Condition: AAC User

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Augmentative and Alternative Communication (AAC) is how we help children to communicate who aren’t able to use their speech mechanisms as well as they need to.  There are a wide range of types of AAC, including sign language, picture boards/systems, low tech devices, and high tech devices.  There is no one-size-fits-all solution for using AAC so we must use dynamic assessment and continued analysis of systems that we try to make sure that we find a good fit for each child.

Developmental Norms:

There is no hard and fast rule for who should be introduced to AAC.  However, there are some guidelines we can use to make that decision.  To give you a point of reference for how many words a child should be using, here is a chart based on age. The number of words represents the average size of a child’s vocabulary at that age, but slightly lower isn’t necessarily a large concern. However, if a child is far off from these numbers, there may be a problem.

Age of Child ~ Number of Words
12 months ~ 2-6 words
15 months ~ 10 words
18 months ~ 50 words
24 months (2 years) ~ 200-300 words
30 months ~ 450 words
36 months (3 years) ~ 1,000 words
42 months ~ 1,200 words
48 months (4 years) ~ 1,600 words

Obtained from Linguisystems Website

When AAC Should Be Considered: 

AAC should be considered when his/her speech output is not adequate to communicate everything that the child wants/needs to communicate.  That doesn’t mean that he/she has to be completely non-verbal/non-speaking in order to proceed.

Things to consider:

  • Child’s frustration levels
  • Adult frustration levels
  • Access to school curriculum:
    • Participation in classroom activities
    • Ability to demonstrate knowledge to teachers
  • Access to home and community environment:
    • Ability to interact appropriately with family and peers
    • Independence in developmentally-appropriate daily activities

Prerequisite Skills for AAC:

A lot of people wonder if there are specific prerequisite skills that must be present before we can try AAC.  My answer to that is no.  We don’t require children to have any prerequisites before we start talking to them and exposing them to spoken language!  So it’s never too early to expose them to AAC either.  

These are commonly used as excuses why AAC devices should not be attempted with children but these are WRONG:

  • The child must understand cause and effect (AAC teaches cause and effect quite effectively)
  • The child must understand that a picture represents an object (again, AAC use teaches this)
  • Child must have good enough motor skills for AAC (there are all kinds of adaptations we can use!)
  • Child must understand enough language for AAC use (babies don’t have great language before they are introduced to speech)
  • Child must be interested in communicating (even acting out can be shaped into intentional communication)

For more information about this, visit our blog post: 

Blog Post About AAC Prerequisites


If you have decided to try using AAC with a child, then the evaluation process is based around evaluating if a particular device or system will work for this child.  Let’s start by defining the terms “AAC System” and “AAC Device”. 

AAC System: A method by which a child communicates other than using spoken speech.  This can including using gestures, signs, pictures, or technology.  The term “system” is used to mean the entirety of the child’s communication with us.  Not just the specific thing he uses to help him.

AAC Device: An actual piece of equipment that a child uses as a part of his AAC system.  Usually this refers to a piece of low-tech or high-tech equipment like a talker or symbol board.  The AAC device is just one aspect of the overall AAC system.

Now, let’s move on to the evaluation process.   You’ll need to choose a system, introduce it to the child, and then track data to determine if that system is appropriate for the child.  

Now that we have that out of the way, let’s talk about how to choose an AAC system for the child.  As we just learned, that means more than just choosing a “talker”.  We must consider all of the child’s needs.  Often, we find that parents or SLPs discount a child’s ability to use AAC because they child isn’t able to use a stereotypical AAC device.  But there are a lot of other ways for children to communicate with us and for us to build an AAC system that works for that particular child.

Types of AAC Systems:

Here is a list of options for AAC devices, methods, and systems that you may want to consider:

  • Gestures/Body Language
  • Sign Language
  • Object Symbols (objects glued to cards)
  • Picture Boards
  • Picture Exchange
  • Written Messages (paper or typed)
  • Single Button Voice-Output Devices
  • Multi-Button Voice-Output Devices
  • Dynamic-Display Voice-Output Devices

Here is a one-page PDF handout that describes each of these a little more: 

Click Here to Download the AAC Types Handout

What to Consider When Choosing a System: 

As we said before, there is no one-size-fits-all approach to choosing the correct AAC system for a child.  The best approach will be to find an AAC evaluation team near you that consists of at least an SLP and an OT and that has extensive knowledge of the current options and technology.  If that’s not available though, you may need to review options yourself.  Here are a list of considerations to make when choosing what AAC system you’ll start with.  Remember, you’ll be trialing them one at a time so you don’t have to get it right the first time.

