Choosing an Augmentative and Alternative Communication (AAC) system is a highly individualized process that involves carefully evaluating the user's unique communication needs, strengths, and environment. The goal is to find a system that empowers effective communication without restricting future potential.
Understanding AAC
AAC encompasses various methods used to supplement or replace speech or writing for individuals with communication impairments. These systems can range from low-tech options like picture boards to high-tech speech-generating devices. The right choice is crucial for developing language skills, expressing needs, and participating fully in life.
The Initial Steps: A Holistic Assessment
The journey begins with a comprehensive assessment conducted by a multidisciplinary team, typically including a speech-language pathologist (SLP), occupational therapist (OT), physical therapist (PT), and the individual themselves, along with their family or caregivers. This assessment is vital for understanding:
- Current Skills, Strengths, and Needs: This involves looking at what the individual can already do, their preferred communication methods, and specific challenges they face. It's crucial not to limit thinking based on current abilities but rather to consider what they could achieve with the right support.
- Communication Environments: Where does the individual primarily communicate (home, school, work, community)? Who are their main communication partners?
- Preferences and Goals: What does the individual want to communicate about? What are their personal goals for communication?
Key Factors to Consider When Choosing an AAC System
When evaluating potential AAC systems, several critical factors come into play. These considerations will help narrow down the vast array of options for different symbols, systems, and access modes.
1. User's Cognitive and Language Abilities
- Symbol Systems:
- Objects: Real objects for very concrete communication.
- Photographs: Pictures of actual items or people.
- Line Drawings/Icons: Standardized symbols (e.g., Picture Communication Symbols, Boardmaker) that represent words or concepts. These are often used for visual communication.
- Text/Spelling: For individuals with literacy skills, text-based systems allow for direct spelling and typing.
- Vocabulary Needs:
- Core Vocabulary: High-frequency words (e.g., "want," "go," "more") that are used across many contexts.
- Fringe Vocabulary: Specific words relevant to an individual's interests, activities, and specific communication situations (e.g., names of friends, favorite foods, specific hobbies).
- Language Organization: How the vocabulary is arranged on the device (e.g., grid-based, visual scenes, semantic compaction/Minspeak).
2. Physical Abilities and Access Methods
The way an individual interacts with the AAC system is paramount. This directly relates to understanding options for different access modes.
- Direct Selection:
- Finger/Hand Touch: Using a finger or hand to point directly to symbols.
- Stylus/Head Pointer: For individuals with limited hand control.
- Indirect Selection (Scanning):
- Switch Access: Using one or more switches to select items as they are highlighted (e.g., eye blink, head movement, finger press).
- Eye Gaze: Using eye movements to select items on a screen. This is a common solution for individuals with significant physical challenges.
- Other Methods: Voice activation, head tracking, or alternative mouse controls.
3. Social and Environmental Factors
- Communication Partners: How easily can others understand and interact with the chosen system?
- Contexts of Use: Is the system suitable for all environments (e.g., quiet classroom, noisy playground, public transport)?
- Portability: Can the system be easily transported between different locations?
- Durability: Is the device robust enough to withstand daily use and potential drops or spills?
4. Technology and Support
- Low-Tech AAC: Non-electronic, simple tools like communication boards, picture exchange systems (PECS), or alphabet charts. These are often used as backups for high-tech devices.
- Mid-Tech AAC: Battery-operated devices with pre-recorded messages or limited dynamic display capabilities.
- High-Tech AAC: Sophisticated electronic devices with dynamic displays, synthetic speech, and extensive customization options, often tablet-based or dedicated devices.
- Technical Support: Availability of training, technical assistance, and ongoing support for the device and software.
- Funding: Cost of the device, software, accessories, and therapy. Explore options through insurance, grants, or state programs. (Learn more about funding AAC devices)
The Assessment Process: A Deeper Dive
The assessment typically includes:
- Case History: Gathering information about the individual's medical history, developmental milestones, previous communication methods, and current daily routines.
- Observation: Observing the individual in various environments and communication situations.
- Direct Assessment: Evaluating motor skills, cognitive abilities, language comprehension, and expression. This helps determine suitable access methods and symbol types.
- Feature Matching: Matching the individual's skills and needs to the features available in different AAC systems. This directly considers "options for different symbols, systems, and access modes."
- Trial Period: Crucially, the individual should have opportunities to try out different AAC systems in real-life situations. This hands-on experience is invaluable for determining the best fit.
Comparing AAC System Features
To illustrate the range of considerations, here's a simplified comparison:
| Feature | Low-Tech AAC (e.g., PECS, Communication Board) | High-Tech AAC (e.g., Dedicated SGD, Tablet App) |
|---|---|---|
| Cost | Low | High |
| Portability | High (lightweight, no power needed) | Variable (depends on device size, battery life) |
| Vocabulary Range | Limited, fixed | Extensive, dynamic, customizable |
| Speech Output | No (requires partner interpretation) | Yes (synthesized speech, various voices) |
| Access Methods | Direct touch, pointing | Direct touch, eye gaze, switch scanning, head tracking |
| Durability | Variable (paper, laminated cards) | Generally robust, often with protective cases |
| Learning Curve | Low for basic use | Variable, can be higher for advanced features |
| Customization | Limited | High (layout, vocabulary, voice, access settings) |
Practical Insights for Your Journey
- Start Small, Think Big: Don't feel overwhelmed. Begin with a system that meets immediate needs, but ensure it has the potential to grow with the individual's evolving communication skills.
- Team Collaboration: Maintain open communication with your AAC team. They are your best resource for guidance and support.
- Embrace Trial and Error: It's rare to find the perfect system immediately. Be prepared to try different devices, software, and access methods.
- Training is Key: Both the user and communication partners will benefit from training to effectively use and support the AAC system.
- Advocate for Potential: Remember that the chosen system should always support the individual's full communicative potential, not just their current abilities.
Choosing an AAC system is a significant decision that requires patience, informed choices, and ongoing support. By focusing on the individual's needs, strengths, and potential, you can find a system that unlocks a world of communication possibilities.
[[AAC Selection]]
