What Are Communication Devices for Non-Verbal Children?

As the parent of a non-verbal (or non-speaking) child, you know how frustrating it can be to decipher your child’s wants and needs without words. Is it hunger? Sleepiness? Pain? Frustration?

When verbal speech isn’t possible, a method called augmentative and alternative communication, or AAC, can help. AAC uses non-spoken communication methods and technology to help both children and adults who have difficulty speaking or using language. AAC can be low-tech and unaided, which means the person communicates without props (or “aids”), such as through gestures or facial expressions. It can also be aided by a communication board or a high-tech communication device that can generate pre-recorded messages.

What is an AAC Device?

An AAC device is an umbrella term for all the tools used to improve or provide alternates to verbal speech. Devices can be anything that a person uses to communicate, says Jaime Van Echo, MS, CCC-SLP, associate director in speech-language pathology at the American Speech-Language-Hearing Association (ASHA).

Studies show that using AAC devices can help some children with language difficulties communicate more effectively. A 2018 review of 13 studies found that both low-tech (pictures) and high-tech (speech-generating devices) AAC improved communication and socialization in children with Down syndrome, for example. And, a 2012 review of 24 case studies, each of which followed a single child, found AAC helpful for improving communication abilities in children with autism. The authors also noted a positive effect of the intervention on social skills, challenging behaviors, and academic skills.

Parents’ reviews of high-tech devices are mixed, but not for reasons you’d imagine. Some parents say these devices help with their children’s communication ability, sense of autonomy, and self-esteem. However, others mention they don’t have enough support or training to use these devices effectively. Shop for AAC devices here.

Can your non-verbal child benefit from an AAC device?

“AAC is for any person who has unreliable speech” or who has trouble communicating, says Van Echo. That can include children with speech and language disorders caused by:

Children as young as 1 year old can learn to use low-tech AAC devices, such as tactile symbols. “The earlier that we start, the better the results are going to be,” says Kjirsten Broughton, MS, CCC-SLP, co-founder of Southern Nevada Speech and Language Services. Just as parents of verbal children teach their children how to speak by exposing them to thousands of words early on, non-verbal children also benefit from communication exposure with AAC devices early on, helping them to learn how to utilize them.

Low-Tech Communication Options

The most basic form of AAC includes methods that don’t involve the use of any equipment requiring batteries or electricity. Examples are:

  • An alphabet board that children point at to spell out words
  • Core word boards, to select important words (food, water, bed) or form sentences
  • Cutouts of pictures or symbols that children can hand to their communication partner
  • Gestures (such as with sign language) or facial expressions
  • Pen and paper, to write or draw a message

Mid-Tech Devices

Switches AbleNet iTalk, Learning Resources Answer Buzzers, AbleNet All-Turn-It Spinner

Mid-tech options are battery-operated devices that can perform simple speech functions. One example is the BIGmack, which is a big red button called a “switch.” When the child presses the switch, it speaks a pre-recorded message created by the parent or practitioner, such as, “I want water.” GoTalk is a slightly more advanced version that can store and speak dozens, or sometimes more than 100 different messages, at the touch of a picture button. Shop for devices here.

Switches can also connect to other devices. For example, a computer can be adapted to allow a switch to control scrolling through web pages. Or toys can be adapted to work with a switch, so your child can more easily turn them on or off and play with them.

Lauren Van Heusden’s 6-year-old son, Wilder, is non-verbal because of a stroke he suffered while in the womb. When he was younger, he communicated through low-tech tools like pictures and tactile objects. As he got older, he graduated to touch-operated switches. “He would press the red button, and it would say ‘no,’ and he would press the yellow one, and it would say ‘yes,’” Van Heusden, who is a full-time caregiver in Grasonville, Maryland, says. “Then we mixed in different voice outputs like ‘Yay!’ or ‘I’m upset,’ ‘I’m excited,’ and we’d change it based on the week and what we wanted to use it for.”

High-Tech Devices

The most advanced AAC devices are usually wired. They allow children to communicate using images on a display screen, such as a tablet. The child chooses the image by either touching it or looking at it, using eye-tracking software.

With the latter method, an infrared video camera can determine the child’s eye position as they look at words, pictures, or letters on the screen. When the child stares at the object long enough (the length of time is determined by the parent or practitioner), the device speaks the pre-recorded message associated with that object. For example, if the child stares at the photo of the bed long enough, the device will say, “I’m tired.”

Tobii Dynavox and ProSlate are two examples of companies that produce eye-tracking devices that offer both the hardware (the tracking mechanism and tablet) and the software (apps for words, games, and more).

You can also download communication apps for your smartphone or iPad, such as the Proloquo2Go app. Other examples of apps that are compatible with touch or head-tracking devices include TouchChat and LAMP Words for Life.

Switch scanning is another way for people using AAC to navigate their device. The switch is attached to the tablet. When the item or link the user wants is highlighted, they simply press the switch to select it.

Eileen Lamb’s 10-year-old son, Charlie, who is non-verbal and has profound autism and intellectual disability, used Proloquo2go. His therapist trained Charlie and his mother to use the app. “At first, it was teaching Charlie to decipher between items. The screen would have only two pictures to choose from, one with the picture of what we expected Charlie to request, and one with a non-preferred item. Charlie understood quickly that clicking on the screen would make the device speak,” says Lamb, who is the social media director for Autism Speaks based in Austin, Texas.

The app helped to reduce Charlie’s frustration. “It gave him a way to communicate. It even encouraged Charlie to produce some sounds. He often tries to repeat what the AAC device is saying,” Lamb says.

Where to buy an AAC Device

You can buy an AAC device online by yourself, but most parents rely on insurance or government assistance because, as with most disability equipment, they can be extremely expensive. It’s important to include your SLP (speech-language pathologist), and sometimes your PT (physical therapist) and OT (occupational therapist), in the decision-making process, depending on the device you’re considering. Van Echo says that experts “can help the parent make the right decision for their child because there are so many devices out there, and they vary widely in price.” Experts will ensure you choose the items that will be most helpful for your child.

Low-tech devices like core word boards are available for a few dollars or, in some cases, for free download. High-tech devices like the Tobii Dynavox, on the other hand, can cost upwards of $10,000, says Broughton.

Again, this is where your team can help. They can write an evaluation explaining the medical need for the device. Some insurance plans or assistance will cover the entire cost, others only a portion. In the latter case, you might want to choose an app on an iPad, says Broughton, if your child is capable of using touch.

Van Heusden said her insurance eventually paid for their Tobii Dynavox, but the process was lengthy. First, their therapist had to write an evaluation to explain why Wilder needed the device. Then that evaluation had to go to Wilder’s doctor to get approved before it could go to the insurance company.

Once you have an AAC device, your SLP can show you how to use it to avoid the frustration some parents have experienced when they try to go it alone. Even simple switch buttons can be easier to navigate with the help of your team. High-tech systems like the Tobii Dynavox can also arrange to have their dedicated staff train you. Your child’s therapist or the brand’s staff can teach you and your child the technicalities of the device, such as how to change out the words, download apps, and rearrange the menus.

Whatever the device, your therapists can also work on what Van Echo calls the “psychosocial” part of the process — helping your child to play, learn, and get excited about their new communication tools.

References and Further Reading

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