About The Book

Augmentative and Alternative Communication: Models and Applications, Second Edition describes augmentative and alternative communication (AAC) comprehensively and offers a framework for understanding how AAC intervention can be used in the process of communication. This textbook is intended to serve as the primary text for graduate-level courses in augmentative and alternative communication in speech-language pathology programs. It also serves as an essential resource for practicing clinicians.

AAC is used by an ever-growing group of individuals of all ages, each with their own personal and communication needs. The book presents the various AAC interventions and teaches the prospective clinician which intervention may be effective depending on the needs, condition, and prognosis of the client. The text details how communication is shaped by internal and external factors and how communication affects social functioning.

New to the Second Edition:

  • A revised introductory chapter reflecting recent changes in the field
  • Thoroughly updated chapters on technology, vocabulary, and assessment
  • Reorganization of the chapters for a more natural flow of information
  • New and revised artwork throughout including images, tables, and charts
  • New and expanded case studies covering different types of communicators, their needs, and AAC solutions
  • Expanded coverage on the following topics:
    • The debate on core vocabulary and discussion of best practices
    • Perspectives and views from AAC users
    • Ethics in AAC service delivery
    • Research issues
  • Access to a PluralPlus companion website which includes PowerPoint lecture slides, recorded lectures for select chapters, links to funding resources, and low tech solutions

About The Author

Filip Loncke, PhD, is a professor at the University of Virginia. For more than three decades he has practiced and conducted research in augmentative and alternative communication (AAC). Dr. Loncke is a past president of the International Society for AAC (ISAAC). He has lectured and taught AAC courses in the United States and Europe since the early 1990s. As reflected in this volume, his research interest is in cognitive and psycholinguistic processes involved in atypical communication.

Table oF Contents



Chapter 1. Augmentative and Alternative Communication: A General Introduction

What Is Augmentative and Alternative Communication?

Standard and NonStandard Forms of Communication Early Assumptions


Learnability of Symbols

A Model for AAC Communication

AAC as Sender Support

Less Is More?

Alternative Access

Adapting Manual Signs

AAC as Support of Signal Transmission


AAC as Support of Receiver

Beyond the Communicator–Partner Interaction

Bronfenbrenner’s Ecological Model

To Sum Up

Points to Remember


Chapter 2. Access and Message Management

Typical Processes Involved in the MicroGenesis of Speech

A Proposed Framework to Understand Access

Rate of Expressive Communication


Physical Access

Mental Access


Sender Access Facilitation


Lexicon Accessibility

Sets and Systems of Symbols: Do They Help in Lexical Access?

Access to Message Assembly Techniques

Message Externalizing



Cognitive Processes

Message Transmission

Multimodality Principle

Materialization Principle

The Receiver’s Role and Assistance from Communication Partner

Help in the Physical Execution of the Message and Facilitated Communication (FC)

Help in Cause-Effect Grasping

Providing Choices

Help with Scanning

Lexical Help

Selection Strategies (Y-N Questions)

Strategic Feedback

Content Feedback

AAC Modeling

Points to Remember


Chapter 3. Nontech, Low-Tech, High-Tech, and Mobile Computing

Assistive Technology

Nontech, Low Tech, and High Tech

Nontech Solutions

Steering Technology

Movement-Sensing Technologies

Multi-Input Strategies

Language Representation Technology

Output Technology

Nontech Output

Device-Generated Speech

Desktop and Laptops

Tablets and Mobile Devices

Lexicon Technology

Lexicon Representation

The Super Lexicon and Increasing Interconnectivity

Growing and Accessible Databases

Conversion Technology

Word from/to Graphic Symbol

Manual Sign from/to Word

Simplification Technology

Recognition Technology

Speech Recognition

Integration with Other NonCommunication Technology


Points to Remember


Chapter 4. The Use of Symbols

What Are “Symbols”?

Symbol Classification

Unaided AAC Symbols

Unaided Symbols: Gestures

Everybody Uses Gesture

Conventional Gestures Are Manual Signs

Linguistic Unaided Symbols

Why Would Manual Signing Work?

Simplified Sign System

Key Word Signing

Aided AAC Symbols

Tangible Symbols

Graphic Symbols

Levels of Understandability of Graphic Symbols

Recognizable Graphic Symbols

Guessable Graphic Symbols

Symbols with Low Picturability

An Interesting Graphic Symbol System: Bliss-Words

Participics: Graphic Symbol Sets for a Specific Group

Animated Graphic Symbols

Adding Sounds to Graphic Symbols

Two Issues of Graphic Symbols: Polysemy and Sequentiality

The Polysemy Issue

The Sequentiality Issue

Uses for Graphic Symbols


Points to Remember


Chapter 5. Vocabulary and AAC

Words, Graphic Symbols, Manual Signs as Lexical Elements

Zipf’s Law, Core Vocabularies, and AAC

Typical Word Development

Balancing Number of Words with Accessibility Requirements: The Problem of Lexical Access

Teaching or Acquiring Vocabulary — Who Determines or Influences Lexical Growth?

The Core Vocabulary Approach

Comparing AAC and Typical Word Development — A Valid or Flawed Approach?

So, Is Core Vocabulary the Solution?

The Initial Lexicon

“Free Access” to Your Own Lexicon

Measuring Lexical Learning

Are Manual Signs the Lexical Equivalent of Words?

Manual Sign Lexicons

Are Graphic Symbols Really the Equivalent of Words?

Doing more with less?

Conclusion: The Vocabulary Challenge in AAC

Points to Remember


Chapter 6. AAC Intervention at the Prelinguistic and Early Linguistic Stages 

The Beginnings of Communication

Forms of Communication

Functions of Communication

Behavior Regulation

Social Interaction

Joint Attention

From Unintentional Behavior to Intentional Communication

Understanding Cause-Effect

The Use of Tools

The Genesis of Internal Mental Representations

Symbol Development

When Does Communication Become Language?

From Idiosyncratic to Conventionalized Symbols

Communication and Symbol Development as Part of Interaction

Symbols Become Part of a Larger Structural Multilevel Combinatorial System

The Communication Matrix

AAC Solutions for Early Intervention

Determining the Communication System in Place

The Partners

The Communicative Environment

Making Unintentional Behaviors Intentional

Identify Potential Communicative Acts

Select Accessible Symbols

Transition to Linguistic Symbols

AAC Applications for People with Severe Developmental Limitations of All Ages

Make and Keep Communication Functional

Address Problem Behavior

Other Intervention Techniques

Requesting and Rejecting

Beyond Requesting and Rejecting

Extension of Communicative Repertoire


Chapter 7. AAC Applications for Individuals With Autism

Autism Spectrum Disorders and the Acquisition of Communication Through AAC

Barriers and Facilitators

Predictors, Moderators, and Mediators

The Specific Nature of Autism and AAC

The Visual Modality, Visual Processing, and Attention

Teaching Needs

AAC and Social Skills in Individuals with an Autism Diagnosis


Chapter 8. Language Intervention and AAC

How Are the Main Mechanisms of Language Acquisition Affected by the Use of AAC?

Biological Factors

Language Exposure

Cognitive Challenges

Social Regulations

What Is the Effect of the Decreased Output Possibilities?

What Do We Know About the Developing Lexicon?

What Do We Know About Phonology, Morphology, and Syntax Development?

Morphology and Syntax

How Does the Use of AAC Affect Literacy?

How Does Software in AAC Devices Represent Language, and Does It Facilitate Language Acquisition?

Language Learning Through Interaction


Amount of Exposure to Communication and its Influence

Learning Structures and Strategies



Points to Remember


Chapter 9. AAC and Literacy Development

Literacy Acquisition and AAC Use: An Interesting Relation

A Help or a Barrier?

