I still remember one of the first kids I ever handed a picture board to years ago. His mom was nervous. She thought giving him pictures instead of pushing him to talk meant we were giving up on speech. Six months later, he was combining two and three words on his own, using the board less and less because he didn’t need it as much anymore.
That moment has stuck with me through fifteen years of working in ABA therapy services. AAC doesn’t replace a child’s voice. It gives them one while their spoken language catches up, or, for some kids, it becomes the voice they use for life. Both outcomes are wins.
If you’re a parent staring down the term “AAC” for the first time, here’s what I want you to actually know: what these tools are, how a child gets matched to the right one, what it realistically costs, and how to actually use one once it’s in your house.
What Is AAC, and Who Is It For?
AAC stands for Augmentative and Alternative Communication. “Augmentative” means it adds to whatever speech a child already has. “Alternative” means it stands in when speech isn’t available yet, or isn’t available at all. It’s not one product. It’s a whole category, ranging from a laminated piece of cardboard to a dedicated computer that talks.
AAC Is Not Only for Nonverbal Kids
This is the part I correct the most on intake calls. AAC isn’t reserved for children who never speak. I’ve used AAC with kids who had plenty of words but couldn’t reliably get them out under stress, kids with apraxia whose mouths and brains weren’t yet in sync, and kids who spoke fine at home but shut down completely at school.
If your child struggles to communicate consistently, not just whether they talk at all, AAC is worth a conversation. If you’re still working out where your own child falls on that spectrum, our post on whether all autistic children are nonverbal is a good place to start.
Signs Your Child Might Benefit From AAC
A few patterns I look for when a family asks whether it’s time to consider AAC:
- Your child has very few words, or words that only close family can understand.
- They point, grab, or lead you by the hand instead of using words to request things.
- Meltdowns often happen because they can’t get a need across.
- They understand much more than they can say (this gap is common in autism and it’s exactly what AAC is built to bridge).
- Speech therapy alone hasn’t moved the needle in six months to a year.
None of these mean your child is “behind for life.” They just mean it’s worth getting an evaluation instead of waiting and hoping speech arrives on its own.
The Three Levels of AAC
Parents usually picture a robotic-sounding tablet when they hear “AAC device.” That’s one option, but it’s the last stop on a much longer road, not the starting line. I walk families through it in three tiers, and most kids move through all three over time rather than jumping straight to the top.
Low-Tech: Picture Boards, PECS, and Communication Books
This is the simplest layer, and it’s often where we start with very young or newly diagnosed kids. The Picture Exchange Communication System (PECS) has a child hand over a picture card to request something: a picture of goldfish crackers for goldfish crackers, a picture of “outside” to ask to go outside.
It’s taught in six structured phases, starting with a single exchange for a single item and building up to full sentence strips and answering questions. Communication books work on the same principle: a binder of laminated symbols organized by category (food, people, feelings, activities) that a child points to or removes and hands over.
Low-tech tools cost almost nothing, they never run out of battery, they work in the bath, at the beach, and in a blackout, and they teach the concept underneath all of AAC: a symbol stands for a want or need, and using it gets a response from another person. That concept has to click before higher-tech tools mean anything at all.
Mid-Tech: Communication Apps on Tablets and iPads
Once a child has the basics down, a lot of families move to an app on a device they already own. Proloquo2Go, TouchChat, CoughDrop, and Avaz are the ones I see most in the field. These apps turn an iPad into a grid of symbols that speak the word aloud when pressed, and they can grow with the child, starting with a handful of core buttons and expanding into full sentences and multiple folders over time.
Most use core word vocabulary systems, meaning the words that show up most in everyday language (“want,” “more,” “stop,” “go”) sit in fixed, predictable spots so a child builds motor memory for where things are, the same way a fluent typer doesn’t look at the keyboard.
The appeal is obvious: it’s a fraction of the cost of a dedicated device, it’s on hardware the family may already own, and siblings and classmates already know how to use an iPad. The tradeoffs are real, too.
A shared family iPad that also has games on it competes for the child’s attention, so most SLPs recommend a dedicated, locked-down device (Guided Access on iOS, for example) rather than the same tablet used for YouTube at bedtime. Mid-tech options also assume decent fine motor control and visual attention to a screen, which not every child has yet.
High-Tech: Dedicated Speech-Generating Devices
At the top of the ladder are dedicated speech-generating devices (SGDs) like the NovaChat by PRC-Saltillo, the Accent device running LAMP Words for Life, the Tobii Dynavox with TD Snap, or the AbleNet QuickTalker Freestyle. These are purpose-built: nothing on them but the communication software, ruggedized cases that survive drops, mounting options for wheelchairs or strollers, and access features like eye-gaze tracking, head tracking, or switch scanning for kids who can’t reliably touch a screen with a finger.
This tier is usually reserved for kids with more significant motor or language needs, kids who need alternative access methods, or families whose insurance will fund a dedicated device but not a “toy” like an iPad (more on that funding quirk below). It’s also the tier that requires the most formal documentation to get approved, which brings us to the next question I get on almost every call.
