AAC Evaluation Information

How does the child answer yes/no questions? Describe:

Who best understands the child and why?

What is your estimate of the child's ability to: (describe)

understand directions/commands?

understand new words?

understand conversations of adults?

play with kids his/her own age?

express general feelings?

express specific ideas, like why he/she is crying or the name of a child or thing he wants?

make choices?

When the child is trying to tell you a specific idea (like something that happened at school), but he/she isn't being understood, does he/she:

Rows	Yes	No	Describe
realize that he/she is NOT understood
keep repeating until he/she is understood
get angry or frustrated or cry
quit and do something else
quit and stop talking
other

Describe how the child communicates when he/she:

is feeling happy or sad

is hungry or thirsty

needs help with something

wants something to stop

wants more of something

wants a specific toy

wants a specific child

wants to do something specific

What, if any kinds of everyday technology or devices does the child use (or try to use)? Examples: TV remote, iPad or other similar tablet, video game, electronic toys.

What specific communication questions and concerns do you want addressed during this assessment?

What long-term communication goals do you have for your child?

Attach any additional information you have which is necessary for this evaluation:

Rows	Yes	No	Describe
Braces (hands/feet/body)
Glasses
Hearing aid(s)
Walker
Stander
Wheelchair (manual/power)
Laptray on wheelchair
Other

AAC EVALUATION INFORMATION

AUGMENTATIVE COMMUNICATION

AAC EVALUATION INFORMATION

COMMUNICATION AND INTERACTION SKILLS