AAC and Speech-Generating Device Evaluations

Helping Every Child Have a Way to Communicate

Every child deserves a reliable way to express their wants, needs, thoughts, feelings, and ideas.

For some children, spoken language may not fully meet their communication needs. Augmentative and alternative communication (AAC) can provide additional ways for children to communicate, participate in school, develop relationships, make choices, and become more independent.

The Marshall University Speech and Hearing Center provides comprehensive AAC and speech-generating device (SGD) evaluations for children and adolescents with complex communication needs.

Our goal is not simply to find a device. We work with children, families, and other members of the child’s team to identify a communication system that matches the child’s individual strengths, abilities, environments, and communication needs.

What Is AAC?

Augmentative and alternative communication, or AAC, includes the many ways people communicate in addition to or instead of spoken speech.

AAC may include:

• Gestures and facial expressions
• Pictures and symbols
• Communication boards and books
• Tablet-based communication applications
• Speech-generating devices
• Typing or written communication
• Eye-gaze technology
• Switch-access communication

AAC does not have to replace speech. Many children use a combination of speech, gestures, signs, pictures, and technology to communicate.

The goal is to give each child access to the communication methods that allow them to express themselves as effectively and independently as possible.

Who Can Benefit from an AAC Evaluation?

AAC may be appropriate for children whose spoken communication does not consistently meet their needs.

Children referred for AAC evaluations may have communication challenges associated with:

• Autism spectrum disorder
• Cerebral palsy
• Childhood apraxia of speech
• Developmental disabilities
• Genetic conditions
• Neurological conditions
• Motor impairments
• Significant speech sound disorders
• Developmental language disorders
• Other conditions affecting speech and communication

A child does not need to have a specific diagnosis to benefit from AAC.

Children also do not need to demonstrate a particular set of skills before AAC can be considered. An evaluation helps determine what types of communication supports may be appropriate

Will AAC Keep My Child from Talking?

This is one of the most common questions families have about AAC.

AAC is intended to support communication—not discourage speech. Children can continue using speech, gestures, signs, facial expressions, and other forms of communication while also learning to use AAC.

We encourage children to use whatever communication method is most effective for them in a given situation.

The goal is not to replace a child’s voice. The goal is to make sure the child has a way to communicate.

What to Expect During an AAC Evaluation

Every AAC evaluation is individualized to the child.

Our clinicians begin by learning about your child’s current communication skills, strengths, challenges, daily routines, and communication needs. We also want to understand how your child communicates with different people and in different environments.

The evaluation may consider:

• Current speech and communication abilities
• Understanding and use of language
• How your child currently expresses wants, needs, thoughts, and ideas
• Symbol and vocabulary needs
• Literacy skills, when appropriate
• Vision and hearing
• Fine and gross motor abilities
• Ability to directly touch or select items on a screen
• Potential need for eye gaze, switches, or other access methods
• Communication needs at home, school, and in the community
• Positioning and seating
• Individual interests and preferences
• Family priorities and goals

The evaluation is designed to identify your child’s strengths and determine which communication supports provide the best opportunity for successful, independent communication.

Trying Different Communication Systems

There is no single AAC system that is right for every child.

Whenever possible, children have opportunities to try different communication systems and access methods as part of the evaluation process.

Depending on your child’s needs, we may explore:

• Different speech-generating devices
• Communication applications
• Symbol-based communication systems
• Text-based communication
• Direct touch
• Eye-gaze access
• Switch scanning
• Keyguards or other access supports
• Alternative pointing methods
• Low-tech communication boards or books

We consider not only whether your child can operate a system, but whether the system allows your child to communicate effectively and efficiently across everyday activities and environments.

A Team Approach to AAC

Successful AAC requires collaboration.

Depending on your child’s needs, the evaluation process may include input from:

• Parents and caregivers
• Speech-language pathologists
• Occupational therapists
• Physical therapists
• Teachers and school-based speech-language pathologists
• Physicians and other healthcare providers
• Assistive technology professionals
• Speech-generating device representatives

Physical or occupational therapy consultation may be particularly helpful when a child has motor, positioning, or access needs.

Device representatives may also participate when appropriate to provide access to equipment and demonstrate device-specific features. Recommendations are based on your child’s clinical and communication needs, rather than a particular manufacturer or product.

