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Augmentative and Alternative Communication (AAC)

Interventions using and/or teaching the use of a system of communication that is not verbal/vocal which can be aided (e.g., device, communication book) or unaided (e.g., sign language)

Evidence Based
Ages: Skip to Evidence

Steps for Implementation

Note: This practice is one of five strategies newly identified as an evidence-based practice (EBP) in the most recent literature review and report on EBPs published in 2020 by the National Clearinghouse for Autism Evidence and Practice (NCAEP). As stated on the TARGET page on research, TSLAT aligns its intervention content with the AFIRM modules created and published by the National Professional Development Center on Autism Spectrum Disorders (NPDC) at the University of North Carolina’s Frank Porter Graham Child Development Institute (FPG). The FPG Autism Team is currently developing new AFIRM modules to reflect the recent research and address the five new EBPs which are: 1) Augmentative and Alternative Communication, 2) Behavioral Momentum Intervention, 3) Direct Instruction, 4) Music-Mediated Intervention, and 5) Sensory Integration®. Once the new AFIRM modules are published, TSLAT will update the TARGET intervention pages for these EBPs, including steps for implementation and a webinar on each new EBP.

Note: Speech Generating Devices (SGD) was once its own EBP and steps for implementation were created for that practice. Therefore, we have included these steps below.

Speech Generating Devices (SGD)

Step 1. Identifying and Setting Up the Device

  1. Select an appropriate device, taking into account how the information is displayed, the learner’s present and potential abilities (e.g., attention span, experience with symbols, ability to establish joint attention), device portability, available training and technical assistance, and funding sources.
  2. Introduce the device to the learner by having a device with few symbols and/or buttons with nothing on them.
  3. Include desirable and undesirable symbols to facilitate the learner’s ability to discriminate.

Step 2. Introducing Direct Support Persons to the Device

  1. Team members are identified and trained in how to program and use the device.
  2. One or two key members of the team are identified as primary contacts regarding the device’s use.

Step 3. Identifying Environments Where the Device Will Be Used and with Which Communication Partners

The device is introduced during familiar routines that allow for frequent communicative attempts (e.g., circle time, English class, snack, lunch, free play).

Step 4. Identifying Vocabulary Appropriate to the Learner and the Environments

Words and phrases chosen for the device should:

  • be age-appropriate,
  • be meaningful and motivating for the learner, and
  • serve an identifiable communicative function (e.g., greeting, requesting).

Step 5. Allowing the Learner to Explore the Device

Give the learner an opportunity to independently explore the device.

Step 6. Setting up Communicative Opportunities

  1. Arrange opportunities within naturally occurring environments that provide the cues and motivation necessary for the learner’s success (e.g., takes into account materials needed and needs of learners; places items out of reach).
  2. Instruct peers in how to respond to learner’s SGD use (e.g., responding to learner rather than teacher).
  3. Use frequent questioning to facilitate communicative exchanges during routines and activities.

Step 7. Providing as Few Prompts as the Learner Requires

  1. Allow pause time (i.e., 4–5 seconds) before using a prompt, depending on the needs of the learner.
  2. Do not begin the communicative exchange by using prompts that are not needed by the learner (e.g., hand-over-hand assistance) when a subtler prompt would suffice.

Step 8. Honoring the Communication

  1. Immediately grant the learner’s requests upon the communication even if it is not a desired item, object, or action.
  2. Explain when a choice is no longer an option.
  3. Give learners choices during routines and activities and follow their lead when appropriate communication is used (e.g., staying on playground to swing, playing on computer during reading time).

Step 9. Reducing Prompts as Soon as Possible

  1. After a few successful trials, use a less restrictive prompt and provide pause time (i.e., 4–5 seconds) in which the learner may activate the SGD.
  2. Be aware of learners’ attention, frustration, and motivation and adjust demands during routines and activities accordingly (e.g., more/less intensive prompts, more/less pause time).

Step 10. Increasing the Environments Where the SGD is Used

  1. Provide opportunities for the learner to use the SGD in environments around the school, home, and/or community.
  2. Encourage the use of the SGD with multiple communicative partners.

Step 11. Increasing Vocabulary

  1. Increase the number of symbols in a single field as the learner becomes more proficient with the device.
  2. Increase the number of overlays as the learner becomes more proficient with the device.
  3. Introduce a new device as the learner’s needs require.

Research and Outcomes

Research Summary

Age Range: 0-18

Skills: Communication, social, joint attention, play, academic/pre-academic, challenging/interfering behavior, motor

Settings: Home, school, community, clinic

Evidence Rating: Evidence Based

The information found in the Research Summary table is updated following a literature review of new research and these ages, skills, and settings reflects information from this review.

Outcomes Matrix

The Outcomes Matrix shows outcome areas by age for which this evidence based practice is effective
Age: 0-5 6-14 15-22
Academic/Pre-academic Yes Yes
Challenging/Interfering Behavior Yes Yes
Communication Yes Yes Yes
Joint Attention Yes Yes
Mental Health
Motor Yes
Play Yes Yes
School Readiness
Social Yes Yes Yes
More about Intervention Outcomes

Augmentative and Alternative Communication (AAC) interventions use and/or teach the use of a system of communication that is not verbal/vocal including aided and unaided communication systems. Unaided communication systems do not use any materials or technology (e.g., sign language and gestures). Aided communication systems include low tech systems (e.g., exchanging objects/pictures or pointing to letters) and extend to high tech speech generating devices (SGDs) and applications that allow other devices (i.e., phones, tablets) to serve as SGDs. Methods of teaching AAC use are also included in this category (e.g., Aided Language Modeling) which may include other EBPs such as prompting, reinforcement, visual supports, and peer-mediated interventions (Steinbrenner, et al., 2020).

• Manualized Interventions Meeting Criteria: Picture Exchange Communication System® (PECS®; Bondy and Frost, 1985).

In the most recent literature review conducted in 2020 by the National Clearinghouse for Autism Evidence and Practice (NCAEP), efforts were made to combine and/or expand EBP categories that shared similar features. Picture Exchange Communication System, which was listed as its own evidence-based practice in previous literature reviews, moved into Augmentative and Alternative Communication.