Autism affects social communication first, and many autistic people speak little or not at all. Augmentative and alternative communication (AAC) gives them other ways to understand and express themselves right now, without waiting for speech and without holding it back.

What is autism today?

Autism spectrum disorder (ASD) is a neurodevelopmental condition that lasts throughout life and shows itself very differently from one person to another. It combines two types of difficulty:

• in social communication and interaction;
• repetitive behaviours, restricted interests and a strong need for routines, which make the unexpected difficult.

Asperger’s, PDD-NOS, childhood disintegrative disorder: these categories are no longer used. The DSM-5 (2013), the reference classification, merged the former pervasive developmental disorders (PDD), including Asperger’s syndrome, PDD not otherwise specified and childhood disintegrative disorder, into a single diagnosis: autism spectrum disorder, which specifies the level of support the person needs. These terms still appear in older reports.

The first signs often appear in early childhood: the child makes little eye contact, rarely responds to their name, plays little with other children, and their language may be delayed. Diagnosis is based on an assessment by professionals: observing the child, interviews with the parents, tests of communication and social interaction. Developmental milestones and care pathways: My child isn’t talking: where to start.

There are many causes: genetic and environmental factors contribute. Vaccines are not one of them: this idea rests on outdated or unproven studies.

To find your way, the National Autistic Society provides information for families and a directory of UK-wide and local services.

Why offer AAC without waiting?

At least 30% of autistic people have little or no functional speech (Beukelman and Light, 2020). Symbols, photos, a talking tablet, signs and gestures give them other ways to express themselves (see What is AAC?). Three points save time:

• No prerequisites. Training eye contact or pointing separately does not improve communication: start straight away (see Myths about AAC).
• AAC does not stop speech: it often helps, including in minimally verbal autistic children (Kasari et al., 2014). See AAC and speech.
• A symbol has to be learnt. Autistic children, like other young children, often misread standard symbols (McCarthy et al., 2018): show them in context.

To do this, the people around the person use the tool themselves as they talk: this modelling has large effects on understanding and expression, including in autism (see Model, wait, respond).

How can you help someone understand and predict?

AAC also supports understanding. A young autistic boy followed one-step spoken instructions, but two or three when his teacher wrote them down as she spoke, and his behaviours that challenge decreased (Light et al., 1998).

Visual schedules meet the need for predictability, at any age (Bopp et al., 2004; Knight, 2015). Two settings help particularly: putting finished activities in an ‘all done’ area where they can still be asked for again, and offering choices within the routine (which step first, who helps). In practice: Visual supports: schedule, sequences, timer.

More than 90% of autistic people show behaviours that challenge at some point (Jang, 2011), which often say ‘I want that’ or ‘I want it to stop’: look for that message and teach another way to say it (see Behaviours that challenge).

How can you communicate beyond requests?

Requesting is a good starting point, not an end point: programmes that focus only on requests produce passive communicators, who ask and answer but rarely start a conversation (Light, Parsons and Drager, 2002). PECS, for example, has strong evidence for learning to request, but little for learning to comment (Ganz et al., 2012): see PECS or robust AAC?. The tool should also let the person refuse, comment, ask questions, greet and tell stories (see Beyond requests).

Sharing attention

Joint attention (sharing interest in the same thing with someone) is a priority goal in autism. The best opportunities are shared reading, videos and play, with their sound effects and refrains. Adding a word on the spot, for example a photo of the horse in the book with its neigh, takes less than a minute and increases the number of conversational turns.

Telling stories with photos and videos

Taking turns and recounting past events are often difficult in autism. Beukelman and Light (2020) recommend video scenes to work on them, and autistic children understood instructions better when they were presented as scenes (Schlosser, 2013). In Buddy, your own photos and the notebooks keep a record of the day to talk about in the evening.

Echolalia: what to do when your child repeats phrases?

Echolalia means repeating words or phrases that you have heard. It affects between 25% and 91% of autistic children depending on the study, because its definition varies widely (Sutherland et al., 2024). There are two forms:

• immediate: to ‘Do you want some water?’, the child answers ‘some water?’;
• delayed: later on, they repeat a line from a cartoon, a teacher’s phrase, a supermarket announcement.

These repetitions often have a function: keeping in contact, saying ‘yes’, asking, reassuring themselves, commenting (Prizant and Duchan, 1981; Prizant and Rydell, 1984). So the question is not whether the child repeats, but why and when.

Observe, then respond to the meaning

Keep a small notebook: the phrase, the moment, what happened just before and just after. Functions will often start to emerge. ‘We’re going to the park!’ said in a character’s voice, by the door, may mean ‘I want to go out’; ‘it’s finished, it’s finished’ during an activity, ‘I want to stop’. Respond to the request, and at the same time show ‘I want to go out’ on the tablet. Write these matches down in a communication dictionary shared with the people around them (see Being understood).

Putting their phrases in the tool

Most people need single words to build sentences and ready-made messages to go fast (Beukelman and Light, 2020). For a child who repeats a lot:

• record the phrases they already use with a clear function (‘let’s go!’, ‘it’s snack time’);
• give the button a label identical to what they say: a ‘dog’ button that speaks a whole sentence causes misunderstandings;
• keep single words next to them, always in the same place, so they can say something else.

Will AAC increase repetition?

The few case studies on this point do not allow any conclusion, and AAC does not hold back speech. A child who presses the same button over and over is often exploring the tool, a bit like a baby babbling, but they may also be regulating themselves or carrying a real message. Respond by modelling other words, rather than taking the tablet away.

What about GLP?

Gestalt language processing (GLP) describes a way into language through whole chunks (phrases, lines) that the child gradually breaks down and recombines. The approach interests many families, but the strength of its evidence is debated (Hutchins, Knox and Fletcher, 2024; Bryant et al., 2025). We don’t take sides: talk to the speech and language therapist about it. A tool that offers both whole phrases and single words, always in the same places, remains compatible with both ways of learning.

Frequently asked questions

My child doesn’t point: can they use a tablet?

Yes. You can start with a few very large cells and model a lot: pointing can develop with use.

How many symbols should you start with?

Few, but motivating and varied words: their own words, plus a few powerful little words like more, all done, stop, help me. Add more as you go (see Which words to put in the tool).

Should you stop a child from repeating?

It is generally more useful to look for what the repetition means, respond to it, and show other ways to say it, than to forbid it.

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

• American Psychiatric Association, 2013, Diagnostic and Statistical Manual of Mental Disorders (DSM-5), American Psychiatric Publishing.
• Beukelman, D. R. & Light, J. C., 2020, Augmentative & Alternative Communication, 5th ed., Paul H. Brookes, chapters 5, 9, 10 and 11.
• Studies cited from Beukelman & Light (2020): Kasari et al. (2014); McCarthy et al. (2018); Light et al. (1998); Bopp et al. (2004); Knight (2015); Jang (2011); Light, Parsons & Drager (2002); Ganz et al. (2012); Schlosser (2013).
• On echolalia: Sutherland et al. (2024); Prizant & Duchan (1981); Prizant & Rydell (1984).
• On GLP: Hutchins, Knox & Fletcher (2024), Autism & Developmental Language Impairments; Bryant et al. (2025), systematic review, Current Developmental Disorders Reports.