10-Minute Speech Practice That Doesn't Require Sitting Still

Last updated 2026-07-09

What does AAC device mean?

AAC stands for Augmentative and Alternative Communication. An AAC device is any tool that supplements or replaces spoken speech to let a person express themselves. "Augmentative" means it adds to whatever speech a person already has. "Alternative" means it substitutes for speech entirely when a person has none.

The American Speech-Language-Hearing Association defines AAC as "all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas" ^[1]. That definition is deliberately broad. It covers everything from a handmade board with symbols glued on to a $7,500 dedicated speech-generating device (SGD) that produces synthesized voice output.

The word "device" gets used loosely. Strictly speaking, a no-tech communication board is also AAC, but most parents searching for an "AAC device" want to know about electronic, voice-output options. That's where most of this article focuses, though the principles apply across the whole spectrum of tools.

One thing worth clearing up right away: using AAC does not stop a child from developing speech. Decades of research have found no evidence that AAC inhibits spoken language development, and several studies suggest it can actually support it ^[2]. This is the single biggest fear parents bring into an evaluation, and the evidence consistently points the other way.

What are the different types of AAC devices?

AAC tools fall into two broad categories: unaided and aided. Unaided AAC uses only the person's body: sign language, gestures, facial expressions. Aided AAC involves an external tool.

Aided tools then split into no-tech, low-tech, and high-tech.

Dedicated SGDs are devices built only for communication. They tend to be ruggedized, water-resistant, and carry stronger insurance billing codes. App-based systems run on a commercial tablet (usually an iPad) and cost far less upfront, but insurance funding is more complicated because the tablet has other uses.

Within high-tech systems, you also choose a language system: grid-based (rows and columns of symbols, like Proloquo2Go), motor-planning-based (consistent locations regardless of page, like LAMP), or vocabulary systems built around a full set of core words. The right system depends on the child's motor skills, cognitive profile, and what their SLP recommends. There is no universally "best" system.

Who needs an AAC device?

There is no single diagnosis that automatically qualifies or disqualifies someone. AAC is appropriate for any person whose ability to communicate through speech alone is not meeting their daily needs ^[1].

In children, the most common diagnostic groups that lead to AAC evaluation include:

• Autism spectrum disorder, especially nonspeaking or minimally verbal autism
• Childhood apraxia of speech (see our piece on childhood apraxia of speech)
• Cerebral palsy
• Down syndrome
• Rett syndrome
• Acquired conditions like traumatic brain injury or Landau-Kleffner syndrome

The phrase "minimally verbal" generally refers to children over age 5 who use fewer than 20 functional words ^[3]. But you don't have to be minimally verbal to benefit. A child who has words but can't sequence them fast enough to keep up in conversation may benefit enormously from AAC as a bridge. So can a child who speaks clearly at home but falls apart under stress at school.

AAC evaluation is a clinical decision made by a speech-language pathologist (SLP), ideally one with specific training in AAC. A pediatrician, teacher, or parent can raise the concern and request the evaluation, but the SLP runs it. If your child has an IEP, the school is required to consider AAC as an assistive technology option under IDEA ^[4].

Age is not a barrier. ASHA explicitly states there is no minimum age requirement for AAC. Some children receive AAC supports as young as 12 to 18 months.

How much is an AAC device?

Cost ranges widely depending on whether you're looking at a dedicated SGD or an app-based setup.

A dedicated SGD like a Tobii Dynavox device typically runs $5,000 to $8,500 before any funding. A high-end PRC-Saltillo device lands in a similar range. These prices feel shocking until you realize a fully funded device through Medicaid or private insurance can cost the family $0 out of pocket.

App-based setups are cheaper upfront. Proloquo2Go costs $249.99 in the App Store as of 2024 ^[5]. TouchChat HD with WordPower runs around $299.99. You still need an iPad, which adds $329 to $749 for a standard model. Total cost for an app-based system: roughly $600 to $1,100 without any funding.

School-provided devices through the IEP process cost the family nothing directly, though the device technically belongs to the school district.

Medicaid is the most reliable funder for dedicated SGDs. Most state Medicaid programs cover SGDs as durable medical equipment (DME) when a licensed SLP documents medical necessity. The documentation requirements vary by state, but the federal floor is set by CMS ^[6]. Private insurance coverage is less consistent: some plans cover SGDs explicitly, others treat them the same as DME with a prior authorization process, and some deny them outright.

