American Speech-Language-Hearing Association
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Appropriate Communication Services: General 'Eligibility' Policies

Communication Services and Supports for Individuals With Severe Disabilities: FAQs

How does my child's cognitive age relate to his/her learning to communicate?

All children can and do learn to communicate! Your child's cognitive age relates to where along the continuum of communication he or she will begin the communication and language intervention process. Your child's cognitive age should not be used to deny providing communication services and supports

Does my child have to have certain cognitive or thinking skills to be ready to learn to communicate?

No. People used to believe that children had to demonstrate certain cognitive skills before they would be able to benefit from communication services Recent research has shown that communication and language develop from early infancy along with cognitive and thinking skills. In fact, sometimes, teaching new communication skills can help the child develop other thinking skills.

For more information:

Position statement of the National Joint Committee

Aren't there cognitive prerequisites for language?

No. All children can learn to communicate! People used to believe that a child had to demonstrate certain cognitive skills before they would be able to benefit from communication services. Research has shown that communication and language are developing from early infancy along with the child's cognitive and thinking skills. The interactions between the domains of cognition and language are certainly complex. In fact, sometimes, teaching new communication skills can help the child develop other thinking skills. A child's cognitive age relates to where along the continuum of communication he or she will begin the communication and language intervention process but should not be used to deny providing communication services and supports.

Studies with children and adults with significant cognitive disabilities have demonstrated that cognitive pre-requisite skills are not essential to the development of communication skills (e.g., Reichle & Yoder, 1985; Romski, Sevcik, & Pate, 1988).

For more information:

Position statement of the National Joint Committee

Reichle, J., & Yoder, D. (1985). Communication board use in severely handicapped learners . Language, Speech, Hearing Services in Schools, 16 , 146-157.

Romski, M. A., Sevcik, R. A., & Fonseca, A.H. (2003). Augmentative and alternative communication for persons with mental retardation. In L. Abbeduto (Ed.), International review of research in mental retardation: language and communication (pp.255-280). New York: Academic Press.

Romski, M. A., Sevcik, R. A., & Pate, J. L. (1988). The establishment of symbolic communication in persons with mental retardation. Journal of Speech and Hearing Disorders, 53 , 94-107.

How do IQ tests take into account speech delays?

In general, IQ tests do not take into account speech delays. In fact, IQ tests often use speech as the child's response mode. Thus, a child with speech delays may be disadvantaged when taking an IQ test that requires an intelligible spoken response. There are a few IQ tests that include both verbal and nonverbal portions and these tests might provide a better indicator of the child's overall skills than one that combines verbal and nonverbal skills into one score.

If an individual's language age is the same as his/her mental age, is it appropriate to provide communication services?

Yes, it is appropriate to provide communication services to an individual whose language age is commensurate with his or her mental age. The relationship between language and cognition is not simple or static. Tests that purport to assess cognitive or language skills often measure the same fundamental skills. Research has shown that children with disabilities, whose cognitive and language skills were measured as equal, nonetheless benefit from language intervention.

In general, IQ tests do not take into account speech delays. In fact, IQ tests often use speech as the child's response mode. Thus, a child with speech delays may be disadvantaged when taking an IQ test that requires an intelligible spoken response. There are a few IQ tests that include both verbal and nonverbal portions and these tests might provide a better indicator of the child's overall skills than one that combines verbal and nonverbal skills into one score.

For more information:

American Speech-Language Hearning Association (1989). Issues in determining eligibility for language intervention. Asha, 31 , 113-118.

Casby, M.W. (1992). The cognitive hypothesis and its influence on speech-language services in schools. Language, Speech, and Hearing Services in Schools, 23, 198-202.

Cole, K.N., Dale, P.S., & Mills, P.E. (1992). Stability of the intelligence quotient-language quotient relation: Is discrepancy modeling based on myth? American Journal of Mental Retardation, 97 (2), 131-145.

Cole, K.N., Dale, P.S., & Mills, P.E. (1990). Defining language delay in young children by cognitive referencing: Are we saying more than we know? Applied Psycholinguistics, 11 , 291-302.

Cole, K.N., & Fey, M.E. (1996). Cognitive referencing in language assessment. In K. N. Cole, P.S. Dale, & D.J. Thal (Eds.), Assessment of communication and language (pp. 143-159). Baltimore, MD: Brookes.

Isn't it too late to do communication training after age 22?

