Aac assessment Introduction

Recent years have seen an increase in the number of individual children with complex communication needs who require high tech augmentative and alternative communication strategies (AAC). Extrapolation of existing data on identified need suggests a prevalence of 0.05% of children and young people needing high technology AAC, representing an estimated 6,200 children and young people in England. Reference: The Communication Council September 2010.

Web Reference:

http://www.thecommunicationcouncil.org/council/communication-council-papers/meeting-on-16-september-2010/

Assessment materials have traditionally been comprised of a mixture of methods, predominately being subjective in nature, such as observational charts and checklists that are based upon knowledge and experience of the assessor. Such assessments play a vital role in highlighting a young person’s abilities and difficulties with regards to communication and AAC use. However, in the ever increasing climate of evidence based practice* and use of SMART* targets, more formal assessments materials have been developed that are specifically aimed at children and young people who use AAC as their prime mode of communication. Demands for performance measures link simultaneously with the demands for reduced costs and such challenges have resulted in ensuring comprehensive and effective management plans which are based upon functional assessment data.

The following pamphlet contains a description of some of the most popular assessments available and an example of their use with a child or young adult, alongside an example of a treatment plan based upon their assessment results.


Evidence Based Practice – This refers to preferential use of health interventions for which systematic empirical research has provided evidence of statistically significant effectiveness as treatments for specific problems.

SMART targets – SMART is a mnemonic and although there is no clear consensus about precisely what the five keywords mean, typically accepted values are: specific, measurable, attainable, relevant and time bound.

Augmentative and Alternative Communication Profile – A Continuum of Learning

ACAP: Augmentative Communication Assessment Profile

Communication Matrix – Online Version (2004)

Social Networks: A Communication Inventory for Individuals with Complex Communication Needs and their Communication Partners

Frenchay Screening Tool for AAC

This assessment is aimed at children who require AAC systems (by this the author typically means use of a high tech communication aid) and some adults with complex communication needs (not acquired communication disorders).

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  It was developed as a comprehensive assessment tool aimed to determine the course of development of communicative competence using AAC.
  
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  It uses Janice Light’s (1989) definition of communicative competence to determine the skills needed to achieve clinical outcomes in areas that support development of communicative competence using AAC. See definition page.
  
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  It is intended for use by a multidisciplinary team, including family members who have knowledge about the person’s physical, cognitive and social skills relating to AAC.
  
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  It measures subjective, functional skills and is aimed at assessment of current and desired communicative competence alongside defining skills required to increase competencies and to measure and document progress towards individualised outcomes.
  

The AAC profile defines five ability related levels, called Skill Set Levels (1-5). These levels represent a continuum of communicative abilities and range from early functioning to independent use and AAC mastery. In the manual there is a detailed breakdown of each Skill Set Level with examples of communication behaviours at each level and a guide of percentage of accuracy. The skill of the person who uses AAC is assessed alongside communication partner skills.

The assessment uses a scoring system of rating the frequency that the person demonstrates the skills. This is 3=frequently, 2=sometimes and 1=seldom.

The assessment is administered by selecting a Skill Set Level (it is recommended to start at Level 1 when unfamiliar with the assessment or where the assessor is confident that the person would score a 3 of the majority of skills at previous Levels). Administer all items within the Level and score. If the majority of the items are scored at 3, continue through each Skill Set Level until the majority of assessment items are rated as 2 or 1. The highest Skill Set Level where the majority score is 3 becomes the current Communicative Competence Level.

The assessment records current Communicative Competence Level for all four areas of learning.

The desired Communicative Competence Level for an Area of Learning may be where the person scores 2 on the majority of items within a Skill Set Level. However, the author recommends that this is up to the AAC team to ultimately decide and may be based upon observations and knowledge of the person who uses AAC.

Performance is then plotted on the Performance Profile summary graph. This represents an individual’s communication abilities using an AAC system and indicates areas of strength and areas that may require increased intervention and can direct treatment plan development. Re-evaluation data can also be added to produce illustrations of change over time.

Practical Case Example

Abigail was four years old when first assessed on the AAC Profile – A Continuum of Learning. She has no diagnosis but has a motor speech disorder, and could only produce vocalisations and a few sounds. She was very communicative and used a mixture of signing, a low tech communication book and a Dynavox Vmax communication aid. Abigail had been using her communication aid for 6 months and was working at navigating her way around the pages and using a mixture of single words and some 2 word level structures on the device. The assessment was carried out in order to determine her levels of competence within the four areas of learning and to help plan future input for Abigail.

The assessment was carried out by her speech and language therapist with input from her mum, teacher, specialised teacher and speech and language therapy assistant.

Abigail’s skills were plotted on each level, beginning at Skill Set Level 1 for each area of learning. The results were plotted on the Performance Profile Summary and indicated that her strengths lay within the operational and linguistic areas of learning. The assessment highlighted the need to increase her social and strategic areas of learning and to provide increased training to her communication partners. It also helped to formulate an effective treatment plan.

