Augmentative and Alternative Communication (AAC) can enhance speech, social skills for kids with ASD

Last month the top 10 mistakes and lessons learned from therapy programs for children with autism spectrum disorders (ASD) were examined in this column.

Now here’s number 11: Parents (or teachers) refusing to try augmentative and alternative communication (AAC) for non-verbal or minimally verbal children or adults with autism.

People with autism often have delays or deficits in communication, especially speech. However, many children and adults with autism have considerably better receptive than expressive skills. That means that they understand a lot more than it appears.

AAC systems can take the place of, or supplement and enhance speech by enabling people who don’t have typical verbal abilities communicate better. AAC systems can improve the ability of children and adults with autism and other disabilities to initiate requests and respond to questions.

Users of AAC include people who are non-verbal as well as those who have limited verbal skills. AAC does not prevent people from speaking, and in some cases it has improved the ability of people with autism to speak. AAC can improve functional and spontaneous communication, enhance social skills, reduce unwanted behaviors, and lead to job opportunities and greater independence. Using AAC also can advance motor skills and help with sensory integration, areas in which many people with autism have problems.

The AAC Connecting Young Kids (YAACK) website dispels some of the myths related to AAC. From the website: “Numerous studies have found that the introduction of AAC frequently has a positive affect on speech; children who are given AAC often develop speech faster than they would have otherwise (Bodine & Beukelman, 1991; Van Tatenhove, 1987).”

Examples of AAC systems include electronic devices that produce voice output based on letters or symbols that are typed, and the Picture Exchange Communication System (PECS), which uses pictures instead of words to communicate.

The Augmentative Communication, Inc. website describes different types of AAC devices. DynaVox makes electronic AAC devices that are among the most popular used by people with autism (see a video of a student using an AAC device).

Other AAC systems include those that use visual symbols to represent words, which can be an advantage for people with autism who think visually. Boardmaker, a system of picture symbols created by Mayer-Johnson, is a software implementation of picture symbols that can be customized to the needs of the student. Programs can be printed out or used online with accompanying audio.

Young children may have a hard time understanding that symbols represent objects so to start out, Google Images can be used to create a customized version of symbols that look more realistic.

Research shows that using PECS can improve verbal language development and social skills and decrease problem behaviors in children with autism. In an empirically based study by Charlop-Christy, Carpenter, Le, LeBlank, & Kellet (2002), three children with autism were evaluated on speech in play and academic settings using PECS. Spontaneous speech increased for each of the participants after using PECS.

The study states, “PECS may contribute to the emergence of vocal as well as pictorial communication. First, the PECS program teaches functional communicative behaviors that incorporate strong reinforcers and are likely to be supported in natural environments.” The study says the focus on requests along with the pairing of the spoken phrase and the picture could also lead to verbal communication if the student imitates the teacher or therapist.

PECS has also been shown to be effective in teaching improvisational language skills to children with autism. A study by Marckel, Neef, & Ferreri (2006) showed that spontaneous requests improved across settings and listeners and the requests were generalized into the environment after PECS training. Learning these improvisational skills helps children become more independent instead of relying on teachers to prompt them.

In one case, a formerly non-verbal child learned to speak after he heard his electronic AAC device speaking the words he typed. (Read more about the technique used by this student and others in a future column in this space).

The book Meaningful Exchanges for People with Autism: An Introduction to Augmentative & Alternative Communication by Joanne M. Cafiero gives criteria for good candidates for AAC. The list includes but isn't limited to the following characteristics: no speech, limited speech, echolalia, behaviors difficult to interpret, communicating only about specific topics, or getting frustrated for unknown reasons.

Cafiero writes, “This book has a ‘zero exclusion’ perspective: no individual with ASD, regardless of the difficulties with or even absence of communication, is excluded from consideration for AAC.”

The National Joint Committee for the Communication Needs of Persons with Severe Disabilities (NJC) published a Communication Bill of Rights in 1992. It states, “All people with a disability of any extent or severity have a basic right to affect, through communication, the conditions of their existence. All people have the following specific communication rights in their daily interactions.”

There is little doubt that AAC greatly improves the lives of people with autism and other developmental disabilities by helping them communicate, which in turns reduces their frustrations. Behaviors are often the result of frustration at the inability of people to communicate their wants and needs. We know this because many adults with autism who have acquired communication skills have told us so.

Some parents refuse to allow their children the opportunity to use AAC, assuming that it may negatively impact their kids’ speech development. However, it has been shown that AAC can lead to gains in verbal communication in some cases. In other cases, the ability to communicate better through AAC can at least help people with autism improve social skills, gain confidence and feelings of self-worth, and reduce frustrations.

Everyone, regardless of disability, has a fundamental right to communicate, and many people with disabilities have higher receptive language skills than are evident from their expressive ability. There is not a correlation between verbal communication ability and intelligence - many non-verbal people have become eloquent communicators through AAC.

Many students with autism are underestimated, even by experienced teachers.Therefore, limits should constantly be tested and pushed rather than underestimated. AAC systems need to be customized to the needs of the student, and AAC systems require a great deal of training, but the training is ultimately worth it.

For more information on AAC, see the following websites:

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