When an AAC User Keeps Pressing the Same Button
For some people who use Augmentative and Alternative Communication (AAC), repeatedly pressing the same symbol, word or phrase can become a noticeable part of how they interact with their device. A child may repeatedly select “car”, return to a favourite page to activate the same word, or press one button several times in quick succession. Parents and professionals sometimes describe this as “stimming on the AAC device”. Within the research literature, the term AAC-related stereotypy has also been used to describe repetitive activation of symbols on electronic AAC systems (Andzik et al., 2022, 2024). When this happens frequently, particularly during therapy or learning activities, the immediate reaction may be to redirect the person or try to stop the repetition. For speech and language pathologists, however, the more useful starting point is not how to stop the behaviour, but what the behaviour may be doing for the AAC user.
What is Stimming?
Stimming, or self-stimulatory behaviour, is a broad term used to describe repetitive movements, sounds or actions. These behaviours can occur for many reasons and may provide enjoyment, predictability, sensory input or regulation. Electronic AAC systems add another interesting element because selecting a symbol often produces immediate auditory feedback. The user presses a symbol and the device says the word aloud, producing the same predictable response each time. Research specifically examining AAC-related stereotypy remains limited. Andzik, Walker and O’Hara (2022) noted that there was very little research available to guide professionals in addressing repetitive AAC use while also protecting functional communication and respecting individual expression. More recent work by Andzik et al. (2024) examined AAC-related stereotypy using functional analysis screening procedures. Their findings suggested that repetitive AAC selections were often automatically reinforced, meaning that something about the behaviour itself may have been reinforcing, although the researchers also found that environmental variables could influence when it occurred.
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The important word here is may. Repeatedly pressing a button should not automatically be labelled as sensory behaviour or stereotypy simply because it looks repetitive. The AAC user may be communicating. Consider someone repeatedly selecting “home”. They may enjoy hearing the word, but they may also be attempting to say “I want to go home” or “Something happened at home”. They may not yet know how to locate the additional vocabulary required to expand that message. Repetition can also be used for emphasis, to gain a communication partner's attention, to explore a new word or simply because the person is interested in the concept. For an individual whose expressive communication is already limited, assuming that repeated output is meaningless creates a real risk that a genuine message will be missed.
The role of the SLP in Stimming
This is where the role of the SLP becomes particularly important. Before attempting to reduce repeated selections, the clinician should observe the behaviour in context and develop a hypothesis about what may be maintaining it. When does it happen? Which words are selected? Does it mainly occur during periods of waiting or low engagement? Does it increase when the AAC user is excited or dysregulated? Does the person look towards another individual while making the selection? What happens when somebody responds to the message? Does the repetition stop or change when the communication partner expands on what has been said? Vocabulary availability should also be considered. A person repeatedly activating the closest word they can find may be demonstrating a language or navigation difficulty rather than stereotypy. This type of observation does not replace a formal functional assessment when one is clinically indicated, but it helps prevent intervention from being based solely on the appearance of the behaviour.
When there appears to be communicative intent, the response should be communicative. If a child repeatedly selects “train”, for example, the adult might acknowledge the message and then model related possibilities such as “I like trains”, “want train”, “train is fast” or “where train?” on the AAC system. The purpose is not to make the child copy the expanded message. Instead, the communication partner is showing what else can be said using the same system. Aided AAC modelling, where communication partners use or point to symbols on the AAC system while interacting naturally with the individual, has a growing evidence base. A 2023 scoping review identified 29 studies involving 237 emergent communicators and reported predominantly positive or mixed-positive outcomes across language, communication and turn-taking measures (Wandin et al., 2023). For SLPs, repetitive selections can therefore sometimes provide an excellent opportunity for modelling rather than correction.
Stimming as an Interference
There are situations in which repetitive AAC use may genuinely interfere with communication, learning or participation. A person may repeatedly activate speech output to such an extent that it becomes difficult for them to formulate another message, or it may significantly disrupt interactions with communication partners. Even then, intervention should be based on the likely function of the behaviour rather than simply attempting to suppress it. Cook et al. (2017) investigated repetitive engagement with an AAC device in one autistic child and found that stereotypical activation occurred at high levels when button presses generated auditory output. When the auditory output was removed within the intervention, repetitive activation decreased and functional requesting increased. This finding is useful because it demonstrates that the auditory consequences of an AAC selection can sometimes contribute to repetitive use. However, it was a single-participant study and should not be interpreted as evidence that clinicians should routinely mute speech-generating devices. The voice output of an AAC system is central to its communicative function, and changing or removing it requires careful consideration.
It is equally important that repetitive use of an AAC system is not treated as something that must be eliminated simply because it appears unusual. If the behaviour is harmless, provides enjoyment or regulation, and does not prevent the individual from communicating effectively, there may be no clinical reason to intervene. Removing the device, physically blocking access to particular vocabulary or withholding AAC as a consequence of repetitive use can be particularly problematic. An AAC system is not a reward for appropriate behaviour. For someone who relies on it, it is their means of communication.
Catering to the AAC User’s Needs
The best response to repeated button pressing therefore depends on what is happening for that individual. Sometimes the AAC user is communicating. Sometimes they are exploring language. Sometimes the sound or predictability of the device may be reinforcing. Sometimes more than one of these things is happening at the same time. For parents, teachers and SLPs, the aim should be to look beyond the repetition itself. Rather than beginning with “How do I stop this?”, begin with “What might this person be communicating or gaining from this?” That shift in thinking allows us to support more effective AAC use while still respecting autonomy, regulation and the person's right to communicate in their own way.
References
Andzik, N. R., Walker, S. F., & O’Hara, C. A. (2022). Stereotypy among individuals who use augmentative and alternative communication. Current Developmental Disorders Reports, 9(4), 220–224. https://doi.org/10.1007/s40474-022-00261-5
Andzik, N. R., Walker, S. F., O’Hara, C. A., Camacho, S. A., Landmeier, L., & Brander, M. (2024). Preliminary assessment of augmentative and alternative communication-related stereotypy. Behavioral Interventions, 39(4), e2042. https://doi.org/10.1002/bin.2042
Cook, J. L., Rapp, J. T., Burji, C., & Nuta, R. (2017). A simple intervention for stereotypical engagement with an augmentative alternative communication device. Behavioral Interventions, 32(3), 272–277. https://doi.org/10.1002/bin.1478
Wandin, H., Tegler, H., Svedberg, L., & Johnels, L. (2023). A scoping review of aided AAC modeling for individuals with developmental disabilities and emergent communication. Current Developmental Disorders Reports, 10, 123–131. https://doi.org/10.1007/s40474-023-00275-7
