FND Education Project

REFERENCE · RECOVERY TECHNIQUE

Communication Support When Speech Is Difficult or Unavailable

Motor or vocal tic-like symptoms may coexist with the symptoms discussed here. Their diagnosis and treatment should follow the individual formulation; communication access remains available when vocal symptoms interrupt a message. [See the dedicated functional-tics page](../17-functional-tics-and-tic-like-symptoms.md).

Most likely fit: Speech is unreliable, exhausting or unavailable, and another way to express needs, choices and ordinary conversation is needed. [Communication-access guidance; aids can be temporary, intermittent or ongoing]

Motor and vocal tic-like symptoms

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You still have things to say when speech is difficult. Writing, typing, a communication board or an agreed gesture may help you say them. You do not have to struggle through a spoken attempt before using support.

The original list called this “temporary communication support.” That can fit a short episode, but support may also be useful intermittently or over a longer period. Its availability should follow your needs. Choosing an aid does not mean abandoning speech therapy.

A few useful words

Augmentative and alternative communication, or AAC, means ways to supplement or replace speech. It can be as simple as a gesture or as complex as a speech-generating device. A communication partner is the person you are exchanging messages with; they also need to learn how your chosen method works.

What this might look like

Think first about what you need to say and what you can comfortably use. A short written message might help in a shop. A large-print board may help when typing is difficult, but be unsuitable when looking at it worsens visual symptoms. A device voice may be useful or too uncomfortable to hear. There is no single best tool for everyone.

As an example, agree ways to communicate “yes,” “no,” “stop,” “pain” and “I need something else,” without limiting conversation to those choices. Test them together when communication is easier. For no-warning episodes, keep a backup within reach; charging, unlocking and finding an app should not be the only route to help.

The examples here are suggestions to discuss with your clinician, not a fixed exercise prescription. [1][2]

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Speak to the person directly and give them time to compose an answer. Ask before reading over their shoulder, speaking their message aloud or completing a sentence. Repeat the meaning back when it is uncertain, and let them correct you.

Do not move an aid out of reach to encourage speech. If a yes/no response is unclear, do not treat your guess as consent. Find a more reliable way to establish the person’s wishes.

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For Clinicians and the Care Team

Selecting the approach

Assess access across motor, sensory, language, cognitive and literacy needs, including changes during episodes. Provide suitable low-tech and high-tech options rather than assuming smartphone use. Maintain the person’s authorship and privacy; physical assistance must not determine the content of a message.

Putting it into practice

  1. Identify urgent and ordinary communication needs with the person.
  2. Trial accessible methods, including a low-tech backup and a way to initiate an exchange.
  3. Agree clear responses and a way to correct misunderstandings or reject offered choices.
  4. Teach partners to wait, verify meaning and address the person directly.
  5. Check availability in appointments, travel, home and low-capacity episodes.
  6. Review usefulness and update support alongside any chosen speech rehabilitation.

Review and stopping points

The 2021 consensus raises concern that aids could perpetuate functional mutism. That concern is not evidence that removing an aid improves outcomes. This collection explicitly prioritizes continuing communication access, informed by ASHA’s broader AAC guidance. Review support collaboratively; do not set a compulsory withdrawal date.

The procedure is an educational adaptation for individual clinical review, not a validated standalone protocol. [1][2]

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Research and Sources

Source for this boundary: Malaty IA, Anderson S, Bennett SM, et al. Diagnosis and management of functional tic-like phenomena. Journal of Clinical Medicine. 2022;11(21):6470. FND-CIT-0110; source.

ASHA supports individualized multimodal AAC and ongoing access to tools. This is adjacent communication-access guidance, not a trial showing that AAC treats FND. The distinction from the consensus paper’s caution about aids is deliberate and stated above.

Citation Full citation Figure
[1] Baker J, Barnett C, Cavalli L, et al. Management of functional communication, swallowing, cough and related disorders: consensus recommendations for speech and language therapy. Journal of Neurology, Neurosurgery & Psychiatry. 2021;92(10):1112–1125. FND-CIT-0025. Source —
[2] American Speech-Language-Hearing Association. Augmentative and Alternative Communication (AAC). Practice Portal. Accessed September 17, 2026. FND-CIT-0106. Source —

Sources checked September 17, 2026 · Speech-language pathology, relevant medical specialties, lived-experience, supporter and accessibility review pending.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
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