Will AAC stop my child from talking?

Does AAC stop children from talking?

No. Two reviews of the research found no sign that AAC holds speech back, and most of the studies they covered reported that speech increased a little.¹² Augmentative and alternative communication, or AAC, means any way of communicating that adds to speech or stands in for it: signing, symbols, books, apps and more.

The first review, from 2006, pulled together 23 studies of 67 people with developmental disabilities. Six of the studies were designed well enough to count as the best evidence, covering 27 cases. In those, none of the cases showed a drop in speech, 11% showed no change, and 89% showed gains.¹ A second review, from 2008, looked at children with autism specifically. It found nine single-case studies (27 children) and two group studies (98 children), and concluded that AAC doesn't impede speech production and that most studies reported an increase.² In a 2005 paper on myths about AAC, Romski and Sevcik call the fear that AAC will take away a child's motivation to speak a myth, and say the available empirical data don't support it.³

How strong is that evidence?

Good enough to say AAC isn't likely to harm speech, and not strong enough to promise it will help it. Both reviews say the gains were modest.¹² The 2006 review also found that 17 of its 23 studies hadn't established experimental control, which limits how much anyone can be certain about the speech results, and the better-designed studies in it used signing or non-electronic systems.¹ The two reviews searched for studies published up to 2003 and 2007, so newer work isn't in them. The authors of the 2008 review asked clinicians and others to keep their expectations realistic.²

If you're worried that giving your child a way to communicate now will cost them speech later, the research doesn't support that worry. Schlosser and Wendt say future studies should try to identify which child characteristics predict gains, so nobody can yet tell you which children will go on to use more speech.²

What counts as AAC?

A lot more than a tablet. The RCSLT divides AAC into unaided and aided.⁴ Unaided AAC needs no equipment: signing (such as Makaton or Signalong), gestures, facial expressions, pointing and looking. Aided AAC uses something extra, such as a communication book or board, objects, symbols, or an app or device that speaks when a child touches a picture.⁴⁵

Many children use a mix, and what they use changes over time. The RCSLT says there's no "best system": AAC is personal, and the best one is the one that fits the child over time. It adds that paper can beat powered kit in plenty of situations, because it's light and goes everywhere.⁴

Does my child need to be ready for AAC first?

No. Romski and Sevcik list the belief that children must have a certain set of skills before they can benefit from AAC as a myth.³ I don't ask a child to meet any set of skills before we start. I begin with what they already do, and every gesture, look, sound and sign counts.

High-tech equipment is the one place where there can be rules, because the regional specialised NHS services have their own eligibility criteria, which the referring NHS therapist can explain.⁶ Those criteria apply to that service. They don't apply to starting with signs, symbols or a book.

What does starting look like at home?

Mostly it looks like you using it too. The RCSLT says AAC is for real life, not just therapy sessions, and that learning it is a team effort involving parents, siblings and everyone who spends time with the child.⁴ Communication Matters compares learning to use AAC well to learning a foreign language, and says seeing someone else use the same method helps.⁵

In practice, that can mean signing a key word as you say it, or pointing to a symbol while you talk about what's happening. Keep the book or board where your child can reach it. Leave a few extra seconds for a reply, and treat any response as communication. Please don't quiz your child with "show me" or make them use it before they get what they want. In my experience that turns it into a test, and children can tell.

What about nursery or school?

AAC helps most when the adults around your child use it as well. The RCSLT says speech and language therapists should help the people who communicate with an AAC user, and that partner training should be part of any therapy plan.⁴ Ask your child's nursery or school how they'll make the signs, symbols or device available all day, who will model it, and how they'll tell you what your child said. I can visit to talk this through with staff, and the schools page has the details.

How do NHS specialised AAC services fit in?

They exist for children who need high-tech equipment, and a child's NHS therapist is the usual route in. One regional service, AAC WEST at North Bristol NHS Trust, says it is one of 15 specialised AAC services in England. It says new assessments can only be referred by speech therapists funded by health, education or social care, that your GP can refer you to your local NHS therapy service if you don't have one, and that private therapists can't refer directly but can support a referral by working with the NHS therapist.⁶ Other services may work slightly differently.

Communication Matters, the UK's AAC charity, describes access to AAC funding and services as unequal and patchy across the country.⁷ The RCSLT says support varies between the four UK nations and sometimes within each one, and suggests asking your therapist how it works locally.⁴

When should I ask for help?

If your child has few or no words and gets frustrated, or people outside the family struggle to understand them, your GP or health visitor can refer you to NHS speech and language therapy. The special educational needs coordinator (SENCo) at nursery or school can raise it from their side. It's free, and you can ask before trying anything else. If your child loses words or skills they had before, ask for an urgent GP appointment or call NHS 111.

What happens if I get in touch?

The free 15-minute call is a chance to tell me how your child communicates now and what you're worried about. You don't need a GP referral to see me, and seeing me doesn't take your child off an NHS waiting list. The first step is an assessment (£270), mostly play, where we'd try a few kinds of AAC to see what your child likes using. My AAC page and the fees page have the rest, including therapy at £85 an hour.