An AAC device is any tool that helps a person communicate when their speech is unavailable, unclear or unreliable. AAC stands for augmentative and alternative communication. The term covers everything from picture boards to tablets running AAC apps and dedicated speech-generating devices that can be used by touch, switches or eye gaze. The right choice depends on the person and how they live.
You may also hear an AAC device called a speech-generating device (SGD), a voice output communication aid (VOCA) or simply a “talker”. The labels change between clinics and suppliers. The purpose stays the same: to give a person a reliable way to ask, comment, joke, refuse, share news and take part in conversation, whether that person is a three-year-old at kindergarten or an adult living with motor neurone disease.
The need is significant. Among autistic Australians, 59.7% had a profound or severe communication restriction in 2022, up from 44.1% in 2018 (ABS, 2022). The ABS counts a person as having a communication limitation if they need help, have difficulty, or use aids or equipment to communicate (ABS, 2022). AAC is also relevant for people with cerebral palsy, Down syndrome, childhood apraxia of speech (a disorder where the brain has trouble planning the movements needed for speech), aphasia after stroke, Parkinson’s disease, dementia and MND.
The four levels of AAC, from hand signs to eye gaze
AAC is usually described as a range from no-tech to high-tech. The table below sets out what each level looks like in practice.
| Level | Examples | What it asks of the user |
|---|---|---|
| No-tech | Gestures, facial expression, key word signs such as Makaton or Auslan signs | Body movement and a communication partner who understands the signs |
| Low-tech | Picture boards, communication books, PECS (Picture Exchange Communication System, where a person hands over a picture card to request something and builds towards sentences) | Pointing or handing over a symbol; no batteries or charging |
| Mid-tech | Simple recorded-message buttons and step-by-step communicators | Pressing a button to play a pre-recorded message |
| High-tech | AAC apps on a tablet, dedicated speech-generating devices, devices used with switches or eye gaze | Selecting words or symbols to build spoken messages, often with large vocabularies |
Higher tech is not automatically better. Most people who use AAC communicate through a mix of methods across the day: a sign at the dinner table, a high-tech device at school, a laminated board in the pool or the car. A low-tech backup matters too, because batteries run flat and screens crack. We think every high-tech setup should come with a paper version of the same vocabulary layout, so the person is never left without words.
Does AAC hold back natural speech?
No. This is the question families ask most often, and the research answer has been consistent for nearly two decades. Reviews of the research involving people with developmental disabilities and autistic people have found no evidence that introducing AAC holds back speech (Millar, Light & Schlosser, 2006; Schlosser & Wendt, 2008).
The careful way to read this evidence is that AAC does not hold back speech. The purpose of AAC is everyday communication and participation at home, at school and in the community.
Holding AAC back while waiting for speech to arrive asks a person to wait in silence, and the evidence gives no reason to make anyone wait.
Children also do not need to show particular skills before starting. There is no requirement to first point accurately, match pictures or show they “understand symbols”. Many of the skills people assume are prerequisites develop through using AAC, not before it.
Choosing an AAC device starts with assessment, not a catalogue
Device choice is a clinical decision. A device chosen from a product page tends to end up in a cupboard, and the common reasons for abandonment are well recognised: a poor initial assessment, a vocabulary that was never customised to the person, too little training for the people around them, and needs that changed without a review.
What the speech pathologist looks at
A speech pathologist leads the AAC assessment. They consider the person’s language and understanding, thinking and learning skills, vision and hearing, fatigue, literacy, and the people they communicate with most. They also look at what the person wants to say. A child who loves trucks and a retired teacher who wants to keep chatting with grandchildren need very different vocabulary.
Where occupational therapy fits
Access is an important part of AAC assessment, and it often decides whether a device gets used. An occupational therapist looks at how the person will physically select messages: direct touch, a keyguard for more accurate touch, switches, head pointing or eye gaze. They also look at positioning and mounting, such as attaching a device to a wheelchair or bed, and at whether the person can carry or reach it during daily routines. Because Astrad offers speech pathology and occupational therapy under one provider, these two assessments can be planned together rather than booked months apart.
Trial in real settings before buying
A device that performs well in a quiet room may struggle in a noisy classroom or a busy kitchen. The UK MND Association’s AAC pathway recommends a trial of at least two weeks (MND Association, 2022). During a trial, families and therapists can watch for these points:
- whether the person can select messages accurately when tired, unwell or excited
- whether the voice output is loud and clear enough in their usual environments
- how quickly carers, teachers and support workers learn to model on it
- whether the device survives daily handling, transport and charging routines
- whether the vocabulary lets the person say more than requests
Trialling in the person’s home, school or community is where a mobile service makes a practical difference. The assessment happens in the places the device will actually live.
Dedicated device or tablet?
A dedicated speech-generating device is built for communication. It usually has a louder speaker, a tougher case, a longer warranty and a locked-down system that keeps games, notifications and updates out of the way. Suppliers often lend a replacement unit during repairs. A tablet running an AAC app is lighter, cheaper and familiar, but it is an open system. It needs a sturdy case, sometimes a separate speaker for noisy places, and careful control of settings. Voice quality, mounting options and eye gaze compatibility also differ between products. Families often plan for breakdowns by backing up vocabulary regularly, checking repair arrangements and keeping a low-tech board on hand. A speech pathologist can help with questions about an individual device setup.
Making AAC part of everyday life
Owning a device and using it to communicate are two different things. The single strongest habit for communication partners is modelling, also called aided language stimulation. This means the parent, teacher or carer touches words on the device while they talk, without expecting the person to copy. Children learn spoken language by hearing thousands of examples before they speak. AAC users need to see their language used the same way.
