Communication Assessment Guidelines

When you're called on to assess people with severe communication impairment,

1.  State what happened, NOT what you read into it.  

e.g.
“Joe showed no obvious response to speech.”
NOT  “Joe doesn’t understand speech.”

2.  Bear in mind that not doing something is NOT the same as not being able to do something.

e.g.
Maria refuses to match colours on request 
but makes mosaics with symmetrical designs involving colour matching.

3.  State the timeframe of your assessment, DON’T make lifelong findings.

e.g.
“On Feb 7th 2002 Joe showed no obvious response to speech.”
NOT  “Joe shows no response to speech.”

4.  Specify the location(s) in which your observations were made. 

e.g.
“When seen at his school on Feb 7th 2002, Joe showed no obvious response to speech.”

5.  Specify the person(s) involved and the activities observed  

e.g.
“When observed with his physiotherapist at his school on Feb 7th 2002, Joe showed no obvious response to her instructions.”

6.  Know the limitations of your test.

Tests which are designed to be administered to people with speech, normal hand skills, sight and hearing - such as most intelligence tests - do not provide accurate information about the understanding or learning potential of people who do not have those skills.  Such tests should not be administered to people who do not have the pre-requisite skills.  The results of such tests should never be invoked as a reason to limit a person’s opportunities.  Never make judgements such as  “Joe scored in the profoundly retarded range on a WAIS therefore he will be unable to use an electronic communication aid.”

7.  Don't double-count impairments.

If using a checklist, mark any items that the person cannot do because of  physical or sensory impairments AND subtract those items from the  total possible score  
e.g.
Joe is blind.  At least 5 out of 15 items on Stage 2 of the Triple C checklist require sight, so the maximum score that Joe can attain is 10.  Hence if he scores 6 he has scored a majority of the possible items.

8.  Don't assume a normal upbringing.

If using a checklist, mark any items which have not been in the person’s  experience AND subtract those items from the total possible score  
 e.g.
 Because Joe is a quadriplegic he has never been given a two-step instruction.

 
9.  If there are aspects of the person’s communication not covered by the checklist, attach explanatory notes  

e.g.
 “Because Joe is blind and has spastic quadriplegia, he could only be scored on 4 items out of the 12 in stage 6 of the Triple C checklist, and 2 of these involve spoken responses.  However, Joe does have clear signals for YES and NO, accurately answers comprehension questions about stories which have been read to him, and laughs at jokes.  Joe has an indexed communication book containing more than 100 items which he uses with partner assisted scanning to ask questions, make choices and give opinions.  He uses this by answering YES or NO to the options read out by his communication partner.  Further details may be found in his school file.”  
 Clearly Joe is an effective communicator for whom further options such as switch-controlled devices with auditory scanning and voice output should be explored.

 10.  Don't accept the test uncritically.

All any checklist can do is provide a snapshot of some aspects of an individual’s functioning while observed by the scorer.  If distributing  or filing a checklist, include a paragraph spelling out its limitations
e.g.
“This checklist contains many items which are not applicable to people with sensory or physical impairments.  It does not include questions about YES/NO responses, social responses such as laughing at jokes or showing distress at a sad story, communication aid use or literacy, and details of these should be listed separately.  
“Some people who have difficulty making controlled movements may be unable to demonstrate their understanding without specialised communication aids.
     “People without known sensory impairments who score poorly on items requiring sight or hearing should be referred for visual or auditory assessment.
     “Completion of a checklist does not obviate the need for assessment by professionals with expertise in augmentative communication.  Completion of the checklist does not in itself generate recommendations about future communication intervention or provide sufficent information to allow recommendation of appropriate communication aids.
     ”Regardless of their checklist scores, anyone who does not have a clear way of indicating YES and NO and strategies allowing them to greet people and communicate in sentences should be referred to an augmentative communication specialist.  This checklist will provide useful information to support this referral.”

11.  Never make sweeping negative statements about the communication of  any person, or any group of people.

 e.g.
  “People who score at Level 1 on the Triple C do not understand speech.”
  “Jane will never speak.”
  The risk of harm from such statements is so great as to outweigh the value of any information they may contain.

 12.  Remember: 

 “We pass through this world but once.  Few tragedies can be more extensive than the stunting of life, few injustices deeper than the denial of an opportunity to strive or even to hope, by a limit imposed from without, but falsely identified as lying within.”
  (Stephen Jay Gould, The Mismeasure of Man, Penguin Books, N.Y., 1981, pp 28-9)