No. Research has shown that many individuals with significant disabilities continue to develop their communication and language skills throughout their young adult years. In addition, as adults move into new living or working environments, they often need communication services to adapt their communication to the needs of the new setting. For example, they may need new words added to their communication device, or may need to learn how to communicate new functions or meanings. Another important outcome for communication services provided to adults is to assure that their new communication partners (co-workers, job coaches, support personnel) can understand and communicate effectively with the individual who uses non-conventional or non-spoken communication.

Although records may indicate that an adult "did not benefit" from communication services provided when s/he was younger, there are many factors that may suggest potential for a better outcome of services offered to the adult. These factors include improved assessment and treatment options, newer communication technologies, and possible changes in the individual's health and developmental status. A number of studies have shown that adolescents and adults with a variety of severe disabilities make measurable gains when provided with appropriate communication services.

Communication services are likely to be particularly important for adults as they leave home and school and move into new living or working environments. During such transitional periods, adults with severe disabilities often need communication services to adapt their current communication systems to the needs of the new setting. For example, they may need new words added to their communication device, or may need to learn how to communicate new functions or meanings. Another important outcome for communication services provided to transitional adults is to assure that their new communication partners (co-workers, job coaches, support personnel, etc.) can understand and communicate effectively with the individual who uses non-conventional or non-spoken communication.

For more information:

Read the NJC position statement on access to communication services for individuals with severe disabilities, including those over age 22 years.

Research showing continued communication development in adolescence and adulthood

Chapman, R. (1997). Language development in children and adolescents with Down syndrome. Mental Retardation & Developmental Disabilities Research Reviews, 3 , 307- 312.

McLean, L. K., Brady, N. C., & McLean, J. E. (1996). Reported communication abilities of individuals with severe mental retardation. American Journal on Mental Retardation, 100 , 580-591.

Research documenting measurable gains from communication services provided to older individuals with severe disabilities

Iacono, T., Carter, M., & Hook, J. (1998). Identification of intentional communication in students with severe and multiple disabilities. Augmentative and Alternative Communication, 14, 102-114.

McLean, L. K. & McLean, J. E. (1993). Communication intervention for adults with severe mental retardation. Topics in Language Disorders, 13 (3), 47-60.

Romski, M. A., Sevcik., R. A., & Pate, J. L. (1988). The establishment of symbolic communication in a person with severe retardation. Journal of Speech and Hearing Disorders, 53, 94-107.

Sack, S. H., McLean, L., McLean, J., & Spradlin, J. (1992). Effects of increased opportunities within scripted activities on communication rates of individuals with severe retardation. Behavioral Residential Treatment, 7 (3), 235-257.

When should a person be discharged from speech-language pathology treatment?

There are a number of reasons for discharging a person from treatment. The ideal circumstance for discharge would be when the team, consisting of the individual with the communication disorder, the family, and the speech-language pathologist, comes to a mutual decision. The main reasons for discharge are a) the communication disorder is remediated or compensatory strategies are successfully established; b) the individual or family chooses not to participate in treatment, relocates, or seeks another provider; or c) treatment no longer results in measurable benefits after multiple modifications have been attempted. Each program should have established policies and procedures for following the individual after discharge. Follow-up is necessary because an individual's circumstances may change, new treatments may become available, or the individual may respond differently due to maturational changes or new life transitions (American Speech-Language-Hearing Association, 2004).

According to the 2004 Admission/Discharge Criteria in Speech-Language Pathology by the American Speech-Language-Hearing Association, the following circumstances would lead to appropriate discharge from direct communication services.

The team decides that the communication disorder is remediated or compensatory strategies are successfully established:

  1. The communication disorder is now defined within normal limits or is now consistent with the individual's premorbid status.
  2. The goals and objectives of treatment have been met.
  3. The individual's communication abilities have become comparable to those of others of the same chronological age, gender, ethnicity, or cultural and linguistic background.
  4. The individual's communication skills no longer adversely affect the individual's educational, social, emotional, or vocational performance, or health status.
  5. The individual who uses an augmentative or alternative communication system has achieved optimal communication across environments and communication partners.
  6. The individual has attained the desired level of enhanced communication skills.

