This guide will help you answer 4.1 Describe different forms of augmentative and alternative communication (AAC) used to promote communication and interaction.
AAC stands for Augmentative and Alternative Communication. This is a term used to describe methods and systems that support or replace spoken or written language. AAC gives a voice to people who have difficulty with speech or writing. These can be children or adults with disabilities such as cerebral palsy, autism, stroke, or learning disabilities. Communication is a basic human right. AAC systems help people express their needs, choices and feelings.
There are many types of AAC, from basic to high-tech. Each person’s needs are different. The right choice depends on the individual’s strengths, preferences and situation.
Types of AAC
AAC systems fall into two main categories: unaided and aided.
- Unaided communication uses the body alone. This includes signs, gestures, and facial expressions.
- Aided communication uses equipment. This might be simple picture cards or electronic devices.
Now, let’s explore each main form in detail.
Unaided AAC
Unaided AAC relies on the person’s own body. No extra tools are needed. People can use:
- Gestures
- Facial expressions
- Body language
- Sign language
Gestures
Gestures are movements that carry meaning. Waving, nodding, pointing, or shrugging shoulders are all gestures. These can be used on their own or alongside speech. Gesture communication can be immediate and clear. For example, pointing to an object to show what you want.
Gestures are most easily used when those communicating know and understand each other well. They suit people with some movement and control over their bodies, but may not work for people with limited movement.
Facial Expressions
Face movements are a universal form of expression. Smiling, frowning, raising eyebrows, or pursing lips can show feelings and reactions without words. These expressions can support or replace speech, helping others know how a person feels or what they may want to say.
People using AAC often depend on facial expressions to add to other forms of communication, like using their eyes to indicate “yes” or “no”.
Sign Language
Sign language is a complete language with its own grammar and structure. It uses hand shapes, movements, and facial expressions. British Sign Language (BSL) is the primary sign language in the UK. Makaton is another system, which uses simple signs and symbols along with speech.
Sign language is very helpful for those who cannot use speech, or whose speech is hard to understand. With training, family, friends, and staff can learn basic signs to support those who use this form of AAC.
Makaton
Makaton is a signing system that uses both signs and symbols, often alongside speech. The signs are based on BSL. Makaton helps people who are learning to speak or who have difficulties understanding speech. It is widely used in schools, care settings, and by families.
Makaton supports learning and understanding. It is used to give choice, support routines, and help people express their needs.
Aided AAC
Aided AAC uses tools or equipment. There are two main types:
- Low-tech (does not need batteries or power)
- High-tech (needs electricity or batteries)
Low-Tech AAC
Low-tech AAC systems are simple, affordable, and do not use electronic parts. Examples include:
- Communication boards or books
- Picture exchange systems
- Writing and drawing tools
- Alphabet boards
- Object cues
Let’s look at each in more detail.
Communication Boards and Books
A communication board is a flat surface with symbols, pictures, words, or letters. The person indicates the item they want, using their hand, eye gaze, or a pointer. Communication books work similarly, but have pages with different topics or activities.
For example, a board could have:
- Foods and drinks
- Feelings
- People’s names
- Activities
Staff, family or carers can make boards specific to an individual’s needs. Choices can be made by touching, pointing with a finger, or eye-pointing for those with limited movement.
Picture Exchange Communication System (PECS)
PECS is a system used mostly with children who have autism or speech difficulties. It uses simple pictures or photographs to build requests and simple sentences. The person hands over a picture card to a communication partner to ask for something, like a drink or a toy.
PECS teaches communication in clear steps. It starts with basic choices and can develop into building sentences. It helps people learn that communication is a two-way process.
Writing and Drawing
Some people can use pen and paper, whiteboards, or chalkboards. They can write words, draw pictures, or use symbols to express themselves. This works well when speech is difficult but fine motor skills are good.
Alphabet Boards
An alphabet board shows all the letters of the alphabet and may include basic words or phrases. A person can spell out words by pointing to each letter in turn. This method is called “letter by letter” spelling. It is slow but suits some people who have lost the ability to speak, like some who have had a stroke or Motor Neurone Disease.
Object Cues or Object Symbols
Some people understand better through real objects than symbols or pictures. These objects are linked to activities. For example, giving a cup to show it is time for a drink, or a hairbrush when it is time to get ready. Object cues are helpful for people with severe learning disabilities or vision impairments.
