Working every day with children whose language is still only forming, I keep hearing the same question from parents:

“Does my child need AAC? How would I know?”

The answer is simpler than many expect. In this article I will explain what AAC is, when it makes sense, and why an early decision is often the best one.

What is AAC?

AAC — augmentative and alternative communication — is every tool and method that helps a person communicate when their speech does not meet their needs. It can include:

  • Low-tech tools: gestures, photo cards, symbols, picture books.
  • High-tech tools: apps running on a tablet or phone, speech-generating devices.

The International Society for AAC (ISAAC) and the American Speech-Language-Hearing Association (ASHA) define AAC as any means that supplements or replaces verbal speech so a person can express their needs, thoughts and relationships with the world around them.

It is important to understand: the word “augmentative” means “supplementing”. AAC does not replace language — it supplements it. For most children AAC is a bridge towards speech, not a substitute for it.

Who needs AAC?

The answer is simple: any child whose speech is not enough to express their needs. That can include children with:

  • autism spectrum disorder — when verbal language develops slowly or is very limited;
  • childhood apraxia of speech — when the child understands language but the brain cannot properly coordinate producing the sounds;
  • cerebral palsy — when motor difficulties get in the way of clear speech;
  • developmental language disorder (DLD) — when language development is delayed without an obvious cause;
  • hearing impairments;
  • intellectual and developmental disabilities;
  • genetic syndromes that affect communication;
  • acquired conditions — head injuries, stroke, brain diseases.

But most important of all: if a child is older than 18–24 months and still cannot clearly express their basic needs, AAC can be one way to help — whether or not a diagnosis has been made yet.

How to recognise that a child may need AAC

In my practice there are a few signs that parents most often notice:

  • The child does not try to say anything, yet actively seeks interaction — pulls at their parents, points, tries to explain with gestures, but the words are not there.
  • The child has words, but they are unclear to others — only the parents understand what the child is saying, while everyone else does not.
  • The child’s vocabulary is not developing — months go by and no new words appear.
  • The child is often frustrated — cries or acts out when they cannot make themselves understood.
  • The child “speaks” in sounds but does not join words into phrases — even at 2.5–3 years of age.

Any one of these signs is reason enough to talk to a special educator, a speech and language specialist or a child development specialist.

Watercolour illustration: a small child trying to communicate with gestures — pulling their father by the hand and pointing with a finger
A child often actively seeks to communicate before the words appear — with gestures, pointing, eye gaze.

Earlier is better

On this point the literature is very clear: starting AAC at an early age does not hold back speech development — on the contrary, it encourages it.

In the broadest meta-analysis in this field, Millar, Light and Schlosser (2006), reviewing hundreds of studies, found that not a single serious study showed AAC slowing down children’s speech. Later, a study by Romski and colleagues (2010) with 68 toddlers demonstrated that children who used AAC alongside language intervention spoke more words than those who received language intervention alone.

This matters, because many parents postpone starting AAC, thinking: “Let’s wait — maybe he will start talking on his own”. The reality is that the longer we wait, the more frustration builds up in the child and the less they communicate overall.

What to do if you think your child may need AAC

  • Talk to a specialist — a special educator, a speech and language specialist, a child development centre or your municipal pedagogical-psychological service. In Lithuania these services are available through the municipal system.
  • Watch your child’s attempts to communicate, not just their words — how they try to interact, which channels already work for them.
  • Do not make the decision alone — the choice of AAC is individual. What suits one child may not suit another.
  • Start early — the earlier, the better.

AAC is not a final step. For most children it is a beginning: the beginning of a way to communicate, the beginning of a relationship with the world around them and, often, the beginning of the road to speech itself. Introduced properly and guided by a specialist, AAC gives a child something nothing else can — the chance to be understood while the words are not there yet.