JUN 15 2020

Tip of the Month - June 2020 - Supporting Adults who use AAC

What is a communication aid or AAC?

Some people use augmentative and alternative communication (AAC) aids. There are of a wide range AAC options available.

Some involve a touch screen tablet, computer or other high-tech system:

Some involve books of letters, words, pictures or photographs:

Some people use pen and paper or whiteboard and erasable marker. 

How to communicate with someone who uses AAC?
  • Firstly, make sure that the AAC system is within easy reach of the person who uses it! If it is kept in a cupboard or out of reach, the person may not be able to communicate with you at all.
  • Establish a way that they can indicate to you that they want their aid/want to say something, e.g. pointing at it with their hand or looking at it with their eyes, an agreed upon gesture which means ‘get my communication system’.
  • If it is an electronic device, make sure that it is switched on and plugged in or well charged.
  • Make sure you know how the person indicates ‘yes’ and ‘no’ – with or without the AAC system. If they can do this without the AAC system, it might be nodding/shaking their head, an agreed upon gesture (thumbs up/down), using their eyes to look at pieces of paper that says ‘yes’ or ‘no’, using their eyes to look up (or long blink) for ‘yes’ and looking to the side for ‘no’, vocalising ‘ya’ or ‘na, etc. 

If the person uses the AAC system to help them understand what you say (comprehension), then use the same system as you say each sentence:

  • Write key words on the piece of paper
  • Show the picture/image of what you’re talking about on the AAC device or communication book

  • Write or show the options to answer a question, e.g. if you asked ‘what would you like to drink, the options are tea, coffee, milo or water’ you can write the options as you say them on a piece of paper or whiteboard.                                                                                                                            

If the person uses the aid to help them to tell you something (expression):

  • Give them plenty of time to use the AAC system to show you their answer/type or write an answer.
  • Try not to anticipate what they are going to say or finish the sentence for them – be patient as you are not a mind reader and might get it wrong.
  • If you are in a situation where you need to predict the finish of a sentence, ask permission first, don’t assume that the person is comfortable with you predicting.
  • Be honest if you don’t understand what they are telling you and ask them if they could tell you in a different way.
  • If you are providing options for them to choose, include ‘something else’ as an option in case they think of something       that you haven’t thought of!
  • Only give options that are available – for example don’t offer coca cola to drink if you don’t have any. 
Supporting adults who use AAC

Communication difficulties happen for lots of different reasons. Someone may have had a communication difficulty for a long time, or it may be very new to them. Some communication difficulties affect the way people process their thoughts, find words and understand what is said to them e.g. as a result of a stroke (aphasia), traumatic brain injury, intellectual disability, dementia or delirium. Some communication difficulties mean that the person knows exactly what they want to say but the muscles for voice or speech don’t work effectively, e.g. as a result of cerebral palsy, motor neurone disease  or stroke (apraxia). Some communication difficulties can be a combination of both of these and can be exacerbated by hearing or vision changes. If the communication difficulty has been present for a long time, the person or their family/whānau may be able to show you the best way of communicating with them.

When you are interacting with someone with a communication difficulty, the most important question is:

How do they usually communicate?

  • Can they tell me what they need?
  • Do they need me to ask the right question?
  • Do they use pictures/writing/drawing to communicate?
  • Do they use a touch screen tablet, computer or other high tech AAC device to communicate?
  • Can they show me using facial expression or gesture?
  • Can I understand what they need by their behaviour?

Asking questions

  1. First, ask open questions e.g. ‘What would you like to drink?’
  2. If they find it difficult to answer, ask a closed question or give choices, e.g. ‘Would you like a hot drink or a cold drink?’ ‘Would you like tea or coffee?’
  3. If they find it difficult to answer from choices, ask questions that need a ‘yes’ or ‘no’ answer, e.g. ‘Would you like tea?’ ‘Would you like water?’
  4. You could also hold up the options e.g. holding up the box of tea bags and the jar of coffee so they can show you which one they want.
General tips 
  • Keep what you say straightforward. If you use long sentences/idioms/metaphors/sarcasm, be aware that not everyone will understand this.
  • Use common words and phrases – if you need to use a medical term, explain what it means.
  • Use a good speaking pace (slower, but not patronising).
  • Make sure the person can see your face – if possible, sit at eye-level and in front of them/on their good side if they have a visual impairment.
  • Have important conversations in a quiet place – reduce distractions such as people walking past, noise from a TV, etc.
  • Be patient! Give people lots of time to process the question and think of their answer.
  • Be honest if you don’t understand.
  • Check that they have understood what you have said.
  • Repeat and/or rephrase what you have said if they haven’t understood.

It is important to include people with communication difficulties in conversations and decisions, even if this is difficult for them. It allows them to have control and choices in their lives and is a right under the Article 12 of the UN Convention of Rights of Persons with Disabilities. If you would like more information about supported decision making go to:

References: resource originally created by Robyn Gibson in 2013 and adapted by TalkLink in 2014

Updated by Jessamy Bell (Speech Language Therapist) April 2020

To download this Tip of the Month as a PDF, please click here

What is a communication aid or AAC?

Some people use augmentative and alternative communication (AAC) aids. There are of a wide range AAC options available.

Some involve a touch screen tablet, computer or other high-tech system: