Someone, maybe a therapist, maybe a grandparent, has suggested picture cards, signs or a talking app, and you may be wondering: if we give our child another way, will they still learn to speak? It is a common fear, and one of the better-studied questions in this field.
The fear, stated fairly
The worry makes intuitive sense. Speech is hard for your child. If a sign or a button gets the juice box faster, why would they do the hard thing? Parents also hear that a device "labels" a child as non-speaking, or that a school will stop trying once the iPad appears.
The research does not support this intuition, partly because it treats communication as a single lane. It is not. Children who can communicate more, in any form, tend to get more responses, more back-and-forth, and more chances to hear the word they were reaching for.
What the evidence says
A 2006 research review of studies on augmentative and alternative communication (AAC) in people with developmental disabilities found no evidence that AAC decreased speech, and most participants showed some gain. 1
A 2008 systematic review focused on children with autism reached the same conclusion: AAC "does not appear to impede speech production and may result in increased speech production", with the caveat that gains are usually modest and vary between children. 2
A 2021 review that replicated and extended the 2008 one found that, overall, AAC resulted in improved speech production, and noted that when speech did grow it did not overtake the child's use of AAC. 3 In plain terms: in these studies the device did not act as a crutch, and it did not act as a cage either. Many children use whichever channel works in the moment.
Three reviews across fifteen years, all pointing the same way, is a consistent finding. The honest caveat is size: AAC is not a speech accelerator. It removes a barrier; it does not build the road for you.
Why it helps rather than hurts
- It lowers the stakes. A child who can already ask for water has less reason to melt down about it. Calmer children often have more attention left for language.
- It gives you something to model. When you press "more" while you say "more", your child sees, hears and can copy. Seeing and hearing a word modelled in context is one of the ways children learn first words.
- It makes communication visible. A symbol stays on the board; a spoken word is gone in a second. Many autistic children may process visual information more comfortably.
- It is speech-friendly by design. Devices say the word out loud every time. Your child hears the target word paired with meaning, many times over.
The kinds of AAC, in plain words
| Type | What it looks like | Good for |
|---|---|---|
| Gestures and signs | Pointing, "more", "all done", "help" | Any age, no equipment, works in the bath |
| Picture cards and exchange systems | Handing a card for a wanted item | Concrete requests, early stages |
| Core boards | A laminated board with 20 to 40 everyday words | Modelling while you talk; cheap; goes everywhere |
| Speech-generating devices and apps | A tablet that says the word when pressed | Full language over time; needs an SLP to set up well |
Most families end up with a mix. A good speech-language pathologist (SLP, orthophoniste in Quebec) will choose based on your child's motor skills, vision and interests, not on a rule.
What to do instead of worrying
Model, don't test. The single most useful habit is called aided language stimulation: you point to or press the symbol as you say the word, in real moments, and expect nothing back. "Let's go." "More bubbles?" "All done." Your child watches. Over time, many children begin to reach for it.
Keep talking. AAC is added to speech, never instead of it. Narrate, sing, wait, respond.
Start with words that do work. "More", "help", "stop", "go", "all done", "mine". Not colours, not animals. Children tend to take up a tool that gets them something.
Honour every attempt. If your child signs, points, hands you a card, or presses the wrong button but clearly means something, respond as if it were a sentence. Communication that gets a response tends to be repeated.
Tell the daycare. Give the CPE a copy of the board and three words to model. Consistency across settings helps.
In Quebec
Ask your CLSC for speech-language pathology; it can start through Agir tôt before a diagnosis. 4 Once your child is followed by the CIUSSS DI-TSA-DP program, ask specifically about AAC assessment. Public waits can be long, so if you can afford a few private SLP sessions, spend them on getting a board or device set up and learning to model, then carry it yourself. Confirm any coverage on the official pages before you plan around it. Who does what, including the difference between an SLP and an audiologist, is on Who does what.
Elsewhere in Canada, provincial programs vary; the same principle usually holds: an SLP sets it up, and the parent carries it into daily life.
Honest limits
Some children will use AAC as their main language for life, and that is a successful outcome, not a failed one. Some will speak and drop the device. Nobody can tell you in advance which, and having a way to communicate now is useful in either case. If your child had words and lost them, that is a separate question to raise promptly with a doctor: see Lost words.
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Sources
- The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: a research review (2006) ↩1
- Effects of augmentative and alternative communication intervention on speech production in children with autism: a systematic review (2008) ↩1
- Augmentative and alternative communication and speech production for individuals with ASD: a systematic review (2021) ↩1
- The Agir tôt program: early screening to better address children's needs ↩1
- Intellectual disability, autism spectrum disorder and physical disability services