the child or around the child. This way, the system becomes a very familiar and common method of communication for everyone and most importantly, for the child.

Another way to have consistency is generalizing the use of the system to different locations, settings or environments. Communication should not be limited only to the home or to parents. People can interact in various places with numerous others using their voices so why individuals who are non-verbal be any different? The AAC can be carried anywhere the child goes. Having the system nearby creates different communication opportunities. And this contributes to consistency and generalizability. In time, individuals can automatically reach to the device when they want to communicate something through just like opening the mouth to speak.

To make sure the child uses the system continuously, reinforcements can be utilized. A basic definition of reinforcement is anything that increases the possibility of an outcome to happen. Tangible rewards (i.e., toys, food), praises, activities (i.e., extra tv time) and many more can act as reinforcers.

When parents try to increase the child’s use of the system, they can use certain rewards. For instance, parents can give rewards immediately anytime the child reaches out to the AAC to interact. In the beginning, children may not look for the device when they want something. Remember it takes time to get familiar. However, parents can physically help their children by moving their hands to push buttons or looking for and selecting pictures together. Immediately after doing so, rewards must be provided so that the behavior of using the AAC strengthens over time.

Remember that if children are confused, frustrated or behave as if they are uncomfortable about the current situation, do not continue. In the end, parents should remind themselves that this system supposed to aid their child, not cause a disturbance. If children are clearly unhappy, being slow and advancing at their pace is more appropriate.

Enabling unaided use of AAC

Strategies mentioned above like modeling and reinforcing are great in teaching and increasing the use of these new communication systems. However, children should not be always relied upon other people to use this new communication modality. Once children learn how to operate the device and get what they desire, parents can start cutting down on the rewards, cues and other helping behaviors.

Of course, observing how the child adjusts to being more independent is key. If more frustrated, parents can proceed to help but do it in moderation. Slowly the child will be more independent and feel more competent in using the AAC to communicate. Don’t worry, requesting something and receiving it using the system is still a constantly rewarding process. Your child will keep on relying on the device because of the responses. For instance, interacting with another person, getting what they want and generally the socializing aspect of communication are naturally reinforcing the use of the device.

How to maintain the use of AAC?

Now that the child understands how AAC works and starts using it independently, what can be done to be sure that this new means of communication is here to stay? Here we offer some tips:

Teaching new symbols or words

Of course, this is important because it expands vocabulary and improves communication. Learning new things motivates the use of the system on its own. Modeling and reinforcing are methods that can be used while introducing new words, symbols or visuals. When it’s certain that the child understands, parents can gradually withdraw from using helping strategies.

Having the AAC at hand during the day is crucial. As it was mentioned above, this enables the child to be familiar with the device and also generalize it as the main modality of communication. Also, when the system is always nearby, there are more circumstances to add to current symbol vocabulary.

Eating, playing, getting dressed, walking and many more daily activities carry many opportunities. For example, food items can be presented according to what’s for dinner at that very moment. The association will be stronger when introductions are blended into natural settings. It is a good idea to start with naming items that the child is already interested in. Also, making sure the child is in a positive or stable state helps this process a lot.

Setting achievable goals to communicate using AAC

When creating goals, both for the parents and the child, being as concrete as possible is key. For example, the aim should be specifically about the child using the device to request certain items: “the child will give the picture of a cookie to the parent to get a cookie”. This kind of a goal indicates that both the parent and the child know how the system functions. The aim is using the AAC to communicate.

However, goals about just using the system (“the child will give picture to request”) is not aimed at meeting interaction needs because it is not specific enough. Also, this type of goals can be too broad and demanding because one can never be sure if it’s achieved.

In short, clear, specific and short-term goals should be preferred while tracking the progress of the child using the AAC.

Readjusting the system in link with the child’s needs

There are many different reasons for readjustments. Maybe the system does not have enough words or symbols to enable better communication. Switching to a system with wider vocabulary of words and symbols may be beneficial.

Or, at first it was a good fit for your child but in time it fell behind. Naturally, as the child ages and acquires new skills, different modalities can be tried out. Also, same system can be updated for increased skill levels. For example, PECS have different progressive stages that are passed one-by-one.

On a different note, there can be maintenance issues with the device, meaning that it failed to operate. Children may be more upset, frustrated and had a difficult time adapting to the system. After contacting with the developers and also the specialists, if issues still continue regarding the system or the child, it may be a better idea to try a different system.

Monitoring the child’s activity

Some high-tech AAC systems are not exclusive for communication. Apps, for instance, are downloaded to tablets or smart devices that also include games and access to internet. This is when monitoring the child’s activity, screen time and setting some ground rules regarding these become essential.

In order to protect the child, access to other apps or internet can be restricted. Certain sites or apps that are addictive or inappropriate can be blocked. If your child also uses the device for playing games, scheduling may help in preventing too much screen time.

Children may also use social media on these devices. It can be a less upsetting and less stressful option for them to interact. Parents can lay down rules about the use of this platforms. Just make sure that this way of communicating does not replace their real-life interactions.

With respect to the child’s age, parents can openly discuss why these restrictions or schedules are needed and encourage them to always ask for permission. Last but not least, it should be clear for the child and the parents that this device is initially for communicating using the AAC app. Which means that parents should not use it for their needs as much and have it always available for the child to use.

