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Image of hands, bodies, and instruments around a face: Autism is a complex developmental disability.


Autism and Communication Challenges

Autism is a complex developmental disability which often impacts the acquisition of social and communication skills to varying degrees in affected individuals. Although there is significant variability in the severity of symptoms, many individuals with autism are nonverbal or demonstrate delayed or impaired communication skills. Since communication impairment is at the core of the autism syndrome, a body of research is developing focused on the development of effective communication interventions for this population. One area that holds promise for helping people with communication impairment is the use of augmentative and alternative communication (AAC) strategies.

What is Augmentative and Alternative Communication?

People with varying degrees of speech or language challenges rely on Augmentative and Alternative Communication (AAC) to supplement or replace non-functional speech. AAC includes all methods of communication that are used to express an individual’s thoughts, needs, hopes, desires, and ideas, with the exception of conventional oral speech and traditional writing. The idea behind AAC is to use the individual’s existing abilities, whatever they are, to compensate for their difficulties and to make communication as efficient, simple and effective as possible when speech alone does not work. AAC users are encouraged to use speech to the extent that they are comfortable and able, while simultaneously using various AAC aids and devices to enhance their communication.

It is important to note that there is not just one type of AAC.  Rather, AAC encompasses a whole range of different activities which includes facial expression, eye pointing, gesture, signing, symbols, spelling out a message on a letter board or computer, electronic speech output aids, etc. There are two main categories of AAC systems: unaided and aided. Most people who use AAC use a combination of unaided and aided methods.

Unaided AAC includes methods of communication that do not involve a piece of additional or external equipment. Body language, gestures, pointing, eye pointing, facial expressions, and sign language are each examples of an unaided method of augmentative communication.

Aided AAC includes methods of communication which do involve additional equipment, such as a picture chart, computer or special communication aid. Aided methods of augmentative communication are categorized as either ‘low-tech’ or 'high-tech’. Both low- and high-tech systems can be used by people who are unable to spell or read, by people who are literate, as well as by people who through increased exposure may learn to develop literacy.

Low-tech communication systems take many forms and do not require a battery to function. Low-tech communication systems include a pen and paper to write messages, alphabet charts, charts and books with picture symbols or photos, and tangible symbols.

High-tech communication systems are devices requiring at least a battery to operate. High-tech systems range from simple high-tech (e.g. single message devices, pointer boards, toys or books which speak when touched) to very sophisticated systems (e.g. specialized computers and programs, electronic aids which speak and/or print).

There is no single AAC system which works best for everyone. Each has its own pros and cons and the most suitable system for an individual will depend on personal preference as well as on specific skills, abilities and needs. As an individual’s abilities and skills grow, the methods or types of AAC used may evolve or change to suit his/her developing needs, skills and preferences. One AAC strategy that has been particularly useful for some individuals with autism is Facilitated Communication (FC). 

What is Facilitated Communication?

Facilitated communication is one of an array of augmentative and alternative methods of expression for people who cannot speak, or whose speech is highly limited (e.g. echoed, limited to one or a few word utterances), and who cannot point reliably. This method has been used as a means to communicate for individuals with severe disabilities, including persons with labels of mental retardation, autism, Down syndrome and other developmental disabilities.

The idea of facilitated communication is to make it easier for a person with a severe communication impairment to use a communication device, usually a portable aid that displays letters, words or pictures. The support varies, from assistance to isolate the index finger, support under the arm to slow down impulsive responses, pulling back on the arm after a selection, monitoring of eye hand coordination with reminders for the person to look at the target, or just a hand on the shoulder to convey confidence.

The idea behind facilitated communication is that a communication partner or trainer aids the individual to overcome neuro-motor problems that impede reliable pointing. Over time, the goal of facilitated communication is to help the person learn to communicate independently. This may require a combination of confidence building and improvement in physical skills of pointing.

Books about Facilitated Communication

A number of books and monographs describe the method and how to provide training as well as how to assess progress with the method. These include:

Biklen, D. (1993). Communication unbound. New York: Teachers College Press.

Biklen, D. & Cardinal, D. (Eds.) (1997) Contested words, contested science: Unraveling the facilitated communication controversy. New York: Teachers College Press.

