How do I order an augmentative and alternative communication (AAC) device for a child?

How to Order an AAC Device for a Child

Refer the child to a speech-language pathologist (SLP) who will lead an interdisciplinary team assessment, conduct a 1-2 month device trial, and provide the prescription documentation required for ordering through medical insurance, educational systems, or assistive technology programs. 1

Step 1: Initiate Referral to Speech-Language Pathologist

• The SLP is the primary evaluator and decision-maker for AAC device selection, coordinating the entire assessment and ordering process. 1
• Assemble an interdisciplinary team that may include physical therapists, occupational therapists, rehabilitation engineers, developmental pediatricians, special educators, and the family, depending on the child's specific disabilities. 1
• Ensure the evaluating SLP has no financial relationship with the device supplier, as this is required for medical necessity determination. 2

Step 2: Complete Comprehensive Assessment

The assessment must systematically evaluate multiple domains:

Functional Communication Assessment

• Determine the child's current functional abilities, environmental situations, and personal preferences using frameworks like the International Classification of Functioning, Disability and Health (ICF). 1
• Establish baseline measurements using standardized instruments such as the Functional Independence Measure (Wee-FIM) or Pediatric Disability Inventory. 1
• Assess current and future language needs, motor abilities and deficits, cognitive functioning levels, vision and hearing status, communication partners, and environmental/mobility considerations. 1

Motor Access Evaluation

• Identify which movements the child can perform consistently and how these can control a device (e.g., direct touch, eye gaze, switch scanning, head control). 1, 3
• Determine the most appropriate access method through systematic experimentation over time, isolating specific motor skills. 3

Technology Level Determination

• Start by considering low-tech solutions (picture boards, PECS) and progress to mid-tech and high-tech devices only if simpler solutions are inadequate. 1
• For children with autism spectrum disorders, simple PECS may be more beneficial initially than complex voice-output devices. 1
• High-tech voice-output communication aids (VOCAs) are appropriate when expandability and flexibility are needed as the child's skills develop. 1

Step 3: Conduct Device Trial Period

• Arrange a 1-2 month trial with a rented or loaned device before purchase to assess effectiveness across different settings and identify strengths and weaknesses. 1
• Use this trial to train the child, family, educators, and caregivers on device operation. 1
• Document the child's ability to use the device effectively during this period, as this demonstrates medical necessity. 2

Step 4: Complete Required Documentation

The SLP must provide comprehensive documentation including:

• Diagnosis of the permanent severe expressive communication disability (e.g., cerebral palsy, autism spectrum disorder, traumatic brain injury). 1, 2
• Formal evaluation report documenting functional communication goals, treatment plan with training schedule, assessment showing natural communication methods are inadequate, and demonstration of cognitive/physical abilities to use the device. 2
• Evidence that alternative low-tech and mid-tech options have been appropriately considered and ruled out. 2
• Justification for specific access method if alternative input devices are needed. 2

Step 5: Submit for Funding and Order

Insurance/Medicare Pathway

• Submit documentation to medical insurance or Medicare demonstrating medical necessity for the speech-generating device. 2
• Include prescription from the physician (often the pediatrician) based on the SLP's evaluation and recommendation. 1, 4
• Medicare authorizes medically necessary SGDs for beneficiaries with functional communication needs and permanent severe expressive speech disabilities. 2

Educational System Pathway

• Work with the school's Individualized Education Program (IEP) team to include the AAC device as an educational accommodation. 4
• Educational systems share responsibility for providing AAC resources alongside medical and family systems. 4

Assistive Technology Programs

• Contact state assistive technology programs or university-based technology centers for device loans, trials, or funding assistance. 1
• These centers may have waiting lists but can provide valuable support for device matching. 1

Step 6: Ensure Training and Monitoring

• Accept responsibility for ensuring the child and all caregivers receive proper training, as this is crucial for successful device use and prevents the 33% abandonment rate seen with inadequate training. 1
• Establish ongoing monitoring with periodic reassessment as the child develops and needs change. 1
• Plan for vocabulary expansion and device modifications as the child's communication skills advance. 1

Critical Pitfalls to Avoid

• Never skip the trial period, as up to 75% of devices are never used successfully when proper assessment and training are lacking. 1
• Do not assume high-tech is always better—low-tech solutions like picture boards should always be available as backup when batteries fail. 1
• Avoid using an SLP with financial ties to the device supplier, as this invalidates medical necessity requirements. 2
• Do not delay AAC introduction waiting for natural speech to develop—AAC does not decrease natural speech and may actually facilitate it. 1
• Ensure the device includes capability for email, text, or phone messages for remote communication, which is a medically necessary feature. 2