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  • Writer's pictureJeena

Augmentive and Alternative Communication – A Journey from Gestures to AAC device


This is a family’s journey through the years (from two and half to 11 years and on..). This should give you an idea about what to expect. If you want to learn the technical details of what is AAC, please take a look at the links below. They provide excellent details about the systems available

This article discusses the process we went through for the acquisition of the Traditional AAC devices. These are expensive and it will take lot of time and effort to aquire. You have to go thru lot of evals and approvals.

Also discussed are the alternatives to the traditional AAC. This is the most cost effective and the stress free way to get the AAC device using hugely popular iDevices (ipod/itouch). But there are limitations in using this based on the child’s need. This may work very well for the kids who doesn’t have motor issues such as kids on the spectrum but may not be a good solution for the others. Check with your SLP> before buying these devices. Most of the SLP’s are not familiar with the software available or not interested in working on these devices.

What is AAC and types of AAC?

ASHA defines it as

What is AAC?

Augmentative and alternative communication (AAC) includes all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas. We all use AAC when we make facial expressions or gestures, use symbols or pictures, or write.

People with severe speech or language problems rely on AAC to supplement existing speech or replace speech that is not functional. Special augmentative aids, such as picture and symbol communication boards and electronic devices, are available to help people express themselves. This may increase social interaction, school performance, and feelings of self-worth.

AAC users should not stop using speech if they are able to do so. The AAC aids and devices are used to enhance their communication.

What are the types of AAC systems?

When children or adults cannot use speech to communicate effectively in all situations, there are options.

Unaided communication systems- rely on the user’s body to convey messages. Examples include gestures, body language, and/or sign language.

Aided communication systems -require the use of tools or equipment in addition to the user’s body. Aided communication methods can range from paper and pencil to communication books or boards to devices that produce voice output (speech generating devices or SGD’s)and/or written output. Electronic communication aids allow the user to use picture symbols, letters, and/or words and phrases to create messages. Some devices can be programmed to produce different spoken languages.

In this case, we are talking about Aided Communication Systems more specifically Speech Generating Device and how to get there and alternatives.

Stage #1: Early Years

When once you realize your kid is not talking (typically around 1-3 years age) or losing speech (in case of autism), you will contact your Primary care physican and they will refer you to an Child Psychologist or Speech Therapist. Most of the cases, this will be a result of an underlying developmental disability.

Your Child Psychologist will evaluate and recommend lot of therapies including Speech and Language (SLP). SLP tries to evaluate and tries to start working on most appropriate for the child. Typically they try to get the speech out first by using traditional methods. Next they will evaluate to see if they can use sign language. This will go on for some time (1-2 yrs or even more). SLP’s and parents wants to bring the natural voice of the child back. Informal PECS may be introduced if there is not much progress in speech.

Typical techniques used by SLP: Traditional speech therapy to help kids talk.

Typical Age: 1-3 years

Funding: Regional Center and/or your insurance. Make sure you have a point of contact at these places so you don’t talk to multiple people. Both Regional center and Insurnace assigned a case manager for us.

Stage #2:Pre-School

Your kid enters school system at 3 years, typically in to a special ed preschool. Now, most of the responsibility is switched to school system. You will have an IEP with speech goals. School SLP will evaluate and make recommendations in terms of goals and services. It is strongly recommended you get an evaluation done outside and keep it ready as the school SLP may be happy to use your eval rather than doing their own or to use your private eval as baseline.

Since they are still young and most of the SLP’s are trained in traditional speech therapies you will still be getting traditional therapies to get the speech out. Parents also wants to keep the hope that they want their kid to talk naturally so the traditional speech continues most of the times.

In other case, parents or SLP’s may start introducing PECS (Picture Exchange Communication Systems).

Typical techniques used by SLP: Traditional speech therapy to help kids talk.

Typical Age: 3-6 years

Funding: School District and/or Insurance.

Step#3: Kinder years

Kid enters the Kindergarten and serious focus on academic starts and they need lot more words to succeed in the classroom. Teachers will be pushing the SLP’s for solutions to help communicate with the child. Typically school districts want to have a low cost solution that is necessary for the kid to succeed in the class room. This means either PECS or push to talk devices.

Parents also start realizing communication doesn’t ONLY mean speech. They will be happy if they know what their kid want. By this time you will realize the lack of communication is not only impacting their acadamics but are also causing behavior issues. I personally realized when my kid is around 6 years old.

