Utter Autism

May 7, 2007

To get a voice (The ins and outs of AAC) continued….

When you think about where a child spends most of his time, it seems rather obvious that home would be the single most important place for a child to communicate. Yet evaluations for assistive technology rarely (if ever) take place in the home.  My experience has been that these evaluations take place in the school setting.  While communicating in school is important, there is a completely different type of communication that occurs in school versus the home environment. School communication revolves around a student being able to respond to demands put on them by teachers.  Spontaneous communication is limited.  The act of learning assumes that the student will be doing a lot of listening, not talking.  In your average classroom, the teacher stands in front of the class and teaches. The only communication given, or tolerated in some classrooms, is answering a question asked by the teacher after raising hands and being chosen to answer.  School is not a place that naturally fosters independent, spontaneous communication.  No, that would be home, where for much of the time the child is self-directed, communicating with family members about things that they choose.  Yet despite this rather obvious fact, AT evaluations, programming and use almost always revolve around school, not home use.


  1. I’m a speech-language pathologist who works primarily in the area of AAC. I trained in the states, but am currently working overseas. In my current job I typically do all my assessments at home if that is the parent’s preference. Some request the assessment to be done at school. In some case we split the difference with the initial assessment done at home and later device trials or training completed at school. I think many evaluators are well aware that it would be beneficial to see kids in a variety of settings – but the funding system in America doesn’t lend itself readily to this… for it to work, I often need multiple visits (since I really don’t know exactly what equipment is needed until I met a child and can’t bring a closet’s worth of gear with me) and travel costs need to be covered. While I feel that its often easier for me to travel to a family than for a child (particularly if they have autism) to come to me, the value clinicians traveling to families isn’t always apparent to funding agencies – let alone issues with shortages of professionals with backgrounds in AAC. Now that this is news to you or any help, I just want to let you know that many of the professionals and ‘experts’ feel frustrated by the system too.

    Where I currently live, AAC evaluations are part of the universal health care system. Although there are waiting lists and other issues, I still find it to be an easier system to work in with added bonuses such as being able to travel to children and see them in their everyday situations. I can also see the entire process through from assessment to trial to training. Families can call us in the years to come when things go wrong (which always will with technology) and if we can’t help we can direct them on to the current resources. I’m constantly learning of new things that we give up by ‘choosing’ to have the type of health care system we do in America. I had no idea until I could see the system from my new vantage point!

    Okay I had a notion that things weren’t optimal when I added up the hours it took to write the funding reports for Medicaid/care and realized that the labor costs of the report nearly equaled the costs of the device. The frustration of trying to gather doctor prescriptions for devices that doctor might know nothing about.. and the idea that by turning off features to make the devices eligible for government funding makes them more expensive based on the crazy difference between dedicated and non-dedicated devices. Don’t get me wrong, I really am glad that there are funding streams now in America, I just wish we could do better – for families and professionals, sometimes I feel like we’re all pulling our hair out it trying to connect kids with a means of communication that work for them!

    Hang in there and I wish you good luck!

    Comment by Claire — May 22, 2007 @ 4:57 am

  2. I appreciate your comments, Claire. We’ve worked with a few SLP’s who have expressed that same frustration. The system really needs to change.

    It’s good to hear that in other places the home is considered a proper place to hold evaluations. Hopefully people here in the US will take note and see the benefits.

    Thanks again for your input!

    Comment by Carol — May 22, 2007 @ 9:52 am

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