AAC and intellectual disability

Intellectual disability (ID) includes difficulty understanding, learning new things and solving problems. In the past, other labels have been used for ID, for example, mental handicap and mental retardation. ID often occurs with other disorders such as Down syndrome and cerebral palsy. ID varies in severity from person to person and can range from mild to severe.

Some people who have an ID have little or no speech. These people may use a range of communication strategies.  For example they may use facial expression, body language, gesture, vocalisations, speech-attempts, communication displays, and/or voice output communication aids.  AAC may also be used to help someone who has an ID to understand other people.

AAC and intellectual disability in early intervention

Early intervention can help children who have an ID to develop their communication skills.  Early intervention may refer to informal therapy activities carried out by a family member at home, or more formal programs run by trained professionals.  Early intervention programs generally see children up to the age of six years.  They may be based at a school, a centre or therapists may see individual children in their homes.  People involved in early intervention programs might include teachers, speech pathologists, occupational therapists, psychologists, physiotherapists and other professionals.

When a child is slow to develop speech or if speech is difficult to understand, he or she might be introduced to AAC. This may be aided or unaided or a combination of both. No matter which method of communication the child is using, he or she needs to see others use it too.  A good time for developing a child’s communication skills is during play and routine activities.  The AAC system selected for each child will depend on his or her physical and intellectual abilities.  Communication strategies might include facial expression, body language, gesture, vocalisations and speech.  The child may be introduced to key word sign (Makaton) or the use of electronic or non-electronic communication aids.  Aided methods might include using objects, photos, pictures and line drawings for choice-making and other communication.  Children at this age generally cannot read and spell.  This means that they usually do not use communication aids that display words or letters of the alphabet.

AAC and intellectual disability at school

Some children who have an ID attend mainstream schools, while others attend special schools.  Children who have an ID may use a range of communication strategies at school.  The communication strategies used will depend on the child’s skills and abilities.  Strategies might include speech, vocalisations, facial expressions, body language, key word sign (Makaton), communication displays and/or voice output communication aids. 

Aided and unaided AAC strategies are also useful to help the child to understand others.  When communication partners use key word sign (Makaton) and gesture to accompany their speech, the child sees and hears what is wanted. When communication partners point to objects, pictures, photos or line drawings, the child is able to learn more quickly. This is called modelling and it is the way we all learn new skills.

If possible, the child will learn literacy and numeracy skills at school. Sometimes an academic curriculum is too hard for a child with an ID. Instead the child may be taught more practical skills based around the activities of daily living such as cooking, shopping and personal care. If the child does not develop literacy skills, other strategies are used to support their learning such as photo or picture-based books and activities.

AAC and intellectual disability beyond school

Most adults who have an ID live in the family home.  Others live in shared housing or supported accommodation.  Supported accommodation facilities, such as community residential units, can also provide respite care for people who normally live at home.  Some people who have an ID and live at home spend time in day centres, which provide care and recreational options for people who have disabilities.  Other people who have an ID are in the paid work-force.

In supported accommodation and day centres, visual supports (eg. objects, photographs, line drawings) can be used to help people who have an ID to understand. When selecting AAC strategies, it is important to consider the individual’s ability to recognise and understand speech, photos, line drawings and/or text.  For example, some people may understand that photographs represent an item, but may not understand that the printed word represents the same object.  This is because words are more abstract than photographs or objects. For someone who does not understand text alone, objects, photographs or line drawings can be used instead.

Routines may be used as an opportunity for interaction and communication.  For example, a routine such as washing clothes may be broken down into small steps, and completed in the same order each time. Each step in the task may be accompanied by a photo.  With a consistent routine, such as this, people begin to develop their skills and independence. Other strategies include the use of picture-based shopping lists and recipe books, visual timetables, activity schedules and chore charts. Sometimes pictures can be used to help the person to remember appropriate behaviour and other social skills.

In general, AAC use for people who have an ID is likely to be less formal within the home.  Members of a person’s family are often the most familiar with his or her unique communication behaviours.  While some of the above AAC methods may be used, communication in the home is generally made up of less formal methods.