The individual or family chooses not to participate in treatment, relocates, or seeks services from another clinician, such as in the following circumstances:

  1. The individual is unwilling to participate in treatment; treatment attendance has been inconsistent or poor and efforts to address these factors have not been successful.
  2. The individual, family, and/or guardian requests to be discharged or requests continuation of services with another provider.
  3. The individual is transferred or discharged to another location where ongoing service from the current provider is not reasonably available. Efforts should be made to ensure continuation of services in the new locale.

Treatment no longer results in measurable benefits and the following factors have been addressed: (a) appropriate intervention goals and objectives were specified; (b) sufficient instructional time was provided; (c) current and suitable intervention methods or materials were used; (d) meaningful and functional performance data were collected and analyzed on an ongoing basis to monitor and evaluate progress; (e) appropriate assistive technology or other technology supports were provided, when necessary; (f) a plan to address the needs and concerns of culturally/linguistically diverse families (e.g., use of interpreter or translator) as they affect participation in communication services was designed and implemented (ASHA, 1983); (g) relevant and accurate criteria were used to evaluate intervention; and (h) health, educational, environmental, or other supports relevant to communication interventions were provided. In addition, when provision of treatment that includes all of these factors is beyond the expertise of an individual clinician or the clinician's recommendations are not acceptable to the individual, referral to professionals with specific expertise in the area of concern should be made prior to discharge. Situations relevant to the criteria include the following:

  1. There does not appear to be any reasonable prognosis for improvement with continued treatment. Reevaluation should be considered at a later date to determine whether the patient/client's status has changed or whether new treatment options have become available.
  2. The individual is unable to tolerate treatment because of a serious medical, psychological, or other condition.
  3. The individual demonstrates behavior that interferes with improvement or participation in treatment (e.g., noncompliance, malingering), providing that efforts to address the interfering behavior have been unsuccessful.

For more information:

American Speech-Language-Hearing Association. (1983, September). Social dialects. Committee on the Status of Racial Minorities. Asha, 25 , 23-27.

American Speech-Language-Hearing Association. Committee on Language Learning Disorders. (1989, March). Issues in determining eligibility for language intervention. Asha, 31 , 113-118.

American Speech-Language-Hearing Association. (1998). Guidelines for referral to speech-language pathologists . Rockville, MD: Author.

American Speech-Language-Hearing Association. (2004). Admission/discharge criteria in speech-language pathology. ASHA Supplement, 24, 65-70.

National Joint Committee for the Communication Needs of Persons With Severe Disabilities. (2002). Access to communication services and supports: Concerns regarding the application of restrictive "eligibility" policies. Rockville, MD: American Speech-Language-Hearing Association.

How long should a speech-language pathologist continue providing communication services and supports to an individual with severe disabilities when she or he is not able to document progress on treatment goals?

There are many reasons for lack of progress on treatment goals. When treatment no longer results in measurable benefits, the team needs to answer a number of questions satisfactorily before discharging an individual. Depending on the answers to these questions, it may be highly appropriate to improve and then continue services

  • Were the intervention goals and objectives appropriate for the needs of the individual?
  • Did planning include the student's teachers and other relevant team members? Was there an active effort to promote skill generalization in the student?
  • Did team members use the same intervention strategies with the student settings and activities where these communication skills were needed?
  • Was sufficient instructional time provided?
  • Were current and suitable intervention methods or materials used?
  • Were meaningful, accurate, and functional performance data collected and analyzed on an ongoing basis to monitor and evaluate progress?
  • Were appropriate assistive technology or other technology supports provided when necessary?
  • Was a plan developed to address the needs and concerns of culturally/linguistically diverse families, such as use of an interpreter or translator?
  • Were relevant and accurate criteria used to evaluate intervention? Were health, educational, environmental, or other supports relevant to communication interventions?
  • Did the clinician have the expertise needed to provide appropriate services?
  • Were referrals made when necessary?

(American Speech-Language-Hearing Association, 2004)

See also: When should a person be discharged from speech-language pathology treatment?

For more information:

American Speech-Language-Hearing Association. (1983, September). Social dialects. Committee on the Status of Racial Minorities. Asha, 25 , 23-27.

American Speech-Language-Hearing Association. Committee on Language Learning Disorders. (1989, March). Issues in determining eligibility for language intervention. Asha, 31, 113-118.

American Speech-Language-Hearing Association. (1998). Guidelines for referral to speech-language pathologists. Rockville, MD: Author.

American Speech-Language-Hearing Association. (2004). Admission/discharge criteria in speech-language pathology. ASHA Supplement, 24, 65-70.

