AAC Assessment: What SLPs Should Look For

AAC assessment is not about determining whether someone "qualifies" for AAC. There are no prerequisites for communication. The real purpose of an AAC assessment is to identify the best system, strategies, and supports for a specific individual in their specific contexts.

Yet many SLPs report feeling underprepared for AAC assessment. Graduate programs often dedicate limited coursework to the topic, and the range of available systems can feel overwhelming. This guide provides a structured framework you can use with confidence.

The Participation Model

The most widely used framework for AAC assessment is the Participation Model developed by Beukelman and Mirenda (2013). Rather than starting with the device, it starts with the person's life.

The core question is: What activities does this person need and want to participate in, and what are the barriers to their participation?

The model follows this sequence:

1. Identify participation patterns. What does the individual's day look like? What activities do they engage in? Where are the communication demands?
2. Assess current communication. How does the person currently communicate? What works? What doesn't? What's missing?
3. Identify barriers. Are barriers related to opportunity (environmental, policy, attitude) or access (motor, cognitive, linguistic, sensory)?
4. Plan intervention. Address both opportunity barriers and access barriers through system selection, partner training, and environmental modification.

Conducting the Assessment

Step 1: Gather Background Information

Before you meet with the client, collect information from multiple sources.

• Medical and developmental history. Diagnosis, motor status, vision, hearing, cognitive profile.
• Communication history. Previous AAC trials, current communication methods (speech, gesture, sign, pictures, devices), what has been tried and why it did or didn't work.
• Environmental inventory. Who are the primary communication partners? What settings does the person spend time in? What communication demands exist in each setting?
• Interview stakeholders. Talk to parents, teachers, aides, and, most importantly, the individual themselves if possible. Ask what they want to say and to whom.

Step 2: Assess Current Communication

Document all the ways the person currently communicates, not just speech. This includes:

• Facial expressions and eye gaze
• Body movements and gestures (pointing, reaching, pushing away)
• Vocalizations (even non-speech sounds that carry meaning)
• Sign language or manual signs
• Picture exchange or low-tech boards
• Existing high-tech AAC devices
• Challenging behavior that serves a communicative function

For each method, note: What can they express with this? In what contexts? With which partners? What can they NOT express?

This creates a communication profile showing strengths and gaps. The gaps are where AAC intervention should focus.

Step 3: Motor Assessment

Motor access is one of the most critical and often underassessed components of AAC evaluation. The question is: How will this person physically operate their AAC system?

Key considerations:

• Upper extremity function. Can they point with a finger? Use a whole hand? What is their accuracy and range of motion?
• Head and neck control. Relevant for head tracking, eye gaze systems, or switch placement near the head.
• Seating and positioning. Motor access changes dramatically based on positioning. Assess in the positions the person actually uses throughout the day, not just in an ideal therapy chair.
• Fatigue. Motor demands that are sustainable for 5 minutes may be exhausting over a full school day. Consider endurance, not just capability.
• Direct selection vs. scanning. Direct selection (touching the screen) is faster and more intuitive. If direct selection is not reliable, explore scanning with one or two switches. An occupational therapist should be part of this assessment.

Step 4: Cognitive and Linguistic Assessment

This is not about setting a cognitive threshold for AAC. There is no minimum cognitive level required to benefit from AAC. Instead, you are assessing where the person is linguistically so you can choose an appropriate starting point.

Consider:

• Symbol understanding. Can they match objects to photos? Photos to line drawings? Do they understand that a symbol represents a concept?
• Receptive language. How much spoken language do they understand? This helps calibrate the complexity of the language system you'll introduce.
• Expressive language level. Are they at a single-word, two-word combination, or sentence level? This determines initial vocabulary layout and grid size.
• Literacy skills. Can they recognize any letters or words? Even emergent literacy skills may influence system selection, since text-based systems become an option.
• Categorization. Can they find items within categories? This affects how easily they'll navigate organized vocabulary pages.

Use dynamic assessment whenever possible. Present a communication system, provide brief instruction, and see how the person responds. Static "can/cannot" testing misses the individual's learning potential. Kangas and Lloyd (1988) advocated strongly for dynamic assessment approaches in AAC evaluation, showing that individuals often demonstrate competencies in supported contexts that static testing misses entirely.

