Augmentative Alternative Communication (AAC)
is an approach with various aspects but only one goal – offer people with complex communication needs the possibility
through channels that go alongside the oral one.
AAC has a great potential, but is still not widespread in our country.
Not being able to speak and practice the human-specific function of speech, that is the verbal language, does not mean being unable to communicate. The sign language used by deaf people is a clear example of it.
Augmentative Alternative Communication is an approach that aims to offer an alternative way to whom, besides being left out from the verbal communication due to congenital or acquired disorders, has also more or less severe cognitive deficits.
AAC refers to strategies, tools and techniques put in place in clinical and domestic settings to ensure communication to people who cannot communicate verbally.
AAC does not aim to substitute the verbal language: since it is augmentative, it involves a simultaneous presence of alternative tools and standard verbal oral language, that go along the symbol visually and orally through the help of the communication partner who reads out loud. Symbols become an alternative support that goes with the verbal oral input and, if possible, goes with and does not hinder the verbal output. Thus, Augmentative Alternative Communication does not block the possible emergence of the verbal language, but aims to reinforce it.
As already said, AAC is not only about communication tools. One of the best known AAC tools is the symbol writing system. The simple use of symbol writing and reading tools is still frequently mistaken for an actual Augmentative Communication intervention. However, the use of this strategy is effective only after having laid and fixed the foundation for an initial communicative competence that does not often spontaneously develop as a consequence of the linguistic and cognitive disorder.
In this light, AAC’s contribution is even bigger: his aim is not only to provide alternative communication tools, but to develop communication abilities, that are the desire of communication, an object to communicate, the possibility to communicate with capable and well-informed partners and the right tools to carry on the communication.
For this reason, the Augmentative Alternative Communication intervention does not require any prerequisite other than the possibility to create an occasion for a communication. The occasions are the basis on which it is possible to develop the different levels of communication, that concern not only the possibility to express a basic need, but also the more important possibility to express a choice or a preference, to give voice to one’s thoughts and to be able to interact on a socio-pragmatic level out of the context. In other words, the Augmentative Communication intervention makes it possible to self-determinate and act on the environment.
The possibility to express one’s thoughts or desires, even if to a limited extent, reduces the feeling of anguish and frustration linked to the impossibility of making oneself understood, proportionally reducing the feeling of strain of a person with complex communication needs and the occurrence of problem behaviors.
It is then necessary for the environment and the communication partners who go along the person with complex communication needs to be welcoming and well-informed, and to participate in the AAC. The first connoisseur and professional of the person with complex communication needs is undoubtedly the family. In a rehabilitation intervention it often assumes a role of passive spectator and rarely joins the activity of the professionals.
If the use of AAC is planned, the role of the family in the communication rehabilitation process must change radically, moving from a marginal to a central one, as described by Rosenbaum in his Family Centered Model (2004).
According to this model, the hierarchical relationship between professionals and family, to which we are accustomed, must leave room for an intense and mutual relationship, in which the specific tasks and skills of both family and professionals are necessary.
Furthermore, the participation and active use of Augmentative Communication must be unanimously and equally undertaken by both parts, in a real teamwork coordinated by clinicians and implemented by the networks that belong to the everyday life, as family and school. The AAC intervention cannot be limited to the few hours of weekly rehabilitation. In that case it would not be integrated communication, but just clinical rehabilitation. In the life of a person with complex communication needs, AAC must be present in the various fields of the everyday life.
That is why the role of the family is fundamental but still not enough. In order to be effective, AAC must be able to involve the surrounding environments, including less familiar ones, as school, recreational settings, up to public and social meeting places. Indeed, the AAC intervention has a high potential on a person only if the whole network works together and participates in this kind of communication.
It is thus advisable to develop more easy urban communication projects in Italy as is already the case in other countries, where shops, recreational places, hospitals and public and everyday life places in the city become accessible to all, through the organized presence of AAC strategies that translate the main information about a place and offer the basic tools to foster the autonomy of the person with complex communication needs in the interaction at that specific place.
This kind of inclusive settings are extremely useful also for foreigners who are learning a new language, or for people who cannot communicate in consequence of surgeries or accidents.
Furthermore, AAC has proved to be a useful and appreciated tool for all preschool children who take their first steps into the reading and independency world.
Augmentative Alternative Communication takes on a double (even triple) advantage and proves to be a powerful tool that creates bonds and inclusion within a society.
But as it was said earlier, in order to get the desired result this approach must be spread from the clinical setting to the social one, not only among those who need it to express their own basic needs, but also to inform the surrounding environment, so that over time and with training and awareness-raising initiatives it becomes an environment which is truly accessible for communication even for those who cannot speak.
Written by Maria Caterina Minardi, Fare Leggere Tutti Aps, October 2018