Teletherapy went from a niche option to a necessity during the COVID-19 pandemic. Now it's a permanent part of the AAC field. Many families continue to receive some or all of their AAC services virtually, whether by choice or because an AAC-specialized SLP isn't available locally.
Virtual AAC sessions can work. But they require different preparation, different parent involvement, and different expectations than in-person therapy. Here's how to make them effective.
The Reality of AAC Teletherapy
Let's be honest about what's different. In person, an SLP can sit next to the child, physically guide their hand to a button, position the device, manage behavior, and respond to subtle cues in real time. On a screen, they can't do any of that.
That means someone in the room with the child needs to take on some of those roles. In most cases, that someone is you, the parent.
This is both the biggest challenge and the biggest advantage of teletherapy. It's harder because you're doing more. It's better because you're learning the strategies firsthand, in your own home, with your child's actual daily routines as context.
Wales, Skinner, and Hayman (2017) reviewed telehealth-delivered speech and language interventions for children and found outcomes comparable to in-person therapy. While their review covered speech-language services broadly rather than AAC specifically, the findings support the parent-coaching model that AAC teletherapy relies on.
Setting Up for Success
The technical setup makes or breaks a virtual AAC session. Here's what you need.
Two devices (strongly recommended)
This is the most important piece of advice. Your child needs their AAC device and you need a separate device for the video call.
If the AAC app is on an iPad and Zoom is also on that iPad, you have a problem. The child can't use the AAC app while the video call is taking up the screen, and screen-sharing creates lag.
Ideal setup:
- AAC device: tablet or phone running SabiKo or other AAC app
- Video call device: laptop, separate tablet, or phone propped up on a stand
If you only have one device, talk to your SLP about workarounds. Some families alternate between the AAC app and the video call. Others use a low-tech communication board during sessions while the screen shows the therapist.
Camera angle
The SLP needs to see the child's hands and the AAC device screen. A camera pointed at the child's face alone doesn't give them enough information.
Best position: Set the camera behind and slightly above the child, angled down toward the table. This shows the child's hands, the device, and any materials being used.
If you're using a laptop, propping it up on a stack of books behind the child usually works.
Lighting and sound
- Face natural light toward the child, not behind them (backlight makes the screen hard to see)
- Mute notifications on all devices
- Choose a quiet room with minimal background noise
- Turn off TV and music
Minimize distractions
Virtual sessions are harder to focus on than in-person ones. Reduce competing interests:
- Clear the table of toys and food (unless they're part of the session)
- Keep siblings in another room if possible
- Close unnecessary browser tabs and apps
What Parents Need to Do During Sessions
Your role in a teletherapy AAC session is different from what you'd do if you dropped your child off at a clinic. You're the therapist's hands.
Be physically present
Sit next to your child throughout the session. You'll need to:
- Position the AAC device when the SLP asks
- Point to specific buttons if the child needs a prompt
- Provide physical support (hand-over-hand guidance, seating adjustments)
- Hold up materials or toys the SLP requests
- Model on the device when directed
Follow the SLP's lead
The SLP will coach you in real time. They might say, "Can you model 'want' on the device?" or "Wait 10 seconds before prompting." Follow their instructions even if it feels unnatural. They're seeing the interaction from a clinical perspective and are adjusting their approach based on what they observe.
Take notes
Keep a small notebook nearby. Jot down:
- What vocabulary the SLP is targeting
- Strategies they're using that work
- Homework for the week
- Questions that come up
These notes become your guide for practicing between sessions.
Don't take over
This is the hardest part. When your child struggles or the session stalls, the instinct is to jump in and do more. But the SLP needs to see what the child can do independently. Let there be awkward pauses. Let the child struggle a bit. The SLP will tell you when to step in.
Activities That Work Well Virtually
Not all therapy activities translate to a screen. Here are ones that work particularly well for AAC teletherapy.
Book reading
The SLP shares a digital book on screen or you hold up a physical book. The child uses AAC to comment on pictures, predict what happens next, or retell the story. Books provide a shared visual focus that helps bridge the distance.
Good AAC targets during books: "look," "more" (turn the page), "uh oh," character names, "what," "funny"
Barrier games
The SLP and child each have matching materials (blocks, coloring sheets, Play-Doh). One person describes what to do, and the other follows instructions using only the AAC device and speech. These games naturally require specific vocabulary and are engaging.
