What is Missing From High Tech AAC?: Meeting the Needs of Culturally and Linguistically Diverse Users

By Shane Johnson

What is AAC?

According to the American Speech and Hearing Association (ASHA), the national association for Speech Language Pathologists (SLPs) and Audiologists, AAC is: “All of the ways someone communicates besides talking.” It can range from low tech such as gestures and picture boards to high tech such as tablets with apps or dedicated Speech Generating Devices (SGDs) [1].

Who Are Culturally and Linguistically Diverse Users?

Culturally and Linguistically Diverse (CLD) users are users who come from a non-dominant cultural background. This means users that are part of racial and ethnic minority groups, use a dialect other than Standard American English, and/or are non-native English speakers [2].

Why is Culturally Appropriate AAC Important?

Culturally Appropriate AAC is necessary for practical, sociocultural, and ethical reasons. On a practical level, rates of AAC device abandonment, where an individual stops using a device even though they still have a clinical need for AAC are high. Research shows that a year after being set up with an AAC device, more than 60% have stopped using it [3]. This rate is likely even higher for AAC which is not culturally appropriate [4].

On a sociocultural level, AAC plays a role equivalent to the voice, enabling users to express themselves and communicate with others. AAC users want to be able to use their devices in the same ways and for the same reasons that individuals use speech [5]. Research demonstrates that the way that someone speaks can convey information about an individual’s age, gender, region, socioeconomic status, and more, sometimes with just a single word [6]. Therefore, culturally appropriate AAC facilitates the ability of users to exert their identity and create a sense of connectedness and belonging with peers. This aspect may be particularly valuable for AAC users, who face increased levels of social isolation as a result of the existing stigma around disability as well as the speed at which they communicate, which can be 10 times slower than speech [7][8].

Perhaps most importantly, culturally appropriate AAC is needed in order to guarantee the fundamental rights of users. The National Joint Committee for the Communication Needs of Persons with Severe Disabilities (NJC) recognizes 12 rights in the most recent edition of its Communication Bill of Rights. Among these are: “The right to meaningful communication that is culturally and linguistically appropriate” and “the right to individualized, working augmentative and alternative communication (AAC) systems and other assistive technology (AT) at all times” [9].

What Challenges Do CLD Users Face With AAC?

CLD users face a variety of additional challenges with AAC as a result of structural factors. These challenges include: Decreased knowledge about and access to AAC, a lack of needed device capabilities and support materials, a shortage of diverse voice output personalization options, and a homogeneous workforce that fails to be representative of the population it serves.

Knowledge and Access Challenges 

Research has repeatedly shown that despite a higher proportion of minority children having speech and language disorders, they are diagnosed later (by an average of 1.6 years for Black children) and receive fewer relevant therapeutic services than their white peers [10][11]. Since dedicated SGDs require a diagnosis and evaluation by an SLP in order to be covered by insurance, this diagnostic delay combined with less engagement with an SLP creates barriers to access, and even knowledge of AAC. 

For example, A recent study found that minimally speaking autistic children from racial and ethnic minority families are far less likely to have an AAC device than white children, 32% vs 84% [12]. In addition to difficulties accessing devices, the study revealed a profound gap in awareness of AAC between groups, with more than half of the families of color indicating they did not know of AAC devices, as compared to only 12% of white families [12].

Technical Challenges 

CLD users who do have access to high tech AAC encounter a number of technical limitations as a result of the fact that devices are designed to cater to the needs of monolingual English speakers from Eurocentric cultural backgrounds. CLD users report a lack of appropriate assistance with and/or necessary features on their devices. These include not having manuals or training materials available in the primary language spoken in the home and not having access to culturally relevant vocabulary on the device [6].

A study examining the ways in which high tech AAC device manufacturers meet the needs of CLD users looked at 68 languages files across a number of manufacturers including Tobii-Dynavox and PRC, which have 45% and 13% market share respectively [6]. Researchers found multiple areas in which manufacturers inadequately accommodate CLD users. Users who utilize a nonstandard dialect are likely to be impacted by the fact that fewer than three quarters of language files are able to be programmed with verbs in nonstandard tenses and fewer than half of language files allow for word endings to be added to words [6]. Meanwhile those who use multiple languages on their device are almost certain to be impacted by the fact that nearly 80% of devices require more than 3 steps simply to change the device’s current language [6]. Additionally, those who want or need to use their device in multiple languages simultaneously, face even worse odds of support as only 9% of tested language files can be used in more than one language at the same time [6].

Voice Personalization Challenges 

CLD users often have very few options for voices which accurately represent them. For example, Acapela Group, a company that provides synthesized digital voices for a number of prominent AAC systems has a catalog of over 250 voices covering a range of languages, dialects, and accents, yet the first voice modeled on African American English was released in 2021 [13][14]. As of now, there are still only 4 AAC voices. One woman’s voice, one man’s voice, and one each for girls and boys [13]. For many bilingual users, the options are even more scarce. Either they must select from a very small pool of specifically bilingual voices (in the case of English-Spanish voices, Acapela’s catalog has 3: a man, a boy, and a girl, but no woman) [13]. Otherwise, they have to choose a completely different voice for each language, creating an inconsistent vocal identity. Even this assumes that there are reasonably representative voices available for each language, which is often not the case. For instance, qualitative research on AAC users of color found that a man who knew both English and Japanese had to program Japanese into his device phonetically because the only Japanese voice available is a woman’s [15].

