My Love for AAC (Augmentative and Alternative Communication)

By Melissa Mcilhiney - Highly Specialist Speech and Language Therapist and Complex Needs Specialist

When training as a Speech and Language Therapist you learn about AAC (Augmentative and Alternative Communication) methods in lectures. I have always been a more visual and hands on learner than one that can sit in a lecture theatre and take in what it being said.   So my love for AAC did not begin straight away but has evolved over the pathway of my career. It has shaped the therapist I have become and the type of client group I specialise in. This may sound cheesy, but it gave me a purpose and a role doing something I love. 

When I was at university I was adamant I would be working with adults on stroke wards or on the head and neck cancer wards in acute hospital settings. How wrong I was! Don’t get me wrong, I had placements on both of these types of ward and I did enjoy them and learnt lots, but this type of work just wasn’t me. To this day, I can’t really explain what was missing from either of these fields for me. I then went on a placement in a DSP (Designated Specialist Provision) attached to a mainstream school I knew this is where I belonged.  I was placed with an amazing Speech and Language Therapist called Sue. She showed me a completely different way of working. I learnt Makaton (signing), was introduced to visuals such as visual timetables and ‘now and next’ boards. I was encouraged to use all of these within my practice with the children I was working with. It was here that my love for AAC began and my career pathway totally changed.  This placement impacted so much on me that I walked away knowing that kind of setting was where I wanted to be. To this day I don’t regret that decision one bit. Seeing the way children can progress and communicate with others, become more independent with their communications and seeing things individualised to each child’s needs lead me to start applying for Specialist Provision posts.  

As a newly qualified therapist you don’t normally even start thinking about a specialism, but I had no doubt that I was taking the right route! It felt natural. So, I applied to a special school and got a job in an MLD (Moderate Learning Difficulties) school working in an Autism base. Here my love for AAC continued to grow. I was introduced to PECS (Picture Exchange System) and we used this daily to take a very functional approach to communication. We used regular visual aids and worked on sensory difficulties at the same time. Therapy there took a very holistic approach and to this day my therapy style is still very holistic. This holistic view of therapy is now supported by the Department of Health and research supports the premise that looking at the child as a whole results in the most progress in their development.   

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I’ve been involved in a few cases where we had to use PECs and visuals to support the communication of children who were going into hospital or in one case had to be interviewed by the police. I remember people saying, “they won’t be able to tell us what they have seen”. How wrong they were!

This role marked the beginning of my dedicated mission to ensure that all children have a “voice” whether via signing, PECS or another method. I was adamant that every child must have a way to communicate. We just need to find the method that works best for each individual child. We know that not everyone is the same and communication (and aids) need individualising around the child’s needs. For example, A child with Retts syndrome who can only eye gaze will need different aids to a non-verbal ASD child.   

After the special school placement I joined the NHS for 6 years and worked in mainstream, pre-school special needs and eventually ended up back in special schools, my most loved environment to work in. I continued to use all different types of no and low-tech AAC devices here and then saw another therapist introduce an electronic aid with a child. I wasn’t directly involved with the child but it sparked my interest and another branch to my love for AAC started to develop. 

I remember sitting in front of the TV one night and seeing an interview with the late Stephen Hawking. I listened intently to every word he said. Not because I understood a word of what he is was on about (quantum physics is just not my thing!) but because I was astonished by the hi-tech aid he was using. The way he was controlling it through eye movement and how quickly and intricately he could explain black holes!  I then got really into researching his story but also the other types of hi-tech aids like Stephen’s there were out there ranging from I-pads to eye gazing machines.  In looking into them I realised that I had children on my caseload these would benefit hugely. We started putting them into the therapy of two children on my caseload. They made amazing progress! I have continued to use these types of aids with suitable children on my caseloads ever since.  

Children are a lot more tech-savvy nowadays. A child on my current caseload was introduced to his aid last term and within days was able to order exactly what he wanted in Pizza Express without having to rely on an adult interpreting his wants and needs as he always had in the past. Children do not normally catch on to their new aids this quickly, but seeing how well children can progress with the right equipment makes this job worthwhile and again highlights the importance of giving each child their “voice”. 

Can you imagine living in a word where someone else speaks for you? Interprets what you want, what you need? Where you literally have no voice? To me this would be the ultimate nightmare and for the children I work with it leads to extreme frustration and behavioural issues. AAC methods give individuals a lifeline, a way of being able to communicate with others without requiring another person to interpret for them. It decreases frustration and most importantly gives people their “voice”. Research supports the use of AAC devices and has shown that using them increases the use of spoken language. Some parents are scared that AAC devices will replace speech this and from my many years of experience this is not the case. But that’s a whole other can worms that I will certainly open in a future blog!  

"I can’t think of a more rewarding job than giving someone their “voice”. And that is why I love AAC and my job"