The assessment was repeated 12 months later. Abigail was then 5, and communicating with a mixture of speech, (3 -4 words together, unclear without context or familiar partner) and her Dynavox VMax. Speech and Language therapy had targeted increasing her social use of communication and development of strategies to help repair misunderstandings, alongside development of language structure and use.

The repeat assessment indicated that Abigail had progressed in the linguistic area of learning and the social area of learning, having increased these skills by one skill set level. She had not made any progress within the operational or strategic levels of learning.

Abigail’s initial treatment plan had highlighted working on all 4 areas of learning and her treatment plan had one goal within each area. As her operational and linguistic learning was progressing but her social and strategic areas remained static it was decided to target these two areas of learning. Class based observations soon highlighted some difficulties. Abigail’s teaching assistant in school had become very familiar with Abigail’s ways of communicating and mostly understood her speech. This meant that Abigail was using speech alone in the everyday classroom situation and was looking at her teaching assistant in order for her to interpret her speech. In effect, she was using the assistant as her communication aid and all her previous AAC strategies were diminishing when in the classroom. In a 1:1 situation with the Speech and Language Therapist she was able to demonstrate good operational and linguistic skills on her Dynavox and could put simple sentences together and was beginning to be able to include some grammatical markers.

The first part of the treatment plan was to develop the role of her communication partners in school and this was carried out by a short “hands on” training session for her teacher and teaching assistant. This highlighted how critical it is to be a good role model in developing children’s use of AAC and short recordings of interaction were used as a focus and discussion point.

Modelling techniques and practical demonstrations were required to show how to create and use opportunities within the everyday situation. In focussed therapy the emphasis was on independent communication and use of some pre-stored phrases which could cue a listener into a topic if Abigail did not know a word. These included phrases such as “the word isn’t here” “it begins with...” “It’s a bit like...” “It’s a person/place/thing”. To develop her social competence the focus was on developing increased opportunities to communicate new information to a peer. For now, there is no emphasis on further developing Abigail’s linguistic or operational skills until she has reached a level of social and strategic competence that mean she is less reliant upon others to interpret her meaning.

This assessment was developed to identify which communication system would be of most benefit to a non verbal child with a diagnosis of Autistic Spectrum Disorder.

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  It was initially an informal assessment tool and was then developed for practitioners who required some objective guidance to assist them in identifying a primary method of communication for an individual child.
  
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  It aims to provide a basis to set objectives in order to develop a child’s communication skills.
  
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  It is an assessment for signing and low tech communication methods only.
  
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  The assessment has been used for children aged 3 – 11 but it is advised that it is appropriate for any age group
  
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  There is a pre-requisite to using the assessment that the child must have at least fleeting attention skills, intentional communication, can differentiate between people and objects and is motivated by one or more item or activity.
  

The Assessment Profile consists of 27 closed questions (yes/no questions) which relate either directly or indirectly to communication. They are organised into 9 categories. Each question has a criterion and a clarification. The criterion is the question and the clarification is an example or statement that matches the question.

The assessment is administered by answering “yes/no” to the 27 questions and then counting up white boxes containing an affirmative response, and then the grey tinted boxes. If the majority of responses are recorded in white boxes, (and within these boxes 5 are highlighted) check if all 5 of these highlighted boxes have been ticked. The manual then advises the assessor to proceed to the interpretation. Likewise, if the majority of the boxes ticked are grey, proceed to interpretation. If the responses fall fairly equally between both white and grey boxes, use the transparent overlay which is provided with the assessment by placing it over the completed form. Ensure all the yellow coloured boxes are ticked. If they are, proceed to interpretation.

The test interpretation gives an indication based on the completed assessment as to the type of AAC that may best benefit the child. The following three examples are provided:

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  Signing - If the 5 bold boxes are ticked, some form of signed communication may be most beneficial.
  
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  Picture Exchange - If predominantly grey boxes are ticked, a picture trading communication system such as the Picture Exchange Communication System (PECS) is indicated. See definition page.
  
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  Picture Pointing - If the yellow boxes are ticked (with use of the transparent overlay) this would suggest that a picture pointing communication system may be most successful.
  

Practical Case Example

Paul was 15 when assessed on the ACAP. He has a diagnosis of autistic spectrum disorder (ASD) and severe learning disabilities. He is predominantly non verbal, only using an occasional word when extremely frustrated. He has used the Picture Exchange Communication System (PECS) for several years now to initiate communication with a partner and make a choice between activities or items. His teacher requested a review of his communication as she was finding that PECS use was becoming very established within certain routines but almost impossible to generalise to a wider range of communicative functions or wider range of choice making. It was decided to assess Paul informally via observation in different environments and to support decision making by carrying out the ACAP assessment.

