Starting out with alternatives to speech


An introduction to the world of communication aids

Hundreds of school aged pupils are not able to solely rely on their speech to communicate. Many different systems have grown up to address this issue and are currently in use the UK. This article is aimed at those supporting children who may need to supplement their speech and are interested in the alternatives. The systems discussed here are often referred to as alternative and augmentative communication (AAC). This term spans a very wide range of systems from the very simple to the dynamic and complex. We will concern ourselves here with the more simple systems that are used when a pupil is starting to use AAC.

So who needs to use AAC? Some children have difficulties with the production of speech due to a physical disability or motor problems. There may also be a learning difficulty in some cases. AAC is used to supplement communication and give these children the power to talk. The ability to communicate underpins all cognitive and social development, a view promoted by the latest government initiative Every Child a Talker. It is essential that communication is two-way, and that the child has fun with their “communication partner”. It is also important that the child works with somebody who understands their difficulty and the system they are using, and who can help to make every exchange meaningful.

There are many disabilities that can affect speech. Pupils who may need AAC intervention include those with ataxia, learning difficulties, difficulties with initiation, an autistic spectrum disorder (ASD) and those with no speech. A wide range of AAC paraphernalia and no-tech resources is available to address this spectrum of need. To follow are two examples of pupils starting out with AAC:

Tom has autism and is included in mainstream primary. He uses a device that offers twenty messages on a fixed overlay, with levels to support activities throughout the day, and coloured literacy symbols. He uses these in class to initiate conversations, join in with storytelling and to demonstrate understanding. New pages are added to his communication book to support his language development and for targeted activities during the day.  A single message device is used to ask an instant question. Tom successfully uses his no-tech aid (communication book) by pointing, to supplement his other ways of conversing.

The approach of teaching core language with supplementary language enables the pupil to build up familiarity with vocabulary finding on their device. A core vocabulary set is generally small, based on typical linguistic development. It is used throughout the day across many situations. Supplementary vocabulary is specific to a pupil, lesson or activity, for example, new topic words or friends and places. The National Curriculum is supported by symbols, and many resources for differentiated teaching are available online. Symbol-supported resources are an excellent way to scaffold the pupil’s learning in all areas, and appropriate symbols can be included in a communication book to be revisited.

Lan Anh has cerebral palsy (CP) and attends a special school. She has learning difficulties and uses two single message devices with photographs to help with memory and selection. Lan Anh uses these for greetings, home/school messages and repeating lines of text in story books. When using two photographs, Lan Anh uses eye gaze to confirm her choice. At home Lan Anh has recently started to talk to relatives by pressing her single message device to relay a message over the phone and via Skype.

With more pupils with complex needs increasingly included in mainstream schools, there is a greater need for ongoing support in the classroom. However, depending on the level of support and the pupil’s ability, advancement with AAC can be rapid. For all pupils using AAC there needs to be intervention from a speech and language therapist (SLT) from the outset. This ensures consistency and the right balance of core language and new materials that challenge.

There is currently a call for a planned progression towards more sophisticated devices that will support greater complexity in speech. With so many approaches and equipment options available,  from no-tech to high-tech, it is important to seek advice and support when starting out.

No-tech may include the use of photographs, symbols, objects of reference or anything else that is engaging and meaningful to the pupil. The most popular forms of no-tech aids include communication books, eye pointing systems, choice boards, time-tables and wrist bands with visual support to help make choices.

Low-tech equipment refers to an assortment of simple devices containing between one and 30+ recorded messages. Anything can be recorded that is motivating such as song clips, silly noises and spoken messages in a voice chosen by the pupil. Symbols and photos of real objects are used on these devices to help with memory and choice. Pupils can then progress to sequencing devices where each press reveals successive communications. This opens up more communicative possibilities, including retelling events, following instructions, telling jokes and singing songs.

Once single message exchanges are mastered, the learner has a wide range of multi message devices available to them. This extends vocabulary in small steps suited to the developmental stage of the pupil, the situation in which they will use it and exactly what they want to say (for example, make a request or answer a question). The overlays used in these devices can be stored in the communication books and reused.

Some children may also have difficulty pointing to or indicating what they want, so they will use various access methods including eye pointing, switch pressing, auto scanning, auditory prompts or partner assisted scanning.  This will need input from an Occupational Therapist (OT) with a sound knowledge of alternative forms of access.

There is no instant fix. The pupil will require planned access to their device in meaningful situations with regular opportunities to talk and participate. There are many current government initiatives to help newcomers to this field. If you want advice or further information, begin by contacting your local OT and SLT teams, your school or outreach centre, or have a look at the websites listed below.

Further information
For further information about Every Child a Talker:

For guidance on how to create effective communication books:

Trish Davidson and Imogen Howarth are from CENMAC, a support service in central London offering assessment, loan of appropriate assistive technology and ongoing support to pupils with a disability who need help accessing the curriculum. CENMAC’s website includes links to information, help, training and other resources and organisations relevant to this article:

Trish Davidson
Author: Trish Davidson

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