Three Abilities and Levels of Graphic Symbol Use

(1) The Ability to Pay Attention to Specifics of a Pictorial Representation

(2) The Ability to Understand the Referential-Pictorial Meaning of a Graphic Symbol

(3) The Ability to Insert a Pictorial Representation in a Meaningful Way in a Sequence of Actions

Can Graphic Symbols Aid Word Recognition Through Association?

Are the Graphic Symbols a Help to Literacy?

Literacy Activities and a Literacy Curriculum for AAC Users

Different Challenges at Different Stages

Literacy Activities as Compensatory AAC Strategies

Measuring Competencies

Becoming a Writer

AAC and Literacy in the Future

Points to Remember


Chapter 10. AAC and Intervention with Acquired Communication Disorders

An Increasing Prevalence

The Nature of the Condition: Cognitive, Linguistic, or Motor

What Is the Linguistic Nature of Disorder?

What Is the Motor Nature of the Disorder?

What Are the Cognitive Elements Affecting the Disorder?

Other Questions

Natural Speech

Acquired Cognitive Challenges

Acquired Linguistic Challenges

Functional Considerations and Classifications

Acquired Motor Impairment

Amyotrophic Lateral Sclerosis

Brainstem Dysfunction

Other Acquired Predominantly Motor Disorders

AAC as Therapy and Rehabilitation Tool

Short- and Long-Term Goals

Effects of (Partially) Device-Based Language Therapy


TelePractice, Self-Therapy, and Distance Intervention

Conclusion 184 Points to Remember


Chapter 11. AAC in Medical Environments

Exchanging Medical Information with AAC Users

Exchanging Medical Information with Non AAC Users

AAC as a Short- and Long-Term Solution for Exchanging Medical Information


Chapter 12. AAC and Assessment

AAC Assessment Is Part of AAC Intervention

Determination of AAC Needs

Communicative Competence as Object of Assessment

Assessment of the Larger Picture

AAC Assessment Is an Ongoing Decision-making, Testing, and Adjusting Process

Principles of AAC Assessment


Can We Predict the Future?

Dynamic Assessment

Measuring Instruments

Measuring Communication as Part of a Developmental Component

Communication Competence Profile

Assessment of PreLinguistic and Early Linguistic Functioning

Language Tests and Their Usability

Measuring of Specific AAC-Related Skills

Conducting an Evaluation

Functional, Developmental, and Dynamic Interpretation of the Data

Feature Matching

The “Fives Approach”


Working with Manufacturers and Sales Representatives

Report Writing

New Ways of Assessment and Data Gathering

Costs and Funding

Points to Remember


Chapter 13. Intervention and AAC

Anticipated and Desired Outcomes

Who Sets the Goals? The Client and the Community of Practice

Creating and Maintaining a Communicative Environment

Planning or Natural Development?

Evidence-Based Practice

Points to Remember


Chapter 14. AAC and the Community

The Community — or the Communities

Social Networks

Making Meaning Through Interaction

Multiple Challenges

Attitudes and AAC

Attitudes of Peers

The AAC User as a Member of Cultures

AAC Linguistic Diversity

AAC and the Family

AAC in Education

Educational Goals and Organizing the Classroom


Universal Design for Learning

Educational Practices and Opportunities

Post-High School

Transitions to Adult Life

AAC in the Workplace

AAC and the Development of Friendships

The Virtual Community

Communication Assistants


Connections with the World

Risk of Abuse

AAC Users and Research

Points to Remember


Chapter 15. The AAC Experience

What Does It Mean to Be an AAC User?

The Difference Made by the AAC Solution

The Uniqueness of the AAC Experience

A Community of AAC Users

Where Do I Get Help?

Discussions about What Works Best

The Broken AAC Device

The New and Better AAC Device — Or Not So Much Better


AAC as a Normal Phenomenon

Perspectives of Hope, Expectations, and Fears

Points to Remember


Appendix 1. AAC and Natural Speech

Appendix 2. Case Discussions

Appendix 3. Discussion and Debate Topics

Appendix 4, Speech-Language and AAC Assessment Protocol



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