The comprehensive AAC assessment

To determine the best AAC system for a child, it is necessary to conduct a comprehensive AAC assessment. This assessment needs to cover both characteristics of the child as well as the potential advantages and obstacles that exist in the environment. Ideally, it results in:

• Deciding which of the child’s current methods of communicating should be maintained and/or developed further.
• Selecting new methods of communication, and determining the best way to implement them.
• Making changes and adaptations in the environment and in the way people interact with the child.

At the core of this assessment are four basic questions.

• What are the child’s communication needs or goals?
• What are the child’s strengths and abilities?
• What barriers are preventing the child from achieving his or her full communication/participation potential?

• What aids and adaptations (e.g. AAC devices or systems, environmental modifications, policy changes, etc.) will best accomplish the child’s goals given his or her strengths and abilities, and current circumstances?

There is no strict order to these questions. In fact, each of them should be asked on a continual basis since, as the child grows and develops, the child’s needs and abilities, and the settings in which he or she functions will change. In addition, no single AAC device will necessarily be able to accomplish all of the child’s needs in all situations. An AAC system should, therefore, be multimodal, that is comprised of a number of different types of communication methods, each of which is used in different situations. (See Multimodal communication.)

The assessment should be made up of information collected in a variety of ways. Included may be interviews with the persons who know the child best, observations of the child in natural settings, formal testing to obtain specific information or to fill in the gaps, and trial periods with actual AAC devices and systems to see how well they suit the child. It is important to make sure that the child is comfortable and not overtaxed during the assessment, otherwise the child may fall short of his or her true abilities. This means keeping assessment periods short, having parents or other familiar persons present and assisting, making everything as fun and interesting as possible, and honoring the child’s need to take breaks or end sessions (Mirenda & Iacono, 1990).

OTHER RESOURCES:

Help me—and everyone who reads this site—by mailing your suggestions, criticisms and personal experiences to Ruth Ballinger at yaack@iname.com

• "Navigating the process: Educational TECH points for parents" by Gayl Bowser and Penny Reed, a guide on getting and using the right technology from your school (not necessarily AAC), at www.closingthegap.com/cgi- bin/lib/libDsply.pl?a=1113&b=5.

• "Augmentative Communication Assessment" by Stacy Dymond at www.ttac.odu.edu/ Articles/AugComAss.html.

• "Augmentative Communication Assessment Protocol for Symbolic Augmentative Systems" by Gamel-McCormick & Dymond at www.ttac.odu.edu/ Articles/Gamel.html.

Communication is functional, interactive and personal. A child’s communication needs are determined by what the child, family members, teachers, and other significant persons want the child to accomplish. Without communication, a child’s ability to have needs and wants met, to develop and enjoy social relationships, and to learn and share new information and ideas is extremely limited. (See What is AAC?) A child develops increasing self-confidence and control over his or her own life as the child improves his or her ability to communicate and interact socially. A child’s communication requirements, therefore, are directly related to the child's need for self-determination and, ultimately, self-satisfaction in participating in the interactions and events that make up his or her day (Light, 1989; Van Tatenhove, 1987). (See Learned helplessness.)

There are two main approaches to identifying what a child’s communication needs and, therefore, goals are. One is to examine and work with the child from the viewpoint of normal speech/language development. This is called the developmental approach. It is based on the fact that typically-developing children go through series of stages. They go through these stages in fairly strict order, and do not progress to the next stage unless previous stages have been mastered. This is true in all areas of development, including motor, cognitive, emotional/behavioral, and speech/language. (See Normal speech and language development.)

Communication intervention that is based on the developmental approach begins with an assessment that identifies at what stage (i.e. what ability or skill level) the child currently is. The goals of intervention,then, are to assist the child in reaching the next stage. The assessment and ensuing therapy are typically done by professionals, with input from family members and others who know the child well. The developmental approach is frequently used with infants and toddlers. (See Organizations supporting children under three.)

However, while this approach often works well with infants and very young children, it tends to become less useful the older the child gets for the following reasons:

• It is extremely difficult to predict speech/language development in an infant or very young child. It is often, if not always, worthwhile to provide therapy based on the assumption that the child will develop normal speech and language, albeit at a slower rate (Beukelman & Mirenda, 1992).

• The divergence in development between a child without disabilities and one with disabilities often increases with time. At a young age, these differences are relatively small. Consequently, early developmental objectives are still age-appropriate. For example, a six month old infant may be working on the skills of a 3 month old. However, as the child gets older and delays increase, the child with disabilities may still be working on skills that are typical of infants or toddlers, in lieu of skills that are more age-appropriate and functional.

• Children with disabilities will not necessarily complete all the developmental stages, nor will they do them in the same order as typically developing children. Early developmental objectives are more likely to be achievable by a child with disabilities. When a child is not able to make progress within a reasonable time frame using appropriate teaching techniques and adaptations, it makes sense to change the objectives. There have been cases in which children were being "taught" pre-communication skills for years, leaving them with no means or opportunity to actually communicate.

