Augmentative Alternative Communication (AAC)

Introduction

AAC is defined by the intersection of Assistive Technology and Communication Disorders Therapy:

AAC Specialist

An AAC Specialist is an SLP who has pursued additional expertise in systems that provide communication options beyond a reliance on conventional means of expression. Like languages, those AAC systems associate forms (such as captioned picture cells) with meanings (such as needs, wants, and other thoughts and feelings). Those form-meaning links are symbols, which the AAC user will access to express their intended meanings.

The actual picture is of course much bigger than this summary, such as words forming compound and complex structures, communication growing into language, balance with a person’s existing speech skills, iconic versus symbolic systems, and so on. A thorough explanation exists across several books, and we are only skimming the surface.

Without regard to their technology, AAC systems should be designed, programmed, trained, and monitored by an AAC Specialist. This is important, because AAC decisions are not risk free, and inaccurate AAC choices are not harmless for the user. But that management is not intended to be entirely exclusive, because it is also important for the user and their communication partners to participate in the living system, crucially informing the content of that user’s comm system. The AAC Specialist can also provide training and other supports for partner involvement in performing some of the programming.

“What communication are we augmenting or alternating?”

1. Speech dominates human language, so speaking is still treated as the most conventional natural modality for expressive communication (among available modalities).
2. Speech is produced intelligibly when a speaker’s sounds pair well with their meanings.
3. Intelligible speech, then, represents the default performance standard.
4. Any alternative communication system that replaces this standard is AAC.
5. Any augmentation that supplements such an alternative system is also AAC.
6. AAC is unaided if it is integral with the body, as in signed gestures or facial expression.
7. All other AAC is aided.
8. Aided systems range from low-tech (e.g., paper-based picture communication boards) to high-tech (e.g., programmable, dynamic display, touch/switch-accessible voice-output devices).
9. AAC is more iconic when a form (such as a toy bus) is chosen when making a symbol because it is similar to its paired meaning (an actual bus).
10. In comparison, AAC is more symbolic when a meaning (such as “stop”) is paired with an arbitrary form (e.g., the written word “stop,” or a stop sign, and so on).

The more aided, symbolic, or higher-tech the system, the more likely that it will need to be provided specifically through AAC services.

An AAC user’s speech remains a valuable part of their communication.

Note 1: While visuomanual languages (such as ASL) do appeal to a modality other than speech, languages are not forms of AAC (no matter their modality). On this point, we disagree with ASHA’s position on the nature of signed communication. A subset of signed gestures, then, can be a valuable part of AAC (such as the sign for ‘help’), but the languages from which those signs are borrowed are not AAC; therefore, AAC Specialists do not act as teachers of signed languages (nor does SLP licensure qualify them to do so).

“Which students need AAC?”

ASHA clarifies that there are no “prerequisite skills” for the introduction of AAC specifically because cognitive challenges are no reason to withhold AAC. That is certainly true; for example, while all of our Life Skills students face severe-to-profound cognitive challenges, none of them are denied communication supports, which can include a wide variety of technologies.

Just to be clear, it is equally true that the reliability of communication skills should inform decisions around the nature of the supports to introduce. We balance rich opportunities for growth (or stretch) against such risks as frustration and rejection (or strain). While “whelmed” can be good, “overwhelmed” is bad.

To that end, the classroom SLP often works with a student on the reliability of joint attention, picture matching, clear selection of choices, and other fundamental communication skills.

As part of the collaboration with the classroom SLP, the AAC Specialist can supply materials for gathering information about the student’s skills with increasingly aided, symbolic, or technical systems.

In so doing, an AAC Specialist will consider the balance between two types of systems (whether unaided or aided), namely:

1. a training system that develops the skills that will be used for AAC later, and
2. an AAC system that relies on those developed skills for AAC now.

While a given system can contain both elements, it remains crucial to consider this distinction; for example, is the system training the student to value joint attention, or does it already rely on the student’s joint attention skills while teaching them to actually communicate through using the system?

This approach is consistent with the today and tomorrow principle presented by Beukelmen and Mirenda (2013, p. 192):

The “today” decisions should aim to meet the person’s immediate communication needs and match the existing capabilities and constraints identified during the assessment process. The “tomorrow” decisions are based on projections of future opportunities, needs, and constraints, as well as capabilities that are likely to result from instruction and practice. Both decisions are critical to the long-term success of the intervention plan.

This applies to diachronic decisions made across any supportive communication systems, whether or not the student is already receiving formal AAC services.

“Who is on the AAC Team?”

The AAC Specialist coordinates both the AAC Team and the AAC Evaluation process. AAC Team membership varies according to individual student need, and might include anyone on the IEP Team plus any other communication partners (e.g., extended family, IAs, therapists outside of school, PSWs, and so on.)

“What happens if the AAC Specialist does not recommend a device?”

For some students, devices that replace or enhance a natural voice are not a good choice for making communication progress. The AAC Specialist submits an analysis of the information collected during both the pre-trial (i.e., baseline) and trial stages of the evaluation. The recommended system, tools, and goals will optimize the likelihood of progress with communication skills. If AAC devices in specific would not be viable for making that progress, then the report will detail the contributing factors for review by the team.

“Who Provides AT and AAC?”

At base, AAC is provided by a student’s home district for Bethel, Eugene, and Springfield; otherwise, Lane ESD is the provider. This is true whether or not the student attends a Life Skills classroom. That said, sometimes these districts arrange for Lane ESD to provide AAC for some of these students.

Lane ESD provides AT in their Life Skills classrooms; otherwise, it is provided by the classroom’s host district. A host district can arrange for Lane ESD to provide AT outside of Lane ESD’s Life Skills classrooms.

Note that other specialists provide some services that overlap AT in the Lane ESD Life Skills classrooms.

This is what it looks like:

	Lane ESD Life Skills	Not Lane ESD Life Skills
AAC	Bethel, Eugene, or Springfield (otherwise Lane ESD)
AT	Lane ESD (some non-LESD specialists provide services that overlap AT)	Host District (can arrange for LESD to be the provider)