Crossley, R. (1994). Facilitated communication training. New York: Teachers College Press.

Books that reveal the progress of individuals who first learned to communicate with facilitation include:

Biklen, D. (2005) Autism and the myth of the person alone. New York: NYU Press.
Crossley, R. (1997) Speechless. New York: Dutton.

Research on Facilitated Communication

Facilitated communication is controversial. This is because it has been shown that a facilitator’s physical touch of the typist’s hand or arm may influence a person’s pointing, and because a number of studies failed to validate authorship (Bebko, Perry, and Bryson, 1996; Bomba, O’Donnell, Markowitz, and Holmes, 1996; Cabay, 1994; Crews, Sanders, Hensley, Johnson, Bonaventura and Rhodes, 1995; Eberlin, McConnachie, Ibel, and Volpe, 1993; Klewe, 1993; Montee, Miltenbgerger, and Wittrock, 1995; Moore, Donovan, Hudson, Dykstra, and Lawrence, 1993; Regal, Rooney, and Wandas, 1994; Shane and Kearns, 1994; Smith and Belcher, 1993; Szempruch and Jacobson, 1993; and Wheeler, Jacobson, Paglieri, and Schwartz, 1993).

Other studies, using a range of test situations as well as linguistic analysis and documentation of physical, independent-of-facilitator typing have successfully demonstrated authorship (Broderick and Kasa-Hendrickson, 2001; Calculator and Singer, 1992; Cardinal, Hanson, and Wakeham, 1996; Emerson, Grayson, and Griffiths, 2001; Janzen-Wilde, Duchan and Higginbotham, 1995; Niemi and Karna-Lin, 2002; Rubin, Biklen, Kasa-Hendrickson, Kluth, Cardinal and Broderick, 2001; Sheehan and Matuozzi, 1996; Weiss, Wagner and Bauman, 1996; and Zanobini and Scopesi, 2001). The studies by Cardinal and his colleagues (1996), Sheehan and Matuozzi (1996), and Weiss, Wagner and Bauman (1996) all involved message passing experiments, but unlike many of the assessments in which individuals failed to demonstrate authorship, these included extensive testing sessions, with the possible effect of desensitizing the subjects to test anxiety. Other studies noted above in which individuals successfully demonstrated authorship employed unobtrusive assessments such as linguistic analysis and observations of independent typing after a period of facilitated typing.

Concerning the latter, Beukelman and Mirenda (1998) state, “in regard to a small group of people around the world who began communicating through FC (facilitated communication) and are now able to type either independently or with minimal, hand-on-shoulder support... there can be no doubt that, for them, (facilitated communication) ‘worked,’ in that it opened the door to communication for the first time.... For them, the controversy has ended” (p.327). In recent years, individuals who have begun to type independently have published autobiographical accounts (Blackman, 1999; Mukhopadhyay, 2000; Rubin, Biklen, Kasa-Hendrickson, Kluth, Cardinal, and Broderick, A., 2001) and one is featured in a research article on learning to speak after first learning to type (Broderick and Kasa-Hendrickson, 2001).

For more information about facilitated communication, visit the web site of the Institute on Communication and Inclusion.

Facilitated Communication Films

Inside the Edge: A Journey to Using Speech Through Typing

My Classic Life as an Artist: A Portrait of Larry Bissonnette

AAC Resources

AAC supports for engaging students with autism spectrum disorders (ASD) in group instruction
Joanne Cafiero

ABLEDATA Informed Consumer’s Guide to Funding Assistive Technology

Assistive Technology: Considerations for School Based Teams
Penny Reed

Augmentative and Alternative Communication (Chapter 12 of “Autism Solutions: How to Create a Healthy and Meaningful Life for Your Child”)
Ricki G. Robinson


Challenging our belief systems regarding people with autism and AAC: Making the least harmful assumptions
Joanne Cafiero


Complete Guide to Educational and Special Needs Apps

Considerations for Using Assistive Technology to Support the Educational Goals of Students with Autism Spectrum Disorders
Kerry Randle


Effects of Augmentative and Alternative Communication Intervention on Speech Production in Children With Autism: A Systematic Review
Ralf Schlosser, Oliver Wendt

Facilitated Communication Training
Rosemary Crossley

Funding Assistive Technology Through State Medicaid Programs
James Sheldon, Maureen O’Connell, Steven Elliott

Increasing Communication Skills in Students with Autism Spectrum Disorders: The AAC Technology Solutions
Joanne Cafiero

The Informative Pointing Method Manual
Portia Iversen

Key Concepts for Using Augmentative Communication with Children Who Have Complex Communication Needs
Linda Burkhart

Making It Work: Effective Implementation of Assistive Technology
Special Education Technology British Columbia

Mobile Devices & Communication Apps

Movement Differences and Diversity in Autism-Mental Retardation
Anne Donnelan and Martha Leary

Promising Innovations in AAC for Individuals With Autism Spectrum Disorders
Pat Mirenda

Research on the Use of Assistive Technology with Students with Autism Spectrum Disorders in British Columbia
Kerry Randle


The Roads to Autonomous Communication Using Aided Language            
Gayle Porter and Linda Burkhart

Speech Generating Device Funding for Children
Lew Golinker

Technology Supports for Individuals with Autism Spectrum Disorders
Joanne Cafiero

Therapeutic and Educational Applications for the iPad
Therese Willkomm, PhD, ATP & Nicole Finch


Toward Functional Augmentative and Alternative Communication for Students With Autism: Manual Signs, Graphic Symbols, and Voice Output Communication Aids
Pat Mirenda

Useful Websites



Alliance for Technology Access

Allison Keller iPad Program (Flutie Foundation)

American Speech-Language-Hearing Association

Anne McDonald Centre (formerly DEAL Communication Centre) Australia

Assistive Technology British Columbia

Assistive Technology Training Online Project (ATTO)

AT Connects

Augmentative and Alternative Communication (AAC) Institute


Closing the Gap

Georgia Project for Assistive Technology

Institute on Communication and Inclusion

Laurie Flutie Computer Initiative (Flutie Foundation)


National Assistive Technology in Education Network

Quality Indicators for Assistive Technology  

Rapid Prompting Method

Rehabilitation Engineering and Assistive Technology Society of North America

Special Education Technology- British Columbia (SET-BC)

Technology and Media Division of the Council for Exceptional Children

Technology for Autism Now

UW AugComm

Wisconsin Assistive Technology Initiative


Alliance for Technology Access (ATA). (2009). What is AAC? Retrieved August 21, 2009, from ATA Website:

American Speech-Language-Hearing Association (ASHA). (2009). Augmentative and Alternative Communication (AAC). Retrieved August 20, 2009, from ASHA Website:   

AAC Institute. (2009). What is AAC? Retrieved August 20, 2009, from AAC Institute Website:

Bebko, J., Perry, A., & Bryson, S. (1996). Multiple method validation study of facilitated communication: ii. individual differences and subgroup results. Journal of Autism and Developmental Disabilities, 26, 19-42.

Biklen, D. (1993). Communication unbound. New York: Teachers College Press.

Biklen, D. & Cardinal, D. (Eds.) (1997) Contested words, contested science: Unraveling the facilitated communication controversy. New York: Teachers College Press.

Biklen, D. (2005) Autism and the myth of the person alone. New York: NYU Press.

Bomba, C., O'Donnell, L., Markowitz, C., & Holmes, D. (1996). Evaluating the impact of facilitated communication on the communicative competence of fourteen students with autism, Journal of Autism and Developmental Disorders, 26, 43-58.

Broderick, A. A. & Kasa-Hendrickson, C. (2001). “Say just one word at first”: the emergence of reliable speech in a student labeled with autism. Journal of the Association for Persons with Severe Handicaps, 26, 13-24.

Cabay, M. (1994). Brief report: A controlled evaluation of facilitated communication using open-ended and fill-in questions. Journal of Autism and Developmental Disorders, 24, 517-527.

Calculator, S. & Singer, K. (1992). Preliminary validation of facilitated communication.
Topics in Language Disorders, 12, ix-xvi.

CALL (Communication Aids for Language and Learning) Centre. (2003). Augmentative Communication in Practice: An Introduction (2nd Edition). Edinburgh: The CALL Center.

Cardinal, D. N., Hanson, D. & Wakeham, J. (1996). Investigation of authorship in
facilitated communication. Mental Retardation, 34, 231-242.

Communication Matters/ISAAC (UK). (2009). Focus on… What is AAC? Retrieved August 20, 2009, from Communication Matters Website:

Crews, W., Sanders, E., Hensley, L., Johnson, Y., Bonaventura, S., & Rhodes, R. (1995). An evaluation of facilitated communication in a group of nonverbal individuals with mental retardation. Journal of Autism and Developmental Disorders, 25, 205-213.

Crossley, R. (1994). Facilitated communication training. New York: Teachers College Press.
Crossley, R. (1997) Speechless. New York: Dutton.

Eberlin, M., McConnachie, G., Ibel, S., & Volpe, L. (1993). 'Facilitated communication': A failure to replicate the phenomenon. Journal of Autism and Developmental Disorders, 23, 507-529.

Emerson, A., Grayson, A., & Griffiths, A. (2001). Can’t or won’t? Evidence relating to authorship in facilitated communication. International Journal of Language & Communication Disorders, 36 (Supp), 98-103.

International Society for Alternative and Augmentative Communication (ISAAC). (2009). About AAC. Retrieved August 20, 2009, from ISAAC Website: 

Janzen-Wilde, M., Duchan, J., & Higginbotham, D. (1995). Successful use of facilitated
communication with an oral child. Journal of Speech and Hearing Research, 38, 658-676.

Klewe, L. (1993). Brief report: An empirical evaluation of spelling boards as a means of communication for the multihandicapped. Journal of Autism and Developmental Disorders, 23, 559-566.

Lloyd, L.L., Fuller, D.R., & Arvidson, H.H. (1997). Augmentative and Alternative Communication: A handbook of principles and practices. Boston: Allyn and Bacon.

Montee, B., Miltenberger, R., & Wittrock, D. (1995). An experimental analysis of facilitated communication. Journal of Applied Behaviour Analysis, 28, 189-200.

Moore, S., Donovan, B., Hudson, A., Dykstra, J., & Lawrence, J. (1993). Brief report; Evaluation of eight case studies of facilitated communication. Journal of Autism and Developmental Disorders, 23, 531-539.

Niemi, J. & Karna-Lin, E. (2002). Grammar and lexicon in facilitated communication: A
linguistic authorship analysis of a Finnish case. Mental Retardation, 40, 347-357.

Regal, R., Rooney, J., & Wandas, T. (1994). Facilitated communication: An experimental evaluation. Journal of Autism and Developmental Disorders, 24, 345-355.

Rubin, S., Biklen, D., Kasa-Hendrickson, C., Kluth, P., Cardinal, D., & Broderick, A.
(2001). Independence, participation, and the meaning of intellectual ability. Disability & Society, 16, 415-429.

Shane, H., & Kearns, K. (1994). An examination of the role of the facilitator in 'facilitated communication', American Journal of Speech-Language Pathology, September, 3, 48-54.

Sheehan, C. & Matuozzi, R. (1996). Investigation of the validity of facilitated
communication through the disclosure of unknown information. Mental Retardation, 34, 94-107.

Smith, M., & Belcher, R. (1993). Brief report: facilitated communication with adults with autism. Journal of Autism and Developmental Disorders, 23, 175-183.

Szempruch, J., & Jacobson, J. (1993). Evaluating facilitated communications of people with developmental disabilities. Research in Developmental Disabilities, 14, 253-264.

Tuzzi, A., Cemin, M. Castagna, M. (2004) “Moved deeply I am” Autistic language in texts produced with FC. Journees internationals d’Analyse statistique des Donnees Textuelleds, 7, 1-9.

United States Society for Augmentative and Alternative Communication (USSAAC). What Is AAC Intervention and What Should It Include?Retrieved August 21, 2009, from USSAAC Website:

Weiss, M., Wagner, S., & Bauman, M. (1996). A validated case study of facilitated
communication. Mental Retardation, 34, 220-230.

Wheeler, D., Jacobson, J., Paglieri, R., & Schwartz, A. (1993). An experimental assessment of facilitated communication. Mental Retardation, 31, 49-60.

Zanobini, M. & Scopesi, A. (2001). La comunicazione facilitata in un bambino autistico.
Psicologia Clinica dello Sviluppo, 5, 395-421.

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