How Does a Child Get Assessed for AAC?
Nobody just hands your child a device and hopes for the best. There’s a real evaluation process behind it, and it matters, because the wrong device (too complicated, too simple, or a poor motor fit) gets abandoned in a drawer within weeks.
Who Runs the Evaluation
An AAC evaluation is typically led by a speech-language pathologist, often working alongside your child’s ABA team if they’re already in therapy.
At True Progress Therapy in New Jersey, our BCBAs and SLP partners coordinate on this together. That’s because ABA sessions reveal a lot about how a child actually communicates. We watch how they request, protest, and comment in real time. This tells us what kind of AAC system will be used at home, not just one that looks good on paper.
What Gets Evaluated
The SLP looks at a mix of things:
- Current communication skills. Does your child point, vocalize, use any words or approximations, use gestures?
- Motor skills. Can they isolate a finger to hit one button on a screen, or do they need larger targets, a different layout, or switch access instead?
- Language comprehension. How much do they understand of what’s said to them, separate from what they can say back?
- Sensory and attention factors. Do bright screens, sound, or busy visual layouts overwhelm them?
- Where the device will actually be used. Home, school, both, in the car, at grandma’s house. A system that only works at a therapy table and never leaves the house isn’t doing its job.
Contrary to what a lot of parents assume, there’s no prerequisite skill your child has to hit before AAC is “allowed.” You don’t need to prove a child can’t talk before introducing a communication tool. Waiting for speech to fail first only costs a child time they don’t get back.
The Trial Period
After the evaluation, the SLP usually recommends one or two systems to trial, not just one final answer handed down on day one. Your child uses the recommended app or device for a set period, often a few weeks, while the team tracks how often it’s used, how quickly the child picks up new vocabulary, and whether it holds up outside the clinic. Only after this trial does anyone move forward with a purchase or a funding request, because fit matters more than any feature list on a spec sheet.
Reassessment Over Time
AAC isn’t a one-and-done decision. Kids outgrow systems. A child who starts on PECS at age three might be ready for an app by five and a dedicated device with more vocabulary by seven, or they might stay happily on an app for years. We revisit the fit periodically, the same way we’d revisit any other therapy goal, instead of assuming day-one recommendations are permanent.
What Does AAC Cost, and Will Insurance Help?
This is usually the real question underneath “what device should I get,” so let’s be direct about it.
Low-Tech and App Costs
Picture boards and PECS binders cost next to nothing. You can build one with a laminator and printable symbol sets, and many SLPs provide starter materials directly. Communication apps run anywhere from free to roughly $250 as a one-time purchase (Proloquo2Go and TouchChat both fall in that range), which is usually cheaper than a single therapy co-pay. These are rarely covered by insurance and rarely need to be, since the cost is already low.
Dedicated Devices and Funding
Dedicated speech-generating devices are a different story. Many run several thousand dollars. The good news is that most private insurance plans and Medicaid classify SGDs as durable medical equipment (DME) when they’re medically necessary, which means they can be substantially or fully covered. The catch is the paperwork. You’ll typically need:
- A completed AAC evaluation from a licensed SLP.
- A letter of medical necessity explaining why this specific device, not just any device, is required.
- A face-to-face physician visit, since Medicare and many Medicaid programs require a doctor to sign off on DME claims.
- Documentation from the trial period showing the device was actually used successfully.
This process commonly takes several weeks and sometimes a few months, so if a dedicated device looks like where your child is headed, it’s worth starting the evaluation early rather than waiting until you’re out of other options.
Other Funding Routes Worth Knowing About
If insurance denies a claim or your plan doesn’t cover DME well, a few other paths exist:
- School districts can fund or provide an AAC device as part of an IEP if it’s written in as assistive technology the child needs for their education, separate from any medical insurance process.
- State Medicaid waiver programs in many states cover AAC devices even when a family’s primary insurance doesn’t.
- Assistive technology loan libraries, often run by state AT programs, let families borrow a device to trial before committing to a purchase or an insurance appeal.
- Nonprofit grants through organizations focused on communication access can help cover the gap for underinsured families.
- Manufacturer payment plans, offered directly by companies like PRC-Saltillo and Tobii Dynavox, for families paying partly or fully out of pocket.
How We Handle This at True Progress Therapy
Insurance verification and authorization paperwork is genuinely one of the more frustrating parts of this process for families, which is why our team handles the verification and authorization legwork directly rather than leaving you to manage vendor calls and appeal letters on top of everything else.
We also build AAC goals into ongoing ABA sessions so the device, whatever level it ends up being, gets practiced daily instead of only during a monthly speech visit.
How to Use AAC at Home
Getting the device is half the battle. The other half is using it in a way that actually builds communication instead of sitting in a bag.
