AAC (augmentative and alternative communication)

Augmentative and alternative communication (AAC) covers the ways people add to their speech or communicate without it. "Augmentative" means adding to speech, and "alternative" means in place of it. Unaided AAC uses only the body, such as gestures, signs and facial expressions. Aided AAC uses a tool. Low-tech tools include picture boards and communication books. High-tech tools include tablet apps and devices that turn words or pictures into speech.

A speech-language pathologist (SLP) assesses your child, suggests a system and teaches you both to use it. Many people use more than one method. AAC may help improve natural speech, and research reviews found it doesn't hold speech back, though the gains were modest.

Your child might point to pictures, sign, or tap words on a tablet app that speaks them aloud. One low-tech program, the Picture Exchange Communication System (PECS), is based on applied behavior analysis (ABA). It starts with your child handing over one picture to ask for something they want. Children younger than 3 can start using AAC. There's no test score or milestone they need to reach first. Your child's ABA team can help them use it in sessions, while the SLP leads the assessment.

• Working with the SLP: Ask your Board Certified Behavior Analyst (BCBA) how they'll work with your child's SLP on AAC.
• Using it in sessions: Ask how your child's AAC system will be part of therapy goals and daily routines.
• Paying for it: Ask your insurance whether it covers the tool your SLP recommends, since some AAC tools are covered and some aren't.