Augmentative and Alternative Communication (AAC) is defined by ISAAC (International Society for Augmentative and Alternative Communication) as "all forms of communication that complement or replace oral communication and/or written language for individuals with severe speech and language disorders." The term "augmentative" means that AAC adds to and supports residual language (it doesn't automatically replace it): it's used to enhance existing communication, not just for people who don't speak at all. AAC includes: low-tech systems (paper communication boards, symbol books), mid-tech systems (non-programmable voice output communicators), high-tech systems (digital devices with AAC software, eye tracking, switch access), sign languages, and manual communication. Primary users of AAC: children and adults with autism and language disorders with absent or limited verbal communication, people with cerebral palsy, people with ALS, advanced multiple sclerosis, stroke survivors, people with moderate to severe intellectual disability.

ARASAAC Symbols: The Italian and International Standard

The ARASAAC system (Aragonese Portal of Augmentative and Alternative Communication) is the most widely used AAC symbol system in Italy and worldwide. ARASAAC symbols: are simple, iconic illustrations representing words, concepts, actions, emotions. They were developed in Aragon (Spain) with public funding and are freely available under Creative Commons license. The catalog includes over 15,000 symbols in many languages, including Italian. Symbols can be downloaded free from arasaac.org. What makes them useful: their iconic simplicity makes them understandable even to people with cognitive disabilities, standardization allows AAC users to communicate with anyone familiar with ARASAAC (caregivers, family members, teachers, doctors), free availability makes them accessible in all settings without cost. Alternative symbols: Boardmaker/PCS (Picture Communication Symbols): commercial symbols widely used (especially in American schools), available by subscription. Mayer-Johnson Symbols: the original PCS system, now part of Boardmaker. Blissymbolics: a complex logographic symbol system, used mainly with people with severe cerebral palsy.

The Most Used AAC Apps in Italy

The market for AAC apps has grown enormously with tablet adoption. The most used in Italy. Proloquo2Go (iOS, €249): the most widely used AAC app in the world. Boardmaker/PCS symbol library, highly customizable, high-quality speech synthesis, switch and eye tracking access. Reference standard in many schools and rehabilitation centers. Grid 3 / Grid Player (Smartbox, iOS and PC, subscription): professional communication system, very flexible and powerful. Used with eye tracking and switch. Grid Player version (communication only, not programming) is more economical. LetMeTalk (Android, free): free AAC app with ARASAAC symbols. Excellent for getting started at low cost. Less powerful than Proloquo2Go but functional. Cboard (web and app, free, open source): free and open source solution with ARASAAC symbols. Accessible from browser on any device. Great for those wanting to start without investment. TalkiMate (iOS, free with in-app purchases): Italian app developed with ISAAC Italy. ARASAAC symbols, Italian interface. Snap+Core First (Tobii Dynavox, subscription): powerful AAC app with core vocabulary symbols (high-frequency words). Standard in many clinical settings. How to choose: app selection depends on the person's communication profile, access abilities (touch, switch, eye tracking), customization needs, and budget. Evaluation by a speech-language pathologist specialized in AAC is essential for the right choice.

AAC Assessment: The Right Path

Before purchasing any AAC app or device, professional assessment is essential. The speech-language pathologist specialized in AAC evaluates: the person's current communication mode (vocalizations, gestures, gaze, communicative behaviors), cognitive abilities (language comprehension, attention, imitation), motor abilities (type of access possible: touch, switch, eye tracking), priority communication needs (communicate physical needs? Express opinions? Socialize?), environmental resources (family, school, caregivers: who will be trained to use the system?). The AAC journey doesn't end with device selection: it requires training all communicators in the environment (parents, teachers, staff), a period of progressive implementation, regular follow-ups to adapt the system to the person's progress. Specialized AAC centers in Italy: Augmentative Communication Centers at local health authorities (present in many regions), specialized rehabilitation centers (E. Medea Institute, Benedetta d'Intino Center, La Nostra Famiglia), certified independent professionals. ISAAC Italy (isaac-italy.it) maintains a list of certified AAC professionals by province.

AAC at School: Rights and Implementation

School is the setting where AAC has the greatest impact on communication and learning for people with communication disabilities. Rights: Law 104/1992 guarantees the right to education and communication for all students with disabilities. The IEP (Individualized Education Plan) must include AAC strategies and tools if the person needs them. The Ministry of Education has issued guidelines on school inclusion that include AAC as a support tool. School funding: the local health authority provides and maintains AAC devices for the student (if prescribed by the speech-language pathologist). The school must have trained staff (special education teacher and communication assistant) on the specific AAC system for the student. Special education teacher training: often inadequate for AAC. Many special education teachers lack specific AAC training. The local health authority speech-language pathologist should provide training to the school team. How to support AAC implementation at school: participate in GLO (Operational Working Group for Inclusion) as a parent, verify that the IEP includes specific AAC goals, ask the local health authority speech-language pathologist to train the school team, bring documentation on AAC best practices (ISAAC Italy guides, demonstration videos). School-to-adult life transition: one of the critical moments for AAC is the transition from school to adult life (work, day centers, residential settings). AAC systems must be transferred to the new setting and new communicators trained. Continuity of the AAC project over time is the main challenge.

AAC and Sign Language: Two Different Tools

AAC and sign language are often confused but are very different systems. Sign language: is a complete natural language (LIS - Italian Sign Language: has its own grammar, syntax, morphology), used primarily by the deaf community as a first language or as an alternative to spoken language. LIS is a language, not an aid. AAC with symbols: is not a natural language but an augmentative/alternative system, used by people with various disabilities (not just deafness) to support communication in contexts where speech is absent or limited. The two systems aren't mutually exclusive: many children with autism or intellectual disability learn both AAC symbols and some simplified signs (Makaton: a system of simplified signs for augmentative communication, different from LIS). What is LIS: Law 194/2021 finally officially recognized Italian Sign Language (LIS) and Tactile Italian Sign Language (Tactile LIS, for deafblind people) as languages of the Italian Republic. Recognition has implications for education (right to LIS interpreter at school and in academic settings), civil life (LIS interpreters in courts, hospitals) and culture (cultural productions accessible in LIS).