Model, Don’t Test
The single biggest shift I ask parents to make is to stop treating the device like a quiz and start treating it like a second language you’re both learning. That means you point to or press words on the board or app yourself, all day, whether or not you’re asking your child to respond. If your child reaches for juice, you say “juice” out loud and press “juice” on the device before handing it over. You’re not testing whether they know the word. You’re showing them where it lives.
Keep It Everywhere
A device that stays in a backpack doesn’t build a habit. Whatever system your child uses, whether it’s a binder or an iPad, it needs to be within reach during meals, play, car rides, and bath time (a waterproof low-tech board works fine there even if the tablet doesn’t). The rule I give families: if your child couldn’t reach their communication system in under five seconds right now, it’s too far away.
Follow Their Motivation First
Early vocabulary should chase what your child actually wants, not a generic list of nouns. Snacks, favorite shows, a sibling’s name, “again” for a tickle game. Functional, motivating words get used. Abstract flashcard vocabulary tends to sit untouched.
What Progress With AAC Looks Like
Parents want a timeline, and I understand why. Here’s what progress realistically looks like, so you’re not measuring your child against the wrong milestones.
The First Few Weeks
Expect slow, small movement at first. A child might only tolerate a handful of symbols, or only use the system when an adult is actively prompting each exchange. This is normal and it’s not a sign the tool is wrong. Most of the early weeks are about building the habit of reaching for the system at all, before vocabulary or sentence length matters.
Signs It’s Working
Look for your child initiating an exchange without being prompted, reaching for the board or device before you’ve asked them to, or using it in a new setting you didn’t specifically train, like the car or a grandparent’s house. Growth in vocabulary usually comes after these habits are solid, not before. A child who reliably requests five things is further along than a child who has forty symbols available but only uses two.
When to Loop Back to Your SLP or BCBA
If your child has plateaued for more than a month, is only using the system in one setting, or seems to actively avoid it, that’s worth a check-in rather than waiting it out. Small adjustments, a layout change, new motivating vocabulary, a different access method, often unstick progress faster than pushing harder with the current setup.
Getting Started
If your child is struggling to make their needs understood, whether that’s zero words, a handful of unclear ones, or perfectly good speech that disappears the moment they’re overwhelmed, an AAC evaluation isn’t a big commitment to make. It’s an hour or so of observation that tells you concretely what will help, instead of guessing from an app store list.
At True Progress Therapy, we build AAC goals directly into your child’s ABA therapy plan and handle the insurance groundwork so you’re not doing it alone.
If you want to talk through where your child might fit, reach out to True Progress Therapy, and we’ll walk you through it.
Frequently Asked Questions
Will giving my child AAC stop them from talking?
No, and this is the single most common fear I address. Every major study on this has found the opposite: AAC use is associated with equal or better spoken language development, not less of it. A child who can reliably get their needs met through AAC has less reason to melt down out of frustration, and every symbol they press pairs the picture with the spoken word, which reinforces language rather than replacing it.
My child has some words. Do they still need this?
Possibly, especially if those words are inconsistent, hard to understand, or only show up in calm, low-demand moments. AAC and speech-building work well side by side. If your goal is specifically growing spoken language, our guide on helping autistic kids build spoken communication covers the strategies we pair with AAC rather than use instead of it. And if speech delay is the main concern rather than autism itself, it’s worth reading about how speech delay and autism relate so you know what you’re actually working with.
How do I know which tier my child needs?
You don’t have to guess. That’s exactly what the evaluation is for. Most kids don’t start at the top tier and stay there. They move through low-tech first, prove out the underlying concept, and only move to an app or dedicated device once that foundation is solid.
What if my child rejects the device or refuses to use it?
This is common, and it’s usually a sign of one of three things: the vocabulary doesn’t yet include what they actually want, the motor demand is too high for where they are right now, or the adults around them aren’t modeling it consistently enough for it to feel useful. It’s rarely a sign that AAC is “wrong” for that child. This is exactly what the trial period and ongoing therapy sessions are meant to troubleshoot before anyone gives up on a system.
Is there an age limit for starting AAC?
No. I’ve introduced PECS to toddlers as young as eighteen months and started dedicated devices with teenagers who never had access to one earlier in life. Earlier is generally better because it gets ahead of frustration-driven behavior, but there’s no cutoff where AAC stops being worth trying.
Can my child use more than one AAC system at once?
Yes, and many kids do. It’s common to see a child carry a low-tech board as backup while an app or device charges, or use sign language alongside AAC for a handful of frequent words. The goal is communication getting through, not loyalty to one method.
Sources:
https://www.autismspeaks.org/technology-and-autism
https://www.autism.org.uk/advice-and-guidance/professional-practice/aug-alt-comm
https://pubmed.ncbi.nlm.nih.gov/25995080/
https://vkc.vumc.org/assets/files/triad/tips/AAC_and_Autism_EDU.pdf
https://sensorysolutions.org/home/blog/5-steps-for-implementing-aac-devices-in-your-childs-routine/
https://raisingchildren.net.au/autism/development/language-development/augmentative-communication-asd
