Effectiveness of alternative and augmentative communication systems in children with ASD: a literature review and comparative analysis

Context and relevance. Among individuals with ASD, the selection of an AAC system is frequently individualized and depends on the child's developmental profile and current skill level. Therefore, analyzing and synthesizing the available evidence on the effectiveness of various AAC systems and their influence on the development of cognitive functions in this population is of particular relevance. Objective. To evaluate the effectiveness of the AAC systems most commonly used with children with ASD. Hypothesis The positive effects of AAC use extend across different areas of development, while the effectiveness of interventions depends on multiple factors, including the intervention trajectory, the type of AAC system used, the child’s characteristics, and the goals of the intervention. Methods and materials. A systematic review of the literature available in PubMed, MEDLINE, and the Russian Science Electronic Library (eLIBRARY.RU) was performed. The key search terms included: autism spectrum disorder, ASD, augmentative and alternative communication, AAC, speech impairment, and effectiveness. Thirty-seven articles by Russian and international researchers that were most relevant to the topic were included in the analysis. Results. Augmentative and alternative communication (AAC) systems have shown high efficacy in promoting communication skills in children with ASD, including vocabulary expansion and the development of expressive and receptive language. In addition to their direct impact on communication, AAC use is associated with several other benefits, such as fewer challenging behaviors, reduced anxiety and aggression, and improved interpersonal relationships. Conclusions. Assessing the effectiveness of AAC systems is a key step toward their wider use in practice. The findings of this review will be of value to both researchers and practitioners in developing evidence-based intervention pathways for children with ASD

1. Андрусенко, В.М., Рыбчинский, В.П. (2023). Особенности использования альтернативной коммуникации PECS в подготовке детей к обучению в школе. Интеллектуальный потенциал образовательной организации и социально-экономическое развитие региона: Сборник материалов международной научно-практической конференции Академии МУБиНТ (с. 246—249). Ярославль: МУБиНТ.
   Andrusenko, V.M., Rybchinsky, V.P. (2023). Features of the use of alternative communication PECS in preparing children for school. In: Intellectual potential of an educational organization and socio-economic development of the region: Proceedings of the International Scientific and Practical Conference of the MUBiNT Academy (pp. 246—249). Yaroslavl: MUBiNT Publ. (In Russ.).
2. Бережная, А.Г., Киселева, Т.Г. (2022). Использование технологии PECS в работе с лицами с расстройствами аутистического спектра. В: Интеллектуальный потенциал образовательной организации и социально-экономическое развитие региона: сборник материалов международной научно-практической конференции Академии МУБиНТ. (с. 246—249). Ярославль: МУБиНТ
   Berezhnaya, A.G., Kiseleva, T.G. (2022). Using PECS technology in working with persons with autism spectrum disorders. In: Intellectual potential of an educational organization and socio-economic development of the region: collection of materials of the international scientific-practical. conf. of the Academy MUBiNT (pp. 246—249). Yaroslavl: MUBiNT Publ. (In Russ.).
3. Гордеева, С.Б (2021). Формирование коммуникативной активности у детей с тяжёлой формой РАС в процессе логопедической работы в начальной школе. В: Современные научно-исследовательские решения в условиях технологических и цифровых новаций: Материалы XLI Всероссийской научно-практической конференции, Ростов-на-Дону, 3 декабря 2021 г. (с. 33—63). Ростов-на-Дону: Южный университет (ИУБиП).
   Gordeeva, S.B. (2021). Development of communicative activity in children with severe forms of ASD during speech therapy work in primary school. In: Modern research solutions in the context of technological and digital innovations: Proceedings of the XLI All-Russian Scientific and Practical Conference, Rostov-on-Don, December 3, 2021 (pp. 33—63). Rostov-on-Don: Southern University (IUBiP) Publ. (In Russ.).
