DIR® Dialogues: The DIR® Approach to AAC

PHOTO CREDIT: Nicola Barts

Episode 324

In this episode we are discussing the use of alternative and augmentative communication (AAC) with five speech-language pathologists who practice DIRFloortime®.

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This Episode’s Guests

Returning guest, DIR-Expert Paula Pacheco, holds a master’s degree in developmental psychology, and holds a PhD from the University of São Paulo, where she conducted research within the DIR® model. She is now beginning her postdoctoral research, also focusing on research within the DIR® model. She is also a DIRFloortime® supervisor in the United States and Portugal. She runs a development center in Brazil called Great Kids where around 100 children undergo DIRFloortime® therapy. She has also translated my book, We Chose Play: Raising an Autistic Child to Thrive and Feel Understood into Portuguese!

First time guest, DIR-Expert Vikki Skarlopoulou is the Clinical Director of a paediatric practice in Athens, Greece, offering therapy based on the DIRFloortime® approach. Her professional areas of expertise include augmentative and alternative communication (AAC), autism, and selective mutism. She is also the founder of AAChellas, an organization dedicated to raising awareness of AAC and promoting access to effective communication support in Greece.

Erin Forward is a full time DIRFloortime® Expert and Training Leader with ICDL, founder of Nourishing Connection LLC, and host of the Rooted in Connection podcast. Her work focuses on feeding, communication, neurodiversity, and the caregiver-child relationship through a developmental, relationship-based lens.

First time guest, Carina Webster, is a neurodiversity-affirming DIR® speech-language therapist at Irvine Therapy Services in California. Her approach is rooted in connection, curiosity, and celebrating every child for exactly who they are. She views therapy as a true partnership, working closely with caregivers to create a safe and relational atmosphere, where communication can naturally grow and each child’s strengths truly shine.

Dr. Joleen Fernald is a DIRFloortime® Expert and Training Leader and owner of Joleen R. Fernald Pediatric Therapy Services, a DIR® accredited practice specializing in Selective Mutism in the Tampa Bay area. She is also co-founder of Reconnections Education Center and REConnections DIR® Center, providing neurodiversity-affirming education, therapy, and caregiver support. Dr. Jo is the creator of the DIR® Selective Mutism Card Deck, published by Bjorem Speech, which we’ll hear more about in Episode 325.

Understanding Communication Beyond Speech

Communication does not start only when a child develops spoken language. Children are communicating from birth through gestures, facial expressions, movement, sounds, scripts, behaviour, music, and other forms of expression. Paula provided an example of a client who communicates through music by finding songs or videos that express what he wants to convey. Rather than focusing exclusively on whether a child is producing words, parents are encouraged to become curious about what their child is already communicating and to look for meaning in those less obvious forms of expression. From a DIRFloortime® perspective, communication is not something a child earns by reaching a developmental milestone, Vikki says. It is about understanding how the child already communicates and expanding opportunities for connection.

AAC Is Not a Last Resort

AAC should not be viewed as something introduced only after spoken language has failed to develop. There are no cognitive, behavioural, or linguistic prerequisites for AAC, and DIR’s emphasis on presuming competence and meeting a child where they are developmentally supports making communication accessible from the beginning. AAC encompasses much more than speech-generating devices. Erin stresses that gestures, facial expressions, sign language, pictures, writing, typing, and other forms of communication can all be considered AAC. The goal is not to replace a child’s existing communication but to expand the ways they can connect, express themselves, and be understood.

Valuing Every Form of Language

Each of this episode’s guests stress the importance of placing equal value on all forms of communication rather than automatically treating spoken words as superior. A child’s facial expression, body movement, gesture, sound, or device may communicate something meaningful, and children with complex profiles may use different combinations of these modalities depending on their regulation, environment, and circumstances. This is a fluctuating capacity because the way a child communicates can change from moment to moment or from one setting to another. We must understanding each individual’s unique sensory, motor planning, and regulation differences in order to support their communication.

Beyond Verbal Speech

Joleen shared how she wonders with families why verbal speech is the goal. Parents may understandably want their child to talk because everyone else talks, because speech seems more efficient, or because they see it as a universal form of communication. It’s important to understand where the parents are coming from in order to examine those assumptions while recognizing that gestures, affect, body orientation, and other forms of communication are already valid and meaningful. For children who experience Selective or Situational Mutism, anxiety, stress, and nervous-system regulation can affect access to spoken communication. The issue is not necessarily that a child is choosing not to speak. In some situations, they physically do not have access to oral speech at that moment.

When Should AAC Be Introduced?

Carina rejects the idea that children need to demonstrate certain developmental skills before they can access AAC. She described a child whose periods of shared engagement were brief and interrupted by movement for regulation. On paper, this could have been interpreted as meaning that the child was not “ready” for AAC. Yet, once he received a device incorporating his interests in vehicles and colours, the device became a powerful way for him to engage in back-and-forth exchanges and share his passions with Carina. Rather than being something that came after developmental progress, AAC actually became a pathway into connection and relationship for them.

