Does AAC stop a child from learning to talk? What the research says

No. The research reviewed by the American Speech-Language-Hearing Association (ASHA) does not support the worry that AAC makes a child stop trying to talk. ASHA describes the belief that AAC "reduces motivation to improve natural speech" as a misconception, and points to studies finding that early AAC use can help speech and language develop. Children who use AAC can use speech and AAC together.

What AAC is

AAC stands for augmentative and alternative communication. ASHA's public guide defines it as "the ways people communicate when they have difficulty speaking". It covers a wide range:

• No-tech and low-tech: gestures, pointing, facial expressions, drawing, picture cards, spelling and writing.
• High-tech: apps on tablets and phones, and speech-generating devices.

Augmentative means it adds to speech. Many children who use AAC also talk, and use whichever way works best at that moment.

Where the worry comes from

It is a reasonable fear. If tapping a picture of "juice" gets juice, why would a child work on saying the word? ASHA's practice guidance for speech-language pathologists names this belief directly and cites research (Millar and colleagues, 2006) that looked at it. The review found that in many of the cases studied, speech improved a little. The studies were small, but none found AAC held speech back.

What the research says

• AAC does not reduce the drive to speak. ASHA calls the opposite belief a myth (Millar et al., 2006; Sedey et al., 1991).
• Early use can help. "Early AAC use can help develop speech and language", with studies of children aged three and younger showing growth in vocabulary (Romski et al., 2010 and 2015).
• There are no prerequisites. A child does not have to reach an age, a test score or a "readiness" level first (Brady et al., 2016). ASHA lists "not ready until school age" as a misconception, and recommends considering AAC as early as possible.
• Seeing it used matters. When the adults around a child use the AAC themselves while they talk, children understand and use more symbols (Binger and Light, 2007; Drager et al., 2006).

What this means at home

1. Talk and tap together. Say the word out loud as you touch it. This is called modeling, or aided language input, and it is how a child sees what the board is for.
2. Count every way of communicating. A word, a sign, a point and a tap are all communication. Respond to the message, whichever way it arrives.
3. Keep it within reach. A board or tablet that lives in a drawer can't be used when the moment comes. Keep it where the child is, at meals, at bath time and on outings.
4. Don't make speech the price of a tap. Asking a child to "say it" before they get what they asked for turns the board into a test. Answer the tap, and say the word yourself.
5. Work with your child's speech-language pathologist. They can help choose the right kind of AAC and set it up for your child.

Where Talking Cards fits

Talking Cards is a picture-card app made by Plapl Games: tap a picture and the word is spoken aloud, then shown big so the child can look, listen and say it too. It supports a child's own talking and is used alongside it, never instead of it. It is not therapy. The guide Modeling: using the board yourself while you talk shows the first tip above in the app.

Sources

• American Speech-Language-Hearing Association, Augmentative and Alternative Communication (Practice Portal), which cites the studies named above.
• Communication Health Support Association, with ASHA, Augmentative and Alternative Communication (AAC).