  • Child’s mobility and physical limitations
  • Family preferences and limitations
  • Number of different desired communication partners
  • Child’s cognitive level
  • Child’s visual and attention skills
  • Likelihood of long-term AAC use
  • Child/Family’s means of acquiring devices
  • What the child will be using it for
  • How well the child does when using the systems during trials or therapy
  • Past success or failures with AAC systems
Once you’ve selected what AAC system you’ll use with the child, you’re ready to try it out.  You’ll want to decide on what goals you’ll be measuring to ensure that the system is actually helping the child.  See the next section on tracking data and make sure you take some baseline data before introducing the system.

For the actual introduction of the system, start with the most simplified version of the system that you can manage.  If you’re using sign language or picture boards, start with just a few, highly-motivating choices.  If you’re using some sort of technology, see if you can hide as many choices as possible aside from those few highly-motivating words.  

A few notes here: 

  • Choose words that can be used in a variety of situations.  Words like “cookie” and “bubble” may be great when those things are present, but they don’t help very much when they’re not present.  Choose words like “go” and “want” that can be used in a variety of settings for a variety of purposes.
  • If you’re using an AAC device where you can hide pictures, try to make sure that the pictures that remain unhidden are the same size and location that they will be once the child “unlocks” the rest of the choices.  For example, if you eventually think the child will be able to select what he wants from a screen of 32 buttons, keep the layout that way.  If you choose two buttons to start with, don’t resize those two buttons so that they each take up half the screen.  Keep them the same size and position that they’ll be on the 32-board but make it so that the child just can’t see or push the rest of them.  If you’re not using device that allows you to hide buttons in this way, you can use a piece of cardboard with a hole cut out over the button you want the child to use so that the rest are blocked.

Once the system is ready, try to introduce it to the child in the most natural way possible.  Think of it as similar to how you would encourage a late talker to speak.

  1. Get Familiar with the Child’s System: Make sure that everyone that is working with the child knows how to use the system and what words you’ll be focusing on at first.  This may mean training everyone how how to use sign language or showing them how to use the talker.
  2. Model AAC Use Around the Child: Children learn to speak by hearing us speak.  Children learn to use talkers by watching others around them using the talkers.  Have the adults use the talker when interacting with that child.  Explain that they don’t have to use it for every word they say, but they can push the correct button when one of the words you’re targeting comes up.
  3. Encourage the Child When he Attempts to Use it and Provide Differential Reinforcement: Help all adults working with him understand to encourage his use of the device, even if he’s just playing with it and pushing random buttons.  This is like a baby’s babble and it’s very important.  Show adults how to provide differential reinforcement, meaning that the child gets rewarded more strongly if he uses language (such as the AAC system) instead of non-language (like pointing or grunting).  For example, if the child points to the cookie, he gets a small piece broken off while the adult models “eat” on the device.  But if he pushes the button for “eat” himself, he gets the whole thing!
  4. Have the Device Present at All Times: We don’t talk away a child’s larynx when he speaks out of turn so we shouldn’t take away his talker either.  Teachers often will take away their talker when they are pushing buttons during circle time because it is distracting other children.  We need to help these teachers see that we wouldn’t do this to any other child so we must similarly help our children with AAC learn how to have quiet voices just as we do other children.  It’s ok to turn it upside down as a physical reminder (I consider this to be the same as having the child place a finger over his mouth in the “shh” position) but not to take it away entirely.
  5. Set Up Opportunities for the Child to Use the AAC Device (in the classroom, at home, in speech, etc.): This is usually where we come in as the speech-language pathologists.  We help stage situations that will encourage the child to communicate using the system. For example, this could mean providing modeling and encouragement during snack time where they only get one piece of food at a time until they start using the AAC.  
  6. Train Other Adults on How to Set Up Opportunities and Provide Differential Reinforcement: As we mentioned, it’s important to make sure that all adults are using the AAC system across all environments. The better we can get everyone on board, the faster we’ll know if the system is appropriate and helping.

Teaching Additional System Functions/Features:

Some systems require additional training beyond just modeling (especially more sophisticated devices). Here are some things to think about:

  • Children may need to be shown where to find certain areas of their device, such as the keyboard, personal information, system settings, etc.
  • Teach children how to use the editing tools to correct their message, such as delete buttons and changing grammatical markers
  • Some systems may need options for “I don’t have a button for that” or “please add/fix something”.
  • You may need to do specific training or games to teach a child how to use adapted means of accessing their device (eye gaze, head switches, scanning, etc.)

