A teenager or adult who communicates with AAC no longer just wants to say ‘more’ or ‘all done’: they want to joke with their friends, choose their clothes, buy their bread, take the bus, say no. For AAC to become a lever for independence, its content has to follow the person’s age, not their assumed level (Beukelman and Light, 2020), and each everyday situation is prepared one step at a time.

How do you adapt vocabulary for a teenager or an adult?

• Pictures for their age. A smiley works for ‘happy’ for a 5-year-old; for a teenager, ‘awesome’ goes down better with a thumbs up or a fist bump.
• The topics that matter to them: friends, music, series, video games, sport, social media, love, a changing body, privacy.
• Expressions for their age, slang and swear words included: that’s for the person to decide, not the team.
• Text-message shorthand (‘lol’, ‘idk’): young people who use AAC ask to learn it (Caron and Light, 2016).
• A profile that belongs to them: an adult decides what is saved, shared or shown.

The device matters too: a mainstream tablet is seen as ‘cool’, whereas a dedicated device can signal disability (Rummel-Hudson, 2011). For some teenagers, that detail changes everything. The Pictalk vocabularies were designed for children and teenagers, with no baby talk: ‘Friends’ and ‘Expressions’ pages, health, consent, puberty and privacy.

How do you move towards independence, step by step?

Becoming independent doesn’t mean doing everything alone overnight. Break an activity into steps, compare what the person does with what their peers do, then remove one barrier at a time: this is the Participation Model (Beukelman and Light, 2020), explained in Setting up AAC as a team. Three tools help at each step:

• A visual schedule to know what is planned and anticipate changes.
• Guided sequences for tasks with several steps: packing a bag, doing the washing, cooking pasta. In Pictalk Buddy, each step can have a symbol, audio or a video.
• Discreet reminders: alarms, or a smartwatch, which saves getting the tablet out in the street (Buddy also works on Android watches).

To set them up, see Visual supports: schedule, sequences, timer.

Going shopping: how do you prepare a transaction page?

Buying something on your own is often the first big win. These exchanges are predictable: you know roughly what will be said, and in what order. So prepare a transaction page, with 4 to 8 messages in the order of the exchange (Beukelman and Light, 2020):

1. Who I am and how I communicate: ‘Hello, I talk with my tablet, thank you for waiting.’
2. The request: ‘I’d like a baguette, please.’
3. The details: ‘Well baked’, ‘And a croissant’.
4. Confirming or repairing: ‘Yes, that’s right’ or ‘That’s not it, let’s start again’.
5. Paying: ‘I’ll pay by card’, ‘How much is it?’.
6. Thanks and goodbye: ‘Thank you, have a nice day!’

It works: after video training, young adults placed orders in fast-food restaurants with their AAC tool, and staff responded appropriately in more than 97% of cases (Mechling and Cronin, 2006). In the Springboard 48 vocabulary, the ‘Store’ page has polite phrases for shop staff: ‘I’d like…’, ‘how much does it cost?’, ‘could you repeat that?’.

The same structure works at the chemist’s or on the bus. To make the page, follow Making a communication board (the bakery example); printable materials are on the resources page.

What do you need for outings, transport and leisure?

• An introduction card for strangers (bus driver, waiter, shop assistant), short and suited to the situation: a waiter only needs to know how to take the order. See Being understood.
• Buttons that do things: in Buddy, a button can call someone close, send a text message, open directions or another app. Handy for ‘I’ve arrived’ or ‘come and pick me up’.
• Phrases for the unexpected: ‘I’m lost’, ‘I don’t know this person’, ‘I want to call my parents’ (the ‘Something’s wrong’ branch of the Pictalk vocabularies).
• Chosen leisure activities: sport, music, cinema, going out with friends, with the words to talk about it afterwards. A life book with a few photos helps to restart the conversation.

For worried families, Buddy can be locked (with a code or a question) to prevent accidental changes, and it explains how to set up the device’s parental controls, to be adjusted with the person according to their age and independence. More independence also means more situations where you need to be able to say no and stand up for yourself: self-advocacy scripts, safety and consent are covered in Body, pain, consent.

How do you prepare for adult life?

The transition is prepared early, from secondary school: for young people with cerebral palsy, a parent quoted by Beukelman and Light (2020) suggests thinking about it around the age of 12.

• Work: general phrases (‘can I have some help?’, ‘I’ve finished, what shall I do now?’), scripts for customers, words for the job, and enough to keep up conversations during the tea break.
• Health: an introduction card for health professionals, and the message ‘talk to me directly, not to my carer’.
• Housing and personal support: being able to explain how you want to be helped, and to say ‘you skipped a step’ or ‘that’s good, thank you’.
• Moving to a new home: visit the new place beforehand, and never change home and AAC tool at the same time.

For people with Down syndrome, AAC often remains useful in adulthood with unfamiliar people, even when speech has developed: see Down syndrome and AAC.

Frequently asked questions

My adult son has never had AAC: is it too late?

No, there is no age limit. Adults who discover AAC after years without a suitable means of communication learn quickly once they have real opportunities to use it, with trained partners (Holyfield et al., 2017; Drager et al., 2019).

Do you have to get the tablet out in the street?

Not necessarily. A phone, a smartwatch or a small paper card can be enough for a specific situation, such as buying bread.

Pictalk Buddy brings together AAC boards, a visual schedule, guided sequences and notebooks, with the same symbols, on Android, iOS, the web and the watch. A pay-what-you-want app, developed by a non-profit association. Discover Buddy

Sources

• Beukelman, D. R., & Light, J. C., 2020, Augmentative & Alternative Communication (5th ed.), Paul H. Brookes, chapters 2, 5, 9, 11 and 13.
• Studies cited from Beukelman & Light (2020): Caron & Light (2016); Rummel-Hudson (2011); Mechling & Cronin (2006); Holyfield et al. (2017); Drager et al. (2019).