text to speech aac device

Top 10 AAC (Augmentative and Alternative Communication) Devices

Augmentative and alternative communication (AAC) devices are cheaper, more user-friendly, and more readily available than ever. No longer relegated to the restrictive domain of uber-expensive and hard-to-use medical hardware, today’s AAC technology is designed for any speech language pathologist to use.

AAC Devices

Chances are you’ve been introduced to AAC devices in your master’s program and during your clinical experiences, but if you haven’t yet had the opportunity to make use of one of these devices with patients, you probably still have lots of questions. And you better know your stuff since the responsibility of finding the one that best fits their needs, their budget, and their technical aptitude is likely to fall to you. Not to mention that you’ll be training your patients tracking their progress.

And there’s a huge variety of options, but most fall into one of three categories:

• Single-meaning pictures (one picture=one word) – These systems are the simplest of all devices. They don’t require literacy, although the pictures may need to be taught to the user.
• Alphabet-based systems (spelling and letter codes) – These systems do require a certain basic level of literacy t use.
• Semantic compaction (multi-meaning icons) – These systems involve short series (usually just 1-2) symbols per word, and training is required.

Many of today’s AAC devices use a combination of the three.

To come up with our list of the top 10 AAC devices, we first considered ease of use – basic functionality and design – and then narrowed down the list to include a variety of systems at assorted price points. After a careful review of the options on the market, we came up with our favorite, presented to you here in no particular order…

Pocket Go-Talk 5-Level Communication Device

Price: About $190

Why We Love It: It easily fits into the hand for on-the-go use.

This is a great device for on-the-go, and it’s sturdy enough to take bumps and falls. It easily fits into the hand, and can just as easily slip into a pocket. It also comes with a lanyard, so it can be worn around the neck. Plus, it has a loud microphone, so even when out in public areas, others can easily hear it.

Just six buttons on this device (with five message options on each button) makes it easy for younger children to use. Simply insert the desired picture overlays into the front position on the device and record the desired word or message. Photos familiar to the user can also be inserted, which may add a degree of motivation.

The MegaBee Assisted Communication and Writing Tablet

Price: About $1,800

Why We Love It: Allows users who lack muscle control to communicate using just their eyes.

This AAC device is designed specifically for users who, due to ALS, a traumatic brain injury, stroke, ALS, muscular dystrophy, etc. are unable to use most of their body’s voluntary muscles.

The device is actually held by the listener who looks through the opening in the center of the device to view the direction of the user’s eye movements. A series of colored buttons allows the listener to push them as the user moves his or her eyes, first at one of six colored blocks, and then at a specific color (representing a letter) within that block. The goal is to spell out what the user wants to say onto the LCD screen.

The device also features a shorthand option, so the user and listener can come up with a personal set of abbreviations for their most commonly used terms. For those with low cognitive or literacy skills, the MegaBee also operates in a picture mode, with the listener placing picture labels in the appropriate areas.

Price: $189

Why We Love It: Because it works with the iPad, a separate AAC device isn’t necessary.

AAC devices are not always device, but often apps that come with the iPad, like Roloquo2Go, designed for children who have difficulty speaking. It provides text-to-speech voices, clear symbols, and a vocabulary of more than 7,000 items.

Enabling Devices Tactile Symbol Communicator

Price: About $500

Why We Love It: The tactile buttons accommodate visually impaired users.

This portable symbol communicator, which can store up to 36 messages, has a total of six removable tactile symbols that allow the user to push a button to relay a message. As a tactile symbol communicator, it is perfect for users who are blind or visually impaired. We like this device because it offers six levels of communication, with six messages per level. When setting up this device, it provides up to six seconds of record time per message.

Price: About $175

Why We Love It: It’s affordable and practical.

This device wins for its affordability. At under $200, the GOTALK 9+ is lightweight and durable and has a 45-message capacity, five recording levels, and a nine-minute recording time. The user simply presses the appropriate message key that corresponds with a picture.

FAB Frenchay Alphabet Board

Price: About $188

Why We Love It: The rugged design makes it ideal for a variety of settings, including nursing homes, daycare facilities, schools, critical care units, etc.

This device is rugged and practical, featuring an anti-bacterial rubber base and washable keyboard protector. The standard alpha-numeric keyboard design allows literate non-verbal users to easily choose the letters and numbers they want, while the listener looks at the keys and spells out the word. Each key features a depression that makes choosing a key easier for the user. It also comes in a smaller, pocket size for on-the-go use. It may be the ideal addition to electronic AAC devices for on-the-go or emergency situations.