How do we know if an AAC System is right for a child?  Do we measure his interest in it?  How resistant he is to using it?  How much his family likes it?  What about how good he is at using it? All of those things are great to know but they’re not what we need to be focusing on.

To know if an AAC system is right for this particular child, we want to focus on what it is doing for his communication skills.  If a child is great at using a particular device and loves playing with it but he doesn’t actually use it to improve his communication and language skills at all, then it’s still not a good fit.  

To write a goal for AAC use, think about what goal you would set for the child is he was using speech instead of the device/system. Write goals for what the child will communicate, not for specific AAC use.

Here are a few examples to get you started:

Good Goals:

  • Child will use single words to request foods during snack time, using spoken words, sign language, or an AAC device.
  • Child will answer “who” questions by indicating the correct person using spoken words, sign language, or an AAC device.
  • Child will create three-word utterances using an “I want…” carrier phrase through use of spoken words, sign language, or an AAC device.

Not-So-Good Goals:

  • Child will push buttons on his AAC device to request.
  • Child will use his AAC device during circle time.
  • Child will answer yes/no questions using his AAC device.
  • Child will find buttons on his AAC device when requested by the therapist.
  • Child will hand a picture to the therapist during PECS training.

Note that in all of my good goals, I talk about how the child will do a specific language skill and then I qualify that it can be done using spoken words or AAC.  That is key!  Our ultimate goal is for the child to speak so we don’t want him to be penalized if he ever does speak instead of using the AAC.  Also, you won’t know exactly which type of AAC he’ll take off with so you don’t want to peg him in to using a specific device when that might not be the one that works out (even if it’s the really expensive one his parents just bought him!).  

How to Make the Goals Measurable: 

Here are a few ways to measure AAC goals:

  • % of attempts: Track each time the child tries to accomplish a goal (like get something) and mark correct if the child uses language of some kind (ex: Child will use language to request during snack on 80% of attempts – Reaching, grabbing, crying, and grunting count as incorrect while using words, signs, or AAC count as correct)
  • # of times in ___ minutes: Track how many times the child accomplishes the goal during a certain number of minutes (ex: Child will use language to request during snack at least 5 times in 5 minutes – Only AAC or spoken words count as correct)

Collecting Data on the AAC System:

What you’ll want to do is pick one or two goals that you will use to evaluate the effectiveness of the AAC system.  Let’s say you use the snack time one above.  So before you even introduce the AAC, you go in and take some baseline data on how many times the child uses actual language (spoken words or sign language if he already knows some) to request during that snack time.  You’ll want to measure the baseline data for the goal in the exact same way that you’ll be doing it during the AAC trials, there just won’t be any AAC present.

Then, once you introduce the AAC system, you can track how many times language is used in the exact same way.  You’ll keep everything the same except for the use of the AAC system.  If the child improves his ability to meet that communication goal, then you have a fairly good idea that the AAC is helping and is a good fit.  If that’s the case, you should continue to integrate use of the AAC device into more of the child’s day by working on the functional communication described in the next step.

If the use of the AAC system does not seem to be helping the child improve on his communication goal, you may have a bad fit.  That doesn’t mean that the child isn’t ready for AAC at all.  It only means that the one specific type of AAC system didn’t work for that child.  Start over and choose a different system.  Do this same process all over again with the second system.  

Here are some additional resources to help you with choosing and evaluating an AAC device/system:

Where to Start with AAC

This hour-long webinar recording will give you information about how to get started with AAC.

Cheap, Easy-to Use AAC Devices


Ideally, the cost or the availability of an AAC system shouldn’t play into the decision for what is best for the child.  However, even the best AAC system is worthless if you can’t get your hands on it.  Here are a few low-cost AAC options to try if you’re looking for something that you can get your hands on now to try with a child: 

Types of AAC Cheat Sheet

This quick handout gives you an overview of the different types of AAC systems/devices you can use with a child.

Suggested Goals:

The purpose of using AAC with a child is to help that child communicate functionally in his/her environment.  The end goal should not be for the child to have mastered his/her device, but rather to be able to communicate with it.  Therefore, all of our suggested therapy goals are communication goals.  Here are some goals that may be helpful for children who are AAC users.  You can click on one of the goals below to learn more.  Or, scroll down to the therapy section for more in-depth resources and support for treating this condition.

