Where Do We Start?

I think one of the biggest challenges is to decide what device is best. There has to be an intensive assessment done prior to the decision. When a school decides that a student needs to use an augmentative communication device they have an assistive technology specialist come in the school to do an assessment. After the assessment there is a team meeting to discuss the best options.
The following are some areas that have to be considered when deciding what device to use.

1) Expressive Communication

What does the student currently use to expressively request objects, continue an action, stop an action, request social interaction, express a feeling, make a
choice, initiate an interaction, terminate an interaction, or request assistance?

2) Cognitive Abilities

Does the student have object permanence? Do they understand cause and effect or means-end actions? What type of symbolic representation (object, picture, line drawing, words) do you think the student best understands?

3) Motor Skills

Does the student have a hand preference and are they able to reach, grasp, grasp and release, isolate a finger, and/or point? In what position is the student able to move and respond? What reliable, predictable motor movements does the student have?

4) Visual Skills

What is the student's visual acuity? What is the best lighting/contrast needed? Can the student fixate on an object and at what distance? Does the student know how to scan? How many items can the student scan and how long does it take them?

5) Auditory Skills

At what decibel level and frequency levels does the student hear best? Can the

student localize to sound? Do they seem to like auditory feedback?
It is also important to take into consideration where the communication is going to take place most frequently. In the beginning the communication system may be used mainly in home and school. The Assessor needs to take into account the noise level and number of distractions when deciding what communication device to use.

Once these things are addressed the environments where communication will occur need to be looked at. Will it be in a quiet room or a noisy classroom? The next step is to identify the types of communication the student will need in order to actively participate in the daily activities in those environments. In addition to the student's basic needs (e.g., eat, drink, toilet), the assessor may also want to consider greetings, initiations,  requests of an activity, social interactions, requesting assistance, or expressing feelings.

Dymond, Stacey. (1995). Augmentative COmmunication Assessment. Retrieved November 26, 2011 from
http://www.arslpedconsultant.com/documents/Handouts%20Two%20Reviews/Augmentative%20Communication%20Assessment.pdf