ABA and AAC Devices: Building Communication Together
In short: ABA therapy uses positive reinforcement to teach communication, while AAC devices provide a voice for those who are non-verbal or have limited speech. Together, they can help build functional communication skills, with ABA therapists often incorporating AAC into sessions. Many insurance plans, including Medicaid, cover ABA therapy with AAC support.
Key takeaways
- AAC devices range from low-tech picture boards to high-tech speech-generating tools that supplement or replace spoken language.
- ABA therapy uses evidence-based strategies like prompting, shaping, and reinforcement to teach effective AAC use.
- Using AAC does not delay spoken language; research shows it often enhances speech development in many children.
- A board-certified behavior analyst (BCBA) can conduct a functional communication assessment and design an AAC integration plan.
What Are AAC Devices?
Augmentative and Alternative Communication (AAC) refers to all the ways someone communicates besides talking. AAC devices are tools that help people express themselves when speech is difficult or not yet developed. They range from simple picture exchange systems to sophisticated speech-generating tablets. For many autistic individuals, AAC opens a door to connection, reducing frustration and building independence.
AAC is often divided into two main categories: unaided (using sign language, gestures, or facial expressions) and aided (using external tools like picture cards, communication boards, or electronic devices). In ABA therapy, both low-tech and high-tech AAC are commonly used to establish functional communication.
🔗 Related reading: Transition to Adult Autism Services in California · Find ABA Near Me
How ABA Therapy Supports AAC Use
ABA therapy is grounded in understanding behavior and how learning happens. When it comes to AAC, a BCBA will assess a learner's current communication skills and identify what motivates them. The therapist then uses positive reinforcement to teach AAC use step by step.
The Science Behind ABA and AAC
AAC is not just given to a child and expected to work. Instead, ABA techniques shape the behavior of using the device. For example:
- Prompting: A therapist might physically guide a child's hand to touch a picture symbol, then fade the help over time.
- Shaping: Reinforcing closer and closer approximations to the correct AAC selection.
- Differential reinforcement: Rewarding successful communication attempts and ignoring challenging behaviors.
This systematic approach ensures that AAC becomes a reliable tool that the learner uses spontaneously in real-world settings.
Building Functional Communication
The ultimate goal is functional communication - using AAC to request, comment, protest, ask questions, and socialize. ABA sessions often target specific communicative functions, such as requesting a preferred item or asking for help. Over time, the learner generalizes these skills across people, places, and contexts.
Types of AAC Devices Used in ABA
There is no one-size-fits-all AAC solution. The best device depends on the individual's motor, cognitive, and language abilities. Here are common types used alongside ABA:
Low-Tech AAC
- Picture Exchange Communication System (PECS): Learners hand pictures to a partner to communicate. PECS is often taught in ABA programs because it is clear, portable, and easy to reinforce.
- Communication boards or books: Static displays of symbols arranged by category (e.g., food, feelings).
- Visual schedules and choice boards: Help with transitions and decision-making.
High-Tech AAC
- Speech-generating devices (SGDs) like dedicated tablets (e.g., from Tobii Dynavox) or iPads with communication apps (e.g., Proloquo2Go, TouchChat).
- Eye gaze systems for individuals with limited motor control.
- Smart speakers or simple button-based devices for single-message recording.
High-tech devices often require more systematic teaching from a BCBA, but they offer flexibility and a natural voice output that peers may understand more easily.
🔗 Related reading: Does Private Insurance Cover ABA in Illinois? · Get ABA Therapy
How to Get Started with AAC and ABA
Introducing AAC begins with a proper assessment. Here is what families can expect:
The Role of the BCBA and Speech-Language Pathologist
Ideally, a BCBA works alongside a speech-language pathologist (SLP) who specializes in AAC. The SLP may conduct an AAC evaluation to recommend specific devices or apps. Then the BCBA creates an ABA behavior plan that incorporates the AAC tool. This collaboration ensures both the device selection and the teaching strategies are evidence-based.
Steps for Families
- Seek an AAC evaluation through a qualified SLP or a clinic that offers AAC assessments.
- Work with a BCBA who has experience with AAC. Apply for ABA can connect you with vetted providers in your area that integrate AAC into their programs.
- Trial devices before purchasing. Many clinics have loaner devices or app demos.
- Set realistic goals with the BCBA, starting with a few highly motivating words or phrases.
Costs, Insurance, and Medicaid Coverage
AAC devices and ABA therapy can be expensive, but many families have strong insurance coverage. Under federal law, insurance plans that cover ABA often also cover AAC when it is deemed medically necessary.
Insurance Coverage for ABA and AAC
Most state-regulated health insurance plans, as well as many employer-sponsored plans, cover ABA therapy for autism. Many also cover a portion of AAC device costs, especially when prescribed by a physician and supported by an SLPs report. It is common for insurance to require a prior authorization for high-tech devices.
Medicaid and State Programs
Medicaid programs in every state cover ABA therapy for eligible children, and many also fund AAC devices. For example, California's Medi-Cal and Texas's STAR Kids both include AAC coverage under their EPSDT benefit (Early and Periodic Screening, Diagnostic and Treatment). Families should check with their state's Medicaid office for specific policies. Apply for ABA can help you find providers who accept Medicaid and have experience navigating these funding sources.
Private Insurance Tips
- Obtain a letter of medical necessity from your BCBA and SLP.
- Ask the device manufacturer about insurance billing assistance.
- Appeal denials; many are overturned when proper documentation is provided.
Common Misconceptions About AAC and ABA
Several myths can stop families from exploring AAC. Let's address them:
"AAC Will Prevent My Child from Learning to Talk"
Research shows the opposite. Using AAC often supports speech development by reducing pressure and providing a clear model of communication. Many children begin to vocalize more after AAC is introduced.
"AAC Is Only for Nonverbal Individuals"
AAC can benefit anyone with limited verbal ability, including those who are minimally verbal or have speech that is difficult to understand in certain settings. It can also be used as a temporary bridge.
"ABA Therapy Doesn't Use AAC"
On the contrary, ABA has a long history of teaching communication through augmentative systems. Many BCBAs are well-trained in PECS, verbal behavior approaches, and device-based instruction.
Practical Tips for Building Communication Together
Here are actionable strategies for families and therapists using AAC and ABA together:
- Model, model, model: Use the AAC device yourself during interactions. If you want your child to request a cookie, tap the cookie symbol while saying "cookie."
- Keep it motivating: Program preferred items and activities into the device first. Fun and access are powerful reinforcers.
- Use natural opportunities: Embed AAC practice into daily routines like meals, play, and bedtime. ABA goals should generalize to real life.
- Be patient with errors: Mistakes are part of learning. The BCBA will guide you in error correction without frustration.
- Celebrate every attempt: Any communication is a win. Reinforce all efforts, whether it's a touch, a vocalization, or a picture exchange.
If you're ready to explore how ABA therapy can incorporate AAC for your family, Apply for ABA is a free service that connects you with BCBA-led providers who have experience in communication programming. Simply fill out our matching form to get started. Building communication together is possible - and the right support makes all the difference.