**3. Augmentative and Alternative Communication (AAC)**

a child may affect such core human behaviours as social interaction, ability to communicate ideas and feelings, imagination, and establishment of relationships with others [3]. Children with autism often are self-absorbed and appear lost in their own world. They are unable to successfully communicate and interact with others. They may have difficulty developing both receptive and expressive language skills. They also may have difficulty in using and under‐ standing nonverbal communication as body posture, hand gestures, eye contact, and facial

In typically growing children, communication and language emerge as an outcome of a neural integrity that helps them function in early social exchanges with parents or caregivers. These interactive behaviours are essential for the cognitive, affective and social growth that lead to development of communication and language skills. In case of children with autism there may be a relationship between atypical central nervous system functioning and impairments in communication and language [5]. The functional differences between typical children and those with autism may contribute to learning styles and strategies that interfere with acquis‐ ition of communication and language skills. Language pattern in autism may be understood well in the context of how nonverbal and verbal communication emerge in children with

**•** Nonverbal communication: Typically growing children use non-symbolic strategies for communicating in early infancy. A child may try to get a toy while looking at it and the parent who can help the child get the toy. This intentional communication is the result of infant and parent social exchange and the parent's ability to understand the infant's signals. These signals are manifest in infant's gestures (e.g. pointing and waving) and vocalizations. Children with autism use gestures and vocalization less frequently and with less sophisti‐ cation than typically growing children. Their gestures often involve contact with people or objects such as leading people by hand or touching the object. Joint attention and pointing are rarely seen. While preverbal children with autism compare favourably to children with developmental delays with respect to production of syllables with consonants, they tend to produce more atypical vocal behaviours such as squeals and yells [6]. Additionally, aberrant or self-injurious behaviours are often used for communication by nonverbal children with autism. These excess behaviours serve a range of functions such as seeking attention, requesting, escaping and showing displeasure and protest. With respect to rate and reciprocity of communication, it is reported that children with autism compare well with typical children in terms of the rate of communication, although their communication is more primitive. However, respondent acts of communication are significantly lesser than initiated communications. This may be due to a limited ability for turn taking in commu‐

**•** Productive speech and language: In verbal children with autism the articulatory and phonological abilities are better in comparison to the overall communication and language

expressions [4]

208 Autism Spectrum Disorder - Recent Advances

autism

nicative interactions [7].

**2. Autism and the language pattern**

AAC has Alternative and augmentative communication (AAC) includes a variety of methods which support or replace oral language. AAC refers to any attempt to improve communication success through unaided methods such as natural gestures, sign language, and vocalization or through use of such aids as pictures, communication boards, and speech generating devices. According to the American Speech-Language-Hearing Association [8] AAC is as an area of clinical practice that attempts to compensate (either temporarily or permanently) for the impairment and disability patterns of individuals with severe expressive communication disorders (i.e., the severely speech-language and writing impaired). It incorporates the individual's full communication abilities. AAC includes the use of visual language modes such as signs, pictures and visual icons representing specific linguistic units. These capitalize on strong visual processing of children with autism. Visual supports are reported to be useful in educational program for children with autism who experience difficulties in acquisition of functional speech or in processing and understanding spoken language & social interaction [9]. Since information provided through visual modes is predictable, static or less transient than words, it improves the autistic child's ability to recognise language input and generate language output [10]. Inability to communicate is often a major factor for emergence of challenging behaviours in children with autism. Training in AAC provides a simple way to communicate basic needs and may lead to a significant reduction in inappropriate behaviour events that hinder learning of social interaction skills [11].

Children diagnosed with autism are unable to verbally express feelings, thoughts and needs. Their struggle to communicate even the most basic needs through nonverbal or verbal modes can be frustrating to them and their caregivers. The lack of adequate communicative behaviour often hampers learning and literacy and creates significant obstacles to social and emotional development and independence. Use of an AAC system can serve as a bridge from a life where thoughts, feelings and needs are held in silence, to a life where interaction, expression and learning are possible. Additionally, use of AAC for children with autism may stimulate brain development; facilitate access to social information and literacy experiences; reduce the need to communicate through aberrant behaviours, and enhance self-concept [12].

#### **3.1. Types of AAC**

While AAC has been categorized as aided and unaided [13], most AAC users and practitioners classify the system as given below.


#### **3.2. Guidelines for AAC use**

Before introducing AAC to a child, his or her communication goals should be determined and discussed by professionals and parents. Assessments may be conducted to decide on the suitability of a specific method of AAC. The following general guidelines [14] may provide some direction for planning strategies for a child who uses an AAC system.


may not be able to start a conversation, get attention, or interrupt others, even if they wish to say something. Communication situations should be structured with a shared focus of attention, to enable children who use AAC systems have many opportunities to communi‐ cate and interact. By including communication opportunities in daily routines, the child who uses AAC will have frequent chances to interact.

development; facilitate access to social information and literacy experiences; reduce the need

While AAC has been categorized as aided and unaided [13], most AAC users and practitioners

**•** Natural communication methods: These include hand pointing, gestures, facial expressions and body language that people commonly use while communicating in spoken language.

**•** Sign language: Traditionally used by people with hearing impairments, sign language consists of manual symbols for linguistic units. Signing is useful for helping children with autism understand language. Signs provide information in visual form. They are also less dynamic than spoken words which helps processing of information. Signing can be used as

**•** Object symbols: Miniatures, models and parts of objects are used as symbols for real objects. Toy cars, doll's clothes, models of fruits etc. may be employed for comprehension and expression of language. At times an object may be used to denote an activity for example

**•** Photos and pictures: Photos, pictures and line drawings of real objects are commonly used as AAC system for children with autism. They are preferred for children with autism as

**•** Communication boards: They are introduced to children once they are familiar with a number of words, and are able to group them in categories, and use them with some syntactical structure. Communication boards consist of photos, pictures and/or words

**•** Speech generating devices: These mechanical aids similar to communication boards. When

Before introducing AAC to a child, his or her communication goals should be determined and discussed by professionals and parents. Assessments may be conducted to decide on the suitability of a specific method of AAC. The following general guidelines [14] may provide

**• Restructure physical environment**: One must ensure that an appropriate technical or nontechnical AAC system is easily available for the child. Additionally, a child should be seated

**• Provide communication opportunities**: Communication is important for learning and development. All children need opportunities to communicate their ideas in order to learn from the environment. Unlike typically developing children, those who use AAC systems

the user presses a button, the machine speaks out the word or the sentence.

some direction for planning strategies for a child who uses an AAC system.

or positioned so that he or she can access the AAC system independently.

they provide information in visual mode, are easy to handle and are low cost aids.

to communicate through aberrant behaviours, and enhance self-concept [12].

These natural methods augment what is being spoken.

a means of expression with other people who know the signs.

**3.1. Types of AAC**

classify the system as given below.

210 Autism Spectrum Disorder - Recent Advances

car keys may denote going for a drive.

denoting people, objects and activities.

**3.2. Guidelines for AAC use**


AAC system regularly to ensure that it continues to be the most effective communication tool for the child.