Vocabulary matters just as much. We favour robust vocabulary systems built around core words such as “go”, “more”, “stop”, “like”, “not” and “different”, which work across almost every situation. A page of food pictures lets someone ask for a snack. Core words let them say the snack is too hot, that they want a different one, or that they do not like it at all. A vocabulary limited to requests tends to produce a communicator limited to requests.
Progress with AAC is usually gradual, and it varies widely between people. Many families find that small, regular moments of modelling during routines such as bath time, meals, play and car trips can help more than a long, formal practice session. Our therapists coach parents, educators and support workers during sessions at home or school, and telehealth works well for device setup checks, vocabulary updates, partner coaching and reviews. That matters for families on the Fraser Coast, in the Northern Rivers or in Tasmania, where the nearest clinic-based service may be hours away.
AAC for adults and older people
Most AAC content online is written about children. Adults and older people use AAC too, and their needs differ in important ways.
Motor neurone disease
For people with MND, it is generally recommended that AAC be considered early and reviewed regularly as needs change, and that voice banking and message banking be offered while speech is still clear. Voice banking uses recordings of the person’s own speech to build a synthetic voice that can later speak any typed message. Message banking saves specific meaningful phrases, such as a family nickname, a favourite saying or “I love you”, in the person’s real voice. Both depend on timing. Once speech has changed significantly, the window for recording closes, which is why early planning with a speech pathologist matters so much for this group. Access needs often change over time too, which brings occupational therapy into the picture for switches, eye gaze and mounting.
Brain-computer interfaces are starting to appear in overseas news and search results. They remain experimental and are not an option Australian families can access through standard funding pathways today.
Stroke and aphasia
Aphasia affects language itself, so a device full of words is not always the answer. Some people do best with a communication book of personal photos, maps and written key words. Others benefit from a high-tech system. Evidence on what predicts successful long-term AAC use after stroke is still limited (Taylor & Francis Online, 2023), which makes individual assessment and real-world trials all the more important.
Dementia
For people living with dementia, low-demand systems tend to work best. Familiar photos, simple yes/no cards and memory books paired with trained communication partners usually suit better than complex technology that relies on learning new skills. Communication partner training is a large part of the work, because how family members and aged care staff ask questions can change how easily the person can respond.
How AAC is funded: NDIS, Thriving Kids and Support at Home
Funding is where families most often get stuck. The rules depend on age, funding scheme and the type of device.
NDIS participants
The NDIS groups assistive technology by cost. Low-cost AT is under $1,500 per item and includes communication boards, PECS materials and simple communicators; it is usually bought from flexible funding without separate pre-approval. Mid-cost communication devices generally need assessment evidence and a quote. Complex or higher-cost devices, such as eye-gaze systems, need more detailed evidence.
Tablets cause the most confusion. A standard iPad is treated as everyday technology, and adding an AAC app does not automatically make it fundable. In some situations a tablet and app may be considered as a replacement support under the NDIS rules introduced with the 2024 legislative changes, and that requires written approval from the NDIA before purchase (NDIA, 2025). Buying first and claiming later is risky.
Astrad is not a registered NDIS provider. NDIS participants can access our speech pathology and occupational therapy, including AAC assessments and reports, through plan-managed or self-managed funding. Funding decisions rest with the NDIA, and no report can guarantee approval of a device.
Young children and Thriving Kids
Thriving Kids is being rolled out for young children with developmental delay or autism who have low to moderate support needs, with supports delivered through mainstream and foundational services. Full rollout is targeted for 1 January 2028, and existing NDIS participants will move across gradually (ABC News, 2026). How AAC devices will be funded for children supported through Thriving Kids has not been fully clarified. Families whose children are moving between pathways can ask their support coordinator or early childhood partner how device funding applies to their situation.
Older people through Support at Home
Older Australians can access communication aids through the Assistive Technology and Home Modifications (AT-HM) scheme under Support at Home. An aged care assessment comes first, and funds can only be spent on items on the AT-HM List. The list was updated in July 2026 and covers letter and symbol boards, dialogue units, face-to-face communication software, voice generators and speech-flow devices (Department of Health, 2026). An assessment from a speech pathologist, with occupational therapy input on access where needed, helps make sure the chosen item suits the person before money is spent.
If you have questions about AAC assessment, device trials or how our mobile and telehealth services work, our team is happy to talk it through. Call 0468 552 997, email [email protected] or reach us through the contact page on our website.
What if a child pushes the AAC device away or will not touch it?
Early rejection is common and does not mean AAC has failed. Some children need time to see adults using the device before they try it themselves. Others may find the screen layout, voice or access method uncomfortable. A speech pathologist can review the setup, the vocabulary and how the device is introduced, and an occupational therapist can check positioning and access. A qualified health professional can advise on the individual situation.
Can someone use sign language and an AAC device at the same time?
Yes. Many people use several communication methods together, choosing whichever works best in the moment. Key word signs may suit quick exchanges with family, while a device gives a voice that strangers, teachers or new support workers can understand. Using more than one method is a normal part of AAC, and a speech pathologist can help plan how the different methods fit together across the day.
Who keeps the vocabulary on an AAC device up to date?
Vocabulary updates are usually shared between the speech pathologist and the people who know the user best, such as parents, partners, teachers or support workers. New interests, a new school year, a holiday or a change in health can all mean new words are needed. Regular reviews, in person or by telehealth, help keep the device relevant so it remains useful in daily life.
Does using an AAC device mean speech therapy stops?
No. AAC is one part of a broader communication plan. Speech pathology sessions may continue to work on spoken language, understanding, literacy, social communication or swallowing alongside AAC use. The balance between these goals depends on the person, their condition and their own priorities, and it is worked out with their speech pathologist and reviewed as needs change over time.