4. Давыдова, Ю.А. (2025). Формирование функций коммуникации с помощью вспомогательной языковой стимуляции у пользователя АДК с тяжелыми множественными нарушениями развития. Аутизм и нарушения развития, 23(1), 59—67. https://doi.org/10.17759/autdd.2025230107
   Davydova, Yu.A. (2025). Development of Communication Functions in AAC Users with Severe Multiple Developmental Disabilities Through Aided Language Stimulation. Autism and Developmental Disorders, 23(1), 59—67. (In Russ.). https://doi.org/10.17759/autdd.2025230107
5. Данилина, К.К., Салимова, К.Р. (2024). Современное состояние проблемы высокофункционального аутизма. Аутизм и нарушения развития, 22(4), 4—12. https://doi.org/10.17759/autdd.2024220401
   Danilina, K.K., Salimova, K. R. (2024). Current state of the issue of high-functioning autism. Autism and Developmental Disorders, 22(4), 4—12. (In Russ.). https://doi.org/10.17759/autdd.2024220401
6. Данилина, К.К., Салимова, К.Р., Хаустов, А.В., Ветров, А.О., Озерова, В.А. (2025). Критерии подбора систем альтернативной и дополнительной коммуникации для детей с расстройствами аутистического спектра. Аутизм и нарушения развития, 23(4), 74—84. https://doi.org/10.17759/autdd.2025230408
   Danilina, K.K., Salimova, K.R., Khaustov, A.V., Vetrov, A.O., Ozerova, V.A. (2025). Criteria for selecting augmentative and alternative communication systems for children with autism spectrum disorder. Autism and Developmental Disorders, 23(4), 74—84. (In Russ.). https://doi.org/10.17759/autdd.2025230408
7. Демидова, А.П., Зиновьева, В.Н., Чернова, З.М. (2022). Развитие речи детей с расстройством аутистического спектра посредством карточек PECS. Проблемы современного педагогического образования, 74(2), 84—87. EDN: UJJKBH
   Demidova, A.P., Zinovyeva, V.N., Chernova, Z.M. (2022). Speech development of children with autism spectrum disorder using PECS Problems of modern pedagogical education, 74(2), 84—87. (In Russ.). EDN: UJJKBH
8. Исенина, Е.И. (1983). Психолингвистические закономерности речевого онтогенеза (дословесный период). Иваново: ИвГУ.
   Isenina, E.I. (1983). Psycholinguistic features of speech ontogenesis (pre-verbal stage). Ivanovo: IvGU. (In Russ.).
9. Караневская, О.В., Антуфьева, Н.Е., Семак, О.Ю. (2025). Специфика формирования коммуникативных навыков у детей раннего и дошкольного возраста с расстройствами аутистического спектра. Аутизм и нарушения развития, 23(1), 23—31. https://doi.org/10.17759/autdd.2025230103 
   Karanevskaya, O.V., Antufueva, N.E., Semak, O.Yu. (2025). Features of Communicative Development in Toddlers and Preschoolers with Autism Spectrum Disorders. Autism and Developmental Disorders, 23(1), 23—31. (In Russ.). https://doi.org/10.17759/autdd.2025230103
10.  Мордвинцева, И.Ю., Пайзиева, М.А. (2023). Применение альтернативной системы коммуникации с детьми, страдающими расстройством аутистического спектра. Вестник Dulaty University, 1, 19—26. EDN:ILAUIB
    Mordvintseva, I.Yu., Paiziyeva, M.A. (2023). Using an alternative communication system with children with autism spectrum disorder. Dulaty University Bulletin, 1, 19— (In Russ.) EDN:ILAUIB. 
11.  Петрова, Д.П. (2024). Альтернативная коммуникация как средство общения подростков с аутизмом. В: Психолого-педагогическое сопровождение общего, специального и инклюзивного образования детей и взрослых: материалы IV Международной научно-практической конференции (с. 291—293). Чебоксары: ИД «Среда»
    Petrova, D.P. (2024). Alternative communication as a means of communication for adolescents with autism. In: Psychological and pedagogical support of general, special and inclusive education of children and adults: Proceedings of the IV International Scientific and Practical Conference (pp. 291—293). Cheboksary: Sreda Publ. (In Russ.). 
12. Попова, О.А., Филина, Н.М. (2021). Влияние системы альтернативной коммуникации PECS на проявления вокальной речи у детей с аутизмом. Аутизм и нарушения развития, 19(2), 23—39. https://doi.org/10.17759/autdd.2021190204
    Popova, O.A., Filina, N.M. (2021). The Effect of the PECS Alternative Communication System on Vocal Speech Acquisition in Children with Autism. Autism and Developmental Disorders, 19(2), 23—39. (In Russ.).  https://doi.org/10.17759/autdd.2021190204.
13.  Попова, О.А., Филина, Н.М., Шведовский, Е.Ф., Дубовицкая, Т.Д., Едигарева, В.Д. (2023). Использование электронного коммуникативного приложения на основе PECS в работе с детьми с нарушениями развития. Кейс-исследование. Клиническая и специальная психология, 12(4), 73—92. https://doi.org/10.17759/cpse.2023120404
    Popova, O.A., Filina, N.M., Shvedovskiy, E.F., Dubovitskaya, T.D., Edigareva, V.D. (2023). The Use of a PECS-based Electronic Communication Application in Working with Children with Developmental Disabilities. Case Study. Clinical Psychology and Special Education, 12(4), 73— (In Russ.). https://doi.org/10.17759/cpse.2023120404 
14. Течнер, С., Мартинсен, Х. (2014). Введение в альтернативную и дополнительную коммуникацию: жесты и графические символы для людей с двигательными и интеллектуальными нарушениями, а также с расстройствами аутистического спектра. М.: Теревинф.
    Tetzchner, S.F., Martinsen, H. (2014). Introduction to Alternative and Augmentative Communication: Gestures and Graphic Symbols for People with Motor, Intellectual, and Autism Spectrum Disorders. Moscow: Terevinf Publ. (In Russ.).
15.  Тумасова, К.А. (2024). Регуляция нежелательного поведения детей 5-7 лет с расстройствами аутистического спектра посредством карточек PECS. В: Здоровьесберегающие и коррекционные технологии в современном образовательном пространстве: сборник научных трудов по результатам Международной научно-практической конференции (с. 205—209). Магнитогорск: Изд-во Магнитогорского государственного технического университета им. Г.И. Носова.
    Tumasova, K.A. (2024). Regulating Undesirable Behavior in 5-7-Year-Old Children with Autism Spectrum Disorders Using PECS Cards. In: Health-saving and correctional technologies in the modern educational space: Collection of scientific papers based on the results of the International Scientific and Practical Conference (pp. 205—209). Magnitogorsk: Nosov Magnitogorsk State Technical University Publ. (In Russ.). 
16. Ястребова, Л.А., Сидоренко, Е.В. (2016). Исследование влияния системы коммуникации PECS на эмоционально-волевую сферу детей с расстройствами аутистического спектра. Экономические и гуманитарные исследования регионов, (6), 108—112. EDN:XIIXGV.
    Yastrebova, L.A., Sidorenko, E.V. (2016). A study of the influence of the PECS communication system on the emotional-volitional sphere of children with autism spectrum disorders. Economic and Humanities Studies of Regions, (6), 108—112. (In Russ.). EDN:XIIXGV
17. Bondy, A., Frost, L. (2001). The Picture Exchange Communication System. Behavior Modification, 25(5), 725—744. https://doi.org/10.1177/0145445501255004
18. Chavers, T.N., Morris, M., Schlosser, R.W., Koul, R. (2021). Effects of a systematic augmentative and alternative communication intervention using a speech-generating device on multistep requesting and generic small talk for children with severe autism spectrum disorder. American Journal of Speech-Language Pathology, 30(6), 2476—2491. https://doi.org/10.1044/2021_AJSLP-20-00353
19. Chavers Edgar, T., Schlosser, R., Koul, R. (2024). Effects of an augmentative and alternative communication intervention package on socio-communicative behaviors between minimally speaking autistic children and their peers. American Journal of Speech-Language Pathology, 33(4), 1619—1638. https://doi.org/10.1044/2024_AJSLP-23-00313
20. Frolli, A., Ciotola, S., Esposito, C., Fraschetti, S., Ricci, M.C., Cerciello, F., Russo, M.G. (2022). AAC and Autism: Manual Signs and PECS, a Comparison. Behavioral Sciences, 12(10), 359. https://doi.org/10.3390/bs12100359
21. Gevarter, C., Najar, A.M., Siciliano, M. (2023). Teaching Children with Autism to Create Multi-symbol Messages on Augmentative Alternative Communication Applications During Play. Advances in Neurodevelopmental Disorders, 7, 314—328. https://doi.org/10.1007/s41252-022-00254-w
22. Hume, K., Steinbrenner, J.R., Odom, S.L., Morin, K.L., Nowell, S.W., Tomaszewski, B., Szendrey, S., McIntyre, N.S., Yücesoy-Özkan, S., Savage, M.N. (2021). Evidence-Based Practices for Children, Youth, and Young Adults with Autism: Third Generation Review. Journal of Autism and Developmental Disorders, 51(11), 4013—4032. https://doi.org/10.1007/s10803-020-04844-2
23. Koudys, J., Perry, A., Magnacca, C., McFee, K. (2023). Predictors of Picture Exchange Communication System (PECS) outcomes. Autism and Developmental Language Impairments, 8, 23969415231221516. https://doi.org/10.1177/23969415231221516
24. La Valle, C., Chenausky, K., Tager-Flusberg, H. (2021). How do minimally verbal children and adolescents with autism spectrum disorder use communicative gestures to complement their spoken language abilities? Autism & Developmental Language Impairments, 6, 23969415211035065. https://doi.org/10.1177/23969415211035065
25. Lorah, E. R., Holyfield, C., Miller, J., Griffen, B., Lindbloom, C. (2022). A Systematic Review of Research Comparing Mobile Technology Speech-Generating Devices to Other AAC Modes with Individuals with Autism Spectrum Disorder. Journal of Developmental and Physical Disabilities, 34(2), 187—210. https://doi.org/10.1007/s10882-021-09803-y
26. Mahoney, B., Johnson, A., McCarthy, M., White, C. (2018). Systematic Review: Comparative Efficacy of the Picture Exchange Communication System (PECS) to Other Augmentative Communication Systems in Increasing Social Communication Skills in Children with Autism Spectrum Disorder. Communication Sciences and Disorders: Systematic Review Publications, 4. University of Vermont. https://scholarworks.uvm.edu/csdms/4/.
