Augmentative and alternative communication (AAC)

What it is

Augmentative and alternative communication, or AAC, means any way of communicating that adds to speech or stands in for it. “Augmentative” means it supports speech. “Alternative” means it can be used instead of speech when needed. We all use some AAC already: pointing, waving, writing a note or showing a photo on a phone.

AAC is usually grouped into three levels.

No-tech

Communication using the body: gestures, signs, facial expressions, pointing and body language.

Low-tech

Communication using simple materials that do not need power: picture cards, choice boards, communication books, alphabet boards and visual schedules.

High-tech

Speech-generating devices or tablet apps that speak a word or message aloud when the person selects a symbol, word or letter. Some can be accessed by touch, by a switch or with eye gaze.

Most people use a combination. A child might sign “more”, point to a picture of the park and use a tablet to tell a story, all in the same day. AAC is not a last resort and not a sign of giving up on speech. It gives a person a reliable way to be understood while speech continues to develop.

AAC and speech

The most common worry families share is that AAC will stop speech. Research over several decades does not support this. AAC does not reduce speech, and many children produce more spoken words after AAC is introduced. A child who can be understood is often calmer, more engaged and more willing to try spoken words.

Who we see

AAC can help anyone whose speech does not yet meet all their communication needs. We see children who are autistic, who have childhood apraxia of speech, cerebral palsy, Down syndrome or developmental language disorder, or who simply have very few words. We also see teens and adults, including people who have lost speech after a stroke or brain injury, or who have a progressive condition affecting speech.

How we assess it

An AAC assessment looks at how the person communicates now and what they need to communicate in daily life. Our speech-language pathologists:

• talk with you about how communication happens at home, school, work or in the community
• observe the person in play or conversation, noticing every way they already communicate
• look at understanding of language, vision, hearing and motor skills, which guide how a system is accessed
• try different options, such as signs, picture boards or a device, to see what works best
• consider the people who will use the system with the person every day

We often work with occupational therapists, educators and other professionals involved. We then recommend a starting system and plan how it will grow. Learn more about our assessment process.

How therapy works at VoxLingue

Our approach is neurodiversity-affirming. We respect each person’s way of communicating, presume competence and focus on helping them say what they want to say, not on making them communicate in only one way.

Modelling AAC

People learn to use AAC by seeing others use it, just as children learn speech by hearing it. This is called aided language modelling. During play, snack or a book, the clinician and family touch symbols on the system while speaking: “Let’s go out.” Over time, the person begins to use the system themselves.

A system that can grow

We favour systems with enough vocabulary to grow with the person, including core words such as “go”, “more”, “not”, “help” and “like”, which work across many situations. We add personal vocabulary such as names, favourite activities and foods.

Real communication

We practise AAC for real purposes: requesting, protesting, commenting, asking questions, telling jokes and sharing news. We avoid quizzing (“Show me the cat”), because communication is not a test.

Family and team training

AAC works best when everyone around the person uses it. We train parents, siblings, caregivers, educators and support staff to model, to wait and to respond to all communication attempts. We also help adapt the system for daycare, school or work.

Your role at home

You do not need to be an expert to start. A few habits make a big difference:

• Keep the AAC system within reach all day, not only during therapy.
• Model a few words during routines, even if you make mistakes.
• Pause and wait after you model, giving time to respond.
• Respond to every attempt, whether it is a word, a sign, a sound or a touch on the device.
• Never take the system away as a consequence. It is the person’s voice.

Bilingual and multilingual families

Using AAC does not mean giving up your family’s languages. Many AAC systems can be set up in more than one language, and families can model in the language they speak most naturally. A child may hear French at daycare, English at school and Arabic or Spanish at home, and their AAC can reflect that.

We plan vocabulary with you, including words that matter in your culture and family life, such as names for relatives, foods and celebrations. Our team speaks many languages. When a clinician who speaks your home language is not available, we help you set up and model the vocabulary in that language.

In person or by telepractice

AAC support is available in person at our Marché Central clinic in Montreal, or by telepractice anywhere in Quebec and Ontario. Telepractice is often very effective for AAC, because your speech-language pathologist can coach you in your own home, with the actual system, during the routines where communication happens. Many families combine both formats.

Getting started

You do not need a doctor’s referral. If you are wondering whether AAC could help your child or a family member, an assessment is a clear first step.

Call our Marché Central clinic at 514-467-9132, or request an appointment through our contact form. Availability of specific clinicians and languages varies, and our team will match you with the right person.