Perspectives of Indian Speech-Language Pathologists on Implementing Augmentative and Alternative Communication Systems for Individuals with Nonverbal Autism Spectrum Disorder

The implementation of Augmentative and Alternative Communication (AAC) systems for individuals with nonverbal Autism Spectrum Disorder (nvASD) remains highly debated, especially in a multilingual and multicultural country like India. Existing AAC guidelines are largely Western-based and may not be fully applicable in the Indian context. This study explored the perspectives of Indian Speech-Language Pathologists (SLPs) on AAC implementation in individuals with nvASD. A cross-sectional study was conducted in two phases. Phase 1 involved developing and validating a questionnaire assessing SLP’s practices and attitudes towards AAC. In phase 2, the validated questionnaire was administered online to 93 Indian SLPs (29.23 years of mean age, 71% female) represented diverse clinical, educational, and academic settings. The survey explored key parameters, including AAC candidacy, cultural and linguistic adaptation, AAC selection and customization, interdisciplinary collaboration and caregiver involvement, outcome based evaluation practices, speech-AAC integration, and barriers to AAC implementation. Most SLPs emphasized working on communication prerequisites before introducing AAC. Vocabulary selection was prioritized over partner training. AAC was primarily used for both intervention and communication, employing goal-oriented approaches alongside other speech and language strategies. Challenges included lack of resources, inadequate training, and limited interdisciplinary collaboration. Parental involvement and caregiver feedback were identified as critical to success. SLPs in India broadly recognize AAC as a valuable tool for individuals with nvASD but report facing multiple systemic and practical challenges to its implementation. The findings underscore the need for culturally and contextually relevant AAC guidelines, targeted clinician training, and supportive policy measures to improve access and long-term communication outcomes in Indian settings.