What Is AAC?
The Basics of Augmentative and Alternative Communication, and Using It in the Classroom

“No voice” does not mean “cannot communicate.” AAC is the idea of consciously using and widening the many ways we already communicate beyond speech.

Drawing on what I’ve seen working at a school for children with disabilities, here I lay out what AAC is, how it is classified, and how you can start — small — in the classroom.

What AAC is

AAC (Augmentative and Alternative Communication) is an umbrella term for ways of communicating that use means other than the voice — for people who find speaking difficult, or who cannot fully get their meaning across through speech alone.

“No voice” does not equal “cannot communicate.” Every day, all of us already use means beyond the voice: nodding, shaking the head, pointing, facial expression, gesture. All of these are part of AAC too. AAC is not “a special tool for special people.” It is the idea of consciously using and widening the natural means of communication that everyone already uses.

The people who need AAC are diverse. Someone whose speech is difficult because of cerebral palsy or ALS (amyotrophic lateral sclerosis); someone whose spoken-language development faces challenges because of intellectual disability or autism spectrum disorder; someone for whom exchanges by voice are hard because of hearing loss — the causes and the ages vary widely. What they share is the situation of “it’s hard to convey this by voice alone,” and AAC is the set of means that fills that gap.

As a framework for classifying AAC, the scheme of ASHA (the American Speech-Language-Hearing Association) is widely referenced in Japan as well. In the next section, let’s look at the whole picture of AAC through that lens.

The four categories of AAC

AAC can be divided broadly into four categories, according to whether a tool is used and how much technology is involved.

Unaided AAC

Ways of conveying meaning using nothing but your own body — no tools at all. This includes gesture, sign language, facial expression, pointing, nodding and head-shaking, eye gaze, and vocalizations (meaningful sounds). Its greatest strength is that it can be used anytime, anywhere.

Low-tech AAC

Ways that use simple tools requiring no power source. Typical examples are picture cards, communication boards, PECS (the Picture Exchange Communication System), letter boards, and photo cards. They are inexpensive, hard to break, and quick to prepare.

Mid-tech AAC

Ways that use simple electronic devices. Record-and-play buttons such as a VOCA (Voice Output Communication Aid) or a BIGmack fall here. Press a button and it plays a pre-recorded message — the operation is intuitive.

High-tech AAC

High-function systems built on tablets or computers. This includes AAC apps (such as Koe Palette), eye-gaze input devices, and dynamic symbol displays. They hold a rich vocabulary of symbols, are highly customizable, and can even produce a “voice” through speech synthesis.

The important thing is that this is not a case of “high-tech is superior and low-tech is inferior.” Realistic AAC means choosing what fits the person’s motor skills, cognitive skills, and everyday situations — and combining several means together.

Low-tech AAC — means you can start today

The flagships of low-tech AAC are the picture card and the communication board. You convey meaning by pointing to, or handing over, cards printed with symbols (pictographs), photos, or illustrations.

PECS (Picture Exchange Communication System) is a system in which communication is completed by handing a picture card to the other person. The act of handing something over makes the “intention to communicate” explicit, and the method is designed to encourage spontaneous, self-initiated communication. It comes with a structured, staged teaching sequence that gradually increases the number of cards and the complexity of sentences, and it is used in education and therapy settings around the world.

There are plenty of ways to use this in the classroom: a schedule board that lays out the morning’s flow in pictures; basic request cards for “toilet,” “water,” “break,” “help me”; YES/NO cards for answering questions; menu-choice cards at lunch.

The cost runs from almost nothing to a few hundred yen (a couple of US dollars). Download free symbol materials online, print them, protect them with a laminating film, and they’re ready to use. Being able to start today, with no special knowledge or qualification, is low-tech AAC’s greatest strength.

High-tech AAC — support that uses technology

In recent years, the combination of a tablet and an AAC app has spread. Behind this are the falling prices of iPads and Android tablets and the rising quality of AAC apps. You no longer need to buy a dedicated device: just install an app on an everyday tablet and you can begin with high-tech AAC.

High-tech AAC has many advantages: because it can output a “voice” through a speech-synthesis engine, the people around receive the message naturally; it can hold hundreds to thousands of symbols, so there is little limit on vocabulary; and it is easy to customize to the user (button size, color scheme, layout).

It also has its challenges: the cost of buying the device, the learning cost of mastering the app, the risk of a flat battery or a breakdown, and outdoor conditions where the screen is hard to see. Rather than relying on high-tech alone, it’s practical to keep low-tech means as a “backup.” For example, always carrying paper picture cards that still work when the tablet runs out of charge brings peace of mind.

In support for people with severe physical disabilities, the evolution of eye-gaze input devices is drawing attention. You can select a symbol on the screen just by looking at it, so AAC is becoming usable even for people for whom operating with the fingers is difficult.

Three steps to bring AAC into the classroom

“I’d like to try AAC, but I don’t know where to begin” — I hear that a lot. You don’t have to be a specialist. You can start small with the three steps below.

1. Observe
   First, observe and record “how is this child communicating right now?” Are they conveying things by pointing? Directing their gaze? Making sounds? Showing a request through a particular behavior (crying, pulling your hand)? Finding the ways of “telling” that already exist is the starting point.
2. Choose a means
   Choose an AAC means that fits the person’s motor skills (can they use their hands? can they point?) and cognitive skills (are photos or illustrations easier to understand? can they grasp what a symbol means?). At first, starting with low-tech and just two or three choices is a good idea. A simple setup — choosing between two picture cards, “water” and “snack” — is plenty.
3. Build the environment
   Deliberately create situations where AAC can be used. Set up choice moments as part of daily life by asking “which one would you like?”; share how to use the AAC with the adults and children around; and make sure the person can build up the success experience of “I got it across!” It’s also important to keep the AAC means within the person’s reach at all times.

Ideally, you would work with a specialist such as an ST (speech-language-hearing therapist) to run an assessment and select the best AAC means. But in reality it can take time to connect with a specialist. A teacher who “just tries it first” is taking the first step toward widening a child’s opportunities to communicate. Begin with the mindset that if it doesn’t work, you can simply change the means.

Koe Palette — a free AAC app

Koe Palette is an AAC support app for iOS and Android. All of its core features are free to use.

What sets it apart is that 400 default buttons come ready-made. They are organized by category — “greetings,” “feelings,” “food,” “school” — so you can start using it the moment you install it. It supports five color-vision modes (typical color vision, protanopia, deuteranopia, tritanopia, and grayscale), a design that respects the diversity of color vision.

The board (the button-layout screen) can be chosen from three size templates. “Just a few” uses large buttons with the choices narrowed down; “Standard” places everyday vocabulary in a balanced way; “Lots” lays out a rich vocabulary at a glance. You can pick the size to match the user’s cognitive skills and ease of operation.

It also supports MIDI input, so you can connect an external switch to operate the buttons. Even someone for whom finger operation is difficult can use an easy-to-press switch to run the app. Audio can be recorded to create custom buttons freely — you can make “buttons that are truly your own” in the voice of the user or their family.

Koe Palette grew out of practice at a school for deaf and hard-of-hearing children. It was developed from the voices on the ground — “this is the kind of feature we want.”

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Koe Palette (AAC app)

400 default buttons, 5 color-vision modes. All core features free.

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In closing

AAC is a way of thinking that aims to deliver a “means to tell” to every child. You can begin with a single picture card, or a single gesture. In the classroom, asking “how does this child want to tell me things?” is the first step of AAC.