Communication aids and AAC: the categories explained

Augmentative and alternative communication, usually shortened to AAC, covers everything a person uses to communicate when speech alone is not enough. Augmentative means alongside speech; alternative means instead of it. Many people use both at different times of day and in different settings, which is the single most misunderstood point about the field.

The categories

Unaided. Signing, gesture, facial expression, body language. No equipment. Always available, and never flat. Makaton and similar signing systems, which pair signs with speech and symbols, sit here.

Aided, low tech. Communication boards and books, symbol cards, alphabet boards, partner-assisted scanning. Cheap, robust, work in a swimming pool and in a power cut. A low-tech board is not a stepping stone to something better; it is the backup that every high-tech user needs.

Aided, mid tech. Devices with recorded speech and a fixed set of messages, often a small number of large buttons. Useful where a person needs a handful of reliable messages quickly, or as an entry point.

Aided, high tech. Speech-generating devices and apps running on tablets, with dynamic symbol or text vocabularies and synthesised speech. Access can be by touch, by switch scanning, by head pointer or by eye gaze.

The questions that decide the choice

Selection is a clinical process led by a speech and language therapist, not a purchase. But knowing what is being weighed helps a family or an employer ask useful questions.

How does the person access it? Direct touch, switch, eye gaze, head movement. This constrains everything else and is usually assessed first.

Symbols, text or both? A literate user needs a keyboard with word prediction; a pre-literate or non-literate user needs a symbol vocabulary. Many people need both in one system, and the transition between them is a design question, not an afterthought.

Which vocabulary organisation? This is the choice with the longest consequences. Core vocabulary systems put a small set of high-frequency words in fixed positions so that motor patterns become automatic, with topic words in secondary layers. Topic-based systems organise by situation. Switching a person between organisations later costs months of relearning.

Does the voice fit the person? Age, gender, regional accent and language. A twelve-year-old given an adult voice in the wrong accent will use the device less. Voice banking, recording a person’s own voice while they still can, is worth raising early where the condition is progressive.

What happens when it fails? Battery, breakage, repair time, and the low-tech backup. Ask about repair turnaround before you buy, not after.

Funding in Europe

There is no single European route. Provision runs through national health systems, social insurance, education budgets or disability agencies, and the split varies sharply between countries. In Germany, communication aids are generally provided as Hilfsmittel through statutory health insurance on prescription, with the assessment documenting why a specific device is required; there is more on the German system on our Hilfsmittel page.

What is common across systems is that the funding decision follows the assessment report. A well-written assessment that documents the access method, the vocabulary requirement and the alternatives considered is the difference between approval and a year of appeals.

The rights angle

AAC is not only a technical topic. Article 21 of the CRPD requires states to accept and facilitate the use of augmentative and alternative communication in official interactions, and Article 12 on legal capacity depends on it directly: a person cannot express a will and preference that nobody has given them the means to express. Where a supported decision-making arrangement is being set up, the communication method is not a detail of the arrangement. It is the arrangement.