National Joint Committee for the Communication Needs of Persons With Severe Disabilities. (2002). Access to communication services and supports: Concerns regarding the application of restrictive "eligibility" policies. Rockville, MD: American Speech-Language-Hearing Association.

Should I terminate services if the individual has made no progress in the past?

A new trial of treatment may be warranted even if prior treatment has appeared to be unsuccessful. There are many reasons for an individual's lack of progress during prior communication services, such as:

  • Insufficient instructional time was provided
  • Intervention methods or materials were not current or suitable to the needs of the individual
  • Meaningful and functional performance data were not collected and analyzed on an ongoing basis to monitor and evaluate progress
  • Assistive technology or other technology supports were not provided when necessary
  • There was no plan to address the needs and concerns of culturally/linguistically diverse families (e.g., use of an interpreter or translator)
  • Relevant and accurate criteria were not used to evaluate intervention
  • Health, educational, environmental, or other supports were not relevant to communication interventions
  • The clinician did not have the expertise needed to provide appropriate services
  • Appropriate referrals were not made

Prior to termination from services, the team needs to determine whether any of these reasons could have accounted for the lack of progress in the past (American Speech-Language-Hearing Association, 2004).

See also: When should a person be discharged from speech-language pathology treatment? and How long should a speech-language pathologist continue providing communication services and supports to an individual with severe disabilities when she or he is not able to document progress on treatment goals?

For more information:

American Speech-Language-Hearing Association. (1983, September). Social dialects. Committee on the Status of Racial Minorities. Asha, 25, 23-27.

American Speech-Language-Hearing Association. Committee on Language Learning Disorders. (1989, March). Issues in determining eligibility for language intervention. Asha, 31 , 113-118.

American Speech-Language-Hearing Association. (1998). Guidelines for referral to speech-language pathologists . Rockville, MD: Author.

American Speech-Language-Hearing Association. (2004). Admission/discharge criteria in speech-language pathology. ASHA Supplement, 24, 65-70.

National Joint Committee for the Communication Needs of Persons With Severe Disabilities. (2002). Access to communication services and supports: Concerns regarding the application of restrictive "eligibility" policies. Rockville, MD: American Speech-Language-Hearing Association.

If classroom staff and family do not support communication, can the SLP dismiss for direct services due to lack of progress, even though there is no functional communication by the student?

This question really has two possible interpretations. The first deals with dismissal of a student when there is no "support" for treatment (i.e., the family no longer desires treatment). If this is the case, the American Speech-Language-Hearing Association (ASHA) suggests that discharge is appropriate. According to ASHA (2004) discharge is defendable when "the individual, family, and/or guardian requests to be discharged or requests continuation with another provider" (p. 5). Of course, one would hope that a discharge decision would not be made without serious consideration of several questions, including, but not limited to, the following: (a) How appropriate were intervention goals? (b) Has treatment occurred with appropriate intensity and over a sufficient amount of time? (c) Have appropriate methods been implemented and data collected and analyzed? (d) Have sufficient supports been provided to optimize opportunities for successful outcomes (ASHA, 2004)?

A second interpretation of the question asks if discharge is appropriate in situations where there is no effort to carry forward treatment suggestions by classroom staff and family members (stakeholders). The assumption here is that the prescribed treatment is appropriate in terms of the goals, methods, and data generated. If, as the question suggests, there continues to be a lack of functional communication on the part of the student, treatment should be continued but approached differently. In this situation, it is possible that stakeholders have yet to buy in with respect to treatment. Again, assuming treatment directions and methods are appropriate, it may be necessary to attempt some direct stakeholder training. The objects of this training would likely be to make stakeholders aware of the potential benefits of treatment participation and to clarify any confusion related to methods used and stakeholders' roles as agents of change.

Schepis and Reid (2003) provided a possible resource to assist with stakeholder training. These authors discussed competency- and performance-based training built on adult learning principles and derived from applied research. The application of stakeholder training could be an initial step in promoting the comprehensive application of communication-based treatment across settings.

For more information:

American Speech-Language-Hearing Association. (2004). Admission/discharge criteria in speech-language pathology [Guidelines]. Available from www.asha.org/policy.

Schepis, M. M., & Reid, D. H. (2003). Issues affecting staff enhancement of speech generating device use among people with severe disabilities. AAC, 19(1), 59–65.

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