2: Assessments

The first step in finding and getting communication supports is getting a good assessment.

An assessment requires a professional to interact with a person who has a communication impairment and identify:

  1. Which challenges the person may face when communicating, including:
    • Sensory impairments
    • Motor impairments
    • Cognitive impairments
  2. What forms of communication the individual already uses
  3. How to support the individual to communicate more effectively

This part of the guide will explain the elements of a good assessment. It will also explain how to choose a professional to conduct the assessment and provide links to guides to getting programs to pay for assessments.  

Components of a Good Assessment

Identify which challenges the person may face when communicating

A good assessment will start by identifying barriers to communication. These may include:

Sensory impairments

  • Hearing: Can the individual hear?
  • Auditory processing: Can the individual distinguish different kinds of speech sounds from others?
  • Vision: Can the individual see?
  • Visual Processing: Can the individual recognize body language, easily distinguish and locate symbols, distinguish between different signs and gestures, etc.?
  • Proprioception: Can the individual tell where his or her body is in space?

Motor impairments

  • Motor strength: Can the individual move the muscles that are required for speech, sign language, pointing, gesturing, or typing?
  • Motor skill: has the individual learned how to move his or her muscles as is needed to produce specific speech sounds, accurately point to items or tap accurately on letter keys?
  • Dyspraxia/Apraxia: Can the individual control the muscles that are required for speech or sign language,  pointing, gesturing, or typing?
  • Motor planning and initiation: Can the individual begin the necessary movements on his or her own, or does he or she need to be prompted in some way? Can the individual carry out a complicated sequence of movements (including a sequence of spoken sounds as needed to make words, or a sequence of hand movements as needed to sign, type, or write?)

Cognitive impairments

  • Can the individual remember and recall words and their meanings? Does the individual need extra time to recall words?
  • Can the individual recognize letters and symbols?
  • Can the individual follow complicated sentences or instructions?

When a person has developmental disabilities, professionals often assume that all communication difficulties are the result of cognitive impairments. This is not true. Many developmental disabilities, including autism, apraxia, and cerebral palsy, come from motor or sensory impairments. A competent communication assessment must address all three types of impairments: sensory, motor, or cognitive.

Remember, motor and sensory impairments are easily mistaken for cognitive impairments. In the past, many Deaf children were assumed to be intellectually disabled because they could not use spoken language in the same way as hearing children. This assumption led adults to simply give up on providing an acceptable alternative form of communication, a decision that led to disastrous consequences for Deaf individuals. It is less dangerous to presume that an individual has sensory or motor challenges, and try different approaches that could address those challenges, before assuming that all communication difficulties result from a cognitive impairment.

Identify which forms of communication the individual already uses

Everyone communicates. Even if a person does not appear to be communicating on purpose, there are probably ways that the person can communicate feelings or wants. The assessor should interact with the individual and the individual’s support network in order to determine how the individual uses:

  • Spoken words
  • Signed words (e.g., American Sign Language, Simplified Sign Language, Signed English, or finger-spelling)
  • Gestures, sounds, facial expressions, or body language
  • Behavior (e.g., moving towards or away from a person or situation, hitting, grabbing, etc.)
  • Typing or spelling
  • Pointing at objects
  • Choosing pictures or symbols (e.g., PECS)
Make Recommendations on how to support the individual to communicate more effectively

The assessment should conclude with recommendations to help a person communicate more effectively. These can include:

  • Introducing forms of communication that compensate for motor or sensory impairments. These might include signing, spelling, pointing, prompting, and/or use of technology or ergonomic supports.
    - Keep in mind that any form of communication that involves spelling or typing must be accompanied by literacy instruction!
  • Strategies that help build vocabulary and strengthen word recall
  • Occupational, physical, or speech therapy to help strengthen communication skills
  • Training the individual’s regular communication partners (e.g., parents, family members, teachers, and classmates) to implement communication supports

A good assessment should include multiple options to try. Keep in mind that nobody, with or without disabilities, uses only one form of communication. Typically, people without disabilities will communicate through a combination of speech, signs, gestures, typing, writing, pointing, and behavior, depending on the situation. The focus should be on ensuring that a person’s communication is as effective as possible - not on forcing a person to communicate in only one or two ways.

Choosing an Assessment Professional

The key to obtaining a quality communication assessment is choosing the right professional. Make sure that the professional is qualified to evaluate people with developmental disabilities. The professional also should be committed to presuming competence and familiar with a wide range of possible communication supports.

Here are some questions that you should ask when deciding whether to use a professional for a communication assessment:

What is the professional’s educational background?

Generally, the person conducting a communication assessment will be a psychologist or speech-language pathologist.

What is the professional’s specialty?

A good communication assessment must be done by someone who specializes in communication and language development - not someone whose primary training is in behavior modification or analysis, or someone whose expertise is in only one kind of communication method.

Is the professional a member of relevant professional associations?

These may include The American Speech-Hearing Association or The American Occupational Therapy Association.

Does the professional have conflicts of interest? 

These may include a business interest in a specific communication method or tool. They also may include a close financial relationship to the entity that will be paying for the communication supports, such as a school district or vocational rehabilitation office. 

Does the professional understand the importance of presuming competence and including motor and sensory challenges in all assessments?

It is critical that the professional be willing to presume competence. The professional should not assume that all of the individual's communication challenges are caused by cognitive or intellectual impairment - even when the individual has been diagnosed with a cognitive or intellectual disability. 

If you are looking for an AAC assessment, you can check AbilityTools.org, run by California's Tech Act Project, for a list of AAC providers in CaliforniaThis list is not a list of endorsed or recommended providers - it simply is a list of providers who have told the Tech Act Project that they do AAC assessments. Make sure to contact each provider for information on their practice and qualifications before picking a provider. 
Paying for the Assessment

Assessments can be expensive if they are paid for out-of-pocket. Fortunately, it's possible to get funding for communication assessments from a variety of sources. This toolkit includes guides for obtaining assessments through:

Health insurance, including

School districts, using the Individuals with Disabilities Education Act (IDEA)