27. Manwaring, S.S., Mead, D.L., Swineford, L., Thurm, A. (2017). Modelling gesture use and early language development in autism spectrum disorder. International Journal of Language & Communication Disorders, 52(5), 637—651. https://doi.org/10.1111/1460-6984.12308
28. Muharib, R., Walker, V.L., Dunn, W. (2024). Effects of Interventions Involving Tablet-Based Speech-Generating Devices for Individuals with ASD: A Meta-analysis. Journal of Autism and Developmental Disorders, 54(12), 4496—4514. https://doi.org/10.1007/s10803-023-06173-6
29. Naidoo M., Singh S. (2020). A Dental Communication Board as an Oral Care Tool for Children with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 50(11), 3831—3843. https://doi.org/10.1007/s10803-020-04436-0
30. Özçalışkan, Ş., Adamson, L.B., Dimitrova, N., Baumann, S. (2017). Early gesture provides a helping hand to spoken vocabulary development for children with autism, Down syndrome and typical development. Journal of Cognition and Development, 18(3), 325—337. https://doi.org/10.1080/15248372.2017.1329735
31. Preston, D., Carter, M. (2009). A review of the efficacy of the Picture Exchange Communication System intervention. Journal of Autism and Developmental Disorders, 39(10), 1471—1486. https://doi.org/10.1007/s10803-009-0763-y
32. Resina, P., Mezzatesta, M., Elias, N., Aparici, M., Mairena, M.A. (2025). Identifying and Describing Best Clinical Practices for Children and Adolescents with Complex Communication Needs: A Scoping Review of Healthcare-Based Interventions. Journal of Intellectual Disability Research, 69(10), 1081—1096. https://doi.org/10.1111/jir.70022.
33. Santos, P.A., Bordini, D., Scattolin, M., Asevedo, G.R.D.C., Caetano, S.C., Paula, C.S., Perissinoto, J., Tamanaha, A.C. (2021). The Impact of the Implementation of the Picture Exchange Communication System - PECS on Understanding Instructions in Children with Autism Spectrum Disorders. CoDAS, 33(2), e20200041. https://doi.org/10.1590/2317-1782/20202020041.
34. Schwartz, I., Garfinkle, A., Bauer, J. (1998). The Picture Exchange Communication System: Communicative Outcomes for Young Children with Disabilities. Topics in Early Childhood Special Education, 18(3), 144—159. https://doi.org/10.1177/027112149801800305
35. Tang, S., Zeng, S., Li, S., Potměšil, M. (2024). The research status of augmentative and alternative communication for children with special needs in mainland China: A bibliometric analysis. Journal of Research in Special Educational Needs, 24(4), 936—947. https://doi.org/10.1111/1471-3802.12680
36. Therrien, M.C.S., Whalon, K., Nunes, D., Marti, P., Sellers, A. (2025). A Systematic review of AAC interventions using speech generating devices for autistic preschoolers. Augmentative and Alternative Communication, 41(2), 114—128. https://doi.org/10.1080/07434618.2025.2479768
37. Zurita Díaz, A.J., Calleja Reina, M. (2025). Enhancing communication and behavioral skills in Spanish-speaking children with autism spectrum disorder using SymboTalk and EC+: A pilot study. Revista de Logopedia, Foniatría y Audiología, 45(3), 100526. https://doi.org/10.1016/j.rlfa.2025.100526