When I was in highschool, a family visited our neighbors . The family had 3 beautiful little girls (ages 2-8) and all were deaf and dumb. They couldn’t talk or hear. Initially we were not able to communicate but within 3-4 days, we understood them pretty close to 100%. The point that I am trying to make here is that don’t be afraid of using alternative technologies. You want them to communicate. Don’t worry about the method. If it makes you feel any better, most of the teenagers use the texting instead of phone calls. So, using alternative is now a norm rather than an exceptionJ.

Typical techniques used by SLP: Traditional speech therapy to help kids talk, PECS, Simple Speech generating devices.

Typical Age: 3-6 years

Funding: School District and/or Insurance.

Step#4: Upper Grades

Kid is in 2nd or 3rd grade and the academic expectations are more. The PECS has so many icons you will keep losing them and the kid is not able to tell what they want. The binder is so big it is not practical to move it around.

You will also realize there are several other options available that you haven’t explored as they were cost prohibitive for you to buy but think they may help your child. Don’t worry you are not alone. If you talk to your teacher or SLP they will feel the same way even though they don’t want to say it because of their job restrictions.

Now you are ready to get the Speech Generating Device (SGD) or AAC device. How do you go about getting one?

Start with an AAC Eval – Your school district shoud be able to fund this. They will give you lot of resistance (it took us 6 years) as they think after this you will want them to buy the device. Also, this eval is not cheap. It costs couple of thousands of dollars as they have to evaluate your child in different settings.

Get a Written Report – The report from an AAC eval is going to be very detailed (or atleast it should be). By this time they would have tested the Speech, Language, Motor skills and determined which devices will work for your kid. Each AAC specialist is comfortable with one high tech device (it is hard to learn these) so they recommend what they know most of the times.

Acquiring device – Your school district is the last resort for getting the device as they consider this a medically necessary device and I tend to agree with them. This is not only required for the kid at school but everywhere else. They will recommend you to get it thru insurance or medical first. If that is not feasible then they will have to acquire it is academic purposes. This means it needs to meet very basic needs and they will push for the low cost push to talk devices.

Your best best will be to get it thru the insurance or medical. Most of the insurances exclude this one in the contract. So, you have to go thru your employer and use your persuasive skills to get it approved.

If you are not successful in getting it thru the insurance you need to go thru medical. In CA, you have to have atleast 2 services from the regional center to be eligible for ‘Institutionally deemed’. Weird name for getting qualified for medical due to medical condition not because of age or income levels. In anycase, this will take a long time if you kid is not already ‘Institutionally deemed’.

Last option is school district. If you are able to persuade the school to buy the device it is given to you as a ‘loaner’ and it is district’s property. District has to allow you to take this home as the kid may have to do homework. If you move to another district or go to high school, the device stays with the district and the new district has to acquire a new one. I strongly recommend you go with the 1st or 2nd option.

I have the device. Now what? – You should learn how to use the device. It is you who will know the device better than anyone else in your child’s life even more than the AAC specialist working with you. So, get ready with a pot of coffee or whatever your favorite drink is and start learning how the device works. You need to add all the pictures your kid needs (mostly food, needs, places etc..). Learn where each of these are on the device so you can help your child.

Device care – Make sure you have case for it as kids tend to throw them during tantrums. Anticipate, Anticipate and anticipate. You should try to anticipate and pull the device out before the kid throws it. Give them a paper version during this time so they can still communicate.

Device Maintenance – In case the device is broke, contact your AAC specialist first and they will guide you thru the process. If it requires repair, insurance or medical will pay for it. But it may take time and during this time you may be without device. Your AAC specialist should have created a paper copy of the device so you can use during these times. Also try to get a loaner from either the AAC specialist, Vendor or School. Don’t rent them as they are expensive. Try to use the paper copy if you can’t get a loaner. This give you and the kid the opportunity to understand the value of the device or lack of it.

Alternative Strategies

With the advent of technology more precisely iPhone/itouch/iPad, it is now easier than ever to get an AAC device in to your child’s hands. These devices cost less than the most of the mid tech speech devices with limited memory, words and customization. So, with these you can skip all the steps that were described above and move the last step of providing AAC as soon as you determine the traditional speech is not working out or you need to augment it.

  1. Low Cost- High portability: ITouch + Communication Software – The cost of iTouch is around $175 and you can get the basic communication software for FREE to $189 depending on the kids need.

  1. Medium Cost – Low portability: Ipad + Communication Software – The cost of IPad is $499 + you can get the basic communication software for FREE to $189 depending on the kids need.


With alternative options you will save lot of time and energy to work with your kid and even if you choose to move forward with traditional AAC, you will have time to deal with it while your kid is learning. This is the best of both worlds option.

Links to AAC

ASHA –There are some additional links here.

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