Lightwriter SL40

Price: $7,000

Why We Love It: The dual-display screen allows for a natural, face-to-face dialogue.

This device is for those who are literate but unable to easily communicate through speech. The device is small, lightweight, and easy to transport, and the dual screen enables the user to type the message while the listener is sitting in a natural position for easy dialogue. It also includes a text-to-speech feature when communicating with others in the room. We also love the SIM card feature, which allows users to send text message to friends and family.

Additional features of the Lightwriter include a notebook feature, built-in buzzers to summon attention, alarms to remind the user of important events, and a built-in remote control for the television.

Gooshy Step Talk Communicator

Price: About $250

Why We Love It: It’s colorful design with lights, vibration, and music provides motivation.

The Gooshy Step Talker Communicator features a series of pre-recorded messages. The moon-shaped, jelly-filled button has floating stars in it, encouraging the user to press it to communicate. The user presses the communicator for the first message, twice for the second message, etc. Depending on the recorded messages, the device can be designed for a variety of tasks, such as multiplication, memorization, directions, sequencing, etc.

Big Talk Assistive Technology Communicator

Price: About $215

Why We Love It: The large target makes it easy for users with limited muscle control.

This device consists of a large, colorful button that can be activated with a slight touch by the user. A single message of up to 20 seconds can be stored. Plus, an external capability switch allows the device to be used as a switch to activate other devices. Use several to create a system of communication.

GoTalk Express 32 – Advanced Communication Aid

Price: About $570

Why We Love It: Allows non-literate users to press multiple picture keys to create sentences

This laptop device features a grid of pictures that allow users to combine them to form sentences. It features two methods of operation: standard and express. When the standard method is chosen, the user simply presses a message key and the device speaks the word. When the express method is chosen, the user can press multiple message keys to create a sentence.

Some of the other features of this device include a shoulder strap for easy carrying, a rugged design with carrying handle, and LED lights for visual prompts.

• Emerson College - Master's in Speech-Language Pathology online - Prepare to become an SLP in as few as 20 months. No GRE required. Scholarships available.
• NYU Steinhardt - NYU Steinhardt's Master of Science in Communicative Sciences and Disorders online - ASHA-accredited. Bachelor's degree required. Graduate prepared to pursue licensure.
• Arizona State University - Online - Online Bachelor of Science in Speech and Hearing Science - Designed to prepare graduates to work in behavioral health settings or transition to graduate programs in speech-language pathology and audiology.

Simple Speech Generation Device | Just Type and Find Your Voice Again

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The Wireless Standard | The Wireless Dual The Wired Large

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Welcome to Talking Keyboards: Your Gateway to Speech Communication

On-the-Go AAC Solution

Lightweight and Portable

Multi-Language Voice Options

Cost effective augmentative & alternative communication devices.

• Effortless Communication: Real-time speech generation from typed messages.
• Diverse Models: Choose from Wireless, Large Wired, or Dual Keyboard options.
• Personalized Phrases: Speak 30 user-defined phrases with ease.

Direct Text-to-Speech Capabilities Now at Your Fingertips

Talking Keyboards Your Voice, Your Power, Anywhere

• Wireless Standard Keyboard: Embrace wireless communication freedom.
• Large Wired Keyboard: Enhanced visibility for low eyesight.
• Dual Keyboard Combination Model: A compact, wireless keyboard perfect for travel.

Experience the most user-friendly augmentative communication device available today.

Why Choose Talking Keyboards over Speech Synthetized Apps?

Speaker features, lightweight and portable:.

Easy to use and carry. Can be powered by both AC and battery, offering flexibility in usage.

Seamless Call Connectivity:

Connect effortlessly for calls with friends and family. Enhancing communication for diverse needs.

On-the-Go AAC Solution:

Perfect for communication on the move, offering instant functionality, no setup required.

Wireless Connectivity:

Seamless wireless connectivity with full-size keyboards. No hassle of cords, convenient setup.

Funding Resources for Talking Keyboards

Rated 4.8/5 by verified users.

What’s in the Box?

• One speaker
• One keyboard
• Power transformer for DC operation
• Instruction manual

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Our Mission

At Spoken, we give voice to those who need it, with personal speech technology that empowers you to be heard.

Speak sentences as fast as you can tap.

Spoken is an app designed for people unable to use their voice due to nonverbal autism, aphasia, stroke, or other speech and language disorders.

It's an entirely new kind of augmentative and alternative communication (AAC) that uses artificial intelligence to learn from how you talk and predict the words you want next.

Spoken makes it easier for you to express thoughts and ideas using your mobile device. Simply download the app on your phone or tablet and tap on the screen to build sentences quickly — Spoken speaks them automatically, with a wide variety of natural-sounding voices.

Speak Naturally

With Spoken you're not limited to simple phrases. It gives you the freedom to express complex emotions and thoughts with an extensive vocabulary. Our selection of natural, lifelike voices also ensures your communication sounds just like you—not robotic.

Personalized

Everyone has their own way of talking, and Spoken adapts to yours. The more you use it, the better it gets at predicting what you want to say. Express yourself quickly and fully using our intelligent word prediction technology.

Spoken is Easy

Spoken is quick and simple to use. It understands what you want to say, so all you have to do is tap to talk. It’s also fully compatible with your existing devices, including Android, iOS, and Mac, ensuring you can communicate effortlessly wherever you are.

Speak easily with advanced technology

We understand the importance of being heard. That's why we've tailored Spoken to be the simplest, most effective AAC app for your self-expression and independence.

Spoken combines advanced AI predictions with next-generation text-to-speech, making it a perfect solution for the communication challenges posed by aphasia, autism, cerebral palsy, ALS, Parkinson's, stroke, and other language impairments.

With Spoken, communication is reliable again. Express your thoughts, share your feelings, and participate in discussions with ease. Our intuitive design and powerful features enhance the quality of everyday interactions and make sure you're never left out of the conversation.

COVID-19 Survivor

Dec 30, 2021

This app is a life saver. On August 3rd, I went into the hospital with COVID and was sedated for about two months. I couldn't speak when I woke up and it hurt so much to see my family and the love of my life and not be able to tell them how much I love them, but this app helped me communicate with my family and nurses as well as doctors. I don't know where I would be without this app when I was in the hospital. Today I have recovered 100% with no long term effects and I'm very grateful and now I just have a tracheotomy scar and feeding tube scar but hey, it's better than not being alive. Thank you to every developer of this app.

Android Review

February 10, 2023

As a partially speaking autistic teen, I LOVE this app. The voice is so customizable (everything from light feminine to androgynous to masculine deep and then you can choose the speed), and then the app is gorgeous! There's also choices between selecting buttons to speak and typing, which really helps in an odd sense.

I Love This App

May 25, 2022

Marvel Fan 239

I have been stuttering for a long time and it's extremely frustrating to sometimes not be able to communicate with family and friends or coworkers. This app helps me in everyday life. Thank you, I couldn't be happier with this app. 11/10.

December 25, 2023

Great idea and easy to get the hang of. Interface is beautiful. I wish Google would add an accessibility tag so it’s even easier to find in the Play Store. Thank you for your work.

Makes Life So Much Easier

February 2, 2023

This app is amazing. I recently got a tracheostomy and was unable to speak. This app completely solved my problem. There are a variety of very nice voices to use. It often has a useful list of words to pick from for auto complete. I absolutely love this app which is why I paid for it! I looked at a lot of speech apps and this one was better in every way.

December 14, 2021

This is great! I had oral surgery and it's hard to understand me when I talk. I have to repeat myself several times, talk louder, and I'm often still not understood, especially with people hard of hearing. I looked for an app to help and most of them are for narration of books and other prewritten pieces. This app helps me be heard! I love the variety of voices to choose from.

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A perfect AAC augmentative communication aid for non-verbal  individuals, post operative patients, or anyone who needs audio feedback with synthesized speech

Choose from multiple keyboard options  

AAC Communicators provide individuals who have limited or no ability to speak.

Medicare has referred to portable electronic communicators as "speech generating devices" (SGD). [Footnote 1: According to www.AACFundingHelp.com , a Web site maintained by the Assistive Technology Law Center, the term SGD was coined by a Medicare policy-making body in an October 2000 policy document that was implemented in January 2001. (See "History of Medicare SGD Funding ", and "SGD or AAC Device ?") Information obtained on March 7, 2008.] Other names for them include voice output communication aids (VOCA) or augmentative and alternative communication (AAC) devices.**

Portable communicators can benefit individuals with a wide variety of disabilities or conditions that impair that person's ability to speak, including non-verbal persons with ALS (Lou Gehrig's disease), Aphasia, Autism Brain injury, Dysarthria, Laryngectomy, Quadriplegia or high level spinal cord injury (SCI), Stroke

TextSpeak is a leading provider of simple augmentative and alternative communication (AAC) aids to assist individuals with speech challenges. 

