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Beyond Speech: When is it time to switch to AAC?

March 2, 2021

So, your child has been in speech therapy for close to a year and little progress has been made. You’ve managed to get some “ma’s” and “pa’s” here and there, but apart from these word approximations, the journey to speaking seems like a long, winding road.

Beyond Speech: When is it time to switch to AAC?

You’re frustrated, and so is your child.

You may be conditioned to think speech is the “gold standard” of communication. You stick through “speech-only” therapy for a few more months, but you and your child only manage to get just a little past the baseline. At this point, you are opening up to the idea of switching to Augmentative and Alternative Communication (AAC) but are still uncertain about its pros and cons.

In my years of experience as a speech-language pathologist, I have noticed many signs that may indicate that AAC is a better fit for a student with autism. Hopefully, this simple guide can answer some questions about whether you should switch to AAC for your child.

Your child’s receptive language holds so much potential

The first sign you should consider an AAC system is when you notice your child’s receptive language is expansive compared to his/her expressive language. Here are a few things to watch out for:

  • Making gestures: When your child is trying to say something, he/she may make up gestures you surprisingly understand even without prior training
  • Using objects to communicate: You may also notice your child will present objects to you to convey a message, such as pointing to a picture of a beach in a magazine to express wanting to go on a vacation. When your child does this, it means he/she understands he/she can use various symbols such as pictures or text to communicate, which is foundational for AAC
  • Easily understanding others: Your child can follow commands easily, answer questions with gestures or word approximations, and seems to follow the conversations of others

Your child has severe motor-speech issues

Another special consideration in switching to AAC is motor-speech disorders. These can include childhood apraxia of speech (CAS) or dysarthria (low muscle tone) as a result of other conditions such as traumatic brain injury, stroke, and brain tumors, among others.

Some motor-speech disorders can be managed successfully through early intervention. However, there are cases where pushing a speech-only intervention can hinder the child’s full capability to communicate.

After five years as an SLP, I am happy to say there are parents who are surprised their child knew and communicated certain concepts after being taught an AAC system. Sometimes, the issue isn’t with your child’s comprehension; all you have to do is provide him/her the right platform to unlock his/her potential.

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There is little progress on speech for quite some time

I understand how some parents can be adamant in their decision to push speech goals for their children. There’s a sense of loss parents feel when their child is unable to participate in conversations, much less utter words they’ve been craving to hear.

It is one thing to be persistent in an achievable goal, but you should also be open to alternatives that can help your child move forward. If there is little progress in speech for a long time, perhaps it is best to explore other options that can help your child communicate.

You can also opt for a management strategy called “total communication”. In total communication, you can choose to intertwine some speech goals with an AAC system. Many children use this method—they communicate using a program called Proloquo2Go along with using words or word approximations.

Experts in your team are suggesting AAC

Therapists, school teachers, and other experts in your child’s intervention community may suggest trying AAC. Although you must provide consent and support to proceed in any AAC program, the experts in your team have a special insight and clinical judgment.

Speech therapists may recommend AAC when they feel like your child has diverse receptive language skills, but his/her expressive communication is limited due to using speech as the main medium. Experts want to close the gap between receptive and expressive language, and this is the purpose of AAC for children who have challenges in speech.

If there’s no suggestion in your team to consider AAC, you can also open the idea if you think it could be a great opportunity for your child. They will assist you in assessing for the right kind of AAC system once this kind of intervention takes place.

The gold standard of communication: where your child will thrive

There’s a misconception that the gold standard of communication is speech. I say, the gold standard of communication is where your child will thrive. There are many wonderful, breakthrough-providing ways for your child to communicate. Whether it’s writing or using signs, iPads, communication boards, flash cards, or gestures, these options can open many doors for self-expression.

This article was featured in Issue 116 – Enhancing Communication Skills

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