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Augmentative and Alternative Communication (AAC) Systems for Autism



Most autistic children experience severe speech and language problems. These communication difficulties often lead to frustrations, outbursts, and other inappropriate and maladaptive behaviors. While many speech alternatives exist, some children do not know they can use speech to communicate. Teaching nonverbal children begins with lowering their stress levels and utilizing their interactive style, but augmentative and alternative communication goes a step further. By using meaningful visual strategies such as pictures, objects, and written words many children with autism can learn to better communicate with others.

What is Augmentative and Alternative Communication (AAC)?

Augmentative and alternative communication is a basic language classification. It includes every form of communication except speech:

  • facial and hand gestures
  • body language
  • pictures and photos
  • objects used as symbols
  • written or typed words
  • sign language
  • communication notebooks and boards
  • electronic devices such as keyboards or computers
  • voice output communication aids (VOCA)

Most of these communication devices utilize visual aids to help autistic children understand the benefit of using language to communicate. Which type of AAC device works best always depends on the child and what he understands. Many autistic children do quite well with pictures, photos, cutouts, objects, or written words, but iPads, computers, and other electronic devices are gaining in popularity. Before deciding which alternative communication system to experiment with, evaluate the program’s goals, the time it will take to set it up, the ability of the child to work with that method, and the cost.

Picture Symbols and Alternative Communication Systems

Most alternative communication methods teach a child to interact both visually and symbolically. For children with autism, object and picture symbols can be a problem. While visual representation systems are helpful for those without visual processing deficits, children who think in literal terms may not grasp the connection between a small miniature toy car and the real car or outing the toy represents. Before parents and therapists can teach an autistic child to communicate, the child must first learn that the pictures and objects represent the real item.

Autistic children tend to learn best with a well-structured concrete format. While parents and therapists can use pictures, flash cards, written words, and objects in a literal way, the goal of alternative communication is to supplement or replace traditional speech. For that reason, visual strategies like the Picture Exchange Communication System (PECS) use methods designed to get the child to initiate the interaction. However, systemic behavioral therapies such as PECS often fail to take advantage of multiple brain triggers that could quicken the speed with which an autistic child learns.

Children with autism usually have an easier time understanding the symbolic nature of pictures and objects if both the picture symbol and the item it represents are in view. It is also a good idea to combine the written word with pictures and objects to pave the way for future mastery of written language. While word and phrase repetition such as echolalia shows a desire to communicate rather than actual interaction, beginning alternative communication with object labeling, prompting, pointing, and picture discrimination helps autistic children learn and comprehend the crucial idea of symbolism. Without that understanding, communication skills will hold little value or meaning for the child.

Making and Using Communication Visual Aids

To a visually inclined child, pictures speak a universal language. They are helpful for others unacquainted with the child, since he can point to a picture that conveys meaning. With visual aids, autistic children can answer questions, show what they want, or even make a choice. Communication pictures are inexpensive. They can come from:

  • photos
  • coloring books
  • activity books
  • clipart or computer images
  • hand drawings
  • magazines
  • books

Use them as is, cut them out along their outline, or mount them to cardboard, poster board, or a heavy colored paper with glue. They can be any size the child relates too – from a large picture to hand-sized cards. It’s best to start with pictures of a simple object such as a plate, glass, favorite food, or toy. Later on, parents can move to pictures that show actions, feelings, or other abstract ideas.

The objects themselves are another great visual aid. Less hassle than pictures, items such as the child’s shoes or coat can easily communicate that he wants to go outside. A toy car can symbolize a coming trip, a baseball can convey why a sibling is not at home, and a fork or spoon can alert the child that it’s almost time for dinner and he needs to pick up his toys. The danger with objects, however, is confusion. At home, it’s easy to keep the symbol consistent, but when not at home, using the item in a different way can frustrate or even overwhelm the child.

Not all autistic children are visual learners. For those that aren’t, written words make a better ACC device than communication pictures. Carefully print the word on a card or piece of paper and attach it to cardboard, poster board, or heavy paper. In addition, these homemade flash cards can also be used with children who are visual learners right along with their pictures or objects. Written words often work better at teaching abstract concepts like “up” or “down.” Simply attach the flash card that says “up” to an object, and then raise the object up to demonstrate the concept.

Teaching with Communication Pictures

Autistic children need to learn how to use pictures and objects as well as the attached symbolism. Try incorporating visual strategies into many of the child’s everyday life skills programs. Posting a picture or word schedule of daily events offers the child a chance to look at the pictures or words several times a day, but it also gives parents a chance to explain sequences. For children struggling with the concept of waiting, “first” and “then” cards emphasized with sequenced pictures can quicken the time it takes for the child to understand.

Sit down at the kitchen table with a communication picture or word card and a related object. Point to the card and say what the picture or word is. Then, show the child the object. It may take many repetitions before the child comprehends how picture symbols or words relate to objects or events, but eventually the list of pictures will grow.

Once a child understands the symbolic nature of pictures, objects, and words – and masters how to use them – parents can begin to encourage the child to interact. Try asking questions that will require the child to pick up a picture or word card to answer; or introduce cards that show action, feelings, and other abstract concepts.

The downside to using pictures and words as symbols is the ever-growing pile of communication pictures and word cards. However, parents can use several augmentative and alternative communication methods at the same time. They don’t have to pick just one visual strategy or AAC device. Teaching autistic children a variety of ways to communicate and interact with others improves the chances that they will overcome the speech and language difficulties associated with autism.

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