Augmentative and Alternative Communication for Speaking Autistic Adults: Overview and Recommendations

In recent years, technologies used for augmentative and alternative communication (AAC) have seen increasing development and availability. As a result, more and more autistic people are using AAC. With the increased use of AAC by autistic people, research on autism and AAC has also increased. However, the vast majority of this research focuses on nonspeaking autistic children. AAC use by autistic adults and by speaking autistic people has received limited academic attention. Speaking autistic adults often use AAC and many have publicly shared information about their strategies and experiences. In this article, we provide an overview of the speech differences autistic adults choose to support through AAC, including varying difficulties with speech depending on environment and content. We also discuss the technologies and strategies adopted by autistic adults, including free or low-cost tools that are not specific to AAC, mobile technologies, and signed languages or gestures. We explore barriers to AAC use, including a lack of awareness of relevant options, misconceptions about who AAC supports are for, and the cost of dedicated AAC applications or devices. We then provide suggestions for autistic adults, people supporting autistic adults, and researchers. Overall communication-rather than speech-should be prioritized. Mainstream communication technologies can support communication for autistic adults and a variety of tools can support communication across contexts. Further research into the use and effectiveness of AAC for autistic adults is needed, as is research on barriers to AAC use.

What is augmentative and alternative communication?: Augmentative and alternative communication (AAC) describes the ways people communicate without, or in addition to, speech.What do we know about AAC for autistic adults who can speak?: Research on AAC and autism has focused on nonspeaking children. However, autistic adults who use AAC sometimes tell each other about AAC. This community knowledge includes reasons AAC is important, useful AAC strategies, and barriers to AAC use. This article talks about autistic community knowledge about AAC and then makes suggestions.Why is AAC important for autistic adults who can speak?: Autistic adults, including those who talk, may not always be able to meet all their communication needs with speech alone. Autistic people who use speech may experience intermittent, unreliable, and/or insufficient speech.What AAC strategies do speaking autistic adults use?: The three main ways that autistic adults report on using AAC include: (1)Free or low-cost tools that are not specific to AAC (e.g., online chat rooms, text messaging applications, or handwriting).(2)Mobile applications designed for communication support.(3)Signed languages such as American Sign Language.What are some common barriers to AAC use for speaking autistic adults?: Several barriers may prevent AAC use. These include the following: Knowledge of AAC optionsAttitudes about who AAC is useful forBeliefs that the use of AAC should be decreased if a person can speakCost of AAC devices and applications.What are our recommendations to autistic adults who might use AAC and their supporters?: Support autistics in defining their own communication needs, regardless of speech.Evaluate communication goals and match them with system features when making decisions about AAC.Prioritize all communication, not just speech.Explore a variety of options to support communication.Explore low- and no-cost options to support communication. What are some research questions that still need to be answered?: What communication strategies do autistic adults see as effective?What AAC strategies are being used, in what environments, and by whom?What prevents effective AAC use?How can AAC specialists and autistic adults best collaborate to promote and evaluate AAC use?How can communication supports be designed to better meet the needs of autistic adults?