September 12, 2022
Augmentative and Alternative Communication (AAC) Assessment is an integral component of serving children with complex communication needs. Unfortunately, it is also an aspect of our field in which many Speech Language Pathologists (SLPs) report reduced confidence or unfamiliarity. The task seems daunting, and it seems especially so if you believe that you are to take it on alone. Most speech/language assessments are conducted by one or (occasionally) two people, so it makes sense that we would default to the assumption that this is a task that only we, the experts in language, can complete; however, AAC assessments are different.
AAC assessments require the involvement of an entire team of related service professionals, educational professionals, and loved ones to help compile a holistic profile of each individual communicator.
One of the most important aspects of an accurate and meaningful assessment is confidence on the part of the evaluator. The process of evaluating a student’s complex communication needs is not the straight line that many SLPs are used to, given our history of assessments such as the GFTA, the CELF, the PLS-5, etc.
These assessments yield a standard score, a number, that denotes the severity of a disorder and outlines a clear path forward. Without a standardized assessment in place for all complex communicators, the path forward can appear to be less clear. SLPs’ confidence levels in administering AAC assessments seem based on their individual experience with communicators with complex communicative modalities (try saying that 5 times fast!).
This anecdotal statement has been corroborated by a study conducted by Sanders, Page & Lesher (2020). They found that when conducting an initial AAC assessment, SLPs who specialize or who have more experience working with students with complex communication needs reported a higher level of confidence in administering a variety of assessment tools to assess current levels of functional communication. SLPs who had less relevant work experience reported a reduced level of confidence using a similar assessment methodology (Sanders, Page & Lesher, 2020). In fact, there is even a notable difference in the way SLPs who are confident in AAC assessment evaluate their students compared to their less experienced counterparts. SLPs who specialize in AAC tend to focus more extensively on participation in daily activities. In contrast, SLPs with less experience comparatively focus on the underlying impairment/disorder of the individual being evaluated (Sanders, Page & Lesher, 2020).
There is no magic cure for a lack of confidence or familiarity with AAC assessment, but hopefully, this reinforces that a lack of confidence in this area is normal. There are so many SLPs with the same struggles, fears, and concerns. We are all humans, doing our best to serve our community in the most effective way we can.
Now let’s get into the details of what this is all about…the specifics of evaluating students with complex communication needs. All AAC Assessments should be gathered using a dynamic assessment approach, but that doesn’t mean that they’re without qualitative data or measurable benchmarks.
As SLPs, we have a wealth of resources at our fingertips – it’s just about knowing the right places to look. One such resource is The Communication Matrix. The Communication Matrix is, according to the website itself, “a unique [tool] in measuring all possible communicative behaviors in non-speaking individuals and accommodates any type of communicative behavior, including augmentative and alternative forms of communication, pre-symbolic communication and typical forms of communication such as speech and writing. The measure covers seven levels of communication occurring during the earliest stages of communication seen in typically developing individuals” (https://communicationmatrix.org, 2022). Each skill is measured on a 4-point scale (not used, emerging, mastered, surpassed). The seven levels of communication measured by the assessment range from pre-intentional behavior to the emergence of language (requesting/refusing, greetings/closures, etc.).
This assessment is ideal for assessing prelinguistic skills, but it does not have quantitative data available for our students who have more robust nonverbal language skills. For that, we turn to The Transdisciplinary Play Based Assessment.
The Transdisciplinary Play Based Assessment (TPBA) can offer qualitative measures that assess communicative abilities past prelinguistic skills. This publication offers skills checklists, observational data sheets, and assessment protocols for sensorimotor, vision, social/emotional, communication, and cognitive development for a wide variety of ages. The data collected on each developmental skill informs not only AAC device selection but also provides clear steps forward on the skills to target (e.g. write IEP goals for) to foster communication or cognitive development. The TPBA offers these assessment measures for a wide variety of age norms, and notably includes many pragmatic language measurements that are not measured in the Communication Matrix. This tool is meant to be used in collaboration with a variety of other disciplines to offer a well-rounded view of the student being evaluated.
