Evidence-Based Practice for Birth–3

Current research clearly documents the efficacy of communication services and supports provided to infants, toddlers, and preschoolers with a variety of severe disabilities. Those involved in care for these children should conduct comprehensive, collaborative assessments. This assessment should address the child's receptive and expressive communication skills, as well as related areas of cognitive and social development, using valid and reliable assessment instruments. Individualized intervention plans for the child and family should be informed by the assessment results. Services can be provided through state early intervention programs.


It is never too early to incorporate augmentative and alternative (AAC) into language and communication intervention for the young child with a significant communication disability. The AAC devices and strategies are a tool, a means to an end—language and communication skills—not the end. AAC does not hinder speech development and offers the potential to enhance communication, language, and learning for children with severe disabilities.

Coaching parents to recognize and support communication in all forms, including AAC, can help prevent failure in language and communication development.

Bottom Line: 

Communication services should be started as soon as a communication delay or disorder is identified and providers should consider the use of AAC for children with severe disabilities.

Functional Communication Skills

Functional communication skills enhance an individual’s ability to meaningfully participate in everyday life as both a speaker and listener. Functional communication varies in its expression and may include personalized movements, gestures, verbalizations, signs, pictures, words, and output from AAC devices. The communication forms a person uses must be understood by all communication partners, particularly if these forms are not conventional or approximate conventional words and signs. The Communication Bill of Rights [PDF] articulates fundamental communicative functions, including the right to share comments and opinions, interact socially, express feelings, and make choices.

For individuals who have severe disabilities, the best times and places for teaching functional communication skills are everyday routines and contexts with a range of communication partners. Instruction, however, needs to be planned and systematic, extend across the individual's whole day, and include ongoing support for using the new skills. Naturalistic methods, such as milieu teaching, have proven to be effective for teaching functional communication. When activities and communication opportunities are meaningful to both the individual and their communication partners motivation is heightened and successful outcomes are more likely to occur.

Bottom Line: 

A focus on functional communication and meaningful participation leads to improved outcomes.


Family Guided Routines Based Intervention

Lacey, E. A., Ogletree, B. T., Rice, T., & Rose, A. (2017). Milieu Training for Adults With Severe Intellectual Disability: A Clinical Illustration. Communication Disorders Quarterly, 38(3), 179–184.

Centers for Disease Control and Prevention: Learn the Signs. Act Early: What Is "Early Intervention"?

Clinical Forum: Interprofessional Collaborative Practices in Service Delivery For Individuals With Severe Disabilities.  A special issue of the American Journal for Speech Language Pathology, May, 2017, Volume 26.


Return to the National Joint Committee for the Communication Needs of Persons With Severe Disabilities (NJC) topic areas list.

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