Background: This investigation of children with Angelman syndrome (AS) examined reported uses of electronic augmentative and alternative communication (AAC) devices (i.e. VOCAs), including speech generating devices, in relation to other aided and unaided methods of communication. Materials and Method: A total of 122 parents of children with AS, mostly from the USA self-administered a survey over the Internet. Qualitative methods based primarily on thematic analysis were used to organize and examine data. Results: Children relied heavily on unaided methods of communication such as natural gestures, regardless of their experiences with electronic communication devices. Parents cited various reasons for children's acceptance or rejection of their most advanced devices. Discussion: Clinical implications are discussed in relation to children's needs for multimodal methods of communication, including accurately matching children's capabilities to AAC device characteristics. Practitioners are encouraged to consider reasons that parents cited for children's acceptance versus rejection of devices when implementing AAC programs.