Image of an AAC screen
Image of an AAC screen

“In this country we are justly proud of the freedom of speech, that we can say what we want. But I think there is an even more basic freedom than the freedom of speech and that is the freedom to speak.” Stephen Hawking

What is AAC ?
As a speech-language pathologist, I have had the pleasure of working with many children and adults whose developmental disorders or traumatic brain injuries have rendered them without a voice. As a result, many communicate with the support of Augmentative Alternative Communication (AAC) systems. AAC is a way to enhance and support communication in people whose existing speech is not functional. AAC can be:

•    High-Tech

  •     iPads;
  •     DynaVox;
  •     Tobii Eye Tracking; or

•    Low-Tech

  •     DynaWrite
  •     voice output; or

•     No-Tech

  •     picture books;
  •     alphabet system

Communication Partners
I worked with Jen*, a former patient of mine who used a communication book with words organized in numbered columns and rows. Jen was a fast user. I was a fast learner. I pointed to each column and row. She would raise her eyebrows to say yes or wiggle her lips to say no. We would eventually land on the target word (“Column 6, Row 2, Word: Hi”). Just as there are communication breakdowns in a speaking conversation, there are those in a conversation using AAC too. There were times when I moved through the columns or rows too quickly, and completely missed Jen’s signal. She would get frustrated. Or, maybe she was tired that day and her ambiguous raised eyebrows looked more like a muscle twitch. I would get frustrated. No matter how many breakdowns or how long it took, we had an endless amount of patience for one another. We were communication partners. We wanted to hear what the other had to say.
*Name has been changed

“And he’s Dopey…He never talks”
Too often I have opened a patient’s file and read ancient medical reports saying, “Patient was unable to respond to my testing questions…Patient is diagnosed with Mental Retardation”. Fortunately, we have come a long way from those archaic testing methods! We know that even though an individual cannot speak, it does not mean that s/he does not THINK (contrary to the classic fairy tale). Across my work, I have had the honor of meeting smart people, who just happen to also be AAC users. They have written books, presented at conferences and produced short films. AAC users have a lot to share with us as long as we are patient and willing to listen.

3 Helpful Tips When Communicating With an AAC User
1.    Remember to Pause. As I have discussed throughout this blog, patience is important, especially when communicating with AAC users. Be sure to provide enough pause time to allow the AAC user to respond to your question or comment.
2.    Face the Speaker. There is more to communication than speech alone. We communicate with our ENTIRE body, using facial cues, hand gestures and body movements. Make sure to face the AAC user while s/he is speaking so that you incorporate all those non-verbal cues and gain a better understanding of his/her message.
3.    Reduce the Use of Questions. There is a sense of pressure to be the one to ask the questions and maintain the conversation. However, questions tend to demand the AAC user to talk and can make the conversation one-sided. Instead, you can elicit a conversation by making comments.

Suggested Resources
•    I Raise My Eyes to Say Yes, by Ruth Sienkiewicz-Mercer and Steven B. Kaplan
•    The Diving Bell and the Butterfly, by Jean-Dominique Bauby (there is a movie too!)
•    Radiolab- Mr. Bliss:
•    Praactical AAC Blog:
•    Augmentative Communication Program at Boston Children’s Hospital Facebook Page:

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