Choose goals in this section that would be similar to communication goals that you would write for other children.  For example, you may write a goal for answering wh- questions (see the video below) or using words in response to greetings from peers.  The only difference will be that you will indicate in your goal that the child may use spoken speech or some form of AAC.  Always indicate that spoken speech is allowed in case the child spontaneously begins speaking.


As mentioned before, the purpose of using AAC with a child is to help him/her communicate, not to master the device.  For that reason, our therapy can focus on helping the child use his/her AAC system for early, functional communication or to expand his/her language use beyond basic skills.  Check out our resources below to help with these two areas:

Now it’s time for the child to begin using his/her AAC system for functional communication.  Some children will really take off with AAC use and will be jumping up to higher skills very quickly.  Others will think you’re crazy for putting this talking box in front of them and will have no interest in it whatsoever.  Be patient and just meet the child wherever he is.

At this stage of AAC use, you’ll start with the most highly-motivating communication tasks first.  Start with things that the child really wants.  You can use preferred sensory activities, toys, foods, etc.  You can also look at challenging behaviors as a clue for which words you should teach first.  A child who is constantly throwing fits to get out of expectations may be particularly interested in the “all done” button.

My favorite way to introduce these first words is using the core vocab approach.  This is the most like natural speech development.  In order to understand how this approach works and how you can use it in therapy and in the natural environment, check out this webinar recording here:

Once the child can communicate a variety of words for a variety of communicative functions, you’re ready to help the child use AAC to expand his language use.  You may find that at this point, some children start using spoken speech.  Often we find that AAC relieves the stress on their speech system because they know they have a backup system so speech actually becomes easier.  For other children, they may finally understand the power of communication and may start speaking on their own.  If that’s the case, then you don’t need to continue to push the AAC system.  You should still have it around as a backup for a while, but if the child is more interested in speech, then run with it!

For other children, AAC is a more long-term strategy for improving communication.  Some children may use it all of the time while others may use it during specific high-demand tasks where others have the most trouble understanding them (like in public when speaking with unfamiliar listeners).  I have had some clients in the past whose parents tell me that they don’t feel the need to use the AAC device at home because everyone in the family understands the child but it still remains very important for the child to use it at school where demands are higher.  And that’s ok!

At this phase of AAC use, we want to make sure that the child is continuing to build an grow his expressive language skills even if his speech mechanism hasn’t caught up to his language skills.  For example, we may have a child with apraxia who is able to speak 1-2 word phrases to get his basic wants and needs across, but he could still benefit from using an AAC device to practice forming full, grammatically-correct sentences.  This will make it so that once his speech mechanism does catch up, his language skills are already ready.

What to Work On:

At this point, you’ll want to focus your goal-writing efforts to what communication skills the child is lacking.  Try to forget that he’s an AAC user for a minute and think about what skills he does not have compared to a same-aged peer.  Don’t let yourself fall into the trap of saying “well he can’t work on that skill yet because he can’t talk”.  With a little creativity, we can work on all of the same skills with AAC that we work on with other children.

Some children may need to work on their syntactic development.  If the child is only using one button at a time to communicate, this is definitely a must.  Consider that child to be the same as a child at the 1-word level.  What types of goals would you write for a child like that?  

Other children may need to work on social skills.  How are other children that age communicating with peers?  Do they greet each other?  Tell each other jokes?  Find ways for the child to use AAC to engage in those types of interactions as well.

Still another child may need to work on answering questions.  How will he participate in classroom discussions if he doesn’t know how to answer basic wh- questions?  You can teach those using AAC as well!

Just as you did in the data tracking section, continue to write goals for the communication skills you want the child to master and make a note in the goal that responses with AAC are accepted as correct.  Again, the focus of the goal should be on the communication, not the use of the device or system.  Then, figure out what additional training or support the child will need to be able to perform that goal with his device.  It may require some programming on your part to get his system ready.  For example, you may have to program specific vocabulary in that matches the words he needs for classroom participation.  Or you may need to program in some jokes that he can tell with his friends.  Based on my own young children, I can tell you that if you have young male clients, you’ll want to make sure you include some potty humor.  He’ll be the most popular boy in class!  😉

The implementation of addressing these goals will look slightly different for each child, depending on his specific AAC system, so we won’t go into depth here about that.  But here are a few resources that will cover the basics of how you work on higher level language skills using AAC:

Webinars, Training Videos, and Other Resources:

How to Use the Core Word Approach to Using AAC – Webinar Recording

An hour-long webinar recording explaining how to use the Core Word approach.  This webinar was presented by Carrie Clark.

Implementation for the Core Vocabulary Approach – Webinar Recording

An hour-long webinar recording about implementing the Core Vocabulary approach with AAC users.  This webinar was presented by Lauren Laur.

Expanding Use of the Child’s AAC System

Once the child has learned how to communicate some basic wants and needs using his/her AAC system, it’s time to branch out and teach the child how to use it for other communication efforts.  This quick video will walk you through that process.

Teaching Wh- Questions to an AAC User

This video will walk you through how to work on wh- questions with a child who is using AAC.  Remember, the goals should be the communication skills but they can be modified to allow answers to be produced using AAC.

AAC Beyond Requesting – Webinar Recording

This webinar explores what to target in therapy for children who have mastered basic requests with their AAC device/system.  The webinar provides examples for how to provide therapy using the AAC device as well.


What do you do if these things don’t work the way they’re supposed to?  Well, nothing’s ever easy, is it?  Try these great troubleshooting tips that some of our other members have found helpful.  Click the problem to drop down the link to the solution.

I get this question a ton!!  Actually, this is a good thing!  Consider the child’s “playing” with the device to be like a baby babbling.  The first the that the baby who is learning to talk must do is try out all of the sounds and see what all his mouth can do.  It may just look like random play but he’s learning!  He’s discovering that every time he places his mouth in the same shape, it makes a sound.  And when he combines sounds a certain way, people respond differently!  For example, when he says “mama”, that one lady gets really excited!

Our children who are given a new AAC device must go through the same process!  They push buttons to discover what each button says.  And sometimes they need to push it over and over and over again to find out if it REALLY says that same thing each time.  And eventually in their play, we want them to discover that those words have meaning.  That comes from those around him.  If he pushes the “Mom” button, we would expect Mom to respond just as she would to a baby saying “mama” in her babble.  Mom should say “mom, that’s me!  I’m mom!”.  The more we respond to the buttons that the child is pushing, the more he’ll associate the actual meaning behind those words and they’ll become less of a thing to play with and more of a thing to use functionally.

So it’s important to let these children have uninterrupted time to “play” with their devices and find out what sounds and words they make.  But also, make sure the child is being exposed to a TON of great modeling from the adults on how he can use it functionally and provide him many opportunities to use it functionally as well.  Basically, just keep doing your therapy as per these instructions and allow time for play as well!

Other Modifications to Promote Functional Use: 

If you’re struggling with the child just “playing”/babbling during your therapy sessions, there are a few modifications you can make to encourage functional use in addition to giving them play time with it at other times.  You can also hide all of the buttons except for the one or two that you need for your particular therapy session.  And if you’re using a screen-based system, you can increase the “hold and release” time for the buttons so that the child has to hold the button down longer in order for it to activate and say something.  This will increase the amount of effort required and will reduce some of the quick pushing of random buttons as well.

Why yes, yes we do!  Here are a few boards that I made that will get you started with AAC.  These are great for initial trials because they will give you an idea of how the child is going to respond to AAC before you invest in a full-fledged system.

Our AAC Boards: 

There are a lot of ways that AAC devices and systems can be adapted to work with children with motor problems.  Check out these videos:

Some children may prefer a text-based approach to AAC.  Here’s an example:

AAC Options for a Child who Only Wants to Spell Things

In this case, I helped brainstorm ideas for a 7-year-old who was refusing to use his AAC system:

Encouraging an Unmotivated Child to Use AAC

Here are some ways you can use AAC to help alleviate some of those aggressive behaviors you may be seeing:

AAC for an Aggressive, Non-Verbal Child with Autism

Oh man have I been there!  Here are some ideas of how to help when the classroom teacher isn’t on-board with your amazing new AAC plan:

Introducing AAC to a Resistant Classroom

Sometimes you have that child who is so un-cooperative that you literally can’t get him to do anything.  Try this therapy idea!

Need to introduce a classroom to some sign language?  This is a great tool for educators to use to help their less verbal children.  Here’s my step-by-step process for this: 

Resources, Tools, and Training for Speech-Language Professionals

*** The SLP Solution is for informational and educational purposes only and does not provide medical or psychological advice.  We provide general resources but cannot tell you exactly what should be done for a specific client.  Every client is different and your clinical judgement should be used when making decisions about specific individuals.


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