A practical AAC guide for families and schools

What AAC is

Augmentative and Alternative Communication (AAC) covers every way of communicating that adds to or replaces speech. The American Speech-Language-Hearing Association (ASHA) includes unaided forms, such as gestures, signs and facial expressions, and aided forms, such as picture boards, communication books, and tablets or phones with apps that speak.

Who it is for

Anyone, of any age, whose speech is not enough to say everything they need: autistic children, people with cerebral palsy, Down syndrome, childhood apraxia of speech, intellectual disability, neuromuscular conditions, or adults after a stroke. There are no prerequisites. Romski and Sevcik showed that ideas such as a minimum age or "being ready" are myths: people learn to communicate by communicating.

Does AAC hold back speech?

No. A 2006 research review by Millar, Light and Schlosser found no case where speech got worse after AAC was introduced, and some participants gained speech. ASHA also states that AAC does not prevent speech development.

Paper board or app? Use core words in both

Low-tech boards need no battery and go anywhere; apps speak out loud and hold many more words. The best setup is both, with the same words in the same places. Build around core vocabulary: a small set of pronouns, verbs, adverbs and prepositions (I, you, want, go, more, not, that, here) that makes up most of what we say, plus the person's own words. Start with our free printable board.

Modeling: what makes the biggest difference

People learn a language by seeing others use it. In AAC that means modeling: you talk normally and point to or tap the key words at the same time. A 2018 meta-analysis by O'Neill, Light and Pope found that interventions where partners model with AAC are highly effective for understanding and expression across ages and diagnoses. Three habits help:

1. Model without demanding. Don't ask the child to repeat.
2. Really wait. Pause for several seconds after you speak or ask.
3. Ask open questions. "What do you want?" rather than "Do you want juice?"

At home and at school

• Start with one daily routine (bath, breakfast, play) and model there every day.
• Keep the app or board within reach all the time, not just "during therapy".
• Involve everyone: grandparents, siblings, teachers, support staff and classmates.
• Respond to every message, and celebrate being understood rather than perfect accuracy.
• Add new words without moving the old ones.

The speech therapist's role

This guide helps you start, but it does not replace a professional assessment. In Brazil, CFFa Resolution 799/2025 (in Portuguese) defines the speech therapist's role in AAC: assessing, recommending and implementing the system, choosing vocabulary with the family and team, monitoring, and coaching communication partners.

Sources

• American Speech-Language-Hearing Association (ASHA). Augmentative and Alternative Communication — Practice Portal.
• International Society for Augmentative and Alternative Communication (ISAAC). isaac-online.org.
• Romski, M. A.; Sevcik, R. A. (2005). Augmentative communication and early intervention: myths and realities. Infants & Young Children, 18(3), 174–185.
• Millar, D. C.; Light, J. C.; Schlosser, R. W. (2006). The impact of AAC intervention on the speech production of individuals with developmental disabilities: a research review. JSLHR, 49(2), 248–264.
• O'Neill, T.; Light, J.; Pope, L. (2018). Effects of interventions that include aided AAC input: a meta-analysis. JSLHR, 61(7), 1743–1765. doi:10.1044/2018_JSLHR-L-17-0132.
• Boenisch, J.; Soto, G. (2015). The oral core vocabulary of typically developing English-speaking school-aged children. AAC, 31(1), 77–84.

This guide is for information only and does not replace assessment and follow-up by health and education professionals.