All children, whether disabled or not, utilize a complex communication system that integrates spoken, written, and pragmatic social language skills.
Augmentative and alternative communication (AAC) includes low- and high-technology devices that supplement these skills and facilitate language learning. Augmentative communication options are appropriate for any child whose natural speech and writing does not enable him or her to express himself or herself to all listeners in all environments and for all communication purposes.
In addition, they are indicated when natural speech and writing does not sufficiently support continued speech, language, and academic learning and success. The cause of the communication impairment may be a motor speech disorder, such as dysarthria or dyspraxia; a cognitive and language disorder, such as global developmental delay, pervasive developmental disorder, autism, mental retardation, traumatic brain injury, cerebral palsy, or learning disabilities; or a neuromuscular disorder, such as muscular dystrophy or spinal cord injury.Communication behaviors develop spontaneously in all children, regardless of the severity and multiplicity of their disabilities. Nonverbal communication behaviors may manifest as vocalizations for satisfaction and dissatisfaction; eye gaze and eye contact; looking away from a person, place, or thing; idiosyncratic gestures; and physically leading adults to desired objects and places. Even when such communication behaviors are more “reflexive” or self-directed than intentionally interactive, parents, caregivers, and familiar listeners typically learn to recognize communicative information from their children’s behaviors.
The goal of AAC intervention includes introducing communication strategies that help the child develop systematic language and communication behaviors. Systematic communication helps listeners to more readily understand a child’s communicative intent, helps to reduce the “20 questions” guesses that parents and caregivers typically engage in, and helps the child and his or her listeners form a communication dyad.
With regards to the psychosocial development of children and adolescents with disabilities, the use of a speech-generating device and/or adapted access to computers may enable them to shift social and communication control of interactions from parents, teachers, and caregivers to the child—just as happens with typically developing children.Not all augmentative communication devices need to be speech-generating. Low-tech aids can include communication notebooks, communication boards, and picture exchange communication displays. They may be even simpler, including no-tech systems, such as refrigerator magnets or homemade picture magnets displayed on the refrigerator or on a cookie sheet for portability.
While it is important that all communicators utilize their residual speech whenever functional, it is especially critical that AAC systems maximize the role of natural speech rather than replace it. Natural speech may be used primarily for initiation and getting attention, with a supplementary device used to communicate specific or complex information. Unaided natural speech may be one’s primary communication technique, but supplemented by a speech amplifier or a speech-generating device in noisy environments (7).