     information on Medicare and  "Speech Generating Devices (HCPCS Code E2510KX)" 

Communications device, speaking software, language problems, speech output devices, communication, assistive technology, computerized speech, language technology, adults, augmentative and alternative communication (AAC) devices 

Digital Acoustics Textspeak series; Leaders in Assistive Talking Keyboards. TextSpeak series generate speech as Augmentative Speech Aid. Adaptive and Assistive Keyboards, AAC, communication devices, assistive technology. Full information on AAC devices ALS assistive ALS  devices

Voice4u TM AAC

Create. tap. speak., symbol-based communication app for those who have speech challenges..

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Voice4u TM TTS

A text-to-speech app with natural sounding voices in 30+ languages and gender options. speak by typing and photographing with camera..

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What is AAC?

An introduction to Augmentative and Alternative Communication (AAC). What is AAC and who is it for? What are the different types of AAC? What are the benefits of AAC?

AAC is short for Augmentative and Alternative Communication.

Communication devices, systems, strategies and tools that replace or support spoken language are known as augmentative and alternative communication (AAC). These tools support a person who has difficulties communicating using speech.

The first “A” in AAC stands for Augmentative Communication . When you augment something, you add to it or supplement. Augmentative communication is when you add something to your speech (eg. sign language, pictures, a letter board). This can make your message clearer to your listener.

The second “A” in AAC stands for Alternative Communication . This is when you are not able to speak. It is also when your speech is not understood by others. In this case, you need a different way to communicate.

Basically, AAC can be tools, systems, devices or strategies. These tools help a person communicate, when they cannot rely on speech. Perhaps your child has not started talking. Perhaps you have lost your ability to speak. Perhaps your speech comes and goes. Maybe speaking is harder than other ways to communicate. AAC can help.

Who is AAC for?

There are many reasons why a person may not be able to communicate using speech. They may have a developmental disability which has affected the development of speech. They may have an acquired disorder that has affected the person’s ability to speak. Many people with different communication difficulties, speech impediments and disorders can benefit from AAC.

AAC finders may help discover who could use AAC, using the AAC finders checklist.

Communicating without speech

Communicating without speech is difficult. People who do not speak are at a disadvantage in a speaking world. It can be confusing and frustrating when messages cannot be given effectively. This is frustrating for both the non-speaking person and their communication partner.

Often a non-speaking person will have many thoughts they wish to communicate. How do they get these thoughts out?

When a person is not able to speak, others often make judgements about their competence, potential, and ability to think and learn .

A person who does not speak will quickly learn that some things are easy to communicate (e.g. reaching for the TV remote to suggest you want to change the channel). They also learn that some things are hard to communicate (e.g. that the TV show reminds you of a family member who is gone).

What types of AAC are often used?

AAC incorporates all the tools and strategies a person can use to communicate, when they are not able to speak. Often we break them into 2 groups: Unaided and Aided AAC.

1. Unaided AAC – or AAC that does not require a physical aid or tool.

• Facial expressions
• Body language
• Sign language

2. Aided AAC – or AAC that uses tools or materials.

• Symbol boards
• Choice cards
• Communication books
• Keyboards and alphabet charts
• Speech-generating devices or communication devices
• AAC apps on mobile devices

We may use a high-tech tool (e.g. a Speech Generating Device, or AAC app on an iPad), or a light-tech/paper-based tool (e.g. a communication book, or board).

Text-based AAC

An AAC system may be a text-based system with a keyboard. This is generally for a person who types the words they want to say. They can often read and spell. Proloquo4Text is AssistiveWare’s text-based AAC solution.

Symbol-based AAC

Many people might need symbols or pictures when communicating. This includes those people who cannot yet read or spell. We can introduce visual symbols that represent words or maybe phrases. Proloquo and Proloquo2Go are AssistiveWare’s symbol-based AAC solutions.

Other people may use Gayle Porter's PODD system. simPODD is AssistiveWare's digital and print PODD solution.

Multimodal communicators

Many people who cannot speak but use AAC are multimodal communicators . This means they have multiple ways to communicate their messages. As well as AAC, they might use vocalizations, word approximations, and maybe some gesture and sign language. Many people show photos from their camera roll to add to what they are saying. All different methods of communication should be valued and respected. Different communication still tells us something!

Even people with some spoken communication, may benefit from AAC. If speech is limited, AAC can help. It can give a person more words and language. They may communicate far more with AAC than they can with speech alone.

