Gestures, pictures, AAC: how alternative communication really works

I will say right away. AAC, cards, gestures are not a "betrayal of speech." These are tools that give the child a way to communicate right now, while oral speech develops (or instead of it, if it turns out that way).

This text is about what this really is and how it works.

Why the word "alternative" scares parents

AAC stands for Augmentative and Alternative Communication.

"Alternative" scares people because it sounds like "instead of speech forever." Do not be scared.

"Alternative" means only that this is also a legitimate way of communication, alongside speech, or in cases where speech is unavailable. Many children over time transition to oral speech, keeping AAC as a backup.

"Augmentative" means that this is a supplement, not a replacement.

The most important myth

"If I give cards or a tablet, the child will not start to speak."

This myth is not supported. Systematic reviews of research, ASHA, JAMA Pediatrics, Cochrane, all point to one thing.

AAC does not slow down the development of oral speech. In many cases on the contrary, it supports it.

Why this is so. When a child has a reliable way to express what they want, frustration decreases. This creates space for speech, not blocks it.

If speech appears, AAC gradually recedes into the background. If it does not appear, it remains a reliable way of life.

First gestures worth starting with

Not "let us teach the alphabet." Start with functional gestures.

• "Give." A fist with an open palm.
• "More." Tap the fingers of one hand on the palm of the other.
• "Stop." Palm forward.
• "Yes." A nod of the head.
• "No." Shake the head.
• "Help." Tap the shoulder of one hand.

This is the basic package. If the child masters it, it is already a huge breakthrough in daily life.

How to teach. Show the gesture yourself together with the word. "More" (with the gesture). "More" (with the gesture). Time after time. Without demanding repetition. When the child starts to show it themselves, praise and immediately give what they are asking for. This makes the gesture useful for the child.

The pointing gesture is a separate big thing

The pointing gesture is one of the most important stages of development. It is a precursor to language.

Why. When the child points with a finger, they share attention with the adult. "Look, here it is." This is basic social communication.

If the child does not have a pointing gesture, this is often the first thing specialists work on.

How to stimulate. Point with your finger yourself. A lot and joyfully. "Look, a car." "Look, a dog." The child sees and gradually starts to copy.

Pictures and communication boards

Simple cards with images are the most accessible format of AAC.

A basic set.

• A "water" or "drink" card.
• A "food" card.
• A "toilet" card.
• An "it hurts" card.
• A "help" card.
• A "more" card.
• A "stop" or "enough" card.
• A "cartoon" card.

This is a starter package. Over time you add more.

How to use. The cards should be within the child's reach. Above the table, near a favorite place, in a folder. When the child takes and gives a card, you react accordingly. "You showed 'water.' Now I will pour it."

PECS is a separate system

PECS (Picture Exchange Communication System) is one of the popular formats. Cards that the child hands over to ask.

How it works. The child does not just point at the card. They take it and hand it to the adult. This is a physical "transfer of the request."

Meta-analyses show. PECS improves functional communication, especially requests and initiation. But the increase in oral speech itself is less consistent.

This means. PECS can be useful, but it is not worth considering it as "the child will definitely speak." It is a communication tool that works as intended.

If you decide on PECS, it is advisable to start with a specialist (speech therapist, behavioral specialist). Because there is a sequence of stages, and a homemade version may not give the same effect.

AAC apps on a tablet

High-tech AAC. Special apps on an iPad or Android with symbols that are spoken with speech synthesis.

Examples: Proloquo2Go, TouchChat, GoTalk Now, Cboard (free open-source). The Ukrainian market is so far poor, but there is something.

Pros. Many words in one device. Can be carried everywhere. Speech synthesis creates an audio signal that not only the adult hears.

Cons. Not all children are ready for a tablet. It may seem like a "gadget" that distracts. And it costs money.

Who should select it. A speech therapist with training in AAC. Not "buy it and figure it out yourself." Because the correct selection of vocabulary, interface, motivation is separate work.

How to choose between gestures, cards, and apps

• Gestures. The fastest and free. Works if the child has no motor difficulties. A basic start for everyone.
• Cards. Simple and accessible. Work in parallel with gestures.
• PECS. If there is a specialist who helps set up the system.
• A tablet. When the child needs a larger vocabulary or a physical card is inconvenient.

Often all at once. The child has gestures, cards, and then a tablet. Each for its own context.

Behavior is also communication

A separate important thing. If the child hits, screams, runs away, this is also a signal. Sometimes the only available one.

"Behavior as communication" is an old idea in working with children with special needs. Before "eradicating the behavior," ask: what is the child trying to say?

"I am overloaded." "It hurts." "I do not want this." "I do not understand what is happening."

If there is an alternative way to say it, the "explosion" of behavior often decreases.

What is not worth doing

• Do not "forbid" gestures in the hope of "making them talk." This harms.
• Do not demand "words first, then a card." If the child can take a card, give them this chance.
• Do not criticize the child for using AAC. "You are big, you can talk." This destroys motivation.
• Do not buy expensive AAC apps without consulting a specialist. You can spend hundreds and not use them.

What is next

Read "How to develop communication at home," about specific strategies that combine all of this in real life.