AAC and Autism: How Alternative Communication Helps Your Child

AAC, or augmentative and alternative communication, is any way of communicating besides talking, such as gestures, signs, picture boards, or a speech-generating app. For many autistic children, AAC gives them a reliable way to ask for what they need, share ideas, and connect with people. Research does not show that AAC stops speech, and it can support spoken language when both are practiced together.

Key takeaways

• AAC includes unaided options (gestures, signs) and aided options (picture boards, communication books, speech-generating apps and devices).
• ASHA states there are no prerequisites for AAC. Your child does not have to “earn” it or reach a milestone first.
• Using AAC does not reduce motivation to talk, and it can help speech when both are worked on together.
• Modeling, where you use the AAC system while you talk, is one of the most useful things families can do.
• A speech-language pathologist can evaluate your child and help choose a system that fits.

What is AAC?

ASHA defines AAC as all of the ways that someone communicates besides talking. “Augmentative” means adding to speech. “Alternative” means used instead of speech. Many autistic children use AAC in both ways at different times.

Some children who use AAC do not speak at all. Some speak a few words. Some speak in full sentences most of the time but lose access to speech when they are stressed, tired, or overwhelmed. AAC can help in all of these situations.

The goal of AAC is not to replace your child’s voice. It is to make sure your child always has a way to be heard.

Types of AAC: unaided and aided

ASHA’s professional guidance describes two broad kinds of AAC.

Unaided AAC

Unaided AAC uses only the body. No tools are needed. Examples include:

• Gestures, like pointing, reaching, or waving
• Manual signs, like signing “more” or “all done”
• Facial expressions and body language
• Vocalizations and sounds

Unaided AAC is always available, which is a big advantage. It does depend on motor control, and not everyone your child meets will understand their signs.

Aided AAC: low-tech and light-tech

Aided AAC uses something outside the body. Low-tech or light-tech options do not need batteries. Examples include:

• Picture boards with photos or symbols for common needs, like snacks, toys, or “break”
• Communication books with pages organized by topic or activity
• Picture exchange, where a child hands a picture to a partner to make a request
• Choice boards that show two or three options at a time
• Letter boards for children who are learning to spell

Low-tech tools are inexpensive, easy to make at home, and work well in places like the pool or the bath.

Aided AAC: high-tech

High-tech AAC includes speech-generating devices and AAC software on tablets or computers. When your child taps a symbol or types a word, the device speaks it aloud.

High-tech AAC can hold a very large vocabulary, which lets your child say more than basic requests. It can be customized with photos of family members, favorite foods, and your child’s interests. It also needs charging, protection from drops, and some setup time.

There are many AAC apps and devices on the market. Rather than choosing one based on reviews or price alone, work with a speech-language pathologist who can match features to your child’s needs.

Which type is best?

Most children use more than one. A child might sign “more” at the table, use a picture board at the park, and use a speech-generating app for longer messages at home and school. This mix is often called multimodal communication, and it is a strength, not a sign of confusion.

Common myths about AAC

Parents often hesitate to try AAC because of things they have heard. Here is what ASHA’s guidance says.

Myth: AAC will stop my child from learning to talk

This is the most common worry. ASHA’s public guidance states that AAC will not stop someone from talking or slow down language development. ASHA’s professional guidance goes further, noting that research shows AAC “does not affect motivation to use natural speech and can, in fact, help improve natural speech” when therapy works on natural speech and AAC together.

Myth: my child has to be “ready” for AAC

ASHA states that there are no prerequisites for AAC intervention. On its public page, ASHA adds that there are no thinking skills, test scores, or other milestones a person needs to reach before AAC can help. Your child does not need to match pictures, point accurately, or sit for long periods before starting.

Myth: AAC is a last resort

AAC does not need to wait until other options have been tried. ASHA notes that people of all ages can use AAC, including children younger than 3. Starting early gives your child a way to communicate while other skills are still developing.