Choice-making activities
The SLP holds up two items on camera. "Do you want playdough or bubbles?" The child uses the device to respond. Simple, motivating, and works well on screen.
Cooking or snack prep
If the SLP guides a simple recipe (making a sandwich, decorating a cracker, mixing a drink), the child uses AAC throughout: "want," "put," "more," "all done," "yummy." This is real-life functional communication with a built-in reward.
Turn-taking games
Online games or apps that involve turn-taking (simple card matching, tic-tac-toe) create opportunities for "my turn," "your turn," "go," and "I win."
Sing-alongs with pauses
For younger children, the SLP sings a familiar song and pauses before a key word. The child fills in the word using the device. "Old MacDonald had a farm, E-I-E-I-___" (child presses "O"). This works surprisingly well over video.
Limitations of Teletherapy for AAC
It's important to be realistic about what teletherapy can't do as well.
Device programming
Setting up or customizing the AAC app is harder remotely. The SLP can walk you through changes step by step, but it takes longer than if they did it themselves. Screen-sharing can help here: the SLP shares their screen to show you what to do, and you mirror the steps on the child's device.
Physical prompting
Some children need hand-over-hand prompting early in AAC learning. An SLP can coach you through this, but it's not the same as having trained hands providing the prompt. If your child needs significant physical support, in-person sessions for the initial learning phase may be worth prioritizing.
Behavior management
If your child has difficulty staying seated or attending to the screen, the SLP's options are limited. They can coach you, but they can't physically redirect. Shorter sessions (15 to 20 minutes instead of 30) may be more productive for children with significant attention challenges.
Social communication
Peer interaction practice doesn't work in a one-on-one teletherapy session. If social communication is a primary goal, look for virtual group therapy options or supplement with in-person opportunities.
The Hybrid Model
For many families, the best approach combines in-person and virtual sessions. A typical hybrid schedule might look like:
| Session type | Frequency | Focus |
|---|---|---|
| In-person | 1x per month | Device programming, physical prompting, assessment |
| Virtual | 2 to 3x per month | Vocabulary practice, parent coaching, strategy building |
This gives you the hands-on support of in-person therapy where it matters most, while making the most of the convenience and frequency that teletherapy allows.
If your SLP is far away (common with AAC specialists), the hybrid model might mean quarterly in-person visits combined with weekly virtual sessions. This is often more effective than infrequent in-person sessions alone, because the weekly virtual contact keeps momentum going.
Making the Most of Between-Session Time
Teletherapy works best when practice happens between sessions. The SLP might spend 30 minutes per week with your child, but you're with them all day.
After each session, identify:
- One vocabulary target to focus on this week
- One daily routine where you'll practice (meals, bath, play, bedtime)
- One strategy the SLP demonstrated that you'll try
Don't try to replicate the entire session at home. Pick one thing and do it consistently. That's more effective than attempting everything and burning out.
When to Advocate for In-Person
Teletherapy is effective for most AAC goals, but there are situations where in-person should be prioritized:
- Initial AAC assessment. The SLP needs to observe the child directly, try different access methods, and evaluate motor skills in person.
- Significant behavior challenges. If the child can't attend to a screen for more than a few minutes, in-person is more productive.
- Complex device customization. Major setup changes (new vocabulary layouts, access method adjustments) are faster in person.
- Transitioning to a new device. Learning a new system benefits from hands-on guidance.
If you're fully virtual, discuss with your SLP whether any of these needs require an in-person visit, even if it's a one-time trip.
Getting Started
- Download SabiKo for free and set it up on a separate device from your video call
- Set up a dedicated therapy space with good lighting and camera angle
- Ask your SLP for their preferred setup and any materials to have ready
- Keep a notebook nearby for in-session notes
- After each session, pick one target word and one daily routine for practice
Virtual AAC therapy takes more effort from parents. But that effort pays off. You're not just attending your child's therapy. You're learning to be your child's best communication partner, in your own home, with your own routines. That's powerful.
Download SabiKo free and bring AAC into your next therapy session.
References
- Wales, D., Skinner, L., & Hayman, M. (2017). The efficacy of telehealth-delivered speech and language intervention for primary school-age children: A systematic review. International Journal of Telerehabilitation, 9(1), 55-70.
- Grogan-Johnson, S., Alvares, R., Rowan, L., & Creaghead, N. (2010). A pilot study comparing the effectiveness of speech language therapy provided by telemedicine with conventional on-site therapy. Journal of Telemedicine and Telecare, 16(3), 134-139.