‘If we give him a tablet, he won’t want to talk any more.’ It is often the first worry when augmentative and alternative communication (AAC) is suggested. The research is clear: AAC does not hold speech back, it often goes hand in hand with it, and it also helps people who speak a little when their speech is not enough.
What do the studies show?
- A literature review found no case of speech loss; some participants even gained spoken output (Millar, Light & Schlosser, 2006).
- In young children with language delay, a device with a synthetic voice went along with growth in spoken words (Romski et al., 2010).
- In minimally verbal autistic children, adding a speech-generating tablet to an intervention programme produced more spontaneous utterances, and the gap stayed clear when only spoken words were counted (Kasari et al., 2014). A review of speech-generating devices in autism points the same way (Schlosser & Wendt, 2008).
- In young children with Down syndrome, a sequence was observed: first visual scenes, then signs, then speech taking over (Light & Drager, 2012).
Acquired or developmental conditions: most people gain or regain some speech with AAC, and families should be told this from the start (Beukelman & Light, 2020).
Why AAC can help speech
- Less pressure. The message gets through via the tool, so speech can be tried without anything at stake.
- A consistent sound model. Every button touched says the word the same way, linked to the intention, hundreds of times.
- More interaction. Someone who can answer, comment and ask gets more replies, and language is built in these exchanges.
- Language before articulation. Words, their meaning and how they combine develop even when articulation has not caught up yet.
What the research does not promise
AAC cannot guarantee that speech will appear: some people will talk, others a little, others not at all. It takes nothing away and gives the person a way to express themselves straight away. Waiting for speech has a cost: understanding grows, but expression stays blocked, with frustration and sometimes behaviours that challenge (Beukelman & Light, 2020). Other myths (age, prerequisites, ‘he’s not ready’) are covered in Myths about AAC.
He speaks a little: what is AAC for?
‘He talks, so he doesn’t need a tablet’: this forgets that nobody communicates in only one way. We all mix voice, gestures, facial expressions and writing depending on the listener and the situation (Williams, Krezman & McNaughton, 2008). A person with limited speech keeps it for what it does well, and relies on AAC to:
Be understoodBy someone who does not know them
Say something new or preciseA name, a place, a pain
Repair a misunderstandingWhen the message has not been understood
Keep communicatingWhen tiredness, emotion or noise make speaking hard
| Who is it for? | When AAC takes over |
|---|---|
| Childhood apraxia of speech | To say more than speech allows and to repair misunderstandings (see below). |
| Down syndrome | To clarify speech that is hard to understand, especially with strangers; its role changes with age (see Down syndrome and AAC). |
| Autism with speech | In overload or stress, ready-made messages (‘I need a break’, ‘there’s too much noise’) can keep the situation from escalating (Zisk & Dalton, 2019). |
| Aphasia after a stroke | To make phone calls, give a number, write a shopping list (Garrett & Lasker, 2005). See AAC for adults. |
| Parkinson’s disease | When speech varies through the day with the effects of medication. |
| Cerebral palsy | Many talk with people close to them and use AAC with strangers. |
How can you help the listener understand?
- Announce the topic by showing a picture or a word (‘school’, ‘football’) before speaking: about 28% more intelligibility for words, 11% for sentences.
- Show the first letter of each word on an alphabet board while saying it: about 25% more for sentences. This means knowing your letters, which is why it is worth working on them early.
These two techniques have mainly been studied in adults whose speech is hard to understand (Hanson et al., 2004): adapt them with the speech and language therapist.
How do you organise part-time use?
- Keep the tool within reach at all times. Put away in a cupboard, it is no use at the moment speech gets stuck. A light format helps: a phone, a printed board in the pocket, a watch.
- Prepare whole messages for the moments when speech fails (‘it hurts’, ‘give me time’, ‘I want to go home’), reachable in one or two moves. See Beyond requests.
- Keep words in the same places: the hand finds the way even after several days without the tool (see Organising the grid).
- Tell listeners that switching from speech to the tool is normal. A card saying ‘I speak a little. If you don’t understand me, I can show you on my phone’ helps with strangers (see the ‘How to talk to me’ card).
- Don’t impose the tool when speech is understood, but don’t take it away when speech improves.
- Repeat the selected word aloud, then expand it (‘more’ becomes ‘more juice’). See Model, wait, respond.
Childhood apraxia of speech: what AAC offers
Childhood apraxia of speech (also called verbal dyspraxia) is a disorder in planning the movements of speech. The child knows what they want to say, but their brain struggles to programme and sequence the movements of the lips, tongue and jaw. Their speech is very hard to understand, or absent, while understanding and the wish to communicate are often there.
Even if speech improves with therapy, the years of waiting have a cost: the child limits what they say to what they can pronounce. Alongside intensive speech and language therapy, AAC lets them produce longer and more elaborate messages than with speech alone (Beukelman & Light, 2020). Depending on severity and age, it serves as the main means of expression, as cues (topic, first letter), as a repair tool, as access to reading and writing or as support for practising speech. It then fades out gently, at the child’s pace.
Recording a sound model on a button
A sound model linked to each message can serve as a reference for practising speech (Ball & Stading, 2006). Choose with the speech and language therapist the words worked on in sessions and record them. In Pictalk Buddy, in Edit mode, open the button and tap ‘Spoken text’, then ‘Audio’: the recording plays instead of the synthetic voice.
Repairing misunderstandings
When you are not understood, you can repeat, or change the message: add information, simplify, say it another way. Teach at least two repair strategies (Halle, Brady & Drasgow, 2004). AAC offers a ‘plan B’: show the word, or use strategic messages such as ‘That’s not it’, ‘It starts with…’, ‘I’ll give you hints’, ‘Hold on, I’m looking…’. In Pictalk vocabularies, they are in the ‘Being understood’ branch.
‘Motor planning’: two meanings
In AAC, the term means keeping each word in the same place on the screen so that the hand movement becomes automatic. In speech and language therapy, it means planning the movements of speech, at the heart of childhood apraxia of speech. Fixed positions are a widely accepted principle; the LAMP approach, which makes them its method, has only preliminary evidence so far (Bedwani, Bruck & Costley, 2015).
What if you are advised to wait?
Ask what exactly you are waiting for, and what the person can use in the meantime to be understood. Communication Matters, the UK chapter of ISAAC, brings together professionals and families.
Frequently asked questions
Will my child become lazy about talking?
Studies do not show this effect. Speaking is often quicker than looking for a word on a screen: when speech is possible and understood, the person uses it.
Which vocabulary for occasional use?
A compact vocabulary, with fixed words and ready-made messages for emergencies and repair. On a phone, PicTalk Essential 24 is a good starting point, to be completed with personal words.
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.
- Studies cited from Beukelman & Light (2020): Millar, Light & Schlosser (2006); Romski et al. (2010); Kasari et al. (2014); Schlosser & Wendt (2008); Light & Drager (2012); Williams, Krezman & McNaughton (2008); Garrett & Lasker (2005); Hanson et al. (2004); Ball & Stading (2006); Halle, Brady & Drasgow (2004); Bedwani, Bruck & Costley (2015).
- Zisk, A. H., & Dalton, E., 2019, ‘Augmentative and Alternative Communication for Speaking Autistic Adults’, Autism in Adulthood.