AAC & Multimodal Communication

Rachel Madel is an LA based speech language pathologist dedicated to coaching parents and professionals on incorporating technology to best support speech and language development. Rachel presents both nationally and abroad on the use of augmentative alternative communication (AAC) devices for children with complex communication needs and coaches, clinicians, teachers and parents on integrating technology in classrooms and at home to support communication. She co-hosts a weekly podcast called ‘Talking With Tech' and creates educational resources, therapy materials and training videos to help support parents and professionals. Let's dive right into the conversation!

Tara: Hi Rachel, welcome to the show.

Rachel: I am so excited to be here!

Tara: So a lot of families and educators are new to having their child or their students start to use an AAC device. So can you tell people who are new to that term what it is and what it means?

What is AAC?

Rachel: AAC stands for Augmentative and Alternative Communication. It's any technology or tool that helps with communication. AAC devices can be used to support verbal speech or as an alternative for those who can't use verbal speech consistently. Some people have verbal speech, but it's hard to understand, so they need some type of backup system so that they're able to repair communication breakdowns or alternative meanings.

So having an iPad or a tablet that you touch a word and it says that word, that's a speech generating device, but it also includes all types of light tech, AAC. Pictures and communication boards and letterboards. It's kind of an umbrella term that encapsulates all those different modalities of communication.

Common Myths

Tara: You mentioned that when parents are first introduced to AAC, they struggle to understand it. In my experience, parents often just want their children to talk, believing AAC might replace or hinder speech. What are your thoughts on this myth?

Rachel: It's a common myth that AAC replaces speech. I often introduce AAC as visual supports in therapy to help parents feel more at ease. Later, when we discuss high-tech AAC, parents worry it will prevent their child from talking. However, research shows AAC can actually encourage verbalization. In my practice, I've seen that children often use the method that's easiest for them. Some use AAC part-time, switching between verbal speech and AAC as needed. By explaining this to families, they see that AAC supports, rather than replaces, verbal communication. We can work on AAC, gestural, and verbal communication simultaneously, supporting multimodal communication.

Tara: I think that's one of the things that has changed for me, being in the field for 23 years. We used to pick a system and stick with it. Now, hearing more and more about multimodal communication, it feels more friendly to parents, to the user, to everyone involved. We accept and honor whatever way they're communicating.

Modeling Without Expectation

Rachel: A common question from families is whether to use AAC if a child tries to speak verbally. We don't need to demand a different method; we can accept any form of communication. We can model language without expectation, acknowledging their gestures and attaching language to them. For children with complex communication needs, this often involves using AAC to enhance their gestural communication.

Tara: This is an important message for paraprofessionals and anyone working with children using AAC. If a child is clearly communicating, we should model without expectation. This approach relieves adults from feeling pressured to make the child use AAC in a different way or longer sentences. It shifts from adult-driven AAC to following the child's lead.

Rachel: Modeling without expectation often leads to the same results but through a different path. Children tend to imitate what they see without feeling pressured, even if they're having a tough day. This approach creates a language-rich environment with fewer demands. In my practice, I've learned that I don't need to push for communication; simply modeling can achieve the same outcomes. When we shift from demanding language to commenting, like saying “That brownie looks so yummy,” it encourages communication naturally.

Tara: Exactly, shifting from constant questioning to simply commenting is a significant improvement. What other common myths do you hear about AAC?

Why kids don’t have to “prove they are ready” for AAC

Rachel: A major myth is that some children aren’t “ready” for AAC, especially those with intellectual disabilities or low-incidence populations. This outdated belief, rooted in the past when high-tech AAC devices were costly and hard to access, no longer applies with the availability of iPads in classrooms. There’s no need to wait for a child to prove they can use technology; we can introduce AAC at any age. Just like early language development, AAC use involves exploration and practice. Kids don’t need to be perfectly accurate from the start. They can begin using AAC immediately, with accuracy improving over time as they practice and receive feedback.

Tara: A piece of that is presuming competence A few years ago, I recommended a device for a student transitioning to kindergarten, and the elementary SLP questioned my choice, assuming he wasn't ready. I was taken aback, but later, his mom shared a video showing him independently using his device to communicate “bowling alley,” which was actually a mislabeled McDonald's icon. This example highlighted how he was learning and experimenting with AAC, even if it took time to get it right.

Presuming Competence

Rachel: Effective AAC use takes time and requires creating opportunities that align with students' motivations. If a student isn't using AAC accurately or functionally, I assess whether they’re getting enough modeling and if the topics are engaging for them. Kids often need more exposure and excitement about what they're communicating. Instead of using irrelevant activities to gauge success, focus on what genuinely interests the child. Sometimes, their motivation might be to express dislike or to avoid tasks. Therefore, choosing motivating content is important when introducing AAC.

Tara: Even non-speaking three-year-olds who seem “not ready” can navigate their favorite songs on YouTube with an iPad. Finding and using motivating content is crucial. At the early childhood level, it’s important to ensure that AAC activities are engaging and not stressful for the child.

Rachel: When AAC is only used for academic tasks or mundane questions, it can seem unmotivating and lead to a lack of success. Instead, we need to focus on what excites and engages the child, as this will spark their motivation. Building a strong foundation of independent initiation in communication is crucial. If we only prompt responses, children become reliant on cues rather than developing their own communication skills. Teaching independent initiation opens up a broader vocabulary and more opportunities for meaningful communication.