Secondhand and loaner devices exist. Many AAC lending libraries (often run by state assistive technology programs funded under the AT Act) let families try devices before committing ^[7]. That's genuinely useful given how hard it is to know which system will work for a specific child without real-world trialing.

How do you get an AAC device for a child?

The path depends on whether you're going through school, insurance/Medicaid, or paying privately. Most families end up working more than one route at the same time.

Through the school (IEP route)

Request an assistive technology (AT) evaluation in writing. Under the Individuals with Disabilities Education Act, schools must provide AT devices and services if an IEP team determines they are necessary for the child to receive a free and appropriate public education (FAPE) ^[4]. The team includes the SLP, teachers, parents, and sometimes an AT specialist. If the team agrees AAC is warranted, the school provides and maintains the device. The downside: the device stays at school or goes home only if the IEP specifies it, and it belongs to the district, not the family.

Through Medicaid

This route requires a prescription from a physician and a detailed AAC evaluation report from an SLP documenting why the device is medically necessary. The SLP's report is the cornerstone of the funding request. CMS guidelines require that Medicaid cover SGDs when properly documented ^[6]. The process takes weeks to months. An SLP who specializes in AAC will know your state's specific requirements.

Through private insurance

Similar documentation requirements as Medicaid, but outcomes vary more by plan. Prior authorization is almost always required. Some families need to appeal an initial denial. Having the SLP write a detailed letter of medical necessity matters a lot here.

Privately

If funding falls through or the process takes too long, many families buy an app-based system on an iPad as an interim solution. At $600 to $1,100 total, it's not cheap, but it beats waiting a year for insurance approval while the child has no means of communication.

A good SLP who specializes in AAC is the single most important person in this process. They know the local funding landscape, the documentation requirements, and which systems are most likely to work for your specific child. Our article on speech therapy covers how to find a qualified SLP.

Does AAC work? What does the research say?

The evidence base for AAC is stronger than many parents expect, though it's also more nuanced than some advocates admit.

A 2006 research review published in the Journal of Speech, Language, and Hearing Research examined AAC interventions across multiple diagnostic groups and found consistent evidence that AAC supports communication development without suppressing speech ^[2]. A 2010 study by Romski and colleagues, one of the most cited in the field, concluded that AAC intervention facilitated speech production in toddlers with developmental disabilities, directly contradicting the assumption that devices kill the motivation to talk ^[8].

For children with autism specifically, a 2010 review of PECS (Picture Exchange Communication System, a structured AAC approach) found positive effects on communication and, in some studies, on spoken word production ^[9].

Nobody has perfect data on which specific AAC system produces the best outcomes. Study populations are small, children vary enormously, and blinding is impossible. The honest answer: the evidence strongly supports using AAC, is less clear on which system fits which profile, and consistently shows no harm to speech development.

A few things predict better outcomes. Starting early. Having consistent communication partners (parents, teachers) who model the AAC system themselves. And giving the child a full expressive vocabulary rather than a small set of "wants" buttons. That last point is a real clinical debate. Many older systems gave children only request words. Modern practice builds a whole vocabulary from the start.

For families working through autism spectrum speech therapy, AAC is increasingly considered a standard tool rather than a last resort.

What is aided language modeling and why does it matter for AAC success?

Aided language modeling (also called ALgS, or aided language stimulation) is the practice of communication partners using the AAC system themselves while they talk to the child. Instead of just handing the device to the child and waiting for output, the parent or SLP touches the symbols on the device as they speak naturally. "Let's eat lunch" becomes touching EAT and LUNCH on the board while saying the words.

This matters because children learn language by hearing it used in context. A child learning to speak hears thousands of hours of modeled language before producing much of it. AAC users need the same: seeing the system used in real communication before being expected to use it on their own. The input window is sometimes called the "language learning period" for AAC, and it can last months.

Research backs this up. A study by Drager and colleagues found that children with autism who received aided language modeling showed increased use of graphic symbols compared to those who didn't ^[10].

So parents matter as much as SLPs in making AAC work. A device left in a bag all week and pulled out only during a 30-minute therapy session will not produce the kind of consistent exposure that leads to independent use. The SLP teaches the child. The parent creates the thousands of repetitions in daily life that actually build the skill.

How is AAC different from a speech-generating device (SGD)?

Speech-generating device is the insurance and medical billing term for a high-tech AAC device that produces synthesized or digitized voice output. All SGDs are AAC devices, but not all AAC devices are SGDs.

The distinction matters mostly in funding contexts. When an SLP or physician submits a request to Medicaid or insurance, they use specific HCPCS billing codes for SGDs (the E2500 series codes) ^[6]. A low-tech communication board doesn't have an equivalent billing code for DME funding. An app on an iPad sits in a gray zone: the app itself might constitute AAC, but the iPad is a general-purpose device, which is why insurance often balks.

In clinical practice and everyday conversation, "AAC device" and "SGD" get used interchangeably when people mean electronic voice-output systems. If an SLP says your child needs an "SGD," they mean a high-tech AAC device with voice output.

Can a child with some speech still benefit from AAC?

Yes. This is one of the most persistent myths in the field: that AAC is only for children with no speech at all.

Many AAC users have some functional speech. They may use speech for simple, practiced phrases and AAC for more complex or novel messages. Some children use AAC during high-stress moments when speech breaks down but speak clearly in calm, structured settings. Children with apraxia of speech often have the language but can't reliably motor-plan the words out loud. AAC can support them while they keep working on speech production.

ASHA's position is clear: the goal of AAC is functional communication, not the elimination of speech. AAC and speech therapy are not competing treatments. They're typically used together ^[1].

The old "wait and see" approach, where families were told to hold off on AAC until it was clear speech wouldn't come, has been largely abandoned in current clinical practice. The cost of waiting (months or years of a child unable to communicate basic needs) is too high.

What about low-tech AAC like PECS or core word boards?

Low-tech and no-tech AAC are legitimate, effective tools. They're not stepping stones to "real" AAC. For some children, a well-designed core word board is the best long-term solution. For others, it's a starting point while waiting for device funding or while figuring out what high-tech system fits.

PECS (Picture Exchange Communication System) is a structured behavioral approach developed by Bondy and Frost. It teaches children to exchange a picture card for a desired item, then gradually builds toward longer messages. Research supports PECS for building functional requesting, particularly in children with autism ^[9].

Core vocabulary boards organize the most frequently used words (like "want," "more," "stop," "go," "help," "different") on a single display, giving access to words that are useful across many situations. The 25 to 50 most common words in English account for roughly 50% of everything we say, which is why core vocabulary boards can be surprisingly powerful even at low tech.

Making a basic core word board costs almost nothing. Boardmaker software (around $379/year) is the industry standard for creating symbol-based materials [see Tobii Dynavox], but free tools like SymbolStix previews or Smarty Symbols exist. A printed laminated board costs a few dollars.

If your child is waiting for a funded device, starting with a no-tech or low-tech system now is almost always the right call. Communication shouldn't wait for paperwork.

How does an AAC evaluation work?

An AAC evaluation is a specialized speech-language assessment focused on finding the right communication system for a specific person. It's different from a standard speech-language evaluation, and not every SLP has the training to conduct one well.

The evaluation typically includes: a review of existing records and diagnoses; observation of the child's current communication (what they can do, more than what they can't); assessment of motor skills (pointing, eye gaze, switch access); assessment of language comprehension; and feature-matching, where the SLP compares available AAC systems against the child's profile.

Feature-matching matters because there is no universally best AAC device. A child with good fine motor control and strong visual memory may do well with a grid-based system. A child with motor planning difficulties may do better with a system that keeps vocabulary in consistent locations. A child who will eventually use eye gaze technology needs a device that supports that access method.

Trialing the device is part of the evaluation. Most SLPs will not recommend buying a specific system without some real-world trialing. This is where state AT lending libraries earn their keep ^[7].

For families starting this process, early intervention services for children under 3 include assistive technology evaluation at no cost under IDEA Part C. For children 3 and older, the school district's special education process is the entry point ^[4].

If you want to supplement what the SLP is doing at home, apps like Little Words (littlewords.ai) are designed for parents to build early communication habits between therapy sessions, though they're not a substitute for a professional AAC evaluation.

What are the best AAC apps and devices in 2024?

There's no objectively best system. The right answer depends on the child. That said, certain systems dominate clinical practice and have the most research behind them.

