AAC

AAC Strategies
• refer to those strategies that can be used to
supplement existing communication for persons
with little or no functional speech in order to
facilitate independence and active participation in
society.

vocalizations, natural
Unaided speech ,gestures and
manual signs
AAC Strategies

Aided Graphic symbol systems and

communication devices

2
• Children with specific language impairment,
pervasive developmental disorder, developmental
apraxia of speech, autism, Down syndrome, or
other types of developmental disabilities may need
to use AAC strategies to supplement or enhance
their language development.

3
 presence and severity of co-
occurring conditions (e.g., cerebral
palsy, apraxia of speech, neurological
diseases).
cul
tur
ling al a
ation bac uis nd
u n ic kgr tic
comm eeds val oun
ues d
n .

Treatment selection
depends on

4
ASHA (1991) defines AAC system as ‘an integrated group
of components including symbols, aids, strategy &
techniques used by individual to enhance communication
where

Symbols: Pictures, gestures, drawings, photographs, objects & orthography

Aid: Communication board, chart, mechanical or electronic device or computer
Techniques: Signing, gestures, speech pointing, direct selection is the way in which
Strategies: is a process or plan of action used to improve performance. The individual uses
symbols and aids to enhance communication by the application of strategies that include
topic setting, letter and word prediction, location of vocabulary for efficient access, and
one-shot message communication aids that allow for the message to be changed for
 Why is AAC important?

• Everyone needs to be able to communicate

functionally

• Social participation is one of the key roles of

communication

• Reducing barriers to social participation is our

responsibility

• A commitment to meet socially defined goals and

empower people with complex communication needs
is our objective
When does a person need AAC?

• To augment natural speech production

• Provide a means for communication when other
means are not available or diminished
• To promote speech/language development
• To address written communication or text needs
when handwriting is impaired
AAC Populations
Congenital disabilities Acquired disabilities
1. Autism spectrum 1. Cerebrovascular accidents
disorder 2. Traumatic or acquired brain injuries
2. Cerebral palsy 3. Neurodegenerative diseases (e.g.,
3. Developmental Amyotrophic lateral sclerosis,
disabilities primary progressive aphasia, and
4. Intellectual disability apraxia)
5. Developmental apraxia 4. Disability following surgeries (e.g.,
of speech and glossectomy, laryngectomy); and
6. Genetic disorders. 5. Temporary conditions (e.g.,
intubation) for patients in critical
care settings.
 AAC Systems

A well-designed AAC system….

1. Flexible and adaptable
2. Allows for changes to vocabulary
3. Mode of access as the individual's language
4. Physical needs change over time.
5. Maximizes the individual's abilities to communicate
effectively and efficiently across environments and
6. with a variety of communication partners
-(Beukelman & Mirenda,
2013)
 Forms of AAC

• AAC is typically divided into two broad categories—

unaided and aided.

• Unaided forms of AAC do not require an external

tool & require some degree of motor control.

• Aided forms of AAC require some form of external

support—either electronic or non-electronic.

– Non-electronic aided forms are often referred to as "light-tech" or

"low-tech."
– Electronic forms are referred to as "high-tech."
Forms of AAC

Unaided Aided

No-tech Low-/Light-Tech High-Tech

 Gestures  Pictures  Speech generating devices (SGD)

 Manual signs  Objects  Single-message devices and recordable/digitized
devices
 Facial  Photographs
expressions  AAC software that enables dynamic symbol/language
 Writing
representation and that is used with some form of
 Vocalizations
 Communication technology hardware (e.g., computer, tablet,
 Body language boards/books smartphone)
 No Technology
• does not require a power source or an external
tool, and include facial expression, vocalizations,
gestures, and sign languages.
 Low technology:

• These are often very simple communication

boards or books, object communication board, E –
tran from which the user selects letters, words,
phrases, pictures, and/or symbols to communicate
a message.
Eye Talk or Yes/No Board
 Tamil Letter Board
Alphabet-based methods use traditional orthography (spelling) and rate enhancement
techniques such as word or phrase prediction.
 E-TRAN Board
• enables people to select letters with their eyes.

• The E-Tran board is for individuals with:

 Very limited movement
 The ability to spell
 Intentional (volitional) eye movements.
Eye Gaze Board
Communication Book & PECS
Communication Chart
 Mid technology:
– Lite/Mid technology: Big mack, tape recorder,
recorded message, speak easy, step by step scanner.
 BIGmack
Single-meaning message
 High technology:

Refers to complex electrical and electronic devices such as computer, VOCA and
environmental controls (Delta Talker, Dynavox, Light writer)
 Proloquo2Go
 daily communication tool and to build language skills.
Dynavox
GoTalk4+, GoTalk9+, GoTalk20+,
 IPAD APPS
Avaz
It has voice output.
App supports multiple language, both Indian and European, and users can also add their
own 'words‘.
The app presents words like building blocks, and you can move them around, and it predicts
the words and prompts you to expand your sentences .
 Picture Communication Symbols
• Over 30,000 Symbols
• Available in colour and black and white
• Available in 40 languages
 Selection Techniques

• Selection techniques are the ways in which messages or symbols are accessed by the client. There
are two main selection techniques —direct selection and indirect selection (scanning).

• Direct selection—The client selects the desired symbol directly from a selection set.
• done with direct physical touch (body part or other object) or
• done with generated activation (via joystick, eye gaze, trackball, traditional or head
mouse, light indicator).

• Indirect selection (scanning)—Each item from a selection set is presented sequentially until the
desired item appears and is selected by using a previously agreed upon motor movement or
vocalization or by using a switch.
• Presentation of items in the selection set can be auditory, tactile, or visual.
• Items are presented in a row, column, or quadrant.