There Is No One-Size-Fits-All AAC System

A DIR® practice mandates that AAC needs to be individualized. A speech-generating device may be useful for one child, while another may prefer typing, writing, sign language, pictures, or lower-tech options. Even within high-tech AAC, individual differences in visual processing, sensory systems, motor planning, praxis, and regulation can influence how a child can best access the system. We want to introduce communication tools without assuming that a child must use them in a particular way, while remaining curious about what the child finds meaningful, Vikki explains.

Culture, Resources, and Family Capacity Matter

Access to technology, school resources, family finances, cultural attitudes, and the capacity of parents and caregivers can all affect what is practical. Paula discussed working in Brazil, where many families cannot afford tablets or where schools may not provide AAC support. Erin also shared that parents can become overwhelmed when AAC is presented as yet another thing they must learn and manage. Supporting the family therefore means not only teaching them about AAC but also helping them notice and understand their child’s existing communication, while avoiding inadvertently adding guilt or pressure.

Gestalt Language Processing and AAC

DIR® practitioners look at the whole child. Gestalt Language Processing can be an important individual difference, but it does not replace attention to development, regulation, relationships, and the child’s broader communication profile. AAC can incorporate a child’s existing gestalts alongside core vocabulary rather than trying to eliminate or replace those scripts. The purpose of AAC is not to change how a child communicates or learns, but to build on what is already meaningful to them.

AAC Doesn’t Have to Sound Like Spoken Language

Another important misconception that Joleen addresses is the expectation that AAC users should communicate in exactly the same grammatical form as someone using spoken language. A child might communicate “cookie, please” through signs or a much simpler combination on an AAC system, and that does not make the communication less meaningful, she argues. The purpose of communication is to convey ideas, emotions, experiences, requests, protests, humour, and connection, not to reproduce the exact structure of spoken language. Whatever modality a person uses, communication partners have a responsibility to recognize and respect its intentional meaning.

Relationship Comes Before the Device

Throughout this episode, you heard us repeat the importance of relationships. Parents sometimes worry that understanding a child’s gestures or responding when they know what their child wants means they are “giving in,” but this is being a safe and responsive communication partner. Likewise, a child may use a device at school but not want to use it at home because they are tired or dysregulated, but it could also be because their parent already understands their communication without it. AAC should support the relationship rather than become something that interferes with moments of connection.

Learning AAC Takes Time

Joleen compared learning AAC to learning a second language. Caregivers and children may need substantial time to become comfortable with a new communication system, and simply handing a child a device and expecting meaningful sentences within a few months may create unrealistic expectations. Just as spoken language develops through years of exposure and practice, learning to communicate through AAC can take considerable time. Joleen emphasizes allowing children to explore, experiment, and develop their own relationship with the system rather than judging its success too quickly, like school systems can sometimes do.

Follow the Child’s Lead

Erin shared a story of a non speaking client who was given access to an AAC device and unexpectedly became interested in its keyboard. Erin followed his interest. He began spelling words related to movie credits, eventually allowing her to type alongside him and later using the device herself to communicate. It is so important to provide access without imposing assumptions about what communication “should” look like. Sometimes the child’s interests reveal a communication pathway that the adult could not have predicted, Erin stresses.

Communication Can Also Be Regulating

I shared that maybe a child may repeatedly type a letter or word, make a particular sound, create a rhythm, or use another form of communication simply because it is enjoyable or regulating. Rather than immediately asking what the behaviour is “for,” Carina encouraged us to be curious about why it might be meaningful. Perhaps the sound, rhythm, memory, or experience is exciting or calming. From a DIR® perspective, regulation itself can have a communicative dimension, and recognizing that can create another opportunity for connection, she offered.

Making AAC Accessible for Motor Differences

For children with challenges with motor planning or apraxia where there is a brain-body disconnect, choosing an AAC system involves considering how the child physically accesses it, Erin offers. Joleen recommends working collaboratively with occupational and physical therapists to consider posture, visual access, motor planning, crossing the midline, and other physical factors. Some speech-generating systems use consistent locations for vocabulary so that the motor pattern required to find a word remains stable, Joleen explains. The goal is to make communication as physically accessible as possible rather than assuming that difficulty using a system reflects a lack of understanding or interest.

Rethinking What “Functional Communication” Means

Carina questions who gets to decide whether an AAC system is being used “functionally” or meaningfully. If a child uses AAC to make jokes, comment on something they love, repeat a favourite word, protest, or simply explore something interesting, that communication may be deeply meaningful to them even if it does not look functional from an adult perspective. Is the communication truly meaningless to the child or simply not meaningful to the adult, Carina suggests discussing. When adults follow the child’s interests and share in that meaning, they create more opportunities for humour, protest, commenting, connection, and increasingly complex communication.

I’m grateful to Paula, Vikki, Erin, Carina and Joleen for their time in recording this DIR® Dialogues episode. If you found this episode helpful and informative, please consider sharing it on social media!

Until next time, here’s to choosing play and experiencing joy every day!