Alternative & Augmentative Communication (AAC) in the management of Neurodevelopmental disabilities in children

Dr. Sudha Kaul
Specialist in Alternative Augmentative Communication


Augmentative and Alternative Communication in the Management of Neurodevelopment Disabilities in Children


SPICES…A model for Inclusion Based on Cultural Knowledge and AAC

Paper presented at the UDAAN Neural Repair & Neuro Rehabilitation Conference

Delhi , 17th September 2007

The purpose of this paper is to demonstrate how an approach to Augmentative and Alternative Communication (AAC) intervention that focuses on cultural knowledge and acknowledges the culture of social inequalities within our Indian society, can be used to find appropriate strategies for alternate communication.

SPICES, a model for alternate intervention is proposed. S P I C E S is an acronym selected to advocate a culturally inclusive model for planning an AAC intervention program.

This is based on our current understanding of AAC and the belief and experiences that cultural knowledge and context is intrinsic to any AAC intervention program.

An organizational framework for viewing communication is suggested which is extremely relevant to people using AAC.

Case studies of clients   from the Indian Institute of Cerebral Palsy, using the SPICE model will be presented to demonstrate the efficacy of this approach.


The SPICE Model

SPICE is a model that is a sangam or confluence of communication, AAC and culture.

The six letters S-P-I-C-E-S encapsulates crucial aspects of Alternate Communication that are both inclusive as well as universal.

Table 1 gives an overview of the Model.

SPICES - Inclusion Model for AAC Intervention

S - Situation




Communication can take place anywhere, anytime, with anyone. Therefore it is important for us to remember the situation in which the communication interaction is or will take place. This is critical to our planning.

Swikriti (ACCEPTANCE)  of the situation by the person who needs the AAC  as well as the communication partner

P -  Partners   

Perceptions and Disability


The speaking partner (facilitator) has a great responsibility in communication exchange with a person who needs AAC. The facilitator’s skills are based on their individual learning, experience, perceptions and attitudes. Attitudes towards persons with disabilities are influenced by the cultural environment of the place they live in.

Intervention programs need to be   ‘culturally sensitive’.


I -  Individual Interests,  


Interaction Skills

and Needs

While planning a program it is essential to look at the knowledge, skills and learning styles of BOTH partners. Based on this knowledge we need to impart need based training to both partners.

Respect personal preferences.


C -  Communicative

Competence  and



To build up communicative competence cognitive, linguistic and access barriers need to be addressed.

E - Environmental

Experiences and

Cultural Values

Cultural practices influence the environmental milieu in which the person who needs alternate communication lives. These also affect the kind of service that they CAN access. In developing economies this will also depend on the family background, their expectations, knowledge and education.


S - Support Systems

Sensitive Solutions  

Systems must be accessible to the person who needs AAC. Solutions need to be pragmatic yet sensitive, culturally appropriate yet individually biased. Strategies that are ‘doable’ and acceptable to the person who needs the alternate means to communication.

Dr. Sudha Kaul
Specialist in Alternative Augmentative Communication
Executive Director, Indian Institute of Cerebral Palsy, Kolkata
Her work at Kolkata has brought her International acclaim for improving communication ability to countless special need adults and children with neurological disabilities