Tips for better communication

Just like learning to speak, learning to use AAC requires support. Even if it’s not conventional, it still counts as communication that needs to be improved. To support the development of using AAC to interact, here are some tips.

• Let them guide the interaction. Initiating and leading a conversation is crucial because this is not something they are used to. Previously, the communication was very one-sided; others talked, and they listened (possibly in frustration). Now they can express themselves too, so it is essential to let them lead.

• Be patient and go slow. Through the interaction, parents should take their time, use few words, repeat them and stop after sentences or words. This facilitates processing what was said and makes responding easier. Questions on the other hand should be short and closed-ended meaning that the child should choose between options. Yes or no questions for instance, are great because they promote interaction.

• Wait for turn-taking. Do not rush and wait for them to finish their part of the conversation. This may take time, longer than in traditional speech. But waiting for an increased amount of time is important because it shows that you respect their efforts. And also, it teaches the reciprocity aspect of interaction; first they communicate, then it is others’ turn or vice versa.

• Have face-to-face contact. Facing the child helps in understanding how AAC is used by them. It is like learning how they use this new language for interaction. How does the child look for symbols, press buttons, wait for response or use additional body language? This gives the message that parents are focused on the child and the interaction is important for them. In time, parents can be coded as the “communication partners” that the child seeks to interact with when it’s needed.

• Use supports for communication. These can be animating actions such as impersonating holding a fork and a knife to symbol “eating”. Also waving hand for “hello” and nodding head for “yes” can be used to teach that communication is more than just sounds, words or visuals. Still, photos of relatives can be used while mentioning them. Also, you can act out interactions and give feedback about behaviors without being too critical.

• Encourage children to communicate. Creating opportunities for them to interact is crucial. This can be playing a song and then letting them continue. Or, putting a desired item nearby but on an unreachable shelf to let them ask for help. Also, asking them to play a 2-person game and allowing them to understand the rules and then, play along. Not to forget, recognizing that they do not want to continue with the activity and letting them signal that they need to stop is important.

• Attract and maintain attention. Being face-to-face helps this process although the child may not engage in eye contact. Still, they know about the other person’s presence and attention. Using their names, engaging in activities that they show interest in and eliminating any distractors (i.e., tv) can help.

• Avoid saying “no” at first. Most AAC systems teach requesting. It may seem unreasonable to always grant every request of the child. Parents may even worry if their children will become needy or spoilt. However, in the process of adjusting to this new means of communication, it is important to respond to every request with providing the desired item. At the first stages, this is necessary to establish trust for the device as a communication method. Otherwise, children may become upset and give up using the system. When it is certain that the child regularly uses the system to communicate, “no” can be introduced as a possible answer.

Tips for teachers

Previously we mentioned that the assessment process should be a team effort. Parents, teachers and other specialists should collaborate. Likewise, implementation of the system should be supported by all of the people in the child’s life, including teachers. Only then AAC can support communication successfully. But how can the system be adapted to the school setting? Before answering this, it is important to note that tips that we gave for parents also apply for teachers to benefit from. But there are also additional suggestions that we offer.

• Know how the system works. Most essentially, teachers should understand how the system operates. Also, they should be aware of the existing vocabulary and symbols, their locations and other aspects of the device.

• Keep the system always available in the classroom. Because AAC is the way the child communicates, it should always be present and available for use. This holds even for the activities that do not aim for students to express themselves like watching a video. Children without communication issues can talk no matter the activity they are engaging in. The same privilege should also be given to the children that use the systems. Full time access is the key element in this process.

• Create communication opportunities. Using AAC in the classroom can be a unique experience. Certainly, there are no structured rules that show how to integrate the system into the class, so teachers may have to be creative. Pairing the child with different classmates, modelling words or verbs of activities, using songs and many more can help. Also, the function of communication can differ. Mostly AAC is used for requesting and labeling but there are many more reasons for communicating. Other chances to practice the system are rejecting, commenting, saying hello or goodbye, giving opinions and so on.

• Acknowledge communication attempts and respond. Being on the alert for every communication attempt made by the child is important. These attempts can be gestures, mimics, facial expressions or the use of AAC. Any effort to communicate should be noticed and answered, especially when using the system. It is like saying “I see and hear you” which further strengthens the use of the device to communicate. When the child uses the system while the teacher is talking or covering a subject, this attempt should still be acknowledged. Teachers can indicate that it is lecture time, and it is their time to talk but always return to the child when they are finished. Even if the attempt is accidental, teachers should give a reaction.

• Start small and go along with the child’s pace. Teachers should begin by choosing one word to practice and wait until they are sure the child can comprehend and use it properly. That way, they can understand the speed in which the child feels comfortable in and then pass on to teaching another word. Remember, there is no need to rush and it may take longer for children to adjust using the system in class. The aim is to support in this duration and practice at all times.

• Use supplementary methods and materials. Traditional ways of teaching are not sufficient and different approaches should be taken. Showing pictures, photos, gifs, videos, scripts and so can be used to assist the learning process. Acting out verbs, showing pictures of people, pointing places from the map and performing facial expressions of emotions are some of the examples that can aid in teaching.

• Have other students and staff learn the system. Because classmates and other staff will be communication partners to the child, they should also be familiar with the AAC. Teachers can allocate some time to explain how the system works and answer any questions. Support, reinforce and encourage communication partners in using the system while interacting with the child. That way, everyone in the child’s life can understand that this is the communication modality for the child and respect it.

References used in this article