Augmentative and Alternate Communication: Bringing communication to those who can’t speak

Ivanna Silva Perez
Wed, 19 Nov 2025 04:40:22 +0000
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New iPhone accessibility features include advanced text-to-speech options and face tracking. Credit: Daniel Bush | Campus Photo Editor

Under the harsh fluorescent lights of an emergency room, most people can verbally communicate their symptoms and severity of pain to a nurse.?

Those who cannot use their voice to communicate must rely on laminated paper boards decorated with words and pictures, pointing and nodding to get their message across.

These boards are one form of Augmentative and Alternative Communication (AAC). Despite how essential it is, AAC is still widely misunderstood.?

Amy Sonntag, a clinical professor for the Department of Speech and Hearing, who does research on this subject, said changes in the iPhone’s operating system now makes basic communication more accessible for people who need AAC.

“Apple has typically been on the forefront of creating accessibility features in phones and tablets,” Sonntag said. “I think it actually will rival some of what’s available in the commercially based AAC systems.”?

AAC devices are essential for a broad range of conditions, not just developmental or cognitive disabilities. Autism, strokes, ALS, aphasia, Parkinson’s disease and traumatic brain injuries are a few of the reasons why people may need another way to communicate, Sonntag said.?

AAC tools are mainly categorized into three groups, low-tech, mid-tech and high-tech.?

Low-tech tools can include paper boards with printed words, pictures and sometimes letters for patients to point out. Mid-tech devices, Sonntag said, can be battery-operated such as buttons with pre-recorded messages.?

The most advanced, high-tech devices have stronger processors and look like regular tablets or computers with customizable software.?

Quinn Baumgartner, a graduate student in speech and language pathology, said she sees the importance of personalized AAC tools firsthand in her work in the emergency room.

“No one in the ER is having a good night,” Baumgartner said. “If we can give kids the best communication possible in a scary moment, that matters.”

She also said that AAC is not limited to a singular type of user.

“AAC looks different on everyone,” Baumgartner said. “It’s just alternative communication that isn’t you vocally talking or using gestures.”

Still, misconceptions about the effects of AAC persist, Rachel Kickbusch, a graduate student in speech and language pathology, said.?

“Parents are scared to buy or acquire [AAC devices] for their kids because they’re scared it’s going to hinder their ability to communicate in the future,” Kickbusch said.

She said research shows exposure to an alternative form of communication supports a child’s development.?

Until now, most AAC technology has been restricted to specialized equipment, creating a cost barrier for many. This cost barrier is only covered by Medicaid and Medicare if a patient has the “correct” evaluation, and not always covered by private insurance.

This is especially frustrating for patients with ALS, a disease with a very predictable deterioration pattern, Sonntag said. Although a friend discovered it was possible to turn an iPhone into an AAC device, Sonntag said the process of making it work that way took over 50 steps to set up different shortcuts in the phone.

That changed with the release of the new iPhone operating system in September, Sonntag said.?

New features, including advanced text-to-speech options, improved customizable shortcuts and head-control, are now available on iPhones. Having these AAC tools directly in people’s pockets lowers the cost barrier for people who may need temporary or long-term communication support, she said.

This shift represents dignity for AAC users because, at its core, AAC is more than technological innovation, it’s about the universal desire to be heard, Sonntag said.?

“The really important thing that I’m trying to help people know is that you never know when you may not be able to speak,” Sonntag said. “One of my mentors, when I was really young and getting started, always said, we are all TABs, temporarily able-bodied.”