The Predominant Focus Is Still on Teaching Children to Make Requests: A Systematic Review of AAC for Autistic Adults and Children.

Only 5 of the 421 participants were adults, so the review tells you almost nothing about AAC for autistic adults. Most studies took place in clinics or isolated therapy rooms within schools, not in the homes, classrooms, or workplaces where communication actually happens. The mean quality score was 2 out of 5 and no study scored the maximum, so the underlying evidence base is weak. 57 of the 69 studies recruited a majority-male sample, and 33 were 100% male, so findings may not generalise to autistic women and girls. No autistic authors were on the research team, which the authors identify as a limitation for framing questions and interpreting findings. Non-English publications were excluded and only six databases were searched, so some relevant work may be missing.

The authors declare no conflicts of interest and report no funding.

Do not read this review as evidence that AAC does not work for broader communication goals. The finding is that those goals have not been studied. The 69 included studies mostly measured whether a child could say 'I want train' in a therapy room, not whether they could join a conversation, express a feeling, or use their device at home with a parent. The gap is in the research, not in the intervention.