Augmentative and Alternative Communication: From Novice to Expert Clinician

By John McCarthy, PhD, CCC-SLP and Aimee Dietz, PhD, CCC-SLP

Augmentative and Alternative Communication

Augmentative and Alternative Communication by John McCarthy and Aimee Dietz

Understanding the personal story of an individual who uses augmentative and alternative communication (AAC) can have a positive impact on the attitudes of people without disabilities toward that individual (McCarthy, Donofrio-Horwitz, & Smucker, 2010). Almost any AAC specialist has story after story of moments when they have helped reveal the true abilities of an individual through AAC:

• The eight-year-old boy with cerebral palsy who everyone assumed had below average intellectual ability and presymbolic language skills, was in fact bilingual.
• The forty-year-old woman with bulbar onset amyotrophic lateral sclerosis who cannot dress or feed herself, but still manages her finances, parents her children, and makes end-of-life decisions.
• The eighteen-year-old girl with autism spectrum disorder whose potential to contribute to society was doubted, yet planned for employment after high school and managed a new mobile device-based communication system.
• The fifty-two-year-old man with stroke-induced aphasia who medical staff assumed was “incompetent”; however, still made informed decisions about medical care and enjoyed friendly banter on the golf course with his adult sons. 

These examples illustrate the heterogeneous nature of people who can benefit from AAC and highlight the vast amount of knowledge a clinician is required to master to provide high-quality AAC services. Requisite knowledge includes the ability to understand how to enhance a person’s communicative strengths amid significantly impaired receptive and expressive language skills and cognitive abilities, and/or fine/gross motor challenges (Beukelman & Mirenda, 2013; Dietz, Quach, Lund, & McKelvey, 2012). Therefore, in a field where evidence and theory must merge with clinical practice, students need practical application of the material as well as access to AAC specialists modeling best practice in order to achieve their goal of becoming outstanding clinical professionals. AAC specialists can make intuitive leaps during the assessment and intervention process, but do not always reflect on their decision-making process (Benner, 1982, 2004; Dietz et al., 2012). In fact, many specialists find it difficult to articulate the steps that led them to a particular decision. This can be challenging for a student who needs help connecting the dots during an AAC assessment in order to plan an effective intervention program. Given the variability in exposure to AAC during clinical experiences, the sage insight of specialists can be especially useful in directing the decision-making skills of less experienced clinicians.

In the past, there have been case-based books in AAC (Beukelman, Yorkston, & Dowden, 1985; Light & Binger, 1999); however, there is a lack of current resources. Moreover, no multimedia resources are available on the topic of AAC assessment and intervention. The current generation of students has grown up in a world of readily available multimedia and has come to expect a variety of presentation modes. Furthermore, the range of individual disorders within AAC is far-reaching and busy, working clinicians may not have time to re-read textbook chapters. As such, working clinicians, who may also be changing the focus of their clinical work due to a change in position or a change in their job environment, need ready access to models of service delivery that will allow them to quickly catch-up on the specific areas of AAC practice in which they require further instruction. The Augmentative and Alternative Communication: An Interactive Clinical Casebook was developed out of this need for a current, multimedia resource in the AAC field.


Benner, P. (1982). From novice to expert. The American Journal of Nursing, 82(3), 402–407. doi: 10.2307/3462928

Benner, P. (2004). Using the Dreyfus model of skill acquisition to describe and interpret skill acquisition and clinical judgment in nursing practice and education. Bulletin of Science, Technology & Society, 24(3), 188–199. doi: 10.1177/0270467604265061

Beukelman, D., & Mirenda, P. (Eds.). (2013). Augmentative & alternative communiation: Supporting children and adults with complex communication needs (4th ed.). Baltimore, MD: Brookes Publishing Company.

Beukelman, D., Yorkston, K., & Dowden, P. (1985). Communication augmentation: A casebook of clinical management. Austin, TX: Pro-Ed.

Dietz, A., Quach, W., Lund, S. K., & McKelvey, M. (2012). AAC assessment and clinical-decision making: The impact of experience. Augmentative and Alternative Communication, 28(3), 148–159. doi:10.3109/07434618.2012.704521

Light, J. C., & Binger, C. (1999). Building communicative competence with individuals who use augmentative and alternative communication. Baltimore, MD: Brookes Publishing Company.

McCarthy, J. W., Donofrio-Horwitz, L. M., & Smucker, L. M. D. (2010). The effects of reading personal narratives written by an individual who uses AAC on the attitudes of pre-professionals in business. Augmentative and Alternative Communication, 26(2), 61–74.

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