Getting Started with AAC
Who can use AAC
AAC is helpful for anyone who is having trouble communicating using speech, including individuals with:
- Autism spectrum disorder (ASD)
- Other developmental disorders or intellectual disabilities
- Apraxia of Speech (AOS)
- Motor speech disorders
- Anyone whose speech is unreliable, hard to understand or easily fatigued.
Prerequisites for AAC
Patience and a desire to learn a new AAC system are all that is needed. Otherwise, according to the ASHA, there are no prerequisites required to use AAC. No specific skills are needed. No “readiness” criteria must be met before using or being given access to AAC. Specifically, AAC is not limited to a specific diagnosis and can be used regardless of:
- age
- diagnosis
- motor skills or ability
- cognitive differences
- expressive or receptive communication differences
When AAC can and should be used
Some autistic individuals use AAC all the time. Others use AAC based on the setting or situation they are in or based on their feelings. For instance, you may find sending someone a text message is easier than calling when you are anxious. Or you may prefer using a gesture or picture to communicate an idea or request in a noisy coffee shop. AAC may not be needed all the time. But it can always be available and play an important role in your communication.
How to get an AAC assessment
Formal AAC assessments are typically completed by a licensed speech-language pathologist (SLP) who specializes in AAC. SLPs are trained to assess communication needs and strengths and to recommend the type of system that best fits their unique profile. The SLP may be assisted by an occupational therapist (OT), physical therapist (OT) or if in a school setting, a special education teacher. To secure an AAC assessment you can:
Get a medical referral. Ask your pediatrician, primary care physician or licensed medical professional for a prescription or referral to an SLP specializing in AAC. If you are going to get an AAC device, you should have a copy of this to give to your insurance provider. If you are in school, you should also give this to your school district to first see if they will assess you.
Make a formal request through your school district. Schools are required to evaluate students for assistive technology, including AAC, if a need is suspected, whether a student already has an IEP or not. It is legally mandated under “Child Find,” under the Individuals with Disabilities Education Act (IDEA). You simply need to request an evaluation and reason for it in writing. There are no behavioral or cognitive prerequisites required. If the assessment determines a need, the results are typically documented in an IEP or 504 plan to secure the device/services.
What to do if you are denied an AAC assessment by the school district
As stated above, school districts have a legal obligation to identify and evaluate all students who may have a disability and need services. If your school district denies your request, they are legally required to provide a Prior Written Notice (PWN) outlining why they do not suspect a disability that warrants the assessment. Of note the school cannot refuse to evaluate because they want to use a general education framework to identify challenges or needs, often referred to as a response to intervention (RTI). In other words, they can’t avoid conducting an assessment without documented, legitimate reason, or delay one for their own convenience.
Whether or not you already have an IEP or 504, if you are denied an assessment, you can request a formal review meeting to discuss your concerns. You also have the right to request a complete evaluation at the district's expense. You should have your medical provider’s referral before you do either of these. If you still face resistance, you should consider consulting with your school district special education parent group, your state’s Parent Training and Information Center (find your PTIC here) or a parent advocate.
Contact your state’s Assistive Technology Act program (AT Act). They may not always provide comprehensive, formal clinical evaluations. But they can facilitate the process by offering trials and lending equipment to professionals, families and school districts. Find your state’s AT Act program here.
For additional help locating an SLP, check out these resources:
ASHA Profind The American Speech-Language-Hearing Association (ASHA) directory to search for certified, licensed professionals by location and specialty.
Member Finder US Society for AAC’s searchable database for local providers including SLPs, collaborators, mentors and families.
Autism Speaks Resource Guide Select ‘Speech and Language Therapy’ under Therapies and Interventions, enter your city, state or zip code, the distance in miles you are willing to travel and find local SLPs in your area.
What to expect in an AAC assessment
AAC assessments can be conducted in school, at home, in a SLPs office or a clinical setting like a hospital outpatient center. The assessment should be a comfortable experience, so it is standard to dress in everyday clothing. You will mostly stay seated during the assessment.
It is acceptable and even recommended that family/caregivers, friends and anyone else who would regularly communicate with you, commonly referred to as “communication partners,” attend assessments to provide input on your needs, share preferences, offer emotional support and help you remember information.
You should also bring your medical records and any devices or tools you currently use to help you communicate.
The assessment can take 1-2 hours, but it is often broken up with breaks. SLPs are trained to work at your pace. Every SLP will have their own unique style, but their assessment will involve the following.
Check-in (often called an “intake”)
Take your history. The SLP will review your medical history and start a medical record for you. This process is similar to what did or will happen when you find a primary care physician or any new adult medical provider. The SLP will ask about any diagnoses, hearing and vision issues, motor issues, present and past therapies, current education and language(s) you use.
They will also go over your referral, discuss why AAC is being considered and ask questions about your specific needs. This is to make sure that nothing was missed in your referral and give you a chance to bring up any concerns not listed in it.