Myth: if my child uses AAC, they will not learn to read

ASHA notes that people who use AAC can also learn how to read and write. Many AAC systems pair symbols with printed words, which gives your child steady exposure to text.

Myth: AAC is only for asking for things

Requests are a common starting point because they are motivating. But AAC can be used to comment, joke, protest, greet, ask questions, share feelings, and tell stories. A good AAC plan aims for all of these over time.

Modeling: the most powerful thing you can do

Children learn spoken language by hearing thousands of words before they are expected to say them. Children who use AAC need the same thing: to see the system used before they are expected to use it.

This is called modeling, aided language modeling, or aided language input. ASHA describes it as an approach where the communication partner provides spoken words along with AAC symbols, and notes that research shows it increases symbol understanding and use.

How to model AAC at home

• Talk and tap together. Say “Let’s go outside” while you touch “go” and “outside” on the board or device.
• Model one step ahead. If your child uses one symbol, model two. If they tap “juice,” you tap “more juice.”
• Do not require a response. Modeling is showing, not testing. Avoid “Show me juice” or taking the device and pressing your child’s hand. Let your child watch and try on their own terms.
• Model many kinds of messages. Beyond “want” and “eat,” try “funny,” “uh oh,” “my turn,” “stop,” “like,” and “not.”
• Start with a few routines. Pick one or two daily routines, such as snack time and bath time, and model during those every day.
• Respect your child’s voice. If your child taps “all done” or “stop,” honor it when you safely can. This shows that their communication has real power.

Modeling can feel awkward at first, and that is okay. Most families find it gets easier within a few weeks.

How families can get started with AAC

You can take small steps even before a formal evaluation.

1. Notice how your child already communicates. Write down how they show “yes,” “no,” “more,” and “help.” These are all real communication.
2. Try a simple choice board. Take photos of two or three favorite snacks and let your child point to choose.
3. Keep it available. AAC needs to be within reach all day, not stored in a drawer between therapy sessions.
4. Accept every way your child communicates. Speech, signs, pictures, and devices all count.
5. Talk with a speech-language pathologist about a full AAC evaluation.

Tips for making AAC part of daily life

• Take the board or device on outings, to grandma’s house, and to the store.
• Add vocabulary for things your child cares about, like favorite characters or pets.
• Share the system with teachers, babysitters, and relatives so everyone models the same way.
• Keep vocabulary in the same place on the device so your child can learn where words are.

The role of the speech-language pathologist

An SLP is the professional who evaluates AAC needs and recommends a system. ASHA explains that an SLP can help find the right AAC system and help you and the people you talk with learn how to use it.

An AAC evaluation often looks at:

• How your child communicates now
• What your child understands
• Vision, hearing, and motor skills, like how your child points or taps
• What your child wants to talk about and where they spend time
• Which types of AAC your child responds to during trial activities

The SLP will then help set goals, teach your family modeling strategies, and adjust the system as your child grows. If your child is also in ABA therapy, the SLP and your child’s BCBA can use the same AAC system and vocabulary so practice stays consistent. Our article on speech therapy for autism explains more about how speech therapy and ABA fit together, and what happens in an ABA therapy session shows where communication practice fits into a typical day.

For questions about your child’s hearing, vision, or motor needs, talk with your pediatrician or a qualified professional as well.

AAC and insurance

Coverage for AAC tools varies. ASHA notes that some AAC tools are covered by insurance, but some are not. Plans that do cover a speech-generating device may ask for an evaluation and documentation from an SLP.

Before you buy a high-tech device, contact your health plan to ask:

• Whether speech-generating devices are a covered benefit
• What evaluation or documentation is required
• Whether prior authorization is needed
• Whether a tablet with an AAC app is treated differently from a dedicated device

Our insurance page has general information about how our team helps families understand coverage and authorization.

Talk with our team

If you are curious whether AAC could help your child, we are glad to talk it through with you. United Autism Therapy offers speech and language therapy and a free consultation for families in Westminster and across Orange County.

Call (714) 709-7819 or contact us to ask questions and learn about next steps.