Module 4

Module 4.5 – Communication

Moico Module 1 Alt
This module is completed when entering the patient registry and updated annually for children under ten then every two years. Information is collected on the methods of communication used, the efficacy of those methods (including specific questions on AAC).
4.5.1. Speech,Language and Communication (ANGBEHDEVSPEECHLANGUAGE)
NoCodeQuestionResponse
4.5.1.3ANGBEHDEVALLLANGPlease indicate all language communication forms used1 – Moans;
2 – Babbles ;
3 – Uses an intentional sound to attract attention;
4 – Single words ;
5 – 2-3 word phrases;
6 – Longer phrase speech
4.5.1.5ANGBEHDEVNUMWORDSHow many words (or word approximations)?1 – 1-5;
2 – 5-10;
3 – More than 10 Range/RadioWidget; ANGNUMWORDSPVG)
4.5.1.6ANGSpeakFrequencyHow often do they use words or word approximations1 – All the time;
2 – Most of the time;
3 – Some of the time;
4 – Rarely;
5 – Never;
6 – Unknown
4.5.1.7ANGSpeakAgeAt what age did they say their first word? 
4.5.1.2ANGBEHDEVALLLANGIf yes, please indicate their most effective verbal language communication.1 – Moans;
2 – Babbles ;
3 – Uses an intentional sound to attract attention;
4 – Single words ;
5 – 2-3 word phrases;
6 – Longer phrase speech
4.5.1.4ANGBEHDEVBESTUNDERSTANDINGPlease indicate their most effective ability to respond to requests.1 – Single word such as no;
2 – Simple phrase command such as “Don’t touch”;
3 -Commands – single step- longer sentence i,e, “Go to your room now”;
4 -Commands – 2 step e.g “Go to your room and bring back your water bottle.”;
5 – Commands – 3 step;
6 – None of the above
4.5.2.11aANGBEHDEVPREFCOMMBEST2What is your child/ adult’s method of communicating with you? Check all that apply1 – Spoken words;
2 – Gestures;
3 – Signing;
4 – Visual pictures;
5 – Eye tracking devices;
6 – Low tech AAC ;
7 – Mid tech ;
8 – High tech AAC
4.5.2. Please rate your child/ adult ability to use the following communication methods/systems: (ANGBEHDEVCOMMUNICATION)
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4.5.2.1ANGBEHDEVCOMSpokenSpoken words1 – Doesn’t use;
2 – Rarely uses;
3 – Uses for single requests or to express basic wants, needs, observations and ideas regularly;
4 – Communicates effectively with known people;
5 – Communicates effectively with known and unknown people
4.5.2.2ANGBEHDEVCOMGestureGesturesAs above
4.5.2.3ANGBEHDEVCOMSigningSigningAs above
4.5.2.4ANGBEHDEVCOMVisPicVisual picturesAs above
4.5.2.7ANGBEHDEVCOMEyeTrackEye tracking devicesAs above
4.5.2.8ANGBEHDEVCOMLowTechLow tech AAC (light tech or paper based, e.g. PODD books, core vocab boards, aided language displays)As above
4.5.2.9ANGBEHDEVCOMMidTechMid tech (big mark switches, tech talks or voice output) As above
4.5.2.10ANGBEHDEVCOMHighTechHigh tech AAC (e.g. Dynamic display, iPad, Novachat Tobii) As above
4.5.3. Assisted and Augmented Communication (AAC) Usage (ANGCOMACCINDIV)
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4.5.3.1ANGAACSLHas your child/adult participated in speech-language therapy before?1 – Yes;
2 – No;
3 – Unknown
4.5.3.2ANGAACCMHave you heard of the Communication Matrix tool?  https://communicationmatrix.org/1 – Yes, and I have completed it myself;
2 – Yes, and it has been completed by a third party ;
3 – Yes, I have heard about it but I have not completed it;
4 – No, I have never heard of it
 ANGCMMATRIXIf you have participated in the Communication Matrix as a caregiver, please record your Matrix ID 
 ANGCMDATEAdministration Date 
 ANGCMTOTALTotal Score 
 ANGCMPERCENTPercentage 
4.5.3.3ANGAACUseDoes your child/ adult use a form of Augmentative and Alternative Communication ?1 – Yes;
2 – No ;
3 – Unsure what AAC is and if it is helpful
4.5.3.4ANGAACInterestIf you have not used AAC, are you interested in using AAC with your child/ adult?1 – Yes;
2 – No
4.5.3.5ANGAACNoWhy not? 
4.5.3.6ANGAACDeny2If you were denied a form of AAC therapy, what reason was given for this?1 – Not making progress;
2 – They were told the individual with AS was not a candidate for AAC;
3 – Need to work on skills before introducing AAC;
4 – Not ready for AAC;
5 – Other
4.5.3.7ANGAACDenyOthPlease state 
4.5.3.8ANGAACLocWhere does your child/ adult use AAC?
