This research is concerned with conversation—the most complex and vital way language can be used to connect with community. Language, as an empowering element of human, social and cultural agency, is used to organise thinking and to express thought. Language and communication are often considered as mutually inclusive but this is only half the story. Language has two representations: the linguistic, where units of meaning can be generated and shaped according to social conventions; and the non-linguistic, where bodily movements are used to augment or to be an alternative to linguistically formed language. Guided by dynamic systems theory this research answers the primary research question: ‘What strategies do adult communication assistants use when they interact with someone who has Down syndrome, Rett syndrome or cerebral palsy. These genotypes have been specifically chosen because of their association with particular augmentative methods of communication. Therefore, when examining the conversational strategies used by their communication assistants it is envisaged that a diverse range of language methods and tools will be evidenced, such as speech approximations, key word signing, eye gaze, pointing, and speech-generating devices. In addition, six secondary research questions are answered to provide a clearer understanding of the nature of communication assistants and conversation in the augmentative and alternative communication (AAC) context.