Communication Services and Supports for Individuals With Severe Disabilities: FAQs

These frequently asked questions (FAQs) are for consumers and professionals. The FAQs have information about communication services and supports for individuals with severe disabilities related to communication development, funding for service delivery, eligibility policies, AAC, IDEA services, interdisciplinary teams, literacy, and specific disabilities and approaches.

Follow links below to browse either the general category or specific questions and responses, which include a brief answer to the question, more detailed information for those wanting a more in depth response, references, and additional resources.

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Communication Development and Concerns

• Can all children learn to communicate?
• What should we do if an individual does not communicate with signs or pictures?
• What are functional communication skills?
• Is it necessary or appropriate to begin communication services or "speech therapy" for a child younger than 2 years old?
• What if the individual shows no interest in communication?
• When I believe that an individual is using problem behavior to communicate, should I ignore it or respond to it as communication?
• What should we do if a child demonstrates communication skills at home, but doesn't use those skills at school?
• What is "evidence-based practice" and how do I determine if a communication intervention is "evidence-based"?
• Are yes/no questions a good way to start teaching someone to communicate?
• If we are supposed to provide "communication services and supports" what is that supposed to include beyond teaching and therapy?
• What role does culture play in serving children and families with severe communication disabilities?
• The school district assistive technology (AT) team says that a student we serve does not qualify for augmentative and alternative communication/assistive technology (AAC/AT) because she has some speech. The student is about 50% unintelligible to familiar partners under known context conditions.
• How should I set up a grapheme/text based AAC system for a young student who speaks English as a second language (at school), but who has family that does not speak English?

Funding for Service Delivery

• Are communication services typically considered medically or educationally necessary?
• How can communication services, including AAC devices, be documented as "medically necessary"?
• How can communication services, including AAC devices, be documented as "educationally necessary"?
• Does a school's obligation to provide AT devices/services mean that the district always pays for them?
• Do Medicaid or Medicare programs provide reimbursement for AAC services?
• If my child needs communication services, including AAC, who pays for it?
• Are communication services, including AAC, covered for children age birth to 3 years?
• Are communication services, including AAC, covered by adult services programs?
• Does private insurance provide reimbursement for communication services, including AAC devices and services?
• Are services free for children age birth to 3 years?
• Can a healthcare provider be reimbursed for indirect services? Do Medicare, Medicaid, or private insurance pay for indirect services?
• Are "maintenance" services eligible for coverage under insurance, special education, or other payment/reimbursement systems?

Appropriate Communication Services: General 'Eligibility' Policies

• How does my child's cognitive age relate to his/her learning to communicate?
• Does my child have to have certain cognitive or thinking skills to be ready to learn to communicate?
• Aren't there cognitive prerequisites for language?
• How do IQ tests take into account speech delays?
• If an individual's language age is the same as his/her mental age, is it appropriate to provide communication services?
• Isn't it too late to do communication training after age 22?
• When should a person be discharged from speech-language pathology treatment?
• 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?
• Should I terminate services if the individual has made no progress in the past?
• 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? 

Basic Information About Augmentative and Alternative Communication

• What is AAC?
• Are there prerequisites to use AAC?
• What is meant by aided versus unaided forms of communication?
• Does the child have to understand the symbols on the device before I put them there?
• Who uses AAC and how do I know AAC is right for my child?
• Who would I contact to learn more about AAC?
• How do you decide what kind of symbols or what kind of AAC device to use?
• What considerations are there when determining the best mode of communication to target in intervention? For example, are pictures always better than signs?
• How should I approach parents about AAC when they are only interested in having their child learn to speak? Many parents seem concerned that AAC will interfere with speech.
• How do I decide whether a high technology communication device or a low technology communication device is better for an individual?
• Can sign language help improve my child's communication?

Communication Services in IDEA (Special Education)

• How do you provide services if your district does not have enough personnel with appropriate training or experience to serve students with severe disabilities?
• What if my child is not learning because the SLP does not have the skills to teach my child?
• Do children with severe disabilities really benefit from being around typical peers?
• How are typically developing children affected by interactions with children who have severe disabilities?
• What is the difference between direct and indirect services?
• What is the difference between individual and group treatment?
• What types of related services are appropriate for secondary students already in a specific learning disabilities class?

Interdisciplinary Teams

• Who are members of an interdisciplinary team? What is their role?
• What does a speech-language pathologist (SLP) do?
• Some professionals from other disciplines are making recommendations about AAC and speech generating devices (SGDs). Is this okay?

Reading, Writing, and Literacy for Children and Adults With Severe Disabilties

• Can children with severe disabilities learn to read or write?
• When should I start reading to my child?
• If a student is non-speaking, and so can't read out loud, how can I assess his or her reading skills?
• What are signs of "emergent literacy" in a child with severe disabilities?
• What strategies can I use to teach reading and writing to an individual with severe disabilities?

Specific Disabilities and Approaches

• I have a couple of students with autism on my caseload. What program should I use?
• Why would a speech-language pathologist work with a child who doesn't talk?
• What is ABA and how is it applicable to communication training?
• What communication services are appropriate for children who are deaf-blind?
• Is it appropriate to work on communication skills if the child has a degenerative condition?
• Does oral-motor treatment help with speech and communication development?
• What approach is best for enhancing communication skills for my child's syndrome or specific disability?
• How can I help providers understand my child and encourage communication, as he/she transitions into new classes at the beginning of the school year?
• What tools could be recommended for assessing a student with intellectual disability or autism spectrum disorder (ASD) who is low verbal?
• What are the recommended assessment and intervention strategies for individuals with Down syndrome?
• What can be said to those who want a formal communication system for an individual with severe intellectual disabilities who does not want to change from a gestural/concrete method?