• When children enter preschool or kindergarten their social and academic progress depends on their ability to function in and derive benefit from school and community activities and environments, and to interact with peers. The developmental approach focuses primarily on learning specific skills, and not on the quality of school and community participation.

In early years, a child’s world consists primarily of family and home and, perhaps, early intervention center and therapists. However, when the child reaches school-age, that world expands to include school, teachers, peers and more of the community. Whereas, previously, life more or less centered around the child’s abilities and needs, school presents the new challenges and rewards of joining in activities and events designed to meet the needs of a whole group of children. Progress and success at this time depend on the child’s ability to fit into and be successful in the new school environment. In addition, the child may also be starting to visit friends’ homes and make forays out into the community. Psychologically, the child wants to establish greater independence, and peers are becoming increasingly meaningful. Consequently, at this age, the assessment of a child’s communication needs must also involve looking at his or her ability to function in these new-found activities and events, and identifying ways in which the quality of that participation could be improved through communication intervention.

Help me—and everyone who reads this site—by mailing your suggestions, criticisms and personal experiences to Ruth Ballinger at yaack@iname.com

The ecological model, thus termed because it examines the quality of the child’s functioning in relationship to the activities and environments in which he or she participates or is expected to participate, is an assessment approach that takes into account the child’s increasingly expanding world. With this method every child is examined on an individual basis in the context of his or her life and lifestyle. (See The ecological approach: Focusing on participation.) The ecological approach is more recent than the developmental approach, and incorporates many aspects of the latter into both its assessment and intervention methodologies. It recognizes that the child’s progress in developmentally-based skills does translate into more meaningful participation in activities and environments. Therefore, while, on a larger level, the ecological approach aims at improving the child’s functioning in activities and environments, it continues to embed specific developmental objectives into activity-based goals in order to achieve the quality-of-life outcomes being sought.

Currently the ecological approach, which looks at the child’s functioning in relationship to the activities and environments in which he or she participates or is expected to participate, is considered by many to be the best method of assessing needs and identifying goals and instructional programs, particularly for school-age children with disabilities. It was originally developed by Brown, Branson-McLean, Baumgart, Vincent, Falvey and Schroeder who, in their landmark 1979 paper, described a procedure of systematically examining every environment, subenvironment and activity in which the child is involved, and looking at the meaningfulness of the child’s participation. They referred to this examination as an "ecological inventory." Rather than looking at the child’s abilities and disabilities in comparison to the norm, their model focuses on quality-of-life features such as the child’s independence, inclusion and self-satisfaction in his or her daily activities and routines. Ensuing goals and instruction, then, are aimed at increasing the overall quality and quantity of the child’s participation.

The ecological approach is typically used to evaluate all domains of a child’s life, but can, of course, be used to look just at specific areas. Communication interventions, in particular, lend themselves very well to the ecological approach since communication is an interactive exchange with other people in the context of particular settings and activities. In examining a child’s communication needs in light of the ecological model, it is useful to keep in mind the basic purposes of communication:

• To indirectly gain control over the environment.
• To regulate social encounters.
• To receive and convey information.

The rationale behind the ecological approach is that a child needs to be more than a spectator or a passive participant in the activities and routines that make up his or her day. Communication taught for the purpose of improving the quality of a child’s participation will have more of an impact on his or her life than language or communication skills that are taught out of context. The basic principles of the ecological approach include the following:

• The intervention process, including assessment and instruction, occurs in the context of natural daily activities and routines.

• The environments and activities focused on are those in which the child is currently involved, or those in which the child is expected to become involved in the near future.

• Goals and objectives are selected on the basis of their functionality and meaningfulness to the child or significant others in the child’s life. They are aimed at increasing the quality and quantity of a child’s participation in regular activities and routines. This implies also that they are individualized to meet the specific needs of the child.

There are many advantages in using the ecological approach for designing interventions for children with disabilities.

• Children are more motivated to learn because the goals are functional and make sense to the child, and because they are embedded in activities and routines that are interesting and fun.

• Children do not have to be segregated while learning, and are less stigmatized since instruction occurs in natural contexts.

• The resultant shorter, more frequent teaching opportunities distributed throughout the day are a more effective way of teaching than longer, less frequent drill-and-practice sessions.

• Children are more likely to maintain their skills because they are practicing them in natural situations everyday.

• Because the skills are functional and meaningful, children are more likely to independently generalize their use to other settings and with other people (Udwin & Yule, 1987).

• Skills taught in natural settings can lead to other benefits, such as better relationships with other persons present, improved academic standing, and greater involvement in activities. (Calculator, 1991).

