Vocabulary Questionnaire to Support Vocabulary Selection for AAC

Vocabulary Questionnaire for Augmentative & Alternative Communication
This questionnaire is designed to aid in the selection of the most important and meaningful vocabulary for children using or beginning to use an augmentative and/or alternative communication system such as a voice output communication device or communication board. The words you choose will help the team develop a communication system that offers your child meaningful and powerful vocabulary.
Child's Name*

First NameLast Name
Note: If you don’t know an answer, leave it blank!
YesNo
YesNo
List any words that you feel the child ABSOLUTELY NEEDS to communicate in order to function in his/her life. * You may cross out words in the checklists and write in any of your child's unique terms. For example, you may want to cross out the word "dinner" and write in "supper."

PEOPLE

Rows	Family Members and other people close to the child (mom, dad, brother, sister, family friends, etc.)	What your child calls the family member to the left (for example: maternal grandmother-Nana)What your child calls the family member to the left (for example: brother - Billy, mom - Momma)
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Where mom works/what she does:
Where dad works/what he does:
What I like to do with Mom:
What I like to do with Dad:

PETS

Rows	Type of Pet	Pet's name
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OTHER PEOPLE IMPORTANT TO THE CHILD

Rows	Relation to child (ex. neighbor)	What you child call the person to the left (for example neighbor - Mrs. Smith)
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PROFESSIONALS CHILD ENCOUNTERS FREQUENTLY (outside of school)

Rows	Professional	What your child calls the person to the left
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SCHOOL PEOPLE (Adults the child interacts with in his/her school)

Rows	School Personnel	What your child calls the person to the left (for example teacher - Mrs. Smith)
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SCHOOL FRIENDS

Rows	Students child interacts with in his/her school environment
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PLACES

SCHOOL PLACES - Places child goes within and outside of the school building

Rows	Place	What your child calls the place on the left
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Where does your child go after school (home, sitter, caretaker, daycare center)
Who child sees after school (family, friends, caretakers, therapists)
HOME PLACES

SOME OF CHILD'S FAVORITE PLACES TO GO ARE:

Rows	(ex. inside, outside, Bobby's house, etc.)
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STORES:

Rows	Which specific stores does the child visit in the community? (ex. Target, Acme, etc.)
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RESTAURANTS:

Rows	Which specific restaurants does the child visit in the community? (ex. McDonald's, Applebees, etc.)
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VACATION SPOTS:

Rows	Which specific VACATION does the child visit? (ex. beach, Ocean City, Poconos, etc.)
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HOME ACTIVITIES

FAVORITE HOME ACTIVITIES:

Rows	Which specific activities does your child like to do at home? (ex. puzzles, reading, cooking, eating, playing cars and trucks, listening to music, computer, dolls, games). Please be specific and name toys, games, toy parts, book names, etc.
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SCHOOL ACTIVITIES: Which specific activities does your child do/enjoy/dislike at school?
FAVORITE MUSIC/ARTISTS: Please name specific music and artists your child enjoys.
FAVORITE TV SHOWS/STARS/MOVIES/DVDS/CDS/CHANNELS: Please name the specific shows, songs and artists your child enjoys.
Child typically watches TV with the following people:
Where/how the child likes to watch:
VIDEO GAMES: If applicable, please list favorite video game system.
FAVORITE SPORTS TO WATCH/ATTEND: If applicable, please list favorite sports/teams (professional and local) your child likes to watch or attend.
FAVORITE SPORTS TO PLAY: if applicable, please list favorite sports your child likes to play. Please name teams if appropriate.
COMMUNITY ACTIVITIES: If applicable, please list community activities in which your child participates (ex. church, music lessons, etc.)
Are there any vocabulary items that should be included about nature?*
Are there any vocabulary items that should be included about specific household items?*
Are there any specific vocabulary items that should be included about parts of the body or hygiene?*
shirtpantsshortsjeansdressunderwearsocksshoesbootssandalssneakerssweatshirtt-shirtskirtpajamasbathing suitcoatmittensgloveshatscarf
CLOTHING: Are there any other vocabulary items that be included about clothing?
Foods/Drinks and Eating

Favorite foods/drinks:
What specific favorite foods and drinks would the child comment on or request?
Least favorite food and drinks: What foods and drinks does the child DISLIKE that he/she would communicate about?
Is the child allergic to anything they may need to tell someone about?*
Slang/Jokes/and Swearing (swearing for teenagers only)
What slang, jokes, swear words (teenagers only) or other unique phrases would your child want to use?
GREETINGS/MANNERS
Are there any other vocabulary items that should be included to express greetings or politeness?*
POSITIONING/ADAPTIVE EQUIPMENT/PERSONAL CARE
Are there any specific words related to physical, adaptive equipment, or other personal care needs that the child would need to say?
Signature*
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Vocabulary Questionnaire for Augmentative & Alternative Communication

PLACES

HOME PLACES

HOME ACTIVITIES

Foods/Drinks and Eating

GREETINGS/MANNERS

POSITIONING/ADAPTIVE EQUIPMENT/PERSONAL CARE