AAC: A parent’s guide to using high tech to help non-verbal children
A speech therapist who specializes in using high tech to help kids talk explains how augmented and alternative communication can help non-verbal children communicate.
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Jay, as he’ll be referred to here, and his family never thought a tablet could change their lives. Jay was born without a corpus callosum, a broad band of nerves that connect the left and right hemispheres of the brain. Even before Jay was born, his parents knew their son could have difficulty with a range of abilities, from walking to talking.
Today, at age 4, Jay is developing typically in many ways. But when I started working with Jay as a speech therapist who specializes in using augmentative and alternative communication (AAC) to help kids communicate, he was non-speaking. Now, Jay is interacting with his siblings, his peers and his parents using a tablet and a specialized communication app that’s helping him express his every thought.
Jay is one among over 2 million Americans who use AAC to communicate, according to the American Speech Language and Hearing Association (ASHA). For parents and kids like Jay, AAC technology can be as accessible as downloading an app. But ease of use and access isn’t all that’s important. While AAC devices are more effective, three out of five AAC apps and devices can be abandoned or forgotten after a year because caregivers struggle to make them work. So, when it comes to helping kids in need use tools to express themselves, a little understanding about this technology can go a long way.
This parent’s guide is ideal for those who are just learning what AAC technologies are and how they can help children better express themselves.
What is AAC?
AAC is any means of communication other than spoken words. It could be a gesture, such as a thumbs up from across the room, or a wave hello. No-tech and low-tech AAC includes written words, sign language and even drawings. High-tech AAC—which we’ll focus on for this article—includes anything that is technology based, such as a computer or tablet with an app that can provide a speech output.
These devices are also known as speech generating devices, or SGD. That’s just a fancy way of saying “it talks for you.” For example, Elizabeth Bonkers, a non-verbal college graduate, recently gave a commencement speech using such a device. You can watch her speech here.
AAC can be used by a variety of kids with a range of abilities. With the advent of AAC applications for smartphones and tablets, they’re more widely available than ever. Most of these new apps are highly customizable so that each child’s needs are met on an individualized basis.
How high-tech AAC helps kids communicate
Long before tablets and apps, AAC devices were paper pages bound in three-ring binders, or they were the size of small computers. Usability was limited to pointing to images or pushing buttons with images, and if there was a voice output, it was mechanical and robotic sounding by modern standards.
Today the technology has gone high-tech. There are AAC apps for tablets and smartphones, and there are standalone devices designed specifically for AAC and preloaded with communication software.
Speech output voices are natural and personalized, and these devices can be accessed with direct touch, eye gaze, keyboards and even electromyography-based controls, which means the device can be accessed by the measurement of electrical activity associated with the activation of a muscle group using a small, wearable piece of tech that interfaces with the device.
With these high-tech changes, AAC is now accessible to people in ways that it wasn’t 20 years ago. And the cost is often partially covered by insurance, but it depends on the policy.
Benefits of high-tech AAC technology for kids
Here are six benefits of going high tech.
Robust vocabulary: High-tech AAC options give children faster access to more vocabulary words. Low-tech options are limited to what can be printed out on a page. For example, if you go out to a restaurant, you’re limited to ordering what you see printed on the menu versus asking for what you really want. Which could be limiting in a situation where communication needs to be more spontaneous, or improvisational.
Adapts with a child’s developmental progress: Apps such as Proloquo2go, a communication tool for iOS devices, are designed to adapt as your child advances. For example, you might start with 15 to 20 vocabulary words per screen on the tablet or device, and as the child grows, you can easily add more words.
Better auditory feedback: Some children have difficulty decoding various parts of verbal communication. For example, one speaker may hear and understand the phrase, “I want the ball.” For those high on the autism spectrum, for example, tiny changes or fluctuations in the speaker’s tone or facial expression could make the phrase mean something different. The consistent message output from a high-tech app or device means the user can experience the message the same way each time it’s produced, making it easier to decode, and then easier to repeat. Research also shows that some children are eventually able to verbally repeat phrases from these devices.
Multiple language options: Many apps and devices offer multiple languages. This is ideal for children who live in bilingual homes. High-tech AAC options make it easy to toggle back and forth between different languages with relative ease.
Communicating with larger groups: With low-tech options, children are often only able to communicate with people who can see their AAC board or display. If the child is communicating, but no one sees them doing so, the message could go unrecognized. The voice output from high-tech apps and devices lets anyone nearby hear the user.
Internet access: Many apps and devices offer options to turn messages into social media posts, emails and more. This is an essential part of being an adolescent in today’s world, and not available when using low tech.
Things to know when choosing high-tech AAC apps and devices
Before choosing an AAC app or device, whether high or low tech, make sure to talk to a speech language pathologist. Making the decision is a long, complicated process that should be completed with a speech language pathologist and an augmentative communication team. This short list can help you get started in your search.
Not every app or device is the same. Some tablets may have limited access to features such as social media or email. Some have monthly subscriptions. Some may not be covered by insurance, so it’s important to work with your insurance company and speech pathologist.
Not all AAC apps and devices are created equal. Some use different symbols than others. Some are very complicated to program. Also in my experience, the less expensive apps don’t work as well. They may be glitchy, or have a lot of pop-up ads. Seek the opinion of a speech language pathologist, and remember, the people who try to sell these devices are trying to sell them. I’ve had experiences where families have talked with a salesperson before a speech therapist. It’s important to ensure that your therapist’s recommendation comes first.
Not every app is available on every tablet. Some apps are only available on iOS devices, and others are available on multiple platforms. This is essential information if you have multiple products you plan to use at your house. For example, you might purchase an app on your phone, only to realize later it can’t be used on your tablet.
How to choose the right AAC app or device for your child
It’s important to note that not all speech therapists have experience with high-tech AAC technology. Ask if they do use them and how long they have worked with kids who use AAC.
Here are some tips for choosing the right AAC technology for your child:
Define your child’s communication needs. What are their communication goals? What do they want to be able to communicate? Who do they talk to? Where will they need to have access to their app or device?
Consider your child’s physical abilities. While there are no prerequisites to using AAC, there are some medical conditions, such as cerebral palsy, that will need a team approach. There are AAC apps and devices designed for different age groups and abilities and your speech pathologist will know what’s best for your family.
Try different devices and apps. Many companies offer free trial periods for their device, and many speech language therapists have access to these apps and devices as well. Obtaining a device can feel like an urgent matter, but picking the wrong device can lead to device abandonment.
Check parental lock options on the tablet. Not all tablets have this feature. Parental locks are essential, especially for devices that are used by younger children. For example, if your non-verbal child is already using a tablet to watch videos or play games, he or she may be more inclined to keep using it for entertainment, not therapy. So, you want to lock down anything on that device that could distract them from using it as a therapy tool.
Check screen light options. Some iOS devices allow you to turn off the blue light from screens, which studies are showing could have a negative neurological impact.
Get a protective case and buy a protection plan if you can. Devices will get dropped, spilled on and more. Be prepared.
If the AAC team can find the right app or device for your child, it’s possible to unlock their world in ways you can’t imagine. Like Jay, your child may grow more confident and engaged with their world. Not only is Jay expressing his wants and desires, but he’s using his device to learn new concepts and interact in social situations.
Recently, using his device, Jay was able to tell his parents, “I love you,” a powerful phrase that’s been in him for some time, and just needed a little high-tech help to express.
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