• Nonprofessionals are often involved in carrying out interventions, and, in fact, may, in many situations, be preferable to professionals because they are the child’s natural communication partners.

• The same types of skills that are targeted by other methods can be taught using the ecological approach, so nothing is lost.

The collaboration and cooperation of the AAC team is especially important when using the ecological approach to assessment and instructional planning. (See The AAC team—the most important component.) Because goals and teaching programs are based on the child’s regular activities, no single person is capable of developing or carrying out interventions. The input of persons who know the child’s interests, typical environments and daily schedule are as important as that of the professionals who understand how to convert that information into goals and instructional programs.

Help me—and everyone who reads this site—by mailing your suggestions, criticisms and personal experiences to Ruth Ballinger at yaack@iname.com

In addition, because persons who are already a part of the child’s life, including family members, often carry out the interventions, they must be involved in the decision-making process in order to optimize outcomes. Interventions must conform to the lifestyle and beliefs of the persons doing the teaching, or else they are likely to be ineffective.

OTHER RESOURCES:

• "A Resource List on Person Centered Planning" by Allen, Shea & Associates at www.napanet.net//business/ personal/ASA/resource.html.

• "Personal Futures Planning for People with Disabilities" by The Center for Disability Information and Referral (CeDIR) at www.isdd.indiana.edu/ ~cedir/pfplan95.html.

Brown et al. (1979)’s ecological inventory starts by examining the typical environments and activities in which the child spends time, and then identifies the adaptations and instruction that are necessary to improve the child’s functioning within them. The ecological inventory is composed of the following steps (Westling & Fox, 1995):

• The child’s AAC team (or special education team) meets. In addition to professionals, family members are essential to this process since they are the experts on the child’s interests, capabilities and daily schedule. Furthermore, it is ideal if other persons involved on a regular basis with the child become involved since they will become an integral part of the intervention. Everyone on the team contributes to the assessment process.

• Together the team first identifies all the environments in which the child regularly spends time, for example, home, school, park, friends’ homes, car, etc. Note, this should include environments in which the child does not yet, but would be expected to participate in the near future, for example preschool or the kindergarten classroom.

• The team next identifies important subenvironments within the larger environments. For example, in the home the child spends time in the kitchen, the living room, the dining room, the bathroom, the child's own bedroom, siblings' and parents’ bedroom, and outside in the yard.

• The team then identifies and describes in detail the specific activities of the child that occur in these environments. For example, at home a child typically has routines for waking-up, meals, play time, toileting and grooming, and bed-time. The bed-time routine may involve brushing teeth, putting on pajamas, reading a story with a parent, and saying good-night. Again, activities in which the child does not yet participate but are considered desirable for the child to become involved in, should be included.

• The next step is for the team to identify and prioritize the activities in which an increase in the quality of the child’s participation is desired. This is often difficult since everyone wants to see the child progress in different areas. In general, activities that are highly motivating to the child, occur more frequently or for longer periods of time, or involve subskills that are used in many different activities (e.g. taking turns or saying "want") should be given higher priorities. It is also important that family wishes be given more weight than those of professionals, since the family is ultimately responsible for the child’s development. (See Forging an effective AAC team.)

• The team can then begin to outline specific ways in which the child can improve his or her level of participation in the target activities. The team conducts "task analyses" of each activity, which means breaking them down into their component steps. These are followed by "discrepancy analyses," in which the differences between the way peers participate in the activities and how the child with disabilities does are outlined. For example, a child without disabilities may typically introduce him or her-self by making eye contact, waving and saying "Hi! I am So-and-so," whereas a child with disabilities may simply look down and smile shyly. Areas in which it is desirable to reduce these differences or modify the manner in which the child functions become the communication needs of the child and the aim of the communication intervention program.

• The team designs and implements instructional programs and adaptations addressing the identified needs. The overall aim is to increase the child’s ability to participate in the target activities with greater independence, self-satisfaction, and social interaction.

  Help me—and everyone who reads this site—by mailing your suggestions, criticisms and personal experiences to Ruth Ballinger at yaack@iname.com

  The goal in the example given above might be to provide the child with a voice output communication device (VOCA) that would allow the child to self-introduce with an electronic "Hi! I am Judy," while the child makes eye contact and smiles.

OTHER RESOURCES:

• Fuchs, D., Fernstrom, P., Scott, S., Fuchs, L., & Vandermeer, L. (1994). Classroom ecological inventory: A process for mainstreaming. TEACHING Exceptional Children, 26, 11-15.

• Westling, D. L. & Fox, L. (1995). Teaching students with severe disabilities. (pp. 125-128). Englewood Cliffs, NJ: Prentice-Hall, Inc.