High-Tech AAC
High-tech AAC systems use electronic devices. These range from simple voice recorders to complex computers with communication software. They can speak words aloud, store messages, use pictures, or link to the internet.
Speech Generating Devices (SGDs)
SGDs are also called voice output communication aids (VOCAs). These devices can produce spoken words or phrases. The user selects words, pictures, or symbols on a touch screen or buttons, and the device “speaks” for them.
Some devices can be programmed with personal voices, or use synthetic voices from text-to-speech technology. High-tech devices are helpful for people who need more choices or want to communicate with many people.
Tablets and Smartphones
Modern technology such as tablets and smartphones are widely used for AAC. There are many apps that turn a tablet into a communication device. These can use symbols, words, or even allow the user to type messages that the device reads out.
Tablets are flexible, easy to carry, and can be personalised. Some apps can save favourite messages, show photos, or be linked to environmental controls to help with everyday life.
Eye-Gaze Technology
Some people are unable to use their hands or have limited movement. Eye-gaze systems track where a person is looking and let them choose words, symbols or pictures on a screen using their eyes only. This is life-changing for people with conditions like locked-in syndrome, spinal injuries or advanced Motor Neurone Disease.
Eye-gaze systems need careful setup and support. They are more expensive than some solutions, but are the main method for those who cannot use other means.
Environmental Control Units (ECUs)
Some high-tech AAC systems do more than communication. Environmental control units allow the user to control lights, TV, doors, and other equipment by using switches or their communication device. This increases independence and lets the user take part in daily routines.
How AAC Promotes Communication and Interaction
AAC is not just about words. It is about connecting with people, making choices, and being part of society. People using AAC are able to:
- Join in conversations
- Make requests and express needs
- Make choices and decisions
- Build relationships
- Show feelings and opinions
AAC helps break down barriers. It turns communication into a shared activity. For interaction to work well, others must learn the system, be patient, and give enough time for the person to respond.
Supporting Communication Partners
AAC works best when those nearby understand and support its use. Training for staff, family, and peers is key. This includes:
- Learning how to use the communication system
- Using simple language
- Waiting for a response
- Making eye contact and showing interest
- Respecting the person’s choices and efforts
The attitude of those around the AAC user can make a big difference. Encouragement, respect, and patience are needed.
Examples of AAC in Health and Social Care
AAC supports children and adults in schools, residential care, hospitals, and at home. Here are some situations:
- A young adult with cerebral palsy uses a speech-generating device to answer questions at college and keep in touch with friends.
- An older person who lost speech after a stroke uses an alphabet board and gestures to order food in a canteen or ask for help.
- A child with autism uses PECS at school to ask for toys and snacks, then makes simple sentences as their skills grow.
- Someone with learning disabilities uses a communication book filled with photos and symbols for daily routines and personal choices.
- A person with advanced Motor Neurone Disease uses eye-gaze technology to communicate with family, carers, and medical teams.
Each example shows how AAC can fit different needs, settings, and abilities.
Overcoming Challenges
Using AAC can bring challenges for both users and their supporters. These may include:
- Finding the right AAC system for each person
- Keeping tools up-to-date and in good order
- Training staff and families to use the system
- Making sure AAC tools are always available, including during outings or emergencies
- Supporting the person’s confidence and self-esteem
- Overcoming stigma or misunderstanding about “talking” in different ways
Practice, patience, and support are needed. Small steps can lead to big progress in communication and quality of life.
Matching AAC to the Individual
No single form of AAC suits everyone. Each person will need support to find what suits them. Assessment by a speech and language therapist or specialist team is important. This helps match the system to:
- The person’s physical abilities
- Learning and memory skills
- Hearing and vision
- Communication goals
- Preferences and interests
Reviewing the AAC system regularly makes sure it continues to suit changing needs.
Final Thoughts
AAC brings powerful changes to people’s lives. It gives a way to speak, share, and be heard. It can support social engagement, independence and wellbeing. The right AAC system is one that matches the person’s needs, respects their choices, and is supported by skilled people.
Staff in health and social care play a key part. Understanding the different kinds of AAC, showing patience, and keeping an open mind will help break down barriers. Remember, good communication is the foundation for good care and helps every person to reach their full potential.
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