The use of a team approach is especially vital when conducting AAC assessments through teletherapy/hybrid models. Teletherapy and hybrid assessment models are here to stay, both in the articulation/language world as well as the AAC world. With rapidly evolving technology and a growing need for SLPs and related service professionals across the country, these new models of evaluation help secure services for students that might otherwise have gone without. The use of a teletherapy or hybrid modality for AAC assessments can yield a wealth of information that might have otherwise gone unattained. When conducting an assessment virtually, it is all that much more important to use a wide variety of assessment tools. These can include parent interviews, short questionnaire forms for teachers or aides, and observational questions for other related service professionals including occupational therapists, physical therapists, psychologists, or counselors.
The Wisconsin Assistive Technology Initiative offers excellent resources for printable observation guides, questionaries, and skills checklists which are intuitively designed for parents or other specialists to complete. In the event you are working with professionals who are not familiar with AAC evaluations or how to provide the information you need, the Texas Assistive Technology Network provides an excellent educational resource and presentation detailing the steps of dynamic assessment for related service professionals. The importance of gathering comprehensive data through a team model truly cannot be overstated, and it is equally important that you are empowering and educating your teammates to the best of your ability.
Assessments discussed above, and additional resources:
Communication Matrix: https://www.communicationmatrix.org/
Texas Assistive Technology Network: https://www.texasat.net/training-modules/evaluation-module
Tobii Dynavox Dynamic Goals Grid: http://download.mytobiidynavox.com/MyTobiiDynavox/dagg%202%20-%20writable.pdf
Wisconsin Assistive Technology Initiative: https://www.wati.org/
References and for Further Reading
Denman, D., Cordier, R., Kim, J.-H., Munro, N., & Speyer, R. (2021). What Influences Speech-Language Pathologists’ Use of Different Types of Language Assessments for Elementary School–Age Children? Language, Speech, and Hearing Services in Schools, 52(3), 776–793. https://doi.org/10.1044/2021_lshss-20-00053
Muller, K., Brady, N. C., Fleming, K. K., & Matthews, K. (2020). Communication Assessment for Individuals With Minimal Verbal Skills: A Survey of Current Practices and Satisfaction. American Journal of Speech-Language Pathology, 29(4), 1997–2011. https://doi.org/10.1044/2020_ajslp-19-00129
Ogiela, D. A., & Montzka, J. L. (2020). Norm-Referenced Language Test Selection Practices for Elementary School Children With Suspected Developmental Language Disorder. Language, Speech, and Hearing Services in Schools, 1–16. https://doi.org/10.1044/2020_lshss-19-00067
Sanders, E. J., Page, T. A., & Lesher, D. (2021). School-Based Speech-Language Pathologists: Confidence in Augmentative and Alternative Communication Assessment. Language, Speech, and Hearing Services in Schools, 1–17. https://doi.org/10.1044/2020_lshss-20-00067
Werfel, K. L., Grey, B., Johnson, M., Brooks, M., Cooper, E., Reynolds, G., Deutchki, E., Vachio, M., & Lund, E. A. (2021). Transitioning Speech-Language Assessment to a Virtual Environment: Lessons Learned From the ELLA Study. Language, Speech, and Hearing Services in Schools, 52(3), 769–775. https://doi.org/10.1044/2021_lshss-20-00149
Quinn, E. D., Cook, A., Wiedrick, J., & Rowland, C. (2021). An Initial Investigation Into the Feasibility of the Communication Matrix Professional Development Program for Educational Professionals Working With Students With Complex Communication Needs. Language, Speech, and Hearing Services in Schools, 52(4), 1080–1094. https://doi.org/10.1044/2021_lshss-20-00154
About the Author
Marisa Julius is a speech-language pathologist that has worked in both public and private school settings with a focus in pediatric augmentative and alternative communication therapy. She currently works for a private specialized school setting with children 5-21 with complex communication needs and a variety of disorders including Autism Spectrum Disorder, Down Syndrome, Childhood Apraxia of Speech, Language Delays, Reactive Attachment Disorder, and more. She is a Missouri native and earned two Bachelor degrees from Truman State University in Communication Disorders and German Studies. She received her M.A. in Communication Sciences and Disorders from Saint Louis University. She considers herself a lifelong learner, and is thrilled to be writing for SLP Toolkit, if only for an additional excuse to read more. In her free time, you can find her cooking, reading, hiking, or showing everyone unsolicited pictures of her dog.