There are several other recommended assessment and planning strategies which use the ecological approach. Each of these methods examines the child in relationship to his or her whole life, and all place a high priority on the input of those persons closest to the child, in particular, family members. One is the McGill Action Planning System (MAPS) (Forest & Lusthaus (1990); ) Vandercook, York, & Forest, 1989)). This process centers around eight basic questions, and utilizes a facilitator to assist the team in reaching consensus. The eight questions are:

• What is MAPS?
• What is the child’s history?
• What is your dream for the child?
• What is your nightmare?
• Who is the child?
• What are the child’s strengths, gifts, and abilities?
• What are the child’s needs?
• What would the child’s ideal day look like and what must be done to make it happen.

OTHER RESOURCES:

• Vandercook, T., York, J., & Forest, M. (1989). The McGill Action Planning System (MAPS): A strategy for building the vision. The Journal of the Association for Persons with Severe Handicaps, 14,.

• "Seeing the Whole Child: Making Action Plans for an IEP" by Tim Weiss at www.napanet.net//business/personal/ASA/maps.html.

• "ABC's of Education Making Action Plans (MAPs)" by Anne Malatchi at www.ttac.odu.edu/Articles/abc.html.

• "Mapping Out the Student's Future..." at www.michiganworks.com/transition/midland/maps.htm.

Another evaluation method based on the ecological approach is Choosing Options and Accommodations for Children (COACH) developed by Giangreco, Cloninger and Iverson (1993). Using the COACH system, the team identifies "valued life outcomes" which are transformed into goals and implemented through instructional programs and adaptations. Goals are categorized either as high priority educational goals (i.e. IEP goals) based on what the family wants for the child, or "breadth of curriculum" goals which extend over additional areas where new skills are desirable. Emphasis is also placed on "general supports" which are adaptations made to the environment that promote a child’s ability to participate. The COACH system is intended to assist children who are already in school, but it can be adapted for use with younger children.

OTHER RESOURCES:

• The most recent book on COACH is Giangreco, M.F., Cloninger, C.J., & Iverson, V.S. (1998). Choosing outcomes and accommodations for children (COACH): A guide to educational planning for students with disabilities (2nd edition). Baltimore, MD: Paul H. Brookes Publishing Co.

• "Description of COACH (Second Edition)" is on the home page of one of its authors, Michael Giangreco, at www.uvm.edu/~mgiangre/coach.html.

Another assessment method based on ecological principles is called "personal futures planning" or "person-centered planning" (Mount& Zwernik, 1988). This strategy focuses on the strengths and capabilities of the child, keeping the child’s needs the central focus of planning, as opposed to any policies or systems already in place. It is comprised of three parts:

• "The personal profile." At the initial meeting, the team shares basic information about the child. This includes a detailed history, the current accomplishments and lifestyle of the child, and what hopes and dreams each participant might have regarding the child’s future.

• "The personal future plan." At a second meeting, goals are developed based on the hopes and dreams envisioned for the child’s future. At the same time, potential obstacles are identified and intervention strategies are developed. These strategies must be actionable immediately.

  Help me—and everyone who reads this site—by mailing your suggestions, criticisms and personal experiences to Ruth Ballinger at yaack@iname.com

• "Building a network." The final step is to create a support network of persons who will meet on a regular basis to continue planning and executing instruction and adaptations. This is very important because it prevents the discontinuities and lapses that so often characterize the intervention process for a child, and ensures that continued progress is made toward the envisioned future. It requires dedication and committment on the part of all members.

OTHER RESOURCES:

• "Focus On Severe Disabilities Person-Centered Planning" at www.ttac.odu.edu/
  Articles/PCentPl.html.

• "Person-Centered Planning: Maps and Paths to the Future" by Howard Garner and Lise Dietz at www.ttac.odu.edu/Articles/person.html.

Besides identifying needs, another function of the AAC assessment is to recognize the current strengths, abilities and preferences of the child, as well as those that seem most likely to develop or change as the child matures. Communicative ability is a highly individualized skill that can really only be evaluated and planned for on the basis of the child’s ability to participate meaningfully in his or her own personal activities and settings. (See The ecological approach: Focusing on participation.) There is, therefore, no universal communication assessment protocol, nor is there a single right way to conduct an assessment. The assessment is typically composed of some combination of interviews with family members, teachers and others who are close to the child, standard norm-referenced and non-standardized protocols, and trial-and-error skill testing both with and without aids and adaptations, including potential AAC systems. In fact, it is often recommended that the child try out potential AAC devices and systems during the assessment phase since this can provide very specific information on how well the child is able to utilize them.

OTHER RESOURCES:

• Some AAC manufacturers have rental programs for potential customers.

• The Alliance for Technology Access (ATA) operates centers in most states which offer support and advice, as well as lend AAC equipment for trial periods. A listing of their centers is available at www.ataccess.org/atacenters.html.

• United Cerebral Palsy (UCP) spearheads a project called Tech Tots which organizes and maintains lending libraries of toys, computers, peripherals, software, and other assistive technology devices for families of young children with disabilities. For more information on Tech Tots, including a list of their centers as well as other organizations that operate lending libraries, go to www.ucpa.org/html/innovative/techtots/index.html.

• Cynthia Cress's Nov. 18, 1998 e-mail response under the heading "Standardized testing and AAC evals" explains why an AAC evaluation is not and should not be a standardized procedure. It is on the RESNA listserv archives at maelstrom.stjohns.edu/CGI/wa.exe?A1=ind9811&L=resna.

• When assessing a skill or ability in a particular domain, it is important not to simultaneously introduce or teach the child anything new in another area. For example, if a child’s ability to activate a particular switch is being assessed, don’t attempt to teach the child choice-making or symbol-recognition at the same time. If the child falls short in such a situation, it will not be apparent whether it was due to difficulties in handling the new switch or with the concept of making choices or understanding symbols.

• Assessing a child’s abilities and skills depends on the child being able to understand what is being asked (called receptive communication), and being able to express his or her understanding (called expressive communication). For example, a child may not activate a switch after a request to do so, whether the request was made verbally, by presenting the child with the switch, or by modeling so the child could imitate. It is not clear whether the child would have been able to activate the switch but did not understand what was being asked, or did understand the request but was not capable of activating the switch—or both. For some children with communication deficits, this presents a catch-22 situation: The child needs AAC in order to be assessed, but an assessment is necessary in order to determine what that AAC should be. In these situations, the answer may be to first provide the child with some type of AAC based on the information that is available. After the child has learned to communicate sufficiently with it, the remainder of the assessment can be completed and a more comprehensive AAC program designed. This is particularly true for children with severe motor disabilities (Goossens', 1989.)

• Ideally, assessments should be conducted in natural environments, that is settings in which the child typically spends time. Information on what the child is capable of and what he or she needs to be learning tends to be more accurate and useful when gathered in this way. Family members and/or other familiar persons should be present not only to make the child feel more comfortable, but so as to include significant others in the sharing of information. (See Arena assessments.) If the child evidences stress, strain or fatigue, the assessment session should be terminated and continued at a later time not only for ethical reasons, but also because information gathered would no longer be accurate.

  Help me—and everyone who reads this site—by mailing your suggestions, criticisms and personal experiences to Ruth Ballinger at yaack@iname.com

• It is not essential to cover every single area of a child’s functioning during an AAC assessment. Only developmental areas that are delayed or involved need to be assessed. In fact, it is undesirable to do so since a complete assessment is time-consuming, stressful and unnecessary not only to the child and family, but to the professionals on the team as well. Assessments or reassessments can be conducted whenever it is felt that a crucial area was missed, characteristics of the child have changed in a substantive manner, or circumstances surrounding the child are different (e.g. the child is in transition, for example, to kindergarten) (Halle, Alpert, & Anderson, 1984).

There are many reasons why a child may not be communicating or participating as well as could be in the activities and events of daily life. Characteristics of the child, the environment, or the persons with whom the child is involved may be at the root of a child’s lack of communication or passivity. Obviously, the child’s own communication impairment is one cause. Other reasons, however, are less apparent, like ignorance or negative attitudes on the part of partners towards individuals with disabilities, or the child’s own lack of self-confidence. It is important to identify these barriers and to address them.

In their book, Beukelman & Mirenda (1992) include detailed descriptions of the different types of obstacles to participation that exist for a child with severe communication impairments. Essentially, they describe two main types: "access barriers" and "opportunity barriers".

Access barriers are those in which the inability to participate is due to problems inherent in the child, the environment, or in the AAC system itself. These are generally addressed by straightforward instruction, aids and adaptations. The following table gives some examples of access barriers to communication, as well as solutions.

Access barriers	Solutions
Child has a communication disability.	Provide child with AAC.
AAC is inaccessible (e.g. AAC is not brought outside during recess).	Ensure availability of AAC at all times. The child may use different types of AAC that are appropriate to the situation (e.g. sign language during swimming). (See Multimodal communication.)
AAC does not have the necessary vocabulary.	Keep vocabulary complete, relevant and up-to-date. (See Vocabulary selection strategies.)
There are obstacles in the environment (e.g. child in wheelchair cannot get close enough to teacher to use his or her AAC system).	Modify the environment.
Child lacks the self-confidence to use AAC in order to participate.	Work with child to increase self-confidence. Also teach partners how to encourage and assist child in participating.

Opportunity barriers are those in which the inability to participate is due to impediments imposed by the attitudes and fears of persons, or dsicriminatory organizations and policies that are external to the child and the environment. These are often more insidious and difficult to pinpoint, but no less inhibiting than access barriers. The following table gives some examples of opportunity barriers to communication, as well as solutions.

Opportunity barriers	Solutions
Partners lack knowledge of how to include child.	Teach or train partners. (See Conversational control vs. conversational efficiency.)
Partners have negative attitudes towards individuals who have disabilities (e.g. peers think child with disability is weird).	Educate, assist and support partners in including child. (See Using peers in interventions.)
Organizations have policies that limit the ability of child to participate (e.g. a chess club does not allow a child to use computer-based AAC during tournaments).	Modify policies.

These questions look at both how the child currently communicates and what the child’s communication needs are.

• How does the child currently communicate?

  Expressive communication may be through speech, gestures, eye gaze, facial expression, non-speech vocalization, crying, etc. Even behavior problems, such as aggression and self-injury, may be forms of communication. (See Children with severe behavioral issues.)

• Does the child engage in intentional communication? If so, does he or she use symbols?

  Unintentional communication is when a child’s behavior is still at the reflexive stage, but adults imbue it with communicative meaning. This is in contrast to intentional communication, when a child communicates in a direct attempt to influence another person.

  A child is presymbolic if he or she must refer to an object or activity that is present in order to communicate about it. The child is capable of using symbols, however, if he or she understands that objects, pictures or other types of representations can stand for other objects, activities or people. (See Normal speech and language development and Assessing intentionality, and the understanding of means-end, causality and symbols.)

• How well does the child understand the communications of others (receptive communication)?

  As mentioned above, receptive communication is important not only to the child’s ability to communicate with others, but also to the assessment itself. A child who does not understand what others are communicating may not be able to respond in a manner that accurately depicts his or her cognitive, motor, expressive language and other abilities. (See General tips in assessing strengths and abilities.)

• In which environments and settings does the child communicate or want/need to be able to communicate?

  Note relevant characteristics such as noise level, typical distance between child and partner, weather conditions, etc.

• With whom does the child typically communicate or want/need to communicate?

  Note relevant characteristics of partners, such as age, whether they are literate or not, special conditions such as vision or hearing impairments, etc.

• What kinds of things does the child communicate or want/need to communicate?

  Consider the functions of communication—to indicate needs and wants, to interact socially, and to convey and receive information and ideas. Also consider the age of the child and who the partners are; a child interacts one way with parents, another way with teachers, and yet another with siblings or peers. (See The ecological approach: Focusing on participation.

• Does the child appear to enjoy social or communicative interaction?

  Some children avoid social contact and initially need to learn how to enjoy interacting with others. (See Teaching a child to enjoy social encounters.)

  Help me—and everyone who reads this site—by mailing your suggestions, criticisms and personal experiences to Ruth Ballinger at yaack@iname.com

• What motivates the child to communicate?

  For example, does the child typically want to obtain or reject objects or activities? Does he or she enjoy attention from adults, or siblings and peers?

• How do others respond to the child’s attempts to communicate?

  Children with disabilities may communicate in very subtle ways, and their communicative attempts may be ignored until they start fussing, crying or behaving in extreme ways. (See Normal speech and language development and Children with severe behavioral issues.)

Understanding a child’s cognitive abilities helps to determine the level of complexity of the contents of the AAC system (i.e. vocabulary, choice of symbols and organization strategies).

• What cognitive understanding does the child have?

  In particular, does the child engage in intentional communicative behavior? Does he or she appear to understand the concepts of causality, means-end and symbols? Causality is the understanding of cause and effect. Means-end understanding is very similar to causality and is the realization that one action results in the occurrence of something else. These are important in teaching a child that pointing to a picture, making a manual sign or pressing a button on a voice output communication aid (VOCA) results in communication to a partner.

  The understanding of symbols is the awareness that one item can represent another. This allows a child to use objects, pictures and, eventually, printed words to represent actions, thoughts and ideas (Van Tatenhove, 1987). (See The first goal: Intentional communication and Assessing intentionality, and the understanding of means-end, causality and symbols.)

  See Children with cognitive disabilities.

• If the child does understand symbols, which ones will work best?

  Usually—but not always—tangible objects are easier to understand than pictures, which are easier than simpler line drawings, which are easier than abstract symbols (Beukelman & Mirenda, 1992; Mirenda & Schuler, 1988; Reichle, York, & Sigafoos, 1991). However, there are tradeoffs among these choices, including portability (objects are heavy and bulky) and the amount of vocabulary that can be made available at one time (not very many objects can be presented at the same time, and even pictures are often bigger than line drawings). Generally, the most abstract system that a child is capable of working with offers the greatest flexibility.

  It may be necessary to actually begin teaching the child a set of symbols in order to determine whether it is the appropriate type of symbol or not. In choosing which symbol system to start with, it is often recommended that a more rather than less sophisticated type of symbol that seems within the realm of the child’s capability be attempted. It may be better to fail at this and to re-select a less advanced symbol system, than it is to settle on a system that does not allow the child to reach his or her full potential. (See Types of symbol systems and Teaching symbols.)

• Does the child do better utilizing recognition versus recall memory?

  Help me—and everyone who reads this site—by mailing your suggestions, criticisms and personal experiences to Ruth Ballinger at yaack@iname.com

  Systems in which the child communicates without external devices, called unaided systems, such as speech or sign language, require recall memory, that is the child has to remember the symbol without any additional cues. Systems in which the child communicates with an external device, called aided systems, such as picture boards and voice output communication devices (VOCAs), involve recognition memory, that is the system itself presents the child with a choice of symbols and the child just has to remember what the symbols mean. Recognition memory is generally considered easier than recall memory. On the other hand, aided systems that utilize recognition memory have vocabulary-size limitations while unaided systems do not have such externally-based restrictions. The child’s memory skills also determine how the symbols are organized and arranged in aided systems. (See Aided vs. unaided systems and Organizing vocabulary for speed.)

Unintentional communication is the nonvoluntary or reflexive behaviors typical of infants that adults interpret and respond to as having communicative value. For example, when an infant cries, the parent may say "Oh, you are crying because you are hungry. Here is a bottle." Intentional communication occurs when a child behaves with the aim of influencing another person. Intentional communication covers a wide range of types of communication from non-symbolic, idiosyncratic behavior all the way to conventional, symbolic communication such as speech, sign language or a voice output communication aid (VOCA). (See Normal speech and language development.)

Causality is the understanding of cause and effect. Means-end understanding is very similar to causality and is the realization that one action results in the occurrence of something else;, for example, giving an adult a wind-up toy will typically result in the adult activating it. These are important in teaching a child that pointing to a picture, making a manual sign or pressing a button on a VOCA produces an effect in another person (i.e. results in communication).

The understanding of symbols is the awareness that one item can represent another. The child can then use objects, pictures and, eventually, printed words to represent actions and thoughts. This allows the child to refer to events and ideas that are not physically present, but are out of sight, in the past or future, or are abstract.

It is very important to determine the extent to which a child understands intentionality, means-end, causality, and symbols. Many practitioners make the implicit assumption that the child understands these by attempting to teach an AAC system that utilizes these concepts (e.g. depends on pointing to pictures, or making signs). The instruction will be unsuccessful, and, frequently, the child, instead of the program, considered a failure.

It is sometimes difficult to determine whether a behavior is intentional or not. Generally speaking, if the behavior would have just as easily occurred outside of the presence of another person, then it is probably unintentional. (However, several researchers point out that some children who produce a communicative behavior even if no one is around, may still be considered intentional communicators. Paradoxically, these are typically children undergoing aggressive communication programs. In the attempt to teach them that their communication does have an effect on other persons, they never experience an unanswered communicative attempt. They never learn the necessity of obtaining the partner's attention prior to communicating because an adult is always there to respond (Reichle, York, & Sigafoos, 1991).

A child probably comprehends the concepts of means-end and causality if the child appears to understand how switch toys operate, demonstrates looking at or giving objects to an adult for the purpose of receiving assistance, or constantly tries to gain the attention of adults in a deliberate manner. If these actions are not present, then the child’s initial AAC program should not consist of switches or other indirect means of signaling. It also means that symbols should not be used, and that the child should be touching, pointing, reaching for or gazing directly at the object in reference.

Generally, a child understands symbols if he or she anticipates an activity by the appearance of one of the objects used in that activity, indicates an awareness of the meaning of frequently appearing symbols such as the CocaCola logo, or is interested in television or books. In contrast, a child is probably at a pre-symbolic level if he or she does not use objects as they were intended, but instead mouths, grabs or throws them (Mirenda & Schuler, 1988).

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A test to determine whether the child understands symbols is to see whether or not the child can match similar objects. Presented with an object that is identical to one place in front of the child, he or she may grab or point to the identical object, or look back and forth between two identical toys ignoring dissimilar ones in the vicinity. If the child appears to be able to match identical objects, the same method can be used to see whether the child can match other types of symbols, such as photos, drawings, or line drawings to an object. (See Teaching symbols.)

If the child is unable to even match objects to objects, then symbols should not be initially used in the AAC program. The child should be taught communication techniques, such as pointing, gazing or gesturing, that refer directly to the object in reference. At the same time, though, the program should begin using communicative techniques that advance the child’s cognitive understanding. This dual approach allows the child to be immediately successful in communicating, which increases the motivation to learn, while simultaneously progressing towards a more sophisticated and powerful method of communicating (Van Tatenhove, 1987).

This determines how the child will access his or her AAC.

• What are the child’s current speech and oral motor abilities, and what are the prospects for their further development?

