Communication & AAC

Communication differences in autism

Autism affects communication in many different ways. Some autistic people are highly verbal but struggle with pragmatic language — the social rules of conversation like turn-taking, reading intent, and interpreting figurative language. Others have limited spoken language or no spoken language at all.

The term "nonverbal" is often misused: many children diagnosed as nonverbal at age 3 or 4 develop functional speech with appropriate support. A more accurate framing is "minimally speaking" or "non-speaking at this time." Access to AAC supports communication regardless of whether spoken speech develops later.

Communication also encompasses more than talking: receptive language (understanding), expressive language (producing), pragmatic language (social use), and alternative modalities (writing, AAC, gesture). An SLP evaluation should assess all of these, not just spoken word count.

What AAC is

AAC (augmentative and alternative communication) refers to all tools and strategies that supplement or replace spoken speech. There are several categories:

• Low-tech: picture exchange communication systems (PECS), symbol boards, communication books. No batteries, durable, inexpensive.
• Mid-tech: simple speech-generating devices with pre-recorded messages (GoTalk, BIGmack).
• High-tech: dedicated speech-generating devices (SGDs) like PRC-Saltillo's Accent or Tobii Dynavox; iPad apps like Proloquo2Go, TouchChat, or LAMP Words for Life.

The myth that AAC reduces speech: this is one of the most common concerns parents have — and it is not supported by research. Studies consistently show that AAC access increases overall communication, including spoken speech, by reducing frustration and providing a model for language structure. The American Speech-Language-Hearing Association's position is clear: AAC should not be withheld based on concern that it will replace speech.

Getting AAC for your child

The starting point is an SLP evaluation focused specifically on communication needs and AAC. This is different from a general speech therapy evaluation — be explicit when requesting it.

Through school (IDEA): AAC is a related service under IDEA. If your child's communication needs affect their education, the IEP team is required to consider AAC as part of the evaluation and plan. Request this in writing. The school must provide what is educationally necessary — not necessarily the most expensive device, but not an inadequate one either.

Through insurance: speech-generating devices are often covered as durable medical equipment (DME). The process: SLP writes a letter of medical necessity, the device is prescribed, and your insurer reviews. Prior authorization is common. Denials happen — appeal using the same process as ABA denials (see insurance & prior authorization).

Trial periods: most AAC systems offer loaner devices or trial periods. An SLP can arrange a trial with a specific system before requesting insurance coverage or an IEP device. Don't commit to a specific system before trialing it with your child.

Supporting communication at home

Aided language input: the most research-supported strategy for AAC learners. You use the AAC device or board to model language yourself — not just prompting your child to use it. When you say "let's eat," also press the "eat" symbol. This gives your child a model for how the system works and shows that the device is for everyone, not just them.

Consistency: AAC works best when used consistently across settings — home, school, therapy, and community. Bring the device everywhere. Work with the school and therapist to keep vocabulary consistent. Vocabulary that exists at school but not at home (or vice versa) slows learning.

Core vocabulary: high-tech AAC systems use a core vocabulary (the most frequently used words: more, stop, help, want, go, I, you, like, not, that) plus fringe vocabulary (specific nouns). Core words are used across many situations. Prioritize learning core words first — they are more generalizable than nouns.

Involving the whole family: children learn language through social interaction, not just therapy sessions. The more people who model and respond to AAC use at home, the faster learning happens. Show siblings and grandparents how to use the system.