Step 5: Sensory Assessment

Vision and hearing directly affect AAC system design.

• Vision. Can they see symbols at the size your proposed system uses? Do they need high contrast? Larger grid cells? Specific color coding? Consult with the vision specialist if there are concerns.
• Hearing. If the device provides auditory output, can they hear it? Is amplification needed? Will the device be used in noisy environments where auditory feedback may be unreliable?
• Sensory processing. Some individuals are overwhelmed by busy visual displays or auditory feedback. Consider a simpler layout or the option to reduce visual clutter and turn off sounds.

Step 6: Feature Matching

Feature matching is the process of aligning the person's abilities and needs with the features of available AAC systems. This is where all the information you've gathered comes together.

Key features to evaluate:

SabiKo is designed with feature matching in mind. It offers multiple grid sizes, clear symbol displays, customizable vocabulary, and offline access, making it a strong option for a range of learners. And it is free to download.

What to Include in the AAC Assessment Report

A thorough AAC assessment report should include the following sections:

1. Background and referral information. Why the assessment was conducted, relevant history, current diagnoses.

2. Assessment methods. List all tools, interviews, observations, and trials conducted. Include dates and settings.

3. Current communication profile. Document all communication modalities currently used, their effectiveness, and their limitations.

4. Participation analysis. Describe the activities the person participates in, wants to participate in, and the communication demands of each.

5. Barrier analysis. Identify opportunity barriers (e.g., partners who don't model, device stored away during recess) and access barriers (e.g., motor limitations, symbol comprehension level).

6. Assessment findings. Report results of motor, cognitive, linguistic, and sensory assessments as they relate to AAC system selection.

7. Feature matching summary. Explain why the recommended system was chosen. Connect each recommendation back to the person's profile.

8. Recommended AAC system. Name the specific system, vocabulary organization, grid size, access method, and any accessories.

9. Implementation plan. Who will model? How often? What training do communication partners need? What goals should be prioritized? For guidance on partner training, see our guide on aided language stimulation.

10. Funding justification (if applicable). If requesting insurance or school district funding, include evidence of medical necessity and expected functional outcomes. Our AAC funding guide covers the process in detail.

Common Assessment Pitfalls

Assessing in only one context. A person's communication needs and abilities vary across settings. Observe in at least two to three environments. When in-person visits are limited, AAC assessment via teletherapy can supplement clinic observations with home or school settings that would otherwise be hard to access.

Focusing only on the individual. The Participation Model reminds us that barriers are often environmental. If no one models AAC, the problem is the environment, not the communicator.

Treating assessment as a one-time event. AAC assessment should be ongoing. Reassess as the person's skills change, as new technology becomes available, and as life circumstances shift.

Requiring prerequisites. There are no prerequisite skills for AAC. This is one of the most persistent myths about AAC. Not cause and effect understanding. Not a certain cognitive level. Not consistent eye contact. The National Joint Committee for the Communication Needs of Persons with Severe Disabilities (NJC, 1992) states clearly that all people have the right to effective communication, regardless of the nature or severity of their disability.

Moving Forward

A well-conducted AAC assessment sets the foundation for everything that follows. It ensures the system matches the person, the goals reflect real participation needs, and the implementation plan addresses both the communicator and their environment.

Take the time to do it thoroughly. The assessment is the blueprint for intervention.

Download SabiKo free and see how a flexible AAC app can support your child's needs.

References

• Beukelman, D.R., & Mirenda, P. (2013). Augmentative and Alternative Communication: Supporting Children and Adults with Complex Communication Needs (4th ed.). Paul H. Brookes Publishing.
• Kangas, K.A., & Lloyd, L.L. (1988). Early cognitive skills as prerequisites to augmentative and alternative communication use: What are we waiting for? Augmentative and Alternative Communication, 4(4), 211-221.
• National Joint Committee for the Communication Needs of Persons with Severe Disabilities. (1992). Guidelines for meeting the communication needs of persons with severe disabilities. ASHA, 34(Suppl. 7), 2-3.