All four of the pre-requisite questions were passed and a profile of his skills within the nine category areas was developed. These areas were, attention, visual, physical proximity, communication, behaviour, cognitive development and receptive language. The questions were straight forward and it was quick and easy for a familiar communication partner to give an accurate answer. The assessment profile indicated that Paul had predominately grey boxes ticked but he did not have the 5 highlighted boxes ticked. According to the interpretation this indicated that a picture trading system (such as PECS) was indicated.

The assessment was useful as a descriptive assessment and clarified what was already known but did not provide any further information over and above what was known at this point, and did not give any indication of input that may be beneficial (although this was never indicated that it would).

The assessment was therefore repeated on a much younger child with a diagnosis of ASD in order to determine if the assessment was better suited to considering use of augmentative communication in a child who had not commenced any form of AAC as yet.

Charlie is 3 years old and has a diagnosis of ASD. At present, all communication is on his terms only and he can become very frustrated, hitting and biting children or adults who try to initiate interactions with him. He has not yet been introduced to any form of AAC as he needs to develop improved emotional regulation strategies. The ACAP assessment was completed to see if introduction of AAC should be considered to eliminate some of the frustrations he shows. All four of the pre-requisite questions were passed and a profile of his skills within the nine category areas was developed. Charlie had a very different profile to Paul and an equal spread of white and grey boxes. The interpretation indicated that he would not yet be ready for introducing signing, picture pointing, or PECS for communicative purposes. This backed up the knowledge that the team around the child already knew.

The assessment appears better suited if looking at introducing AAC for a child where the team feel the child is ready, rather than a child who may not be ready (e.g. Charlie) or who is already using a system (e.g. Paul). It would also serve as a useful assessment tool for an individual who is developing skills in working with children in ASD and wishing to expand their knowledge as to why AAC may be successful.

This assessment is an easy to use online assessment designed for individuals of all ages who function at the earliest stages of communication. It was first published in 1990 and reviewed in 1996 and 2004. It aims to document the expressive communication skills of children with severe and multiple disabilities including sensory, motor and cognitive impairments.

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  The Matrix accommodates any type of communicative behaviour, including augmentative and alternative forms of communication (AAC) and pre-symbolic communication (such as gestures, facial expressions, eye gaze and body movements).
  
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  The Communication Matrix is NOT suitable for individuals who already use some form of language meaningfully and fluently.
  
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  The Communication Matrix involves three major aspects of communication. These are, the behaviours that someone uses to communicate (such as pointing), the messages that someone expresses (such as “I want that”) and the level of communication (such as use of symbols)
  
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  There are 7 levels of communicative behaviour, from pre-intentional communication through to use of simple combinations of words or symbols.
  
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  The Matrix is organized into four major reasons to communicate that appear across the bottom of the Profile and these are:
  
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    to REFUSE things that we don't want;
    
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    to OBTAIN things that we do want;
    
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    to engage in SOCIAL interaction;
    
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    to provide or seek INFORMATION.
    

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  Under each of these four major reasons are more specific messages that people communicate: these correspond to the questions that must be answered as the Matrix is completed.
  
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  The information that you provide is used to generate a one page Profile and a Communication Skills List.
  

The Profile provides a one-page visual summary of the information that has been

entered about an individual’s communication skills.
Communication Skills List

The Communication Skills List lists each message (such as "Obtains More of

Something"), and how it was communicated alongside if the skill has emerged or is mastered.
Using this Assessment

Register online for free by providing an e-mail address and password. Demographic information will be collated but no personal details stored. Three questions are asked which determines which section of the assessment will need to be completed. These three questions will then direct the assessor to the appropriate section (Section A, B or C). Between 3 and 24 questions will be asked about specific messages that the individual communicates. For each behaviour the assessor has to select whether the child has mastered the skill or if the skill is emerging. Once all the appropriate questions are answered, a profile of the child’s skills is produced and can be viewed in different formats. Progression can be documented and intervention can be planned based upon gaps in the child’s profile, or increasing particular skills which have been highlighted as requiring development. Levels of communication can be targeted and specific messages and communication behaviours can be developed.

Two very different children have been assessed on the Communication Matrix to compare and contrast the assessment for use with children with very differing needs.

Molly is 2. She has a metabolic condition and as a result of this has profound and multiple learning difficulties. She also has a severe visual impairment and is registered blind. The Communication Matrix assessment was completed, involving answering a set of questions about Molly’s skills. A profile was generated indicating that she has mastered level 1 (pre-intentional behaviour) for all of the major reasons of communication (refusal, obtaining and social). She is developing skills at an intentional level (level 2). Within the subsections of this level she has mastered refusal (intentional protesting) but has not yet used any communicative behaviours to obtain something. Within the social section, her skills at this level are emerging (attracting attention by vocalising).