The typical view in popular culture of someone who uses augmentative and alternative communication is generally that of an adult impacted by a global motor impairment. Certainly this is at least partially due to the visibility of Stephen Hawking, who uses AAC as a result of amyotrophic lateral sclerosis, or ALS (also referred to as motor neuron disease). There are a great many other individuals who use – or could benefit from using – AAC.
One way that Speech-Language Pathologists think about communication disorders is in terms of their etiology – essentially the “when and why” of a disorder. There are essentially three etiologies to consider: Disorders that are congenital (you’re born with them, like Autism Spectrum Disorder), acquired (like a head injury), or degenerative (like ALS). These etiologies are relevant because they have an impact on what we are trying to accomplish with AAC. With congenital disorders our goal is to habilitate the user, meaning that we’re teaching them skills they haven’t had before. With acquired disorders we instead seek to rehabilitate; our goal is to replace or restore an ability that was once there. In cases where communication disorders are degenerative, we seek also to rehabilitate but also to preserve existing ability as long as possible while we also begin to employ AAC.
Common congenital causes of communication disorders among individuals who can benefit from AAC are Autism Spectrum Disorder, Downs Syndrome, Cerebral Palsy, intellectual disability, motor speech disorders like childhood apraxia of speech, and a whole host of what we call “low-incidence” disorders (meaning they don’t occur often) like Rett syndrome or Angelman syndrome. Acquired causes of communication disorders are almost always the result of brain injury, whether through a cerebrovascular accident (stroke), cancerous growth, or trauma. Degenerative causes of communication disorders can also often be thought of as congenital, in that individuals are born with them but they do not become symptomatic until later in life. This type includes amyotrophic lateral sclerosis, muscular dystrophy, Huntington’s disease, Parkinson’s disease, and others.
When someone you know begins using an AAC device, it can feel like there’s nobody else out there like them, which can be a very lonely experience. Just remember that AAC is used by millions of people for very different reasons, and is no less valid a method of communication than any other! Typical speech, after all, is really just the ability to squirt air through our face.