Promotion of Communication Access, Choice, and Agency for Autistic Students.

This paper argues that all autistic children should have access to different ways of communicating, not just speech. Many speaking autistic adults say they wished they had access to communication tools like picture boards or devices when they were younger. The current approach often treats these tools as a 'last resort' only when speech isn't developing. Instead, professionals should offer multiple communication options from the start, giving autistic children more ways to express themselves and make choices about how they communicate.

This tutorial examines the historical 'last resort' approach to augmentative and alternative communication (AAC) for autistic students and advocates for a paradigm shift. The authors highlight that speaking autistic adults report they would have benefited from AAC access as children, yet current practices often prioritize spoken language over multimodal communication options. The paper discusses how medical model perspectives and ableism contribute to restricted AAC access, emphasizing the importance of autistic expertise in evidence-based practice. The authors recommend speech-language pathologists implement multimodal communication strategies and normalize AAC use for all autistic students regardless of their current spoken language abilities, promoting communication access, choice, and agency.

Speech-language pathologists should consider implementing multimodal communication approaches for all autistic students, not just those without speech. This involves normalizing AAC use, promoting communication choice and agency, and moving beyond 'last resort' thinking. Clinical practice should incorporate autistic expertise and experiences into evidence-based decision making.

This is a tutorial paper rather than empirical research. The authors note that studies on this topic are rare. No sample size or specific research methodology is reported. Findings are based on theoretical discussion and autistic adult reports rather than controlled studies.

Families and professionals often consider augmentative and alternative communication (AAC) a "last resort" for persons with communication challenges; however, speaking autistic adults have reported that they would have benefited from access to AAC as children. This tutorial discusses the history of this "last resort" practice and its perpetuation within the medical model of disability. The tutorial focuses on communication access, choice, and agency for autistic students. We provide a brief overview of the AAC community and their preferred terminology, review the history of traditional approaches to research on AAC and autism, and then examine the relationship between disability models and ableism to views of spoken language as a priority of intervention.

Studies on this topic are rare, and resisting ableism requires acknowledging and honoring disabled people's experiences and expertise. Therefore, we promote autistic expertise within the framework of evidence-based practice and discuss the experiences of autistic people and spoken language. Finally, we consider the role of the speech-language pathologist (SLP) in assessment and offer autistic-based strategies and recommendations for communication support. Speaking autistic students who could benefit from AAC may not have access to AAC due to the prioritization of spoken language and lack of awareness of the benefit of AAC.

We recommend that SLPs and school-based professionals support and facilitate access, communicative choice, and agency by implementing multimodal communication strategies to include AAC use for autistic students regardless of their spoken language status. Promoting all types of communication and ensuring opportunities for communication across multiple modalities are paramount to a child's agency and self-determination, as is normalization of AAC.