Augmentative and Alternative Communication at Eis Laasois By: Devora Szanzer, M.S, SLP-CCC, C/NDT

• February 3, 2025
• 15 Min Read

By: Devora Szanzer, M.S, SLP-CCC, C/NDT

According to the American Speech-Language-Hearing Association (ASHA), “Augmentative and Alternative Communication (AAC) means all of the ways that someone communicates besides talking. People of all ages can use AAC if they have trouble with speech or language skills. Augmentative means to add to someone’s speech. Alternative means to be used instead of speech. Some people use AAC throughout their lives. Others may use AAC only for a short time, such as when they have surgery and can’t talk.  There are many different types of AAC. No-tech and low-tech options include things such as gestures and facial expressions, writing, drawing, spelling words by pointing to letters, and pointing to photos, pictures, or written words. High-tech options include things like using an app on an iPad or tablet to communicate and using a computer with a “voice," sometimes called a speech-generating device.

A person may use different types of AAC because there are many ways that we all communicate. An AAC system means all of the tools of this type that a person uses (asha.org).”

Within the AAC community, there is a mindset to introduce children to a high-tech device (such as an iPad) immediately and to skip the transition from the low tech to high tech.  However, our goal is to ensure that the children understand that these photographs and picture symbols are for the purpose of communication and we want the children to carefully attend visually to the photos and symbols.  For some children, if they are introduced too early to the device, it becomes a toy that they press that emits noises that they don’t understand (meaning speech) instead of being specifically communicative.  This, then, distracts from the purpose of AAC.  Consequently, we carefully evaluate when the introduction of a device is appropriate from the start and when the child requires a careful transition from low-tech to high-tech.  This decision is based on the individual child with a number of factors that are considered.  Some children can successfully start on a high-tech device earlier on. 

Many of the children who I have treated over the years presented with limited receptive and expressive language skills when they started preschool at Eis Laasois.  My goal with regard to using AAC therapeutically was to help children understand spoken language as a prerequisite for learning how to say words purposefully to communicate.  For the children who require beginning with low-tech, I begin by introducing the children to the use of simple sign language, gestures such as pointing, and photographs of favorite toys paired with favorite toys in the context of play.  Parents often ask me if this will stop their children from wanting to speak, as they will rely on the signs, gestures, or photographs, instead.  My response is that children innately want to communicate via speaking.  It is the simplest and most effective way to tell people what you want.  However, until the children have the ability to use the small structures of their mouth (i.e.; lips, tongue, etc.) in rapid movements that enable us to speak, the use of AAC is a crutch to help them tell others what they want to say.  It is crucial for children to feel empowered to make changes in their environment through communication.  Research has shown that the use of AAC actually expedites children’s ability to communicate verbally and in no way hinders it.

Once children begin to pay attention to the photographs that I present and demonstrate understanding of what they represent, I then move onto picture symbols, which is a higher level, as it is a stick figure drawing instead of a photograph.  My goal is to teach the children nouns, verbs, and what are called “core words”, such as “more, up, open, and not.”  Core Words within AAC are words in our daily vocabulary that make up most of our communication. These words enable children to express their basic wants and needs using a broader vocabulary. 

A device that I introduce early in the process is a Mini-Com, which is a small square shaped object.  You can record a single word on the device and then allow the child to push the square button on top in order to “speak” the pre-recorded words.  This allows a child who cannot yet speak to “say” specific words so that s/he can participate in a vocal manner.  The children often light up at this opportunity to “say” words.  I often record simple words, such as “I want,” “more,” or the names of simple toys with which we are playing, such as “ball.”  I also pair this with hand gestures that mimic the way we say our sounds, so that children can “hear” themselves speak using the Mini-Com and “see” how these words are produced through my hand movements.  This often helps children imitate specific sounds and words.  For example, for the /p/ sound, I deliberately close my fist in a circular shape and then pop open the fist, in the same manner we close our lips and then pop them open to release the air, which results in the /p/ sound.  I tend to focus on a small set of words that we practice over and over again to help the children understand the meaning of the words and then actually say them.  Mass practice, a key element within principles of motor learning, is a crucial tool to helping children learn new skills. 

During group speech therapy sessions at Eis Laasois, we use a combination of photographs and picture symbols, as well as the Mini-Com and iPad containing computerized AAC apps, so that the children have a variety of expressive language tools to communicate and participate within a group setting based on their level of skill.  While the verbal children in the group can spontaneously imitate words such as “bus,” this enables the not-yet-verbal children to “speak” via activating the Mini-Com, pressing the appropriate button on the AAC app, or selecting the photographs/ picture symbols and holding them up for the other children to see while the speech therapist models the word verbally for them.  It is inspirational to witness the children’s joy at their ability to participate by expressing themselves.

There are a variety of computerized AAC apps that are used, with specific rational for each.  Programs such as Go Talk, Proloquo, and TD Snap are utilized at Eis Laasois.  Once we assess that the child is on a path to requiring an individual dedicated device (their own personal speech generated device), meaning the child is demonstrating the potential and capability to do so, we request an AAC evaluation from the Center for Assistive Technology (CAT) team at the Board of Education.  Based on our report and their assessment, which demonstrates some level of skill, the child can be approved for his own iPad, along with the appropriate AAC app that is determined by the team.  This iPad is used at school, both in individual therapy sessions and in the classroom, and can be sent home, as well.  Parents are entitled to one training by the Department of Education’s CAT team at their school each year so they can learn how to use the device and add specific words, as needed.  At Eis Laasois, we encourage parents to come in, observe us work with their children, and become comfortable using the device, as well. 

Using the Go Talk Program, in a few months, we have seen children learn to use their eyes to scan a variety of possible activities on a pre-programmed home page.  They show understanding that pressing the picture of a specific toy will bring them to a whole new page that has vocabulary words that are associated with that toy.  So, for example, if the child chooses Mr. Potato Head from the home page, they understand it will bring them to another page that has vocabulary, such as specific body parts, “nose, eyes,” and associated words such as “hat, shoes, push, and finished.”  When the child presses the “finished” button, it will bring them back to the home page so they can choose another activity.  This is called the ability to navigate the system, so that the child can use the device to communicate a variety of communicative functions (i.e.; requesting help, requesting more, answering yes/no) and choose a variety of activities within a speech session.  One of the children with whom I worked loved getting his mother’s shoes from her closet and playing with them.  When I introduced Mr. Potato Head and he had the opportunity to press the button for the word “shoe,” and then physically push the shoe into the Mr. Potato Head toy, you could literally feel his excitement.  This, then, enhanced his ability to learn, since the word ‘shoe’ was very meaningful to him.  It then motivated him to learn the other words associated with the task. 

Many of us, such as myself, are innately visual learners.  The use of AAC just taps into that for the children with whom we work.  It results in a quicker, empowering, and joyful method to help our children speak and allow their voices to be heard.