Plain guide
What is an AAC device?
An AAC device is any tool that helps someone communicate when they cannot rely on speech, from a printed board of words to an app on an iPad to a computer controlled by eye movement. AAC stands for augmentative and alternative communication: augmentative when it adds to speech someone already has, alternative when it replaces it. It carries the person’s own words. It does not decide what they say.
The shortest useful version: if speaking is not reliably getting a person understood, that is the whole threshold for trying AAC. There is no prerequisite to meet first and no age at which it is too early or too late.
The four kinds of AAC
AAC is usually grouped by how much technology is involved. Most people use more than one kind, and that is normal rather than a sign something failed.
No-tech
Gestures, pointing, facial expression, eye pointing
No equipment at all. Always available, and always part of the picture even when someone also uses a device. Limited to what the partner can interpret.
Low-tech
Printed boards, symbol books, alphabet charts, pen and paper
Paper does not run out of battery, does not crash, and costs nothing. Its limits are that it cannot speak aloud and it only works when the right board is in the room. Even people with a full app should keep a printed backup.
Mid-tech
Single-message buttons, recorded-phrase devices
A small number of pre-recorded messages on physical buttons. Simple and durable, but the vocabulary is fixed to whatever was recorded.
High-tech
AAC apps on a tablet or phone, dedicated speech-generating devices
Speaks aloud, holds a large vocabulary, and can be customised. This is where most people end up. A dedicated device is built for communication only and is the route insurers have historically funded; a tablet with an app is cheaper and more flexible.
Does AAC stop someone from learning to speak?
No. This is the question families ask first, and the evidence does not support the fear. Reviews of the research have consistently found that AAC does not inhibit speech development, and that speech gains often accompany AAC use rather than being displaced by it.
The intuition behind the worry is understandable: give someone an easier route and they will stop taking the hard one. But communication is not a zero-sum effort. A person who can finally make themselves understood usually communicates more, in every form available to them. The real cost of waiting is the months or years spent unable to say anything at all.
If you want to check this yourself rather than take our word for it, the American Speech-Language-Hearing Association is the reference point most clinicians work from.
Where to actually start
Print a board today
You do not need funding, a referral, or an assessment to start. Print a free communication board and put it where it is needed. It costs nothing and it works this afternoon.
Try a free app before paying anything
The paid apps in this category run to hundreds of dollars, and the free ones are good enough to learn what a person actually needs. Compare the free AAC apps first.
Find a speech and language therapist if you can
An SLP (called a speech and language therapist in the UK) is the person who matches a system to the individual. This is worth real effort, though access varies enormously and plenty of people start well without one.
Then look at funding
Only once you know what someone uses is it worth pursuing insurance, Medicaid, a charity grant, or a school. Buying a dedicated device before you know what suits the person is how expensive equipment ends up in a cupboard.
Questions people ask
What is an AAC device?
An AAC device is any tool that helps someone communicate when they cannot rely on speech. AAC stands for augmentative and alternative communication: augmentative when it adds to some existing speech, alternative when it replaces it. The term covers everything from a printed board of words to an app on an iPad to a dedicated computer controlled by eye movement. It carries the person's own words. It does not decide what they say.
Who uses an AAC device?
People whose speech does not do what they need it to. That includes autistic people who are nonspeaking or minimally speaking, people with aphasia after a stroke, people with ALS, cerebral palsy, or apraxia, and people who lose speech temporarily, such as patients who are intubated. Age is not a factor: AAC is used by toddlers and by adults in their eighties.
Is an iPad an AAC device?
An iPad running an AAC app is an AAC device in everyday use, and it is how most people start. The distinction that matters is funding, not function: insurers and Medicaid have historically funded dedicated speech-generating devices, which are locked to communication only, rather than general-purpose tablets. A tablet plus an app is usually the cheaper and more practical route when you are paying yourself.
How much does an AAC device cost?
The range is wide. Printed boards are free. AAC apps run from free to roughly $250 one-time, and several have moved to subscriptions of about $9 to $10 a month. Dedicated speech-generating devices typically run into the thousands and are usually pursued through insurance, Medicaid, or a grant rather than paid for directly. Prices in this category change often, so check the current listing before relying on any figure.
Does an AAC device need internet?
It should not. Communication cannot depend on a signal, so any AAC tool worth using speaks fully offline, with the voice running on the device itself. Some apps use the internet for optional extras such as backup or sharing boards between carers. If an app cannot speak without a connection, that is a serious limitation, not a detail.
Does using AAC stop someone from learning to speak?
No. This is the most common fear families raise and the research does not support it. Reviews of the evidence have consistently found that AAC does not inhibit speech development, and in many cases speech gains accompany AAC use. Waiting to try AAC costs a person time they could have spent communicating.
Go deeper
This page is the overview. Each of these takes one part of it seriously.
Free communication boards
The low-tech end of AAC, free to print or use online. Core words, hospital, adult and autism boards.
Read this →The free AAC apps, compared
Which AAC apps genuinely cost nothing, which are free-to-start, and which are neither.
Read this →AAC for adults
Why most communication apps are built for children, and what works after a stroke or with ALS.
Read this →Hospital communication board
For patients who are intubated, ventilated, post-stroke, or in intensive care. Free to print.
Read this →Start with something free
A printed board costs nothing and works today. SayHarbor is an AAC app where speech is never behind a paywall, coming to iPhone and iPad.