• Partner-assisted scanning is an indirect selection technique in which the communication partner

presents messages or letter choices in a sequential fashion (visually or auditorily) to the client, and
the client then makes selection using a previously agreed upon motor act (blinking, raising a hand,
etc.).

• Partner-assisted scanning
– is used with individuals who have severe motor, visual, and/or communication impairments.
 SPECIFIC INTERVENTION STRATEGIES FOR
CHILDREN WITH AUTISM
• It is estimated that 30% to 50% of individuals
with autism have difficulty in communicating
effectively through speech (National Research
Council, 2001).
• AAC strategies have been used as a way to
enhance functional communication and
language learning.

29
Candidacy of ASD children for AAC
intervention:
• optimum time for beginning communication
intervention for autism is when the child is
preschool age or younger (Hoyson, Jamieson
& Strain, 1984; Lovaas, 1987).
• who do not possess these prelinguistic skills
remain as the candidates for AAC intervention

30
Why AAC strategies for children with Autism?
• important rationale is that AAC tends to have a
positive effect on speech development in
individuals with developmental disabilities
(Miller et al., 2006).
• many children with Autism who can speak
clearly do not use their speech skills in a
meaningful or functional way.

31
• Using AAC options, children with ASD can learn new
vocabulary, increase the length of utterance they produce, and
learn new word forms (e.g., plurals, verb tenses,
comparatives).

• communication involves the frustration that children

experience when they are unable to express themselves
effectively. There is an abundant literature documenting the
effectiveness of AAC strategies at reducing difficult behaviours
demonstrated by individuals with developmental disabilities;
Schlosser, Blischak, Belfiore, Bartle, and Barnett (1988)

32
• The initial focus of intervention for children
with autism should be to facilitate existing
non-symbolic forms of communication in
preparation for a more formalized system later
(Mirenda & Schuler, 1988).
• Clinician should identify specific non-symbolic
form of communication which needs to be
trained further.

33
Picture Exchange Communication System (PECS)

• It is one training approach that has been used

successfully to promote symbolic
communication in children with autism
(Bondy& Frost, 1993).
• teaches children to initiate a communicative act
to receive a concrete outcome.
34
• Because children with autism are not highly
reinforced by typical social rewards associated
with the act of communication, the use of a
picture exchange setup can provide for
immediate and concrete reinforcement while
teaching the social interaction necessary for
communication

35
• The Six Phases of the Picture Exchange Communication System Are:
•
• PECS PHASE I: How to Communicate
The child with autism learns to exchange single pictures for items or
activities they really want.
•
PECS PHASE II: Distance and Persistence
Still using single pictures, the child with autism learn to generalize this
new skill by using it in different places, with different people and
across distances. They are also taught to be more persistent
communicators.
•
PECS PHASE III: Picture Discrimination
The child with autism learns to select from two or more pictures to
ask for their favorite things. These are placed in a communication
book, a ring binder with Velcro strips where pictures are stored and
easily removed for communication.
• PECS PHASE IV: Sentence Structure
The child with autism learns to construct simple sentences
on a detachable sentence strip using an "I want" picture
followed by a picture of the item being requested.
•
PECS PHASE V: Answering Questions
The child with autism learns to use PECS to answer the
question, "What do you want?"
•
PECS PHASE VI: Commenting
Now the child with autism is taught to comment in
response to questions such as, What do you see?, What do
you hear? and What is it? They learn to make up sentences
starting with I see, I hear, I feel, It is a, etc.
 advantages
• The picture symbols used in AAC intervention are
more concrete than the symbols we typically use in
conversation (i.e spoken words).
• symbols are for the most part static and do not
disappear.
• related to our ability to teach children new skills.
Children with ASD, touch, pick, point to the pictures
that they use for communicative purposes. Those
who are just learning to do so can be physically
guided even at the earliest stages of AAC
intervention.
38
 Orthographic Communication Systems

• AAC systems that use written words to facilitate

communication in individuals with autism.
• Many children with autism of PDD demonstrate
hyperlexic reading abilities (Burd, Fisher, Knowlton,
&Kerbeshian, 1987
• have been known to use the written word to cue speech
and formulate verbal output. Low tech setups using the
written and pictures can be used to supplement general
communication needs across various settings

39
 Visually cued instruction
• symbol exchange,"
• child requests a desired object
by presenting a picture symbol
of it to the adult, and exchanging
the symbol for the object.
• It teaches intentional
communication, the use of
symbols and requesting
simultaneously.

40
• excellent approach for children who are
visually oriented, and who may not be
exhibiting many of the social behaviors that
underly effective communication, such as eye
contact or orienting one’s face towards the
listener.

41
 Video-Based Instruction
• called "video modeling“ - observational mode
of teaching
• uses video recordings to provide a model of
the target behavior or skill
• Video recordings of desired behaviors are
observed and then imitated by the individual
• The learner's self-modeling can be videotaped
for later review.

42
 Visual Schedules

• method of visual prompting.

• Visual schedules use objects, photographs,
drawings, written words, or other symbols to
cue or prompt individuals to complete a
sequence of tasks or activities
• Symbols on the display are presented
horizontally or vertically in sequence of
occurrence and can represent activities within
a day or week (or longer period) or the steps
within a particular activity
43
Visual schedules can be used to
• improve understanding of routines and
expectations;
• increase engagement time;
• ease transitions from one activity to the next
and increase an individual's control over his or
her daily life (Mechling, 2007).

44