Get to know you. The SLP will ask you about your interests and priorities. They will also want to know what frustrates you and where you want help. They will want to know where you must communicate and with who you must communicate. The SLP will then ask any parent/caregiver, friend or communication partner about what they notice you need in your daily life and what works and doesn’t work for you.
Evaluation
Learn about your communication and language skills. The SLP will ask questions about how you communicate at home, at school and/or work, and in the community to understand the following:
- Expressive communication: How you currently show your wants/needs. Is it through speech, gestures, signs, pointing, behavior, facial expression, vocalizations or a combination of any/all? They will also ask about any challenges you deal with using your current communication method(s).
- Receptive language: Your ability to understand spoken words, follow directions, respond to yes/no and identify objects/pictures/words when asked.
- Language skills: Your vocabulary size, how you combine words, your grammar, and your ability to ask questions, comment, protest and tell stories, if appropriate.
Understand your thinking, memory and attention (together, often called “cognitive” skills). The SLP will do activities with you to see how well you can recall images, remember sequences, organize thoughts or symbols to create messages and solve puzzles. While they do this, they will also notice what may make you tired or bore you, what holds your attention and for how long.
Check your sensory processing. The SLP will assess your vision and hearing needs. They will want to know if you need large letters or symbols and if you require high or low contrast on screens. They will also want to figure out if would do well with visual feedback after hearing something, what volume you prefer and if you would do well with headphones. They may have your parents/caregivers, teachers, OT and/or PT answer a questionnaire to help them with this part of the assessment.
Evaluate your motor skills. An OT or PT may work in collaboration with your SLP to check your ability to physically use AAC. They will test how well you can move your head, eyes, neck, arms, hands and fingers. They will look at how well you can hold a pen/marker and how well you can use it to draw, write, point to objects. They will also see how well you can use a keyboard or a touchpad.
Have you test out AAC tools. Based on everything they observed, the SLP will then have you try using a variety of low- to high-tech devices. They will observe your comfort, ease of use, accuracy and watch for any preferences you have.
Recommendation
After the SLP completes the evaluation, they will supply you with their recommendations for an AAC system. It is important this states the system is a “medical necessity” and details why. This will be important for obtaining your system.
Their recommendation will specify the AAC system they determined will best work for you based on their evaluation. It will identify the component(s) of your system – whether they will be light-tech, mid-tech or high-tech. It will also indicate whether it will be symbol/image-based, text-based or a combination of both. These decisions will depend on your reading skills, ability to tell the difference between images, ability to navigate multiple pages and your preferences. More on this under Person-centered AAC in the next section.
Your SLP will most likely set you up with a trial period to make sure the system works. This trial will include a practice plan and follow-up. You may try several systems. That is ok. During this time the SLP will work with you to further customize your system for your preferences and needs. For instance, they will determine what messages you need most, when to use pictures, symbols, or text and how words are organized for easy access. It may take some time, but it will be worth it to find the right system for you.
How to get and pay for an ACC
There are two main ways to get your system:
School district: If your student’s IEP team finds or learns that an AAC is required to benefit their education, or an SLP assessment finds that your student needs one which prompts either a revised or new IEP or 504 plan, the school district is responsible for supporting those devices and related services.
Learn more: Know Your Rights to Access Assistive Technology
Health insurance (Private/Medicaid/Medicare): Many plans cover AAC if it’s “medically necessary” which is why it is important to get an assessment done by and receive a recommendation for one from an SLP.
What to do if you are denied by health insurance
Insurance denials are often the result of missing or incorrect documentation or a lack of proven "medical necessity". Your first step then is to review the details of the denial which you should receive in writing. If the issue is related to the timing of your claim, you need to call and explain your assessment and AAC determination process. You should also make sure all your information and medical need are properly documented. If the sole reason seems based on medical necessity, request a peer-to-peer review with your SLP or physician and the insurance company's medical director.
There are also a few alternative methods to get your AAC:
State AT Act program: Every state has a program that may loan equipment for trial periods and then provide loans or funding for purchasing AAC systems. Find your state’s AT Act program here.
Vocational Rehabilitation (VR): Some state’s VR offices will fund AAC for adults with disabilities to support them so they can obtain and maintain employment. Find your state’s VR office in our State Directory: Transition to Adulthood.
AAC device vendors: Individual technology vendors that sell AAC systems often have a funding department and can be very helpful. PRC-Saltillo and Tobii Dynavox, the leading, research-based manufacturers of AAC devices and software, have dedicated funding departments to assist with insurance submissions.
Nonprofit grants: Many local charities offer grants for AAC. Organizations such as The Arc has national initiatives, such as one with Amazon, to help provide access to technology for people with disabilities. Local chapters also often help provide, fund or secure AAC.
For additional help funding an AAC device, check out these resources: