AAC

Also called Augmentative and alternative communication, Alternative communication, Assistive communication

AAC is every way of communicating that adds to speech or stands in for it, from a pointed finger to a device that talks.

What it is

AAC stands for augmentative and alternative communication. It is the umbrella term for every method a person uses to communicate that isn't spoken words: signing, gesture, pointing at pictures, spelling on an alphabet board, typing into a device that speaks. If it gets a message from one person to another and it isn't speech, it is AAC.

The word covers the whole spread, from a laminated card with two symbols on it to a computer driven by the eyes. That range is the point. Nobody is "an AAC user" in one way; most people who use it use several methods and switch between them through the day.

Who it can help

Anyone whose speech does not do everything they need it to, at any age. Children who are not yet talking, adults after a stroke, people with cerebral palsy, motor neurone disease, a learning disability, autism, or a tracheostomy on a ward for a fortnight.

It is not only for people with no speech at all. Someone whose words are clear at home and lost in a noisy shop can use AAC for the shop. And it is not a last resort or a sign that speech has been given up on; the research on children is consistent that AAC supports spoken language rather than replacing it.

How it works

The field sorts itself along two axes. The first is unaided against aided: does the method need anything beyond the person's own body? The second is low-tech against high-tech: does it need a battery?

Underneath that sit the choices that shape what a person can actually say. What words are on offer (core and fringe), how they are arranged (vocabulary organisation), and how the person reaches them (the access method). Get those three right and almost any device will do. Get them wrong and the most expensive device on the market will sit in a drawer.

Getting started

Start with the cheapest thing that could work, this week, and see what happens. Open the Talk board on any phone or tablet, or print a core board, and use it yourself while you talk: point to "more" as you say more, to "stop" as you say stop. That is aided language stimulation, and it is the single most effective thing a partner can do.

Don't wait for an assessment before you begin. An AAC assessment is worth having, but a person can use pictures and a board today, and what you learn from the trial is exactly what the assessor will want to know.

Presume competence. Put more words in front of the person than you think they understand. Nobody was ever held back by having too many words available.

Where to get help

Communication Matters is the UK charity for AAC and the best first stop for a family or a professional; it runs a helpline, a national conference and a directory of services. ACE Centre and CALL Scotland publish free resources and printable boards.

The NHS route is through a speech and language therapist, reached by referral from a GP, a school or, in many areas, self-referral. Complex needs go on to the regional specialised AAC service, which is free at the point of use in England.