Alternative and augmentative communication

  • After a brain injury, some children may have significant problems with speech or language. These children may need extra help to communicate better and more effectively. A speech pathologist may be able to recommend a communication device to help with communication.

    What is an augmentative communication device?

    Augmentative communication means to add to or supplement a child's current ways of communicating. A child's communications include any type of speech, gestures and/or writing abilities they may already have. There are several types of augmentative communication devices, ranging from very simple signs or gestures to high-tech electronic systems.

    Some examples of augmentative communications systems are:

    • signs and gestures
    • symbols - pictures, tactile feeling boards, real objects, printed words
    • light/low technology systems - communication books/boards and switches
    • high technology systems - speech output systems, sound picture boards and computers.

    Who selects the best communication aid for my child?

    Different types of systems may be useful for your child, depending on the nature and severity of their communication problems. Communication problems often change from the early stages of recovery through to the final stages of recovery. Therefore, the type of communication system needed by your child may change.

    Selecting the best communication system for a child involves a very thorough evaluation and assessment. The assessment is usually done by a speech pathologist. Sometimes other health professionals, including an occupational therapist, communication technologist or even an engineer, are also involved.

    Several factors may influence the type of system chosen:

    • vision problems
    • memory
    • ability to learn new things
    • attention span
    • any physical disability
    • fine motor skills - the ability to make small movements
    • ability to access a computer
    • previous knowledge or use of technology
    • the environment - including any factors which may affect the use of a system
    • the child's mobility and the size of the device
    • how many people the child needs to communicate with and how often
    • how long the system may be needed

    If a long term or high technology device is needed, your child may be referred to a specialist outside agency. This assessment may involve a team of professionals and may be done at the rehab centre, at home or at school. Specialist services generally provide assessment and trials of different symbol or electronic devices. They will then recommend the most suitable system for your child. These services do not provide ongoing therapy or follow up. There may also be a fee for these assessments.

    All children and their families, teachers and/or carers will need some training. This ongoing training and therapy is usually provided by your local speech pathologist.

    Key points to remember

    • Always consult a speech pathologist if you have any concerns about your child's speech and language.
    • Augmentative communication devices add to or supplement a child's existing communication skills.
    • Communication problems often change as a child recovers and so the type of communication system your child will need may change.
    • All children and their families will need some training to effectively use their communication system.

    For more information


    Developed by The Royal Children's Hospital Paediatric Rehabilitation Service based on information from the Brain Injury Service at Westmead Children’s Hospital. We acknowledge the input of RCH consumers and carers.

    Reviewed September 2020.

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit


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