Benefits of AAC

Many people who cannot rely on speech, could benefit from AAC. And there are challenges when people do not have AAC.

People who use AAC describe benefits

These include:

• stronger friendships and deeper relationships
• richer, more frequent social interactions
• deeper social roles: family member, friend, professional, student
• increased autonomy and decision-making power over their own life
• increased independence
• more respect from others
• greater participation in their family lives and communities
• improved information sharing with physicians
• improved personal safety in a variety of care settings, such as hospitals or long-term facilities
• more employment and volunteer opportunities
• improved physical and mental health

Challenges for people without AAC

There are often difficulties without AAC, when someone cannot talk reliably.

People who use AAC say that, prior to having a communication system, they experienced:

• more social isolation and loneliness
• increased frustration and acting out with loved ones
• greater vulnerability, especially when alone in a care setting
• feeling shut out of important decisions over their own life
• inability to show what they know or can learn

The AAC journey

Communication is a fundamental human right . A person with speech impediments or disorders can communicate with AAC.

Before starting, you may still wonder whether AAC is really needed. Will AAC be beneficial? When should we consider AAC? If you need help answering these questions, please check the “Do we need AAC?” article.

If you are using symbols and wish to make plans that support change and progress, please use our Learn AAC Guide . This may help you to consider selecting the right AAC system for a person, getting set up for AAC and then helping to build language and real communication.

Good luck, please reach out to our support team if you need any help along the way!

Links & references

• ASHA. Augmentative and Alternative Communication . [Article and references]
• Ahern, Kate. (2014). Why "prove it with low tech first" doesn't work . [Blog post]
• Beukelman, D., & Mirenda, P. (2013). Augmentative and Alternative Communication (4th Ed.). Baltimore: Paul H. Brookes.
• Brady, N. C., Bruce, S., Goldman, A., Erickson, K., Mineo, B., Ogletree, B. T., Paul, D., Romski, M., Sevcik, R., Siegel, E., Schoonover, J., Snell, M., Sylvester, L., & Wilkinson, K. (2016). Communication services and supports for individuals with severe disabilities: Guidance for assessment and intervention. American Journal on Intellectual and Developmental Disabilities, 121 (2), 121–138.
• Farrall, Jane. (2015). AAC: Don’t Demand Prerequisite Skills . [Blog post]
• Kangas, Kathleen & Lloyd, Lyle. (2009). Early Cognitive Skills As Prerequisites to Augmentative and Alternative Communication Use: What Are We Waiting For?. Augmentative and Alternative Communication. 4. 211-221.
• Light, J., & McNaughton, D. (2014). Communicative competence for individuals who require augmentative and alternative communication: A new definition for a new era of communication? Augmentative and Alternative Communication, 30, 1–18.
• LoStracco, Heidi. (2014). The Myth of Augmentative and Alternative Communication (AAC) Pre-Requisite Skills . [Blog post]
• National Joint Committee for the Communication Needs of Persons With Severe Disabilities. NJC on AAC . [Article]
• Romski, M.A. & Sevcik, R.A. (2005). Augmentative communication and early intervention: myths and realities. Infants and Young Children 18 (3), 174.

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Abilia Lightwriter SL50

Clear, natural communication that is always ready to talk!

Lightwriter SL50 has been designed to be the best dedicated text-to-speech device for literate users who are unable to communicate effectively through speech. With a Lightwriter you can participate in social interactions while at work or during leisure time, even in noisy, sunny outdoor or poorly lit environments. Every part of the Lightwriter SL50 has been designed specifically for purpose. From the dual screens and loud clear speakers, to the user interface and word prediction - everything is focused on delivering your speech as effectively as possible. So, no more compromises, no more distractions, just clear, fast effective communication at the press of a button.

Highlights of Value and Functionality

•    Easy to use, fast and dedicated keyboard-based      (text-to-speech) device for literate users •     Communicate efficiently either through face-to-face  

      communication, SMS texting, or mobile phone calls •     It can be used both by typing the keys and by scanning with 1 or 2

      control switches

•    Fast start-up and simple to use menu interface •    Personalized vocabulary for quicker communication •    Connect to a mobile phone using Bluetooth •    High quality Acapela voices or My Own Voice input •    Simple ‘plug and play’ 1-switch or 2-switch scanning •    Dual displays and outward facing speaker •    Backlit screens and keys which automatically adjust to different

      light levels •    Remote software

New for the Lightwriter SL50

•    Fast start-up •    User ’Structured’ Menus •    Backlit colour display •    Plug and Play Scanning •    Backlit keyboard •    Fast charge (4 hours) and all day battery life •    Weight 740g (>100g lighter) •    Remote SW updates via Ethernet port

•    A selection of Acapela voices and import of new voices including

     voice banking •    Multi-lingual •    Import of personalized vocabularies •    Mobile phone and SMS (via Bluetooth)

Click on the button for a Lightwriter sales sheet.

