The Big Picture: AAC (Augmentative and Alternative Communication) is a powerful bridge. It is not a “replacement” for a person’s natural voice; rather, it is a collection of tools and strategies that ensure no one is left stranded when spoken language feels out of reach. This Mifsud (2026) review highlights a significant gap in research on AAC use among adults. Yet we know that for an adult, AAC is the difference between isolation and employment, or between being “cared for” and having independence.
Study Type: Systematic Review
Participants: No traditional participants. Since this is a review of past studies, most prior AAC studies have focused on children, even though AAC is a lifelong tool.
Key Findings:
- Foundation: AAC is about maintaining connection rather than just “fixing” speech.
- Relief: Providing a secondary means of communication often lowers the user’s stress levels.
- The “Requesting” Trap: 71% of AAC studies still rely on these behavioral “stimulus-reward” methods. While requesting is a start, communication should be about so much more than just getting a “thing.”
Examples of AAC
Low-tech AAC
| Support | What it is |
|---|---|
| Picture cards | Cards with images for needs, feelings, places, people, choices |
| Written choices | “Do you want water, food, rest, or quiet?” |
| Communication board | A page with words, symbols, or phrases the person can point to |
| Yes/no cards | Simple cards for answering without speaking |
| Pen and paper | Writing, drawing, or pointing to words |
| Gestures | Pointing, thumbs up/down, nodding, showing objects |
High-Tech AAC
| Support | What it is |
|---|---|
| AAC app | App on a tablet or phone with buttons, words, phrases, or symbols |
| Text-to-speech | Person types and the device speaks aloud |
| Speech-generating device | Dedicated AAC device, often with a customized vocabulary |
| Visual schedule app | Helps communicate plans, routines, transitions |
| Wearable or phone notes | Prewritten scripts like “I need a break” or “I can hear you but can’t respond right now” |
No two communicators are the same, and most people use a “multimodal” approach, mixing and matching different tools depending on their energy levels or the environment. AAC support is not just handing someone an app. It includes making communication easier.
Access Status: [Open Access / Free]
Direct Link: The Predominant Focus Is Still on Teaching Children to Make Requests: A Systematic Review of AAC for Autistic Adults and Children – Mifsud – 2026
Adult Autism Insights 