Working With Your Child’s School

Children communicate in many different environments, and school is an important part of that picture.

When appropriate and with family permission, our clinicians can collaborate with school-based professionals to better understand the child’s communication needs and support successful use of AAC across environments.

This may include communication with:

• School-based speech-language pathologists
• Teachers
• Special education professionals
• Occupational and physical therapists
• Assistive technology specialists
• Other members of the child’s educational team

A child’s AAC system should provide access to more than requesting preferred items. Children need opportunities to ask questions, participate in classroom activities, socialize with friends, express opinions, advocate for themselves, and communicate what matters to them.

What Happens After the Evaluation?

If a speech-generating device is recommended, our team will help families navigate the next steps.

The process may include:

• Completing a comprehensive AAC evaluation report
• Documenting medical necessity
• Identifying the recommended communication system and access method
• Coordinating with the device company
• Completing required insurance documentation
• Communicating with the child’s physician when additional documentation is needed
• Assisting with the device funding process

Obtaining a communication device is only the beginning.

After a child receives a device, continued speech-language therapy may be recommended to help the child learn to use the system and to help parents, caregivers, teachers, and other communication partners learn strategies for supporting AAC throughout everyday activities.

Insurance and Funding

The Marshall University Speech and Hearing Center bills insurance for AAC and speech-generating device evaluations. Coverage and individual out-of-pocket costs vary by insurance plan.

If a speech-generating device is recommended, the device itself is typically billed separately through the device provider. Insurance requirements and coverage vary depending on the child’s plan and recommended equipment.

Our clinicians work with families, physicians, device companies, and funding sources to complete documentation needed to request coverage for medically necessary speech-generating devices.

Schedule a Pediatric AAC Evaluation

If your child has more to communicate than they can currently express through speech, AAC may provide another way for their voice to be heard.

You do not have to wait until your child stops speaking or exhausts other therapy options before exploring AAC.

Contact the Marshall University Speech and Hearing Center at 304-696-3641 to learn more about pediatric AAC services, physician referral requirements, insurance billing, or scheduling a comprehensive AAC and speech-generating device evaluation.

Helping Adults Maintain Communication and Independence

When speech becomes difficult, communication should not stop.

The Marshall University Speech and Hearing Center provides comprehensive augmentative and alternative communication (AAC) and speech-generating device (SGD) evaluations for adults whose natural speech no longer fully meets their communication needs.

AAC can provide additional ways to communicate when speech becomes weak, slow, difficult to understand, unreliable, or no longer possible.

Our goal is not simply to identify a device. We work with each individual to find a communication system that matches their abilities, needs, preferences, environments, and goals—while supporting as much independence as possible.

What Is AAC

Augmentative and alternative communication, or AAC, includes the many ways people communicate in addition to or instead of spoken speech.

AAC may include:

• Gestures and facial expressions
• Writing or typing
• Alphabet or communication boards
• Smartphone or tablet-based communication
• Speech-generating devices
• Eye-gaze technology
• Switch-access communication
• Alternative computer access
• Low-tech backup communication systems

AAC can supplement speech or provide a primary means of communication.

Some people use AAC only in situations where speech is difficult, while others rely on it throughout the day.

Who Can Benefit from an AAC Evaluation?

AAC may be appropriate for adults whose speech does not consistently meet their communication needs.

Individuals referred for AAC evaluations may have communication changes associated with:

• Amyotrophic lateral sclerosis (ALS)
• Parkinson’s disease
• Multiple sclerosis
• Stroke
• Traumatic brain injury
• Cerebral palsy
• Muscular dystrophy
• Brain tumors or other neurological conditions
• Progressive neurological disease
• Severe dysarthria
• Apraxia of speech
• Other medical conditions affecting speech or physical access to communication

A person does not need to completely lose speech before considering AAC.

For progressive neurological conditions, early evaluation can be especially helpful because it allows time to explore communication options, identify an appropriate system, and learn to use it before speech or motor abilities change significantly.

Signs You May Benefit from an AAC Evaluation

Consider an AAC evaluation if:

• Others are having increasing difficulty understanding your speech
• Speaking requires significant effort or causes fatigue
• You frequently have to repeat yourself
• You rely on family members to interpret what you are saying
• Speech is becoming weaker, slower, or less reliable
• You avoid conversations because communicating is difficult
• Phone calls or communication with unfamiliar people have become challenging
• You have a progressive neurological condition that is expected to affect speech
• Hand or arm weakness makes traditional writing or device access difficult
• You may need eye gaze, switch access, or another alternative way to control a communication system
• You want to plan ahead for future communication needs

You do not need to wait until communication becomes impossible to begin exploring AAC.

What to Expect During an AAC Evaluatio

Every AAC evaluation is individualized.

Your clinician will begin by learning about your current communication abilities, medical history, physical abilities, daily routines, and the communication situations that are most important to you.

The evaluation may consider:

• Current speech and communication abilities
• Speech intelligibility
• Language abilities
• Reading and spelling skills
• Vision and hearing
• Upper-extremity and motor abilities
• Ability to directly touch or type on a device
• Potential need for eye gaze or switch access
• Positioning and seating
• Communication needs at home, work, medical appointments, and in the community
• Communication with family and caregivers
• Computer and technology needs
• Current and anticipated future communication needs
• Individual preferences and priorities

The goal is to identify a system that supports effective and efficient communication while requiring the least amount of physical effort possible.

Trying Different Communication Systems

There is no single speech-generating device that is best for everyone.

During the evaluation, you may have opportunities to try different communication systems and access methods.

Depending on your needs, we may explore:

• Touch-screen speech-generating devices
• Text-based communication systems
• Symbol-based communication systems
• Eye-gaze access
• Switch scanning
• Head tracking or alternative mouse access
• Keyboards and alternative keyboards
• Mounting and positioning options
• Low-tech communication boards or alphabet boards

We consider not only whether you can use a system, but whether you can use it efficiently, comfortably, and independently in everyday life.

Eye-Gaze and Alternative Access

For some adults, physical changes make it difficult to touch a screen, type, or use a traditional computer mouse.

AAC systems can often be accessed in other ways.

Depending on the individual’s abilities, our clinicians may evaluate:

• Eye-gaze technology
• Switch access
• Head tracking
• Alternative mouse systems
• Keyguards
• Scanning systems
• Other adaptive access methods

Finding the right access method is just as important as selecting the communication software itself.

What Happens After the Evaluation?

If a speech-generating device is recommended, the AAC team will complete the clinical documentation necessary to request funding.

The process may include:

• Completing a comprehensive AAC evaluation report
• Documenting medical necessity
• Identifying the recommended communication device
• Identifying the appropriate access method
• Coordinating with the device company
• Obtaining required physician documentation
• Submitting information to insurance or other funding sources

Our team will help explain the next steps and work with the necessary providers throughout the funding process.

After You Receive Your Device

Receiving a speech-generating device is only the beginning.

Continued speech-language therapy may be recommended to help you:

• Learn how to operate the device
• Customize vocabulary
• Communicate more efficiently
• Learn shortcuts and advanced features
• Practice using the device in everyday conversations
• Transition to eye gaze or alternative access when necessary
• Develop backup communication strategies
• Train family members or caregivers

Therapy is individualized based on the person’s communication goals and technology needs.

Physician Referral

A physician referral is required for an AAC or speech-generating device evaluation at the Marshall University Speech and Hearing Center.

Our staff can provide additional information about referral requirements and scheduling.

Insurance and Device Funding

The Marshall University Speech and Hearing Center bills insurance for the AAC evaluation.

If a speech-generating device is recommended, the device itself is typically obtained through a separate device provider and may involve additional costs.

Insurance coverage varies by plan and may include:

• Deductibles
• Copayments
• Coinsurance
• Prior authorization requirements
• Device-specific coverage requirements

Our clinicians work with individuals, physicians, device companies, and insurance providers to complete the documentation required to request funding for medically necessary speech-generating devices.

Schedule an Adult AAC Evaluation

If speech is becoming difficult, unreliable, or physically exhausting, you do not need to wait until you can no longer speak to explore other communication options.

Early planning can provide more choices and more time to become comfortable with communication technology.

Contact the Marshall University Speech and Hearing Center to learn more about adult AAC services, physician referral requirements, insurance billing, speech-generating device funding, or scheduling a comprehensive AAC evaluation.