The Complete Guide to Augmentative and Alternative Communication (AAC): Empowering Communication for All

Augmentative and Alternative Communication (AAC) gives people of all ages the tools and strategies they need to communicate when speech is limited, developing, or not available. From simple picture boards to powerful speech-generating apps, AAC can open doors to learning, social connection, independence, and dignity. This guide explains what AAC is, who can benefit, what the evidence says, and how Canadian families, educators, and caregivers can get started—practically and confidently.

What is AAC?

AAC stands for Augmentative and Alternative Communication. “Augmentative” means supporting existing speech; “alternative” means replacing speech when it’s not reliable. AAC includes a wide range of tools, from gestures and signs to paper-based boards and high-tech devices that speak aloud.

Unaided vs. aided communication

• Unaided AAC: Uses the body only—facial expressions, eye gaze, pointing, gestures, and sign language.
• Aided AAC: Uses external tools—picture boards, communication books, single-message buttons, tablets with communication apps, or dedicated speech-generating devices (SGDs).

From low-tech to high-tech

• Low-tech: Paper core boards, topic boards, alphabet boards.
• Mid-tech: Devices with recorded messages (e.g., one or multiple buttons).
• High-tech: Dynamic display devices or apps that generate speech, with features like word prediction, symbol sets, and language systems.

Who benefits from AAC?

AAC is not just for one diagnosis or age group. It supports children, youth, adults, and older adults whose speech is hard to understand, limited, or fluctuates.

Common scenarios

• Developmental: Autism, Down syndrome, developmental language disorder, childhood apraxia of speech.
• Neurological: Cerebral palsy, stroke (aphasia), traumatic brain injury, ALS, Parkinson’s disease, multiple sclerosis.
• Temporary or fluctuating needs: Post-surgical recovery, intubation, fatigue, selective mutism, or functional voice loss.
• Multilingual contexts: AAC can support communication across languages by mapping to symbols and multiple voice options.

Disability and communication differences are common in Canada. As noted by Statistics Canada, many Canadians live with disabilities that may affect communication and participation. AAC is one way to reduce barriers and improve inclusion.

Myths and misconceptions

• Myth: “AAC will stop someone from talking.” Fact: Research consistently shows AAC does not hinder speech; for many, it supports language development and can increase verbal attempts.
• Myth: “AAC is a last resort.” Fact: Early AAC helps build communication while speech develops and can prevent frustration and challenging behaviours.
• Myth: “AAC is only for people who can’t learn to read.” Fact: AAC and literacy reinforce each other; AAC users can and do learn to read and write.

Types of AAC systems

Choosing AAC is not about one device or one app. It’s about matching tools and strategies to a person’s strengths, goals, and contexts.

Unaided strategies

• Consistent gestures (e.g., thumbs up/down, pointing, nodding or shaking head).
• Natural sign language or key word signing.
• Eye gaze to choose between options (e.g., look left for “yes,” right for “no”).

Low- and mid-tech tools

• Core word boards: A small set of high-frequency words (e.g., “go,” “stop,” “more,” “help,” “like”) arranged for quick access.
• Topic boards: Words and phrases for specific contexts (e.g., cafeteria, medical appointments, work tasks).
• Alphabet boards: For spelling names or novel words; useful for literate users or emerging spellers.
• Single/multi-message devices: Recordable buttons for greetings, requests, or routines.

High-tech speech-generating devices

Tablets with communication apps or dedicated SGDs offer synthesized or recorded speech, robust vocabulary systems, and access features (e.g., switch scanning, eye gaze). They can be personalized with voices, languages, and symbol sets.

Access methods (overview)

• Direct touch: Tap or press buttons directly, sometimes with a keyguard.
• Switch scanning: One or more switches cycle through options; user selects when the target is highlighted.
• Eye gaze or head tracking: Cameras track eye or head movement to select items.

What the evidence says

Global and national health bodies emphasize assistive technology’s role in communication, education, and participation. The World Health Organization highlights assistive technology as essential to health, well-being, and inclusion. In Canada, disability inclusion and accessibility are national priorities, as reflected by the Government of Canada and related policies and programs.

What research shows

• AAC supports language development, social interaction, and participation across ages.
• Introducing AAC early can reduce frustration and challenging behaviours by giving people a reliable way to communicate needs, choices, and ideas.
• Communication partner training (family, educators, staff) is a strong predictor of success—AAC works best when everyone knows how to support it.

Literacy and language growth

Robust AAC systems include core words, grammar supports, and spelling tools. Access to literacy activities (shared reading, letter-sound play, writing with keyboards or letter boards) helps AAC users develop language and literacy together. Progress is often gradual and steady; consistent access and modelling matter more than perfect device setup on day one.

Getting started in Canada: assessment and supports

A good AAC plan begins with a comprehensive assessment led by a speech-language pathologist (SLP), often with occupational therapy and physical therapy input. If you’re looking for a broader overview of services, see our guide to practical, evidence-based speech therapy at any age.

Assessment steps

1. Gather information: Communication history, current abilities, preferences, motor/vision/hearing considerations, and daily environments.
2. Trial tools: Try different boards, apps, and access methods. Start with functional goals (e.g., making choices, greeting peers, telling jokes).
3. Co-create goals: Prioritize participation: asking for help, joining play, contributing at work or school, managing health needs.
4. Develop a plan: Select equipment, vocabulary, access method, and training for family and staff.

Choosing a clinician who understands AAC is key. For practical tips, see how to choose a speech-language pathologist in Canada.

Funding and supports

Funding for AAC varies by province/territory and by device type. Some people access support through provincial programs, insurance, charities, or workplace/school-based services. The Government of Canada provides information on disability-related programs and benefits; provincial/territorial ministries provide additional details. Your SLP can help document needs for funding applications and recommend appropriate suppliers.

Building communication with AAC

Successful AAC use is not just about the device; it’s about creating rich opportunities to communicate. Focus on real-life messages, not just labelling pictures.

Core and fringe vocabulary

• Core words: Small set of versatile, high-frequency words (e.g., “go,” “stop,” “want,” “more,” “that,” “help”). These power many messages across contexts.
• Fringe words: Personal nouns and topics (names, favourite foods, sports teams, classroom terms).

Use both. For example, “I want more” (core) + “pretzels” (fringe), or “Go” + “outside.”

Aided language input (modelling)

Partners model on the AAC system while they speak—like pointing to “go” and saying, “Let’s go!” Aim to model one or two words above the AAC user’s current level. Modelling shows where words live and that the system is a valid way to communicate.

Prompting that respects autonomy

• Use least-to-most support: wait, model, then cue if needed.
• Avoid hand-over-hand unless the person consents and benefits; try hand-under-hand or visual prompts instead.
• Celebrate all attempts—gestures, partial selections, or approximations—and expand naturally.

Integrating AAC at home, school, and in the community

Communication grows fastest when AAC is available all day, across settings.

At home

• Keep the device or board within reach at meals, playtime, and routines.
• Model during fun, motivating activities: cooking (“mix,” “taste”), games (“your turn,” “again”), and screen time (“like it,” “change”).
• Use quick phrases for daily needs: “help,” “stop,” “bathroom,” “finished.”

At school

• Include AAC in IEPs or learning plans with specific goals (e.g., initiate 3 peer interactions per recess).
• Ensure the system has vocabulary for classroom tasks and social talk (not just requests).
• Train staff on modelling, access settings, and troubleshooting.

In the community and online

• Mount or carry AAC for outings—grocery lists, ordering at a café, bus travel.
• Use phones or tablets to message, email, or join virtual groups with AAC.
• For remote support, learn what works via telepractice. See our evidence-based overview of virtual speech therapy and its benefits.

Training communication partners and overcoming barriers

People use AAC best when those around them are confident and consistent.

Partner skills that make the biggest difference

• Always have AAC available and charged; back up vocabulary.
• Model regularly in meaningful activities; don’t wait for perfect grammar.
• Provide wait time; avoid interrupting or over-prompting.
• Respond to all communication attempts (gesture, look, partial selection) as meaningful.

Behaviour and AAC

AAC reduces frustration by giving clear ways to request, refuse, and negotiate. Track which messages help most (e.g., “break,” “help,” “finished,” “not that”). Build these into routines before challenges occur.

Executive skills and AAC

Planning, attention, and flexibility affect AAC use. Some learners benefit from simpler layouts, consistent motor patterns, visual schedules, and predictable routines. For a deeper dive into how executive function shapes communication and what helps, see our guide on executive dysfunction and practical supports.

Access methods and physical considerations

Access is how someone selects messages. The right access method can transform usability.

Direct touch

• Best when finger isolation or stylus use is possible.
• Use larger targets, reduced page sets, keyguards, or dwell settings if targeting is difficult.

Switch scanning

• Works with limited movement—one or two switches can navigate choices.
• Adjust scan speed, auditory cues, and row/column patterns; start with small sets and build.

Eye gaze and head tracking

• Useful for those with minimal limb movement; requires calibration and stable positioning.
• Consider fatigue, lighting, and seating; collaborate with OT/PT for mounting and posture.

Vision and hearing considerations

• Use high-contrast symbols, larger fonts, or auditory scanning if vision is reduced.
• Include visual alerts or amplified audio for hearing differences.

Maintenance and monitoring progress

Plan for growth. AAC systems should evolve as communication expands.

Customization and maintenance

• Personalize vocabulary with names, places, interests, and routines.
• Organize buttons consistently so motor plans become automatic.
• Back up vocabulary files; keep chargers, spare batteries, and a low-tech backup board.

Lightweight data collection

• Track a few indicators weekly: number of initiations, new words used, situations where AAC was available, and successful interactions.
• Note what helped (modelling, wait time, favourite activities) and what barriers appeared (noise, fatigue, device out of reach).

Signs AAC is working

• More participation: joining conversations, games, or group tasks.
• More autonomy: expressing preferences, refusals, and opinions.
• Language growth: combining words, using new vocabulary, experimenting with grammar and spelling.
• Reduced frustration and clearer repair strategies (e.g., repeating, pointing, spelling when misunderstood).

Ethical and cultural considerations

AAC is about communication rights. People have the right to communicate in ways that are effective and personally meaningful.

Consent and autonomy

• Prioritize the person’s preferences—message content, device form factor, privacy (e.g., use of headphones or low volume in public).
• Support access to private communication (texting, typing) when appropriate.
• Document consent and respect boundaries around saved messages and shared data.

Culture, language, and voice

• Offer vocabulary and voices that reflect the user’s age, identity, culture, and languages.
• Include words for cultural practices, foods, and community events.
• Balance English and home languages where relevant; many systems support multiple language profiles.

Health agencies underscore the importance of accessible, person-centred care. See Health Canada for information about health and accessibility in Canada.

Conclusion

AAC is not a single tool but a practical, evidence-informed approach to supporting communication for people of all ages. With the right assessment, access method, vocabulary, and partner training, AAC can unlock participation at home, at school, at work, and in the community. Consistent modelling, respect for autonomy, and thoughtful customization are the keys to long-term success. As Canadian supports evolve, staying informed and collaborative helps ensure everyone has a voice—spoken, signed, typed, or selected.