(Select all that apply)
1 – Home;
2 – School;
3 – Speech therapy;
4 – Other
4.5.3.9ANGAACLocOthPlease state 
4.5.3.10ANGAACHomeHow often do you estimate that they use AAC to communicate at Home?1 – All of the time;
2 – Some of the time;
3 – Rarely;
4 – Never
4.5.3.10aANGAACHomeTypeWhat type of AAC does your child/ adult use to communicate at home?2 – Gestures;
3 – Signing;
4 – Visual pictures;
5 – Eye tracking devices;
6 – Low tech AAC (light tech or paper based, e.g. PODD books, core vocab boards, aided language displays);
7 – Mid tech (big mack switches, tech talks or voice output);
8 – High tech AAC (e.g. Dynamic display, iPad, Novachat Tobii);
9-Other
4.5.3.10bANGAACHomeOtherIf other, please describe 
4.5.3.11ANGAACSchoolHow often do you estimate that they use AAC to communicate at School?1 – All of the time;
2 – Some of the time;
3 – Rarely;
4 – Never
4.5.3.11aANGAACSchoolTypeWhat type of AAC does your child/ adult use to communicate at school?2 – Gestures;
3 – Signing;
4 – Visual pictures;
5 – Eye tracking devices;
6 – Low tech AAC (light tech or paper based, e.g. PODD books, core vocab boards, aided language displays);
7 – Mid tech (big mack switches, tech talks or voice output);
8 – High tech AAC (e.g. Dynamic display, iPad, Novachat Tobii);
9-Other
4.5.3.11bANGAACSchoolOtherIf other, please describe 
4.5.3.12ANGAACSTHow often do you estimate that they use AAC to communicate at Speech Therapy?1 – All of the time;
2 – Some of the time;
3 – Rarely;
4 – Never
4.5.3.12aANGAACSpeechTypeWhat type of AAC does your child/ adult use to communicate at speech therapy?2 – Gestures;
3 – Signing;
4 – Visual pictures;
5 – Eye tracking devices;
6 – Low tech AAC (light tech or paper based, e.g. PODD books, core vocab boards, aided language displays);
7 – Mid tech (big mack switches, tech talks or voice output);
8 – High tech AAC (e.g. Dynamic display, iPad, Novachat Tobii);
9-Other
4.5.3.12bANGAACSpeechOtherIf other, please describe 
4.5.3.13ANGAACHearHow did you hear about AAC? Select all that apply.1 – Online;
2 – At a conference;
3 – From another parent;
4 – From a teacher;
5 – From a speech therapist;
6 – From another therapist;
7 – From behavioral services;
8 – From genetics/medical doctor;
9 – Can’t remember/Unknown
4.5.3.14ANGAACStartHow long after diagnosis did you start using AAC?1 – Upon diagnosis;
2 – Less than three months after diagnosis;
3 – 3-6 months after diagnosis;
4 – 7-24 months after diagnosis;
5 – 2 – 4 years after diagnosis;
6 – 5+ years after diagnosis
4.5.3.15ANGAACFunctionFor what function of communication does your child/ adult use AAC with you? Select all that apply.1 – Make requests;
2 – Reject/refuse;
3 – Make comments ;
4 Express emotional and physical states ;
5 – Label ;
6 – Answer questions;
7 – Call someone ;
8 – Assert independence ;
9 – Greet;
10 – Ask questions;
11 – Direct other’s actions ;
12 – Share personal experiences ;
13 – Share thoughts and ideas;
14 – Express manners
4.5.3.16ANGAACDeviceDoes your child/ adult use an electronic communication device for other purposes than AAC? Select all that apply.1 – Watching videos ;
2 -Listening to music;
3 – Playing games;
4 – Other
4.5.3.17ANGAACDevOthPlease specify 
4.5.3.18ANGAACDurCOMOn a typical day, how many hours do they spend using the device for AAC purposes?1 – Less than 2 hours;
2 – Between 2 and 4 hours;
3 – More than 4 hours
4.5.3.19ANGAACDurOthOn a typical day, how many hours do they spend using the device for other purposes than AAC?1 – Less than 2 hours;
2 – Between 2 and 4 hours;
3 – More than 4 hours
4.5.3. Assisted and Augmented Communication (AAC) Usage (ANGCOMACCINDIV)
NoCodeQuestionResponse
4.5.3.1ANGAACSLHas your child/adult participated in speech-language therapy before?1 – Yes;
2 – No;
3 – Unknown
4.5.3.2ANGAACCMHave you heard of the Communication Matrix tool?  https://communicationmatrix.org/1 – Yes, and I have completed it myself;
2 – Yes, and it has been completed by a third party ;
3 – Yes, I have heard about it but I have not completed it;
4 – No, I have never heard of it
 ANGCMMATRIXIf you have participated in the Communication Matrix as a caregiver, please record your Matrix ID 
 ANGCMDATEAdministration Date 
 ANGCMTOTALTotal Score 
 ANGCMPERCENTPercentage 
4.5.3.3ANGAACUseDoes your child/ adult use a form of Augmentative and Alternative Communication ?1 – Yes;
2 – No ;
3 – Unsure what AAC is and if it is helpful
4.5.3.4ANGAACInterestIf you have not used AAC, are you interested in using AAC with your child/ adult?1