Proloquo2Go (AssistiveWare) is probably the most widely used AAC app globally. It runs on iPad, uses the SymbolStix symbol library, and offers multiple language layouts including a core vocabulary scaffold. Cost: $249.99. Strong research base, large community of SLP users.

TouchChat HD with WordPower combines the TouchChat platform with WordPower vocabulary, developed by Nancy Inman. Good for users who can handle a word-based rather than purely symbol-based system. Cost: around $299.99.

Snap Core First (Tobii Dynavox) merges the old Snap and Core First apps. It's grid-based, symbol-supported, and integrates with Tobii's dedicated hardware. Available as an app or bundled with a dedicated device.

LAMP Words for Life (PRC-Saltillo) is built on the Language Acquisition through Motor Planning principle, keeping symbols in consistent locations to support motor memory. Often recommended for children with motor planning challenges, including apraxia. Available as an app or on dedicated hardware.

Dedicated devices from Tobii Dynavox, PRC-Saltillo, and Lingraphica tend to be the funded choice through Medicaid because they meet SGD billing requirements more cleanly than tablet-based apps.

For families weighing options, many SLPs recommend downloading 2-3 trial versions and spending a week with each before committing. Most major apps offer free trials or demo modes.

Frequently asked questions

What does AAC stand for?

AAC stands for Augmentative and Alternative Communication. "Augmentative" refers to tools that add to existing speech. "Alternative" refers to tools that replace speech when a person has none or very little. The term covers everything from picture boards to high-tech speech-generating devices that produce synthesized voice output.

At what age can a child start using an AAC device?

There is no minimum age. ASHA explicitly states that AAC can be introduced as early as 12 to 18 months when communication concerns are identified. Early intervention services under IDEA Part C (for children birth to age 3) include assistive technology evaluation at no cost. Earlier access to AAC is consistently associated with better communication outcomes.

Will using an AAC device stop my child from learning to talk?

No. This is the most common fear parents have, and the research consistently contradicts it. Multiple systematic reviews have found no evidence that AAC inhibits speech development. A 2010 study by Romski and colleagues found AAC intervention actually facilitated speech production in toddlers with developmental disabilities. AAC and speech therapy work alongside each other.

How much does an AAC device cost?

A dedicated speech-generating device (SGD) costs roughly $5,000 to $8,500 before funding. An app-based system on an iPad costs $600 to $1,100 total. Low-tech options like printed symbol boards cost under $50. Medicaid, private insurance, and school IEP funding can cover some or all of the cost depending on documentation and eligibility.

How do I get an AAC device funded through Medicaid?

You need a physician's prescription and a detailed AAC evaluation report from a licensed SLP documenting medical necessity. CMS requires state Medicaid programs to cover SGDs as durable medical equipment when properly documented. The process typically takes several weeks to months. An SLP who specializes in AAC will know your state's specific requirements and billing codes.

Can I get an AAC device through my child's school IEP?

Yes. Under IDEA, schools must provide assistive technology devices and services if the IEP team determines they are necessary for FAPE (free and appropriate public education). Request an assistive technology evaluation in writing. If the team agrees AAC is needed, the school provides and maintains the device at no cost to the family, though the device belongs to the district.

What is the difference between AAC and PECS?

PECS (Picture Exchange Communication System) is a specific structured approach to teaching AAC. A child learns to physically hand a picture card to a communication partner in exchange for a desired item, then builds toward more complex messages. PECS is a type of low-tech AAC. High-tech devices with voice output are also AAC but use different teaching approaches and vocabulary systems.

What is a speech-generating device (SGD)?

An SGD is a high-tech AAC device that produces spoken voice output, either synthesized text-to-speech or digitized recorded speech. SGDs range from simple single-message buttons to complex dynamic-display devices with thousands of vocabulary items. The term SGD is used in insurance and Medicaid billing (HCPCS E2500 codes) to distinguish funded devices from general-purpose tablets.

Does my child need a diagnosis to get an AAC device?

No specific diagnosis is required. AAC is appropriate for anyone whose communication needs aren't being met by speech alone. That said, a diagnosis often helps with insurance and Medicaid funding documentation. The key requirement for funding is an SLP's evaluation documenting that a device is medically necessary for the individual, not a specific diagnostic label.

What is aided language modeling?

Aided language modeling (ALgS) is when communication partners use the AAC system themselves while speaking to the AAC user. A parent touches symbols on the device as they talk naturally. Research shows this gives the child the same kind of language input that helps speaking children learn. It's considered the most important thing families can do to support AAC progress at home.