AAC and PECS

Tara: I agree completely. Early PECs training emphasized initiation, but it was often adult-led. Now, the focus is on encouraging children to generate their own ideas and communication, not just respond.

Rachel: It's funny you mention PECS, which focuses on teaching initiation, but I find it easier to start with high-tech AAC systems that allow students to initiate communication directly, like by hitting “YouTube” on a device. Transitioning from PECS to high-tech AAC later seems inefficient since we eventually want kids to use all the features of advanced systems. Starting with high-tech AAC from the beginning can be more effective, as it aligns with the end goal of using a full-featured device for communication.

Tara: Then you have to teach a whole new system.

Different Types of AAC

Rachel: We're often behind on AAC implementation, missing valuable years of language learning due to a focus on speech. Once AAC is introduced, we need to use our time strategically with a long-term vision to make the most of this opportunity.

Tara: Given the use of PECS in the past, when might it be appropriate to use a communication book with pictures or single images for exchanges? Also, have you used such books and modeled their use in a less adult-led manner?

Rachel: Light-tech AAC, like communication books, has value, especially when starting before high-tech devices are available. However, I’m concerned about the adult-led, compliance-based approach of PECS, which can violate autonomy and may not always engage children effectively.

Motor planning is a key issue with PECS, as changing the order of pictures can make it difficult for kids to locate what they want to communicate. For example, like how you can easily find Instagram on your own phone but struggle on someone else's, children need consistent placement of symbols to develop motor plans.

Instead, using a communication board with consistent symbol placement can support motor planning and transition more smoothly to high-tech AAC. Modeling without expectation and focusing on motivation are also crucial for success.

I often use this analogy in my workshops: imagine using an AAC system with 70–100 icons but no labels. You’d end up pressing buttons randomly and listening to the sounds. Our non-literate students are doing the same thing with their devices, but we sometimes misinterpret this as non-functional use. Just like us, they’re exploring and figuring out the system without the benefit of reading labels.

How to get “buy-in” with AAC

Tara: How do you get buy-in from everyone in the child's environment when you start to use AAC? 

Rachel: Great question! The key to getting buy-in for AAC is building strong connections and understanding roadblocks. Start by building rapport with communication partners, as frequent but brief interactions can help. Ask targeted questions to uncover specific challenges, like time constraints or mindset issues. Focus on simplifying and achieving one success at a time to avoid overwhelming them. By listening well and addressing their concerns, you can help them feel successful and motivated to continue.

Tara: Absolutely, relationship building is key! It’s important for both engaging students and gaining support from colleagues.

Rachel: Fostering connections between a child and a communication partner, like teaching a mom to connect with her son, is the essence of our work. By integrating meaningful routines and setting achievable goals, we turn overwhelming tasks into exciting opportunities for connection and progress.

Connect with Rachel

Tara: As we wrap up, I want to highlight Rachel's online course, AAC Ally. It’s a comprehensive, step-by-step guide on conducting dynamic and collaborative AAC assessments and coaching communication partners.

I’m currently taking the course myself, and all I can say is—wow! It’s both affordable and packed with valuable, practical information. Rachel truly goes above and beyond to offer exceptional content. Is there anything specific you’d like to add about the course or its next enrollment period?

Rachel: Thank you so much for the kind words! We open the course a few times a year. You can sign up for the waitlist at rachelmadel.com or simply search for it online to get notified when enrollment opens.

Tara: Is it just for SLP's or could parents or special educators benefit?

Rachel: I’ve had a diverse range of participants take the course, including SLPs, parents, and teachers. While the course is primarily designed for SLPs and uses professional terminology, it has proven valuable to many different roles.

I’m also planning to develop a simplified version specifically for parents and paraprofessionals in the future. For now, if you take the course and feel it’s not valuable, I offer a money-back guarantee. Out of over 3,000 participants, only one has requested a refund, which speaks to the course’s effectiveness and value.

Tara: Where can they find you on social media?

Rachel: I'm RachelMadelSLP, and you can connect with me on Instagram, Facebook, and TikTok, where we share all sorts of AAC insights and resources. We recently launched our TikTok in January, so check out our reels there!

Visit my website, rachelmadel.com, where you’ll find the Freebie Vault with over 15 valuable resources. I also have a YouTube channel dedicated to breaking down AAC concepts into bite-sized videos that are perfect for families just starting with AAC.

Don’t miss our podcast, Talking with Tech, where my co-host Chris Bouguet and I explore various AAC and assistive technology topics each week. We often feature episodes with AAC users sharing their personal experiences, which I believe are the most impactful and insightful. If you’re new to the podcast, definitely check out these episodes for a deeper understanding of AAC from the user's perspective.

Tara: Well, thank you for sharing your expertise and just amazing ideas with us today!

If you'd like to listen to the podcast version, click here: Episode 24

Related Topics:

Multi-Modal Communication

AAC For Everyone

If you use visual supports in your classroom or home, you are going to want to sign up for this free Visual Supports Starter Set ASAP! Click here to have one sent to your inbox. Also, be sure to read more about visual supports and how they can help autistic children here.