Peds AAC: where communication can begin!

Augmentative and Alternative Communication (AAC) is a vital yet often misunderstood area of speech-language pathology. While AAC is sometimes viewed as a last resort—something to consider only after traditional speech therapy has "failed"—this perspective couldn't be further from the truth. For many children with complex communication needs, AAC is not just an option; it’s a pathway to language, connection, and self-expression. Whether through low-tech tools like core boards or high-tech speech-generating devices (SGDs), AAC can be a powerful and dynamic support for developing communication skills.

While I’ve worked with adults recovering from strokes and brain injuries, I had a two year stint where I did ONLY pediatric AAC consultants, and let me tell you, that was some of the most rewarding work I’ve done. But pediatric AAC presents a different set of challenges and opportunities. Many parents and educators hesitate when introducing AAC, worried that it might hinder verbal speech development or that a child is "too young" to use it. The reality? AAC supports language development, fosters interaction, and empowers children to communicate more effectively. Let’s explore some key considerations when introducing AAC for pediatric users.

1. Start Early and Model Often
   One of the most common misconceptions about AAC is that children need to show readiness before it’s introduced. In reality, we don’t wait for children to prove they can talk before we speak to them—so why should AAC be any different? Early exposure to AAC helps build language skills over time. Modeling (or aided language input) is crucial: communication partners should use the AAC system to model words and phrases just as they would with spoken language. The more a child sees and hears language through AAC, the more likely they are to use it.

2. Prioritize a Robust Communication System
   Children need access to a comprehensive vocabulary, not just a handful of requesting words. A robust AAC system includes core vocabulary (high-frequency words like "want," "go," and "help"), fringe vocabulary (specific interests like "dinosaurs" or "basketball"), and language-building tools like word prediction and phrase-based communication. Giving children a broad vocabulary from the start allows them to move beyond basic requests and engage in real conversations.

3. Access Methods: How Will the Child Use AAC?
   Not all children will use AAC in the same way, so assessing access methods is essential.

• Touch Access: Many children can use a touchscreen with their fingers or a stylus. Features like keyguards or touch-and-hold settings can help refine selection accuracy.

• Switch Access: For children with motor impairments, switches can provide an alternative means of accessing AAC. This method requires careful customization to match the child's physical abilities.

• Eye Gaze: Some children benefit from eye gaze technology, which allows them to control a device using their eye movements. While often associated with conditions like cerebral palsy, eye gaze can be an excellent option for any child with significant motor challenges.

1. AAC Does Not Hinder Speech Development
   A persistent myth about AAC is that it prevents children from developing verbal speech. However, research consistently shows the opposite: AAC can support and even accelerate spoken language development. By reducing frustration and providing a reliable means of communication, AAC encourages children to engage in more interactions, strengthening their overall language skills.

2. Make AAC Part of Everyday Life
   AAC shouldn’t be limited to therapy sessions or structured activities—it needs to be part of a child’s daily routine. Families, teachers, and caregivers should incorporate AAC into playtime, mealtime, and social interactions. The goal is for AAC to become as natural as spoken language, seamlessly integrated into all aspects of a child’s life.

Pediatric AAC is not about replacing speech—it’s about providing a bridge to communication. Every child deserves the opportunity to express themselves, build relationships, and develop language in a way that works for them. By embracing AAC early, prioritizing robust vocabulary, and ensuring appropriate access, we can empower children with complex communication needs to find their voices and thrive.