Difficulties Beyond Devices

Even if all of the aforementioned challenges were addressed, CLD users would still have to contend with the fact that the field of speech language pathology is overwhelmingly white and monolingual. According to ASHA’s 2022 Member and Affiliate Panel, 91.2% of SLPs are white, while a mere 3.7% are Black, and only 8.3% identify as multilingual [15]. This means that CLD individuals are nearly always crossing a cultural and/or linguistic gap when engaging with the professionals who prescribe, program, model, and evaluate their use of AAC devices. It is well documented that minority groups have improved outcomes when under the care of a health professional with whom they share an identity. This is also true for speech pathology [4]. Moreover, with more targeted research, this may be found to be especially important given the highly social and communicative nature of the field.

How Do We Better Meet the Needs of Culturally and Linguistically Diverse High Tech AAC Users?

The numerous challenges faced by CLD users of high tech AAC devices make abundantly clear that individuals with disabilities, even similar types of disabilities, are not a monolith. Far from simplifying or negating experiences of race, gender, and linguistic and cultural background, disability complicates them. As a result, the presence of advanced technology designed to address the needs of “disability” will never be sufficient on its own in meeting the specific needs of disabled individuals who belong to other marginalized groups.

Meeting the needs of these users will require a multipronged approach that includes universities and professional organizations investing in efforts to recruit and retain students from BIPOC and multilingual backgrounds, manufactures working to codesign devices and software with CLD users, and scholars conducting participatory research that centers the experience of a group whose needs have long been seen as too niche to warrant investment.

References:

[1] “Augmentative and Alternative Communication (AAC),” American Speech-Language-Hearing Association. Accessed: Jun. 23, 2026. [Online]. Available: https://www.asha.org/public/speech/disorders/aac/?srsltid=AfmBOoqWjShJfjfr2lnmMqOotPnTjISAW6d5dhV3hqCfLktEvAU8wGmA 

[2] S. Kulkarni and J. Parmar, “Culturally and linguistically diverse student and family perspectives of AAC,” Augment. Altern. Commun., vol. 33, pp. 1–11, Jul. 2017, doi: 10.1080/07434618.2017.1346706. 

[3] A. Smidt and R. N. Pebdani, “Rethinking device abandonment: a capability approach focused model,” Augment. Altern. Commun., vol. 39, no. 3, pp. 198–206, Jul. 2023, doi: 10.1080/07434618.2023.2199859. 

[4] National NSSLHA, Language, Culture, and AAC, (Mar. 07, 2025). Accessed: Jun. 22, 2026. [Online Video]. Available: https://www.youtube.com/watch?v=qRxVKPZgV-g 

[5] M. Wickenden, “Whose Voice is That?: Issues of Identity, Voice and Representation Arising in an Ethnographic Study of the Lives of Disabled Teenagers who use Augmentative and Alternative Communication (AAC),” Disabil. Stud. Q., vol. 31, no. 4, Oct. 2011, doi: 10.18061/dsq.v31i4.1724. 

[6] B. J. Frick, A. F. Bean, and A. M. Sonntag, “Multicultural considerations in augmentative and alternative communication,” Assist. Technol., vol. 35, no. 5, pp. 435–450, Sep. 2023, doi: 10.1080/10400435.2022.2108931. 

[7] G. Blasko, “Unveiling underlying systemic isolation challenges for AAC users,” Augment. Altern. Commun., vol. 41, no. 3, pp. 215–222, Jul. 2025, doi: 10.1080/07434618.2025.2515279. 

[8] “Why Give People Who Use AAC More Communication Time,” Lead. Live, Oct. 2020, Accessed: Jun. 22, 2026. [Online]. Available: https://leader.pubs.asha.org/do/10.1044/2020-1016-aac-awareness/full/ 

[9] National Joint Committee for the Communication Needs of Persons with Severe Disabilities. (2024). NJC Communication Bill of Rights (3rd ed.).

[10] M. Mindel, “Talk Like Me: Supporting Students Who Are African American Using Augmentative and Alternative Communication,” Perspect. ASHA Spec. Interest Groups, vol. 5, pp. 1586–1592, Dec. 2020, doi: 10.1044/2020_PERSP-20-00041. 

[11] L. Pope, J. Light, and A. Franklin, “Black Children With Developmental Disabilities Receive Less Augmentative and Alternative Communication Intervention Than Their White Peers: Preliminary Evidence of Racial Disparities From a Secondary Data Analysis,” Am. J. Speech Lang. Pathol., vol. 31, no. 5, pp. 2159–2174, Sep. 2022, doi: 10.1044/2022_AJSLP-22-00079. 

[12] K. Sweeney, “Study Reveals Wide Gap in Awareness of AAC Devices for Children With Autism,” Children’s Hospital Los Angeles. Accessed: Jun. 22, 2026. [Online]. Available: https://www.chla.org/blog/experts/research-and-breakthroughs/study-reveals-wide-gap-awareness-aac-devices-children-autism 

[13] “Repertoire,” Acapela Group. Accessed: Jun. 22, 2026. [Online]. Available: https://www.acapela-group.com/voices/repertoire/ 

[14] “VOICE AI: Meet the 1st African American English digital voice!,” Acapela Group. Accessed: Jun. 22, 2026. [Online]. Available: https://www.acapela-group.com/news/african-american-english-digital-voice/ 

[15] S. Lund et al., “Listen up! perspectives of people of color who use augmentative and alternative communication in the United States,” Augment. Altern. Commun., vol. 41, no. 2, pp. 156–168, Apr. 2025, doi: 10.1080/07434618.2024.2407798.