Anti-ableism and AAC
So you are a fan of AAC? GREAT! But here is why that is not enough...
Supporting neurodiversity affirming practice does not just mean offering AAC, it MUST INCLUDE anti-ableist initiatives with implementation, expectation, and acknowledgment of communication.
Before we jump in, some important definitions:
AAC - Alternative and Augmentative Communication - “an area of clinical practice that supplements or compensates for impairments in speech-language production and/or comprehension, including spoken and written modes of communication. AAC falls under the broader umbrella of assistive technology, or the use of any equipment, tool, or strategy to improve functional daily living in individuals with disabilities or limitations. AAC is augmentative when used to supplement existing speech, alternative when used in place of speech that is absent or not functional… (Elsahar et al., 2019).” - ASHA 2024
SGD - Speech Generating Device - a high tech AAC system which often looks like an app, computer or tablet that has text/symbol to voice options.
This is parched out here because often when someone hears “AAC” they immediately think “SGD”. That is not the case! AAC includes high tech options (like speech generating devices) AND low tech options.
Body language
Sign language
Gestures
Eye gaze
Writing
Drawing
Other symbolized communication systems (braille, picture selection)
Literally anything other than verbal communication.
Neurodiversity affirming practice - people with developmental disabilities, (e.g. ASD, ADHD, cerebral palsy, down syndrome) or other acquired disabilities, have differences that are NOT deficits that need to be corrected to fit the neurotypical (majority) standard. In sum, everyone has the right to show up authentically and receive care in a way that is NOT focused on “being normal” but instead, care that prioritizes being your best self.
Now, let’s jump in.
Some steps you can take for neurodiversity affirming practice with AAC:
Honor ALL TYPES of communication. If your neurodivergent (ND) client is utilizing a speech generating device (SGD), great! Is your client also using other types of AAC to protest, request, or otherwise tell you something? (pushing the SGD away, reaching for something they want, using vocalizations) We MUST honor it!
Requiring communication solely on the targeted SGD is not affirmative. There are varying statistics about how much of communication is totally “nonverbal”, however the stats do agree that it is the majority of communication! Why would we ignore our ND clients when they are clearly communicating with body language (another form of AAC)?
What you CAN do - If your client is CLEARLY saying “no” through vocalizations, body language, protestations of any kind, just respect it! This shows mutual understanding, respect, empathy, AND builds rapport! If your client is showing joy through other forms of AAC respect it! Celebrate it! You don’t have to require all communication on an SGD, just as we dont require all neurotypical communication to be spoken!
Honor body autonomy. Common practices such as PECS and hand over hand modeling are not in alignment with ND affirming practice. Teaching clients that they are in charge of their own communication AND in charge of their own body is a basic human right. If we are aiming to have communication autonomy, body autonomy is a requirement as well.
Reliance on physical prompting for AAC usage is counterproductive to communication independence. Furthermore, teaching children of all neurotypes they are in charge of their bodies goes far beyond the scope of communication. It encourages body safety practices that start young and last a lifetime in helping your client stay safe.
What you CAN do - “Making” your client communicate by handling their body isn't your only option. Think about how to encourage your client to use their AAC through motivating and engaging ways like client preferred activities! If your client has physical limitations that could be a barrier to direct selection on an SGD device, hand UNDER hand might be an option to help introduce the client to the device. This is still physical prompting, but it takes out the body restriction of hand over hand, and allows the client to remove their hand if they want to.
DO NOT withhold communication access.
Taking away devices because of “behavior” is not ND affirming. Having access to communicate in times of heightened emotion is crucial.
Removing communication devices because “client just keeps hitting a button over and over” is also ableist. This could be exploratory! This could be motor planning! This could be jargon/babbling! This could also be stimming! Stimming is also critical for ND people to achieve regulation. Taking away a regulation tool is not ND affirming, more on that next.
If neurotypical, speaking people have access to their voices 24/7 why would we ever remove that same access for ND people? Again, the point is communication independence with AAC! Unrestricted access leads to independence.
What you CAN do - Be curious! Think “why is this happening?” don’t just assume! See if there is a sensory need that could be met (light up toys, tactile fidget). See if the client is communicating something in their own way (look at the environment, look at before and after this occurs, ask parent questions). Be patient. Be curious.
Regulation over expectation! Regulation and communication are linked! Requiring our ND clients to communicate through dysregulation is not facilitating communication, it is expecting compliance. Compliance is never the aim of ND informed practice! Instead, provide regulation tools and honor regulation attempts! This can look like providing fidgets, allowing movement, and celebrating stimming during treatment to help your client feel more regulated. Prioritizing regulation instead of expecting immediate communication WILL help your client.
When you are dysregulated do you find it more difficult to communicate? What about when you wake up in the morning and haven’t had your coffee yet? Or when someone asks, “What’s wrong?” and you're so overwhelmed you can’t find the words to express? We all need regulation! Neurotypical people wouldn’t want to be denied a support (like morning coffee) or demanded compliance (having to answer someone’s question while in distress) either!
What you CAN do - Think about including these supports in your treatment:
tactile sensations (pop its, squeeze toys)
visual sensations (light up toys or darker rooms)
auditory sensations (preferred songs/videos or headphones)
vestibular sensations (spinning or swinging)
Focus on regulation first! Provide time and space for your client to transition, find calm, find joy, and build trust with you. It is never a waste of time to help your client regulate. They will benefit and YOU will have more positive sessions I promise!