  While some children with severe disabilities may never be able to depend on speech as their primary method of communication, many will be able to develop enough speech to effectively communicate with certain people or in certain situations. It is strongly recommended that vocalization be one part of a comprehensive AAC program whenever possible. Even children who never develop any speech may be able to communicate through non-speech vocalizations. For example, the quickest and most convenient way for a child to get someone’s attention may be to produce a sound loud enough to be heard across a room, as opposed to locating and pressing a button on an AAC device. It also means that a child is always with a means to communicate at least somewhat even if his or her primary AAC system is unavailable.

  See Children with motor impairments.

• What movements does the child have sufficient control over that can be used for AAC activation and control?

  A child with good motor control may be a candidate for sign language or gestures. For children with greater motor disabilities, the primary purpose of this part of the assessment becomes to find one or more motor responses that the child can accomplish consistently and reliably. This would allow the child to activate one or more switches on an electronic device, or indicate a symbol on a communication board or to a partner who is scanning a communication board. (See Switches and other types of input.) Besides consistency, it is important also to note the speed and force or pressure with which the movement can be made, any undesirable movements or reflexes that accompany it, and how fatiguing it is over time (Silverman, 1980).

  Help me—and everyone who reads this site—by mailing your suggestions, criticisms and personal experiences to Ruth Ballinger at yaack@iname.com

  It is also essential that proper positioning of the child be determined, not only for the purpose of the assessment, but for the future use of AAC as well. Positioning is absolutely key, particularly for a child with severe motor impairments. A child who is improperly positioned will experience unwanted reflexes, decreased range of motion, reduced field of visibility, and/or fatigue.

• How does the child move from place to place?

  While this does not have a direct impact on the use of AAC, portability is a significant, and often overlooked, issue. It is important to determine how a device is to be transported and made available to a child who walks and runs versus one who uses a walker or wheelchair. In addition, children are not as large or as strong as adults and many AAC devices are too big or bulky to be carried comfortably. This can result in the AAC not being accessible for substantial portions of time.

• Does the child have any vision difficulties?

  There are many different types of vision problems that can affect a child’s ability to discriminate among and utilize visual symbols besides visual acuity. It may be difficult to evaluate exactly what a child can and cannot visually process. Sometimes there is the mistaken assumption that because a child can navigate successfully around a room, he or she is able to utilize visual symbols. This is not always true since the visual requirements for maneuvering through space are different from those used in distinguishing visual symbols.

  See Children with sensory disabilities.

  A child with vision impairments may require enlarged or otherwise specialized visual symbols, or even tactile or auditory symbols. It may be necessary to test several types of symbols before deciding which ones work best. (See Types of symbol systems.)

• Does the child have any hearing difficulties?

  A child with hearing impairments may not be able to hear speech intelligibly, and, thus, may need adaptations in receiving communication from others. This places an added burden on partners who may have to learn a new visually-based AAC system, such as sign language, gestures or visual symbols. Children with some residual hearing often benefit from a simultaneous language teaching approach in which the adult utilizes a visual AAC mode along with regular speech. (See Simultaneous communication.)

• Is the child overly sensitive to stimuli?

  Some children evidence extreme sensitivity to certain textures, pressures, sounds, or visual images. It is important to become aware of these and to adjust instruction and the environment in order to accommodate and/or overcome them. (See Children with autism or autistic-like behaviors.)

• Does the child engage in inappropriate or challenging behaviors, including aggression, self-injury or self-stimulation?

  Sometimes children who are unable to communicate effectively will resort to inappropriate behaviors as a way to accomplish what they want. One solution is to determine what it is they are trying to communicate, intentionally or unintentionally, and then provide them with the means to communicate the same messages in an acceptable manner. (See Children with severe behavioral issues.)

• What are the access or opportunity barriers preventing the child from achieving his or her full communication/participation potential?

  (See Access barriers and opportunity barriers.)

• What aids and adaptations (e.g. AAC devices or systems, environmental modifications, policy changes, etc.) will best accomplish the child’s goals given his or her strengths and abilities, and current situation?

  Essentially, this constitutes the child’s actual communication intervention program. Ideally, this should be a comprehensive, multimodal plan encompassing the types of AAC that the child will be using and how their instruction will proceed, as well as adaptations to the environments in which the child typically spends time and modifications to individual attitudes and organizational policies so as to encourage or enhance the child’s ability to communicate/participate. If any component of the plan is neglected, progress of the child may be compromised.

  Help me—and everyone who reads this site—by mailing your suggestions, criticisms and personal experiences to Ruth Ballinger at yaack@iname.com

  This requires that the AAC team continue to meet on a regular basis to constantly reevaluate the child’s development and make adjustments to the plan as necessary.

OTHER RESOURCES:

• "Using An Assistive Technology Checklist to Facilitate Good Assessment and Planning" by Kelly Jo Lynch, OTR, ATP and Penny Reed, Ph.D, Director, Wisconsin Assistive Technology Initiative at www.dinf.org/csun_98/csun98_157.htm.