What AAC apps are available for iPad?

The most widely used AAC apps on iPad include Proloquo2Go ($249.99), TouchChat HD with WordPower ($299.99), Snap Core First, and LAMP Words for Life. Most offer free demo or trial modes. An SLP specializing in AAC should guide the choice based on the child's motor skills, language profile, and vocabulary needs rather than cost alone.

Can a child who has some speech still use AAC?

Yes. Many AAC users have some functional speech and use the device for more complex messages or during high-stress moments when speech breaks down. Children with apraxia of speech, for example, often have the vocabulary but struggle with motor execution. AAC can support them while they continue speech therapy. There is no requirement to be completely nonspeaking.

How long does it take to learn to use an AAC device?

There is no fixed timeline. Most clinicians describe a language learning period that mirrors how speaking children acquire language: months of input before consistent independent output. A child who receives daily aided language modeling from family and SLPs typically shows functional use within 3 to 12 months, though this varies widely by age, diagnosis, and consistency of support.

Where can I try an AAC device before buying it?

State Assistive Technology programs, funded under the federal AT Act, maintain lending libraries where families can borrow devices for trial periods at no cost. Most major AAC apps also offer demo modes. Your child's SLP should facilitate device trialing as part of the AAC evaluation process. Buying without trialing is almost always a mistake given the cost.

Sources

1. ASHA – Augmentative and Alternative Communication (AAC) overview: ASHA defines AAC as all forms of communication other than oral speech used to express thoughts, needs, wants, and ideas; states there is no minimum age for AAC
2. Millar, D.C., Light, J.C., & Schlosser, R.W. (2006). The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: A research review. Journal of Speech, Language, and Hearing Research, 49(2), 248–264.: Systematic review finding no evidence that AAC inhibits speech development and consistent evidence it supports communication
3. Tager-Flusberg, H., et al. (2009). Defining spoken language benchmarks and selecting measures of expressive language development for young children with autism spectrum disorders. Journal of Speech, Language, and Hearing Research.: Minimally verbal children defined as those over age 5 using fewer than 20 functional words
4. U.S. Department of Education – Individuals with Disabilities Education Act (IDEA), 20 U.S.C. § 1401: Schools must provide assistive technology devices and services if the IEP team determines they are necessary for FAPE; AT evaluation required under IDEA Part C for children birth to age 3
5. AssistiveWare – Proloquo2Go AAC app product page: Proloquo2Go listed at $249.99 in the App Store
6. CMS – Centers for Medicare & Medicaid Services, Speech Generating Devices (SGD) coverage policy, HCPCS E2500 series: CMS guidelines require Medicaid to cover SGDs as durable medical equipment when properly documented by a licensed SLP with a physician prescription; HCPCS E2500 series billing codes apply
7. ATAP – Association of Assistive Technology Act Programs, state AT lending libraries: State AT programs funded under the federal AT Act maintain device lending libraries for no-cost trial of AAC devices
8. Romski, M., et al. (2010). Randomized comparison of augmented and nonaugmented language interventions for toddlers with developmental delays and their parents. Journal of Speech, Language, and Hearing Research, 53(2), 350–364.: AAC intervention facilitated speech production in toddlers with developmental disabilities, contradicting concerns that devices suppress speech motivation
9. Flippin, M., Reszka, S., & Watson, L.R. (2010). Effectiveness of the Picture Exchange Communication System (PECS) on communication and speech for children with autism spectrum disorders. American Journal of Speech-Language Pathology, 19(2), 178–195.: Review finding positive effects of PECS on communication and, in some studies, on spoken word production in children with autism
10. Drager, K., et al. (2006). Effects of aided AAC interventions on AAC use, speech, and symbolic capacities of young children with autism spectrum disorders. Journal of Autism and Developmental Disorders.: Children with autism who received aided language modeling showed increased use of graphic symbols compared to those who did not
11. American Academy of Pediatrics – Autism Spectrum Disorder, communication and AAC guidance: AAP guidance supporting early AAC use as part of autism intervention and opposing 'wait and see' approaches to communication supports
12. U.S. Department of Health and Human Services – Assistive Technology Act of 2004, 29 U.S.C. § 3001: Federal AT Act funds state programs including device lending libraries and AT demonstration centers available to families at no cost