Please note that like any of our devices, the lightwriter can be added to a custom forbes aac wheelchair mount to solve all of a user's mobility needs. contact your local rep for help determining the best mounting scenario..

Available as a Dedicated Speech Generating Device (SGD) meeting the requirements of HCPCS code E2510.

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The Ultimate Guide to Augmentative and Alternative Communication (AAC)

What is aac, who can benefit from aac, types of aac, how to implement aac, challenges of aac, 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

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.

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.

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.

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

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.

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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.

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:

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.

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.

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 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.

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.

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.

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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.

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.

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.

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…” .

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.

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).

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.

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).

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.

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.

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.

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

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Assistive Devices for People with Hearing, Voice, Speech, or Language Disorders

On this page:

What are assistive devices?

What types of assistive devices are available, what types of assistive listening devices are available, what types of augmentative and alternative communication devices are available for communicating face-to-face, what augmentative and alternative communication devices are available for communicating by telephone, what types of alerting devices are available, what research is being conducted on assistive technology, where can i get more information.

The terms assistive device or assistive technology can refer to any device that helps a person with hearing loss or a voice, speech, or language disorder to communicate. These terms often refer to devices that help a person to hear and understand what is being said more clearly or to express thoughts more easily. With the development of digital and wireless technologies, more and more devices are becoming available to help people with hearing, voice, speech, and language disorders communicate more meaningfully and participate more fully in their daily lives.

Health professionals use a variety of names to describe assistive devices:

• Assistive listening devices (ALDs) help amplify the sounds you want to hear, especially where there’s a lot of background noise. ALDs can be used with a hearing aid or cochlear implant to help a wearer hear certain sounds better.
• Augmentative and alternative communication (AAC) devices help people with communication disorders to express themselves. These devices can range from a simple picture board to a computer program that synthesizes speech from text.
• Alerting devices connect to a doorbell, telephone, or alarm that emits a loud sound or blinking light to let someone with hearing loss know that an event is taking place.

Several types of ALDs are available to improve sound transmission for people with hearing loss. Some are designed for large facilities such as classrooms, theaters, places of worship, and airports. Other types are intended for personal use in small settings and for one-on-one conversations. All can be used with or without hearing aids or a cochlear implant. ALD systems for large facilities include hearing loop systems, frequency-modulated (FM) systems, and infrared systems.

This logo informs people that a public area is looped. Source: HearingLoop.org

Hearing loop (or induction loop) systems use electromagnetic energy to transmit sound. A hearing loop system involves four parts:

• A sound source, such as a public address system, microphone, or home TV or telephone
• An amplifier
• A thin loop of wire that encircles a room or branches out beneath carpeting
• A receiver worn in the ears or as a headset

Amplified sound travels through the loop and creates an electromagnetic field that is picked up directly by a hearing loop receiver or a telecoil (see sidebar), a miniature wireless receiver that is built into many hearing aids and cochlear implants. To pick up the signal, a listener must be wearing the receiver and be within or near the loop. Because the sound is picked up directly by the receiver, the sound is much clearer, without as much of the competing background noise associated with many listening environments. Some loop systems are portable, making it possible for people with hearing loss to improve their listening environments, as needed, as they proceed with their daily activities. A hearing loop can be connected to a public address system, a television, or any other audio source. For those who don’t have hearing aids with embedded telecoils, portable loop receivers are also available.

What’s a telecoil?

A telecoil, also called a t-coil, is a coil of wire that is installed inside many hearing aids and cochlear implants to act as a miniature wireless receiver. It was originally designed to make sounds clearer to a listener over the telephone. It also is used with a variety of other assistive listening devices, such as hearing loop (or induction loop) systems, FM systems, infrared systems, and personal amplifiers.

The telecoil works by receiving an electromagnetic signal from the hearing loop and then turning it back into sound within the hearing aid or cochlear implant. This process eliminates much of the distracting background noise and delivers sound customized for one’s own need. For people who are hard-of-hearing who do not have a telecoil-equipped hearing aid or cochlear implant, loop receivers with headsets can provide similar benefits but without the customized or “corrected sound” feature that matches one’s hearing loss pattern.

Many cochlear implants have a telecoil built into the sound processor, or can use an external telecoil accessory with both hearing aid compatible telephones and public loop systems. A simple switch or programming maneuver performed by the user activates this function.

See the NIDCD fact sheet Hearing Aids for more information.

FM systems use radio signals to transmit amplified sounds. They are often used in classrooms, where the instructor wears a small microphone connected to a transmitter and the student wears the receiver, which is tuned to a specific frequency, or channel. People who have a telecoil inside their hearing aid or cochlear implant may also wear a wire around the neck (called a neckloop) or behind their aid or implant (called a silhouette inductor) to convert the signal into magnetic signals that can be picked up directly by the telecoil. FM systems can transmit signals up to 300 feet and are able to be used in many public places. However, because radio signals are able to penetrate walls, listeners in one room may need to listen to a different channel than those in another room to avoid receiving mixed signals. Personal FM systems operate in the same way as larger scale systems and can be used to help people with hearing loss to follow one-on-one conversations.

Infrared systems use infrared light to transmit sound. A transmitter converts sound into a light signal and beams it to a receiver that is worn by a listener. The receiver decodes the infrared signal back to sound. As with FM systems, people whose hearing aids or cochlear implants have a telecoil may also wear a neckloop or silhouette inductor to convert the infrared signal into a magnetic signal, which can be picked up through their telecoil. Unlike induction loop or FM systems, the infrared signal cannot pass through walls, making it particularly useful in courtrooms, where confidential information is often discussed, and in buildings where competing signals can be a problem, such as classrooms or movie theaters. However, infrared systems cannot be used in environments with too many competing light sources, such as outdoors or in strongly lit rooms.

Personal amplifiers are useful in places in which the above systems are unavailable or when watching TV, being outdoors, or traveling in a car. About the size of a cell phone, these devices increase sound levels and reduce background noise for a listener. Some have directional microphones that can be angled toward a speaker or other source of sound. As with other ALDs, the amplified sound can be picked up by a receiver that the listener is wearing, either as a headset or as earbuds.

The simplest AAC device is a picture board or touch screen that uses pictures or symbols of typical items and activities that make up a person’s daily life. For example, a person might touch the image of a glass to ask for a drink. Many picture boards can be customized and expanded based on a person’s age, education, occupation, and interests.

Keyboards, touch screens, and sometimes a person’s limited speech may be used to communicate desired words. Some devices employ a text display. The display panel typically faces outward so that two people can exchange information while facing each other. Spelling and word prediction software can make it faster and easier to enter information.

Speech-generating devices go one step further by translating words or pictures into speech. Some models allow users to choose from several different voices, such as male or female, child or adult, and even some regional accents. Some devices employ a vocabulary of prerecorded words while others have an unlimited vocabulary, synthesizing speech as words are typed in. Software programs that convert personal computers into speaking devices are also available.

For many years, people with hearing loss have used text telephone or telecommunications devices, called TTY or TDD machines, to communicate by phone. This same technology also benefits people with speech difficulties. A TTY machine consists of a typewriter keyboard that displays typed conversations onto a readout panel or printed on paper. Callers will either type messages to each other over the system or, if a call recipient does not have a TTY machine, use the national toll-free telecommunications relay service at 711 to communicate. (See Telecommunications Relay Services for more information.) Through the relay service, a communications assistant serves as a bridge between two callers, reading typed messages aloud to the person with hearing while transcribing what’s spoken into type for the person with hearing loss.

With today’s new electronic communication devices, however, TTY machines have almost become a thing of the past. People can place phone calls through the telecommunications relay service using almost any device with a keypad, including a laptop, personal digital assistant, and cell phone. Text messaging has also become a popular method of communication, skipping the relay service altogether.

Another system uses voice recognition software and an extensive library of video clips depicting American Sign Language to translate a signer’s words into text or computer-generated speech in real time. It is also able to translate spoken words back into sign language or text.

Finally, for people with mild to moderate hearing loss, captioned telephones allow you to carry on a spoken conversation, while providing a transcript of the other person’s words on a readout panel or computer screen as back-up.

Alerting or alarm devices use sound, light, vibrations, or a combination of these techniques to let someone know when a particular event is occurring. Clocks and wake-up alarm systems allow a person to choose to wake up to flashing lights, horns, or a gentle shaking.

Visual alert signalers monitor a variety of household devices and other sounds, such as doorbells and telephones. When the phone rings, the visual alert signaler will be activated and will vibrate or flash a light to let people know. In addition, remote receivers placed around the house can alert a person from any room. Portable vibrating pagers can let parents and caretakers know when a baby is crying. Some baby monitoring devices analyze a baby’s cry and light up a picture to indicate if the baby sounds hungry, bored, or sleepy.

The National Institute on Deafness and Other Communication Disorders (NIDCD) funds research into several areas of assistive technology, such as those described below.

• Improved devices for people with hearing loss NIDCD-funded researchers are developing devices that help people with varying degrees of hearing loss communicate with others. One team has developed a portable device in which two or more users type messages to each other that can be displayed simultaneously in real time. Another team is designing an ALD that amplifies and enhances speech for a group of individuals who are conversing in a noisy environment.
• More natural synthesized speech NIDCD-sponsored scientists are also developing a personalized text-to-speech synthesis system that synthesizes speech that is more intelligible and natural sounding to be incorporated in speech-generating devices. Individuals who are at risk of losing their speaking ability can prerecord their own speech, which is then converted into their personal synthetic voice.
• Brain–computer interface research A relatively new and exciting area of study is called brain–computer interface research. NIDCD-funded scientists are studying how neural signals in a person’s brain can be translated by a computer to help someone communicate. For example, people with amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease) or brainstem stroke lose their ability to move their arms, legs, or body. They can also become locked-in, where they are not able to express words, even though they are able to think and reason normally. By implanting electrodes on the brain’s motor cortex, some researchers are studying how a person who is locked-in can control communication software and type out words simply by imagining the movement of his or her hand. Other researchers are attempting to develop a prosthetic device that will be able to translate a person’s thoughts into synthesized words and sentences. Another group is developing a wireless device that monitors brain activity that is triggered by visual stimulation. In this way, people who are locked-in can call for help during an emergency by staring at a designated spot on the device

The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language. 

Use the following keywords to help you search for organizations that can answer questions and provide printed or electronic information on assistive devices:

• Assistive technology
• Assistive listening device
• Augmentative and alternative communication

For more information, contact us at:

NIDCD Information Clearinghouse 1 Communication Avenue Bethesda, MD 20892-3456 Toll-free voice: (800) 241-1044 Toll-free TTY: (800) 241-1055 Email: [email protected]

NIH Publication No. 11-7672 December 2011

*Note: PDF files require a viewer such as the free Adobe Reader .

Free Text-based AAC Apps for the iPad

July 1, 2013 by Carole Zangari - 4 Comments

Looking for an AAC app for someone who reads and writes? Here are a few free ones that you can explore and use in your evaluations.

1.       Verbally (Free) : Plus a premium version for purchase that allows for more customization and prestored mesages for things the client may want to say over and over (e.g., What’s going on with the kids? Can you help me with something? I don’t agree with that. I need my pain medicine, It’s too cold in here. etc.)

2.       Locabulary Lite

3.       Phrase Board

4.       Small Talk Conversational Phrases

5.       Small Talk Daily Activities

6.       Small Talk Pain Scale

7.       Talk Assist

 Do you use one that didn’t make it onto our list? Please let us know.

Filed under: PrAACtical Thinking

Tagged With: free , iOS , iPad , print , text , text-to-speech

This post was written by Carole Zangari

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Hi Carole- I initially sent this question to Sean and he suggested that I check out your blog.

The agency that I’m consulting with is considering getting a few tablet devices and they’re questioning why to get I-Pads when Android tablets are so much less expensive. I’ve narrowed down the software to Proloquo2Go. I’d appreciate your opinion as to whether the I-Pad is a better choice over the Android and if there is a better software system to use for speech generating purposes with multiple users. Thank you- Gene Pizzolato , SLP

Gene, thanks for your question. It really depends on what the planned use for the device is. For AAC, while there are options for the Android tablets, there are a great many more for the iOS platform. On average, I think the quality of the AAC apps is better on iOS than Android, although there are some very good apps on both. Again, the answer is driven by the purpose that you want the device to serve. Ferrari makes an awesome car, but I wouldn’t want to drive it on the beach or use it to pull a trailer. Knowing what you want the device to do will help you make the best decision. If I was purchasing one for an agency so that the SLP could use it for evals and therapy with people who need AAC, I would most likely choose the iOS device. Hope that is helpful, Gene.

Thanks Carole!

I have anxiety and sometimes go nonverbal. I use a text based AAC app, called EmergencyChat. I consider EmergencyChat to be aac because it’s a text based app.

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