Assessing Kids’ Needs for AAC (Augmentative-Alternative Communication) - How Do You Look?

So many things go into an AAC evaluation. And, while the format of most of those evaluations has changed over the years, the things that need to be taken into account haven’t.

Over the years, some of the device manufacturers and some software (and now app) developers have created formalized (though not standardized) assessment activities.  These look at the size, style/representation format, array size, location on screen, amount of contrast and color that the user responds best to.  These are all important factors that we have to think about.  

Some students have difficulty when there are more than, say, 6 buttons or symbols on a page.  Some users with cortical vision impairment (c.v.i.) respond best to specific color contrasts; such as the use of bright red, or use of a dark gray background.  Some students need picture spaces/buttons to be at least, say, 2” in size, due to motor issues.  There are lots of these functional details to consider.

Another thing we need to look at is the user’s support system and environment.  Who will be communicating with the individual?  Where do they spend their time? How consistent can those communication partners be with using Aided Language Stimulation, or with learning a completely new symbol language system; such as Unity?  How much support are parents going to get from other sources?

Recently, I did a consultation with a 4 year old boy with cerebral palsy who had no prior experience with using pictures at all.  He was unable to move any part of his body volitionally, except for his head.  He wore glasses, AFO’s, and sat in his mother’s lap during the assessment being completely supported.  He was unable to move his arm to reach without support/full assistance, although he was reported to be able to reach out and touch somethings sometimes.  
His family said that they had an iPad that he could “touch.” (His hands were fisted. After trying unsuccessfully to touch an iPad, I demonstrated 'Accessibility' features of the system and created a new gesture for him.)

I started blowing bubbles at him.  He smiled each time.  His mom said he likes bubbles a lot.  If he had been able to access a device I would have continued with the bubbles activity, using any combination of bubbles activities pages on a variety of systems.  I would have tried to get from "blow" to "blow more" to "blow more bubbles," and see where I could get him to go.

Right off the bat, without a way to utilize direct access to pictures through point or touch, I had to think about scanning in some form.  But this was a little boy who had no prior experience with using pictures to communicate.  He had no idea, yet, of the power of communication beyond the few gestures and vocalizations he had been using.  So, I want to get him a good, solid start with picture-based communication and picture aided input.

So I demonstrated the PODD (Pragmatic Organized Dynamic Display) communication book (designed by Gayle Porter) for them, and modeled how to provide Aided Language Stimulation.  I talked about how the pragmatic branch starters work; how finding words for different message functions was an important part of learning how to navigate.  And I modeled Partner Assisted Scanning.  

Unusually, for me, they did not show disappointment at not walking out with a shiny, bells and whistles, communication device (or at least a recommendation for one).  They were happy to find a place to start, and one that would provide sufficient vocabulary for their son to communicate about lots of different things in his life.  He smiled.

How are you assessing AAC users?