SLP - Augmentative & Alternative Communication (AAC)

Augmentative and Alternative Communication (AAC)

At the most basic level, AAC is anything that supports communication when traditional methods aren’t sufficient, (Cress, 2011). AAC can involve “unaided” personal tools such as signed language or facial expressions, or “aided” external tools like a speech-generating device. It includes a range of technologies, such as “low-tech” pictures and books, to “high-tech” apps and software. We often talk about AAC as the “formal” system a communicator learns, such as picture symbols. However, AAC can – and usually should- be “multimodal,” which takes advantage of a variety of tools that are available to the individual.

Because AAC users’ needs are typically complex, it’s natural to ask whether they can be appropriately served through telepractice. As always, SLPs must assess individual client needs. However, a growing body of evidence helps us consider the possibilities.

Fissel and colleagues modified emergent literacy assessment procedures to be administered through telepractice to an AAC user. Their results indicated that this type of evaluation was viable through telepractice. Allen and Shane compared the assessment of two AAC users, one onsite and one remote. The study demonstrated that individual needs must be considered for telepractice to be successful. However, it also suggested that useful assessment data can be collected effectively and efficiently through telepractice. Creating an inventory of a child’s communication behaviors is an effective assessment strategy. This may require special training of on-site partners and equipment to help the SLP observe subtle behaviors.


After creating an inventory of behaviors, SLPs can work with onsite partners to expand the child’s repertoire into more meaningful communication. Cynthia Cress shared a model for doing this:

  • Tempt: Adapt the environment or partners to elicit the child behaviors the child already has. This may involve some physical components, like presenting or holding back toys, motion, sounds, or activities. Telepractitioners should work with onsite partners to create give the child a reason to communicate.
  • Trigger: This is the child’s natural reaction to the “Tempt.” Telepractitioners and partners can help the child focus on the behavior they produced, (e.g., “I see you looking at the ball.”)
  • Transfer: The SLP and partner transfer the behavior to a more conventional form. They treat the more conventional or symbolic form as though it’s intentional and offer a natural outcome. Example: The child points to a desired toy. The remote SLP prompts the onsite partner to place a picture of the toy at the child’s fingertip. The partner gives the toy to the child.
  • Touch: A concrete form of feedback (often touch) is used to help the child realize which behavior got the response. The SLP provides auditory feedback (“You told me you wanted the truck”) while the onsite partner gives tactile feedback, (e.g., patting the finger that pointed to the picture).

AAC services require a lot of coordination, even onsite. However, there is evidence that even indirect, telepractice support can be effective, (as described by Cason and Cohn). Additionally, Hall (2013), showed us that “active consult” or telecoaching could be effective in guiding tele-AAC services.

There is still much we don’t know. However, there is promising potential for AAC-users to be appropriately served through telepractice!

  • Allen, A. A. & Shane, H. C. (2014). The Evaluation of Children with an Autism Spectrum Disorder: Adaptations to Accommodate a Telepractice Model of Clinical Care. Perspectives on Telepractice, 4(2), 42-51.
  • Cason, J. & Cohn, E. R. (2014). Telepractice: An Overview and Best Practices. Perspectives on Augment Alternative Communication, 23(1), 4-17.
  • Cress, C.J. (2011) Providing Culturally-Responsive Services to Individuals with Severe Disabilities. Presentation at the Bilingual Therapies Symposium, July 2011, San Juan, Puerto Rico.
  • Fissel, S. N., Mitchell, P. R., & Alvares, R. L. (2015). An Adapted Assessment Model for Emergent Literacy Conducted via Telepractice. Perspectives on Telepractice, 5(2), 48-56.
  • Hall, N. (2013). An Investigation of the Efficacy of Direct and Indirect AAC Service Provision via Telepractice (Doctoral Dissertation). Retrieved from:

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