I first learned AAC assessments my second year of graduate school. I was a part of the AAC evaluation team, which gave me many insights into how AAC assessments or evaluations are conducted.
Over time, my knowledge and insights into AAC assessment have grown and evolved. I am sharing my most recent recommendations and insights on AAC assessment with you, so that you can also confidently select an AAC system that has a high chance of being a successful communication method for your clients with complex communication needs.
A good way to start any AAC assessment is to get a history or background of your client. You will want to know what communication systems were used in the past and why the client or team thinks the system is not sufficient.
Note any high-tech, mid-tech, or low-tech devices, and no-tech systems used (e.g., writing, sign language, etc.).
Ask the family/caregivers about the client’s medical history, any diagnoses they have, and their challenges with speech production.
Take into account any language testing or cognitive testing, if you feel that this is useful information and was conducted with integrity. If you feel this testing is inappropriate due to the client being non-speaking, then feel free to not use the scores in your formal assessment (or notate that they were not able to fully participate due to being non-speaking). Test scores of language or of cognitive abilities do not determine the type of system a person will receive, but rather provide us information about their strengths.
This can be over the course of many weeks, not just one visit. Talk to the family about what they envision for the client’s communication. Take note if you hear hesitation about getting an AAC device, and if you can respond with answers that reflect the current research findings (e.g., AAC systems do not discourage nonspeaking clients from speaking (Schlosser & Wendt, 2008); low-tech AAC does not need to come before high-tech AAC).
I make sure to ask the family what interests the client has, and I then try to use them during our speech/language sessions to increase the likelihood of the client participating in the AAC evaluation process.
I recommend you ask the family what languages are spoken at home, at school, and in the community. If there are multiple languages, which languages will be used in the AAC system? All? One? These are important considerations when selecting an AAC system, as not all systems have the capacity for multiple languages.
One thing to note is to ask the family what the most challenging situation currently is. This could be potty training, finding out if the client is in pain, the client's academic success, etc. Tell the family how AAC could potentially help the family through these tough situations. This encourages the family or caregiver to proceed with the assessment and to persist with finding an AAC device for the client.
I recently interviewed Rachel Madel, CCC-SLP and Autism Expert and AAC Specialist for this article. She had great insights into working with the client’s team when going through the AAC assessment process:
I think we make a big mistake as clinicians when we don't consider an AAC assessment as an interdisciplinary team process. One clinician should not be making a unilateral decision as to which system is best for a child. We should be collecting as much information as possible during our assessments and then present our findings to the entire team to determine what system is the best fit. I think clinicians understand the importance of this at a fundamental level but logistics get in the way of us actually implementing such an approach. When an entire team feels like they are a part of the decision-making process they automatically show up to the game with buy-in and are more motivated in helping a child become a successful AAC user!
I agree that including team members’ input during your assessment can increase buy-in from critical team members, improve your data, and improve the outcome of your assessment.
Now that you have looked at previous systems used and interviewed the family, it’s time to select systems to trial. I recommend starting with two systems and adding more later, if needed. As Rachel mentioned, consult with the client’s team when selecting which systems to trial.
To gain access to systems to trial, contact local representatives of device companies, and seek free resources like state lending libraries.
It’s important that you take data on the vocabulary the client can access without and with each communication system.
You want to be diligent in your collection of data, and note how much support the client needed, what field size they used, what field sizes you tried, and if it was a one hit or sequenced hit (if applicable).
Have multiple team members take data during the day and in different environments, if possible. This will ensure that the system is successful in multiple settings and in different communication scenarios. Communication doesn't end when they leave your office, so it's important that other environments are accounted for in your data collection!
Once your trials are completed and you have selected a communication system with the client’s team, it’s time to implement or purchase the system. You finalize the assessment results which indicate why you and the team selected the system, which is demonstrated by the data you and the team have collected. You compare the systems you trialed, and indicate why the one you selected is a better fit for the client than the other(s). If you are moving from low- or mid-tech to high-tech, indicate why low- and mid-tech do not fit the client’s needs in your report.
Unlike other types of assessments in language/speech, AAC is more intensive and includes more data collection and informal assessment protocols. One tool I encourage you to use is the Communication Matrix. This free assessment tool allows a familiar staff member or caregiver to answer questions that indicate how the client is communicating and what communicative functions they currently have.
To summarize, here are the steps I take for assessing AAC:
If you follow these guidelines for your AAC assessment, you are likely to find that you are selecting AAC systems with confidence and with increased buy-in from the family members and team members. We all want what’s best for our clients with complex communication needs, and when we are thoughtful and intentional with our approach, everybody wins.
To learn more about Rachel Madel, visit her website and follow her on instagram at @rachelmadelslp (click here to go to Rachel's Instagram). I also highly recommend listening to her podcast, Talking with Tech available here.
Schlosser, R. W. & Wendt, O. (2008). Effects of augmentative and alternative communication intervention on speech production in children with autism: A systematic review. American Journal of Speech-Language Pathology, Vol. 17, 212-230. doi:10.1044/1058-0360(2008/021)
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