General overview

The use of Alternative and Augmented Communication began in 1950 with patients who lost the ability to speak after surgery. But it was not until 1980 that AAC began to emerge as a field in its own right thanks to rapid advances in technology (computers, touch pads, voice synthesis systems, eye-tracking, etc.). 


There are several forms of AAC today: 

  • AAC without technical assistance (those who do not require any external tools and use only voice, gestures, sign systems or facial expression) 

  • The technically assisted CAA (with or without an electronic device to transmit or receive a message).  


There are several methods of AAC for example: 

  • The Makaton programme: a comprehensive and very flexible communication programme developed by Margaret Walker, a British speech and language therapist in the 1970s, based on a vocabulary of 450 concepts organised on 8 levels (and one complementary level) and 7000 concepts organised by theme. The objective is to conduct a real reflection with the child on the choice of concepts while adapting to his or her specific needs.  This program is easily adapted to the different communication needs: development of oral, written, vocabulary, syntax, articulation, according to different levels of use. 

  • The PECS program: it is an image exchange communication system developed in the USA in 1985 by Dr. Andy Bondy and speech therapist Lori Frost, implemented today worldwide with thousands of learners of all ages. The method is based on B.F. Skinner's book Verbal Behabior and is divided into six phases, the main objective being to teach functional communication.  

  • The Rett University program: developed for children with Rett syndrome, this method is also adapted for children with motor and non-verbal disorders (severe cerebral palsy for example)

Main objectives of the method

Alternative and Augmented Communication (or AAC) covers all the human means and tools that enable a person with communication difficulties to communicate (i.e., to understand his environment and be understood by his entourage) by replacing oral language if it is absent (alternative) or by improving insufficient communication (augmented). The objective of the CAA is to enable children to better understand their environment, by making them more readable and predictable to facilitate their ease of understanding and to offer them various means and tools to help them express themselves. 

Specificities of the method

AAC is a repetitive and regular method that uses symbols as a medium of passage to oral communication (gestures, photographs, drawings, letters, words, used alone or in combination). The specificity of this method consists in an intensive use of specific equipment (electronic or not) to find accessible and understandable alternatives to verbal or written communication. 


The Makaton program is very flexible and can be easily adapted to the child's level thanks to the many tools available. However, this program mainly uses pictograms, sometimes abstract, to force children to conceptualize words. 


The images in the PECS programme are freely chosen (e.g. images from the child's favourite book), which adds an emotional dimension to the learning. 




















































Rett University

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Who is this method for ?

AAC is for children with a wide range of speech and language disorders, which may be caused by cerebral palsy, intellectual disability, autism... to enable them to communicate as effectively as possible in all situations of daily life.

What parents say about it

William's mother, 3 and a half years old, also practices PECS on a daily basis and is rather optimistic. Her little boy was diagnosed with autism a little over two months ago at the Robert Debré Hospital in Paris. He does not speak at all, but already, with the PECS, he has made progress in getting in touch.

Scientific references

Making progress with Makaton, Daiane Cristina Volpato, 1986, Makaton Vocabulary – Uses and effectivneness, Margaret Walker, 1987,


AAC technologies for young children with complex communication needs : state of the science and future research directions, Janice Light, 2007,


Using the picture exchange communication system (PECS) with children with autism : assessment of PECS acquisition, speech, social-communicative behabior and problem behavior, Krstien Kellet, 2002,

To know more about the topic

Special Education Topics: What is AAC ?, ThoughtCO,


Rettu University, official website,


Alternative and Augmented Communication (AAC), Information booklet for families of persons with ASD, file:////Users /Downloads/la-caa-livret-dinformation-a-destination-of-families-of-persons-tsa.pdf


A very comprehensive presentation on AAC:


On the PECS:


PECS, a short guide for parents,

Any remarks or comments ?

This work is based on a collaborative approach to sharing research and family experience.

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