AAC Information: An Overview
What Is AAC?
Augmentative and alternative communication (AAC) is any communication that is not speech.
AAC is a system of communication that can use multiple ways of communicating such as gestures, body language, sounds, alphabet boards, picture symbols, programmed messages or words on a communication device, and more.
AAC takes an approach of “total communication,” which includes multiple ways to communicate. This approach gives flexibility to the person communicating to use whatever method is most efficient in the moment.
For examples of tools and other links, see our Favorite AAC Resources page.
AAC Evaluations
Augmentative and alternative communication (AAC) evaluations are conducted by speech language pathologists (SLPs) who are trained in AAC. Often, an occupational therapist (OT) or physical therapist (PT) may assist in the evaluation if an individual experiences complex movement, positioning, vision, or other sensory challenges.
You can inquire about AAC services at:
- Hospitals or SLP clinics
- Local School Districts
- Vocational Rehabilitation
During an AAC evaluation, the therapist:
- Looks at all forms of current communication
- Starts with where the person is now and plans for the future
- Considers a variety of tools for social participation and language development
- Looks at physical interaction with communication tools
- Includes at all methods of communication, not just “high tech” devices
- Often takes many sessions and trials to determine the best fit for communication tools, especially for children
Anyone at any age can start using AAC. An AAC evaluation can benefit:
- A person of any age who is not able to fully express themselves with speech, gestures, and body language
- Infants and young children with significant physical disabilities who have difficulty with their speech muscles
- A person with developmental or acquired disorders
- Someone who temporarily experiences loss of speech
- A person who may need help to develop language skills and potentially develop speech
Access to AAC in the Portland-metro Area
Children
Many school districts have speech language pathologists (SLPs) who specialize in AAC or use regional services. Evaluations and device trials may result in a school district purchasing equipment or submitting a request through medical insurance.
There are also several SLPs specializing in AAC at local hospitals, clinics, or non-profit organizations. The list below was compiled to provide ideas, but may not be complete. We will attempt to keep it up-to-date:
Adults
There are several SLPs specializing in AAC who evaluate adults at local hospitals, clinics, or non-profit organizations. This list was compiled to provide ideas, but may not be complete. We will attempt to keep it up-to-date:
When an Occupational Therapist (OT) May Be Helpful
People with motor, sensory, or motor planning difficulties may benefit from an evaluation looking at visual and physical access to communication tools. A person may need alternative access or help with seating and positioning to use their AAC tools. Ask your SLP if occupational therapy would be helpful.
Examples include using head or eye movement for mousing on a screen and using switches to scan through items. Even if a person uses their finger on a screen, using a plastic key cover with holes—called a “keyguard”— can help improve accuracy.
Funding AAC Tools
There are three main ways to fund AAC Tools. The information shared here is specifically for funding sources in Oregon.
- Medical Insurance
- State and County Funds
- Charity Funds or Grants
Medical Insurance
Communication is medically necessary. Communication devices—called “speech generating devices” (SGDs)—are often fundable by insurance. This may includes Medicare, Medicaid, and private insurance. “Light-tech” AAC, such as a communication book or board, is not funded by insurance.
SGDs are categorized as durable medical equipment (DME). Typically, insurance will only replace equipment every five years. Therefore, careful consideration should be made before requesting communication devices. An SLP must complete a written evaluation for an SGD to be approved by medical insurance. All of the companies that sell fundable SGDs have funding departments to work directly with medical insurance.
Here are resources for SLPs who are new to writing an SGD evaluations:
- ASHA Information
- SGD Evaluation Templates—Library of templates to guide with writing process; page created by an SGD vendor
iPads
iPads for communication are covered by insurance when they are coded in a specific way, making them an SGD.
There are currently two vendors that sell iPads with the choice of any communication app, both funded by insurance. They are sold through:
Other tablets
All the other SGD companies sell a variety of tablet styles and sizes, including iPads and Windows-based tablets with their own communication software funded by medical insurance. They also have a variety of access methods for their devices.
An SLP can contact these companies to get demonstrations, trials, and loans while exploring which device is the best fit for someone. If you do not have an SLP, the companies have information on how to find one. They all have funding specialists that will work directly with medical insurance.
The following is a list of links to the most common SGD companies in the United States
State and County Funds
If the communication tools are not fundable by insurance or if they have been denied, there are options for funding through multiple state and county entities. In Oregon, these funds include:
- Medicaid waiver/K-plan
- School funds
- Telecommunication Devices Access Program (TDAP)
- Vocational Rehab (VR)
- Oregon Commission for the Blind (OCB)
If you have a developmental disability (DD) caseworker, school personnel, vocational rehabilitation (VR) counselor, or SLP, you should talk to them about options since there are many variables around communication equipment funding.
Charitable Funds or Grants
There are local and regional grants that may cover communication devices and tools that are not fundable, or if a fundable device is denied by insurance. For a list of some of these grants and for information on general AT funding, visit our AT Funding page.
Working Together for AAC Success
Finding and getting AAC tools is only the beginning of the AAC journey. Using AAC tools can take time to learn, especially if the tools are new to a person. The world has speech everywhere but not AAC!
A person learning AAC needs to see others use it in meaningful ways in natural contexts. The use of AAC by family, friends, caregivers, teachers, therapists, and other important people in a person’s life is called modeling.
Modeling is often where we start when introducing AAC. The goal is to make using AAC as easy as possible, so partner support can really help while learning. Also, it should be as fun, empowering, and socially engaging as possible. After all, don’t we all communicate best when we are happy and engaged?
Using AAC tools is demanding. You need to:
- Know what you want to say
- Know when you should say it
- Know where to find it in the AAC system
- Actually find it
- Backtrack if you made an error
- Physically activate what you wanted to say
With so much to keep track of, it can be hard to remember what you wanted to say in the first place. In addition, you have to hope that the conversation hasn’t shifted to something else while you were creating your message.
That is a lot to do! So, be patient and supportive while someone learns and uses AAC.