The Predominant Focus Is Still on Teaching Children to Make Requests: A Systematic Review of AAC for Autistic Adults and Children.

This review looked at 69 studies about communication devices and supports for autistic people. Most research focuses on teaching children to make simple requests rather than broader communication skills. Very few studies looked at autistic adults or measured whether AAC improves quality of life or social relationships. The researchers say we need better studies that include adults and look at how AAC affects overall wellbeing, not just basic communication.

This systematic review of 69 studies examined AAC research for autistic people published after 2013. The analysis revealed significant gaps in current research: most studies focused on children rather than adults, emphasized basic requesting skills over broader communication functions, and rarely measured generalization or quality of life outcomes. Speech-generating devices and picture exchange systems were the most studied AAC types, typically implemented through behavioral interventions. The review found that research quality was generally low, with limitations in study design and diagnostic procedures.

The authors argue for expanded research priorities including adult populations, diverse AAC modalities, and outcomes beyond immediate communication goals.

Clinicians should expand AAC goals beyond basic requesting to include quality of life and social outcomes. AAC interventions should be offered to autistic adults, not just children. Practitioners need to consider broader impacts and measure generalization of skills across settings and relationships.

Study quality was generally low with limitations in design and diagnostic procedures. The review was limited to English-language studies published after 2013. Most included studies had narrow outcome measures and limited follow-up periods for assessing generalization.

Autistic people with communication support needs can benefit from the use of augmentative and alternative communication. While research has considered the use of AAC to supplement communication and improve communication effectiveness, less is known about other potential outcomes across the lifespan such as wellbeing and social interaction. The aim of this systematic review was to synthesise current research regarding the use of AAC for autistic adults and children; exploring how AAC supports the individual's communication, adaptive functioning and quality of life. A systematic search was conducted across six databases; PsychINFO, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Educational Resources Information Centre (ERIC), and Google Scholar.

Eligibility criteria included experimental design, peer-reviewed publications and papers published in English after 2013. Relevant papers were exported to Covidence; screening, full text review and data extraction were conducted in duplicate and quality appraisal was completed for all papers using the Scientific Merit Rating Scales (SMRS). Included studies were grouped by age, intervention types, AAC types and reported outcomes, and described qualitatively. The 69 included papers focused on a range of AAC types.

The majority investigated speech-generating devices and low-tech picture exchange. Most used behavioural intervention techniques. Most papers focused only on children, with only three papers investigating outcomes of AAC use with adults. The results were largely descriptions of proximal outcomes, such as simple requests, with few considering generalisation of skills or distal outcomes such as quality of life.

The quality of the papers was generally low, with limitations in study design and diagnostic ascertainment noted. AAC has the potential to be an important support for autistic people, however, evidence regarding the impact on the broad range of communication functions and quality of life is very limited. A greater focus on the impact of AAC on these areas is needed in both research and practice along with a stronger focus on adults and a greater range of AAC types. PROSPERO number: CRD42023473247 WHAT THIS PAPER ADDS: What is already known on this subject The use of augmentative and alternative communication (AAC) with autistic adults and children is an established practice.

Previous research has shown some effectiveness related to the specific goals being studied but it has centred mostly on children, and most research has focused on making requests, rather than broad communication or life outcomes. What this paper adds to existing knowledge This study explores the literature about autism and AAC and seeks to specifically examine the range of outcomes reported. We found that most of the research on this topic continues to focus on children, aided rather than unaided communication, and on outcomes related directly to the intervention, such as making requests. Very few studies included measures of generalisation or considered broader outcomes of AAC supports, such as quality of life, or enhanced social interactions.

What are the potential or actual clinical implications of this work? Clinicians and researchers should consider the potential for broader impacts of AAC and ensure that goals focus on skills beyond immediate functions to areas such as quality of life, well-being, learning and employment, and the development of social relationships. Clinicians and researchers should also ensure that AAC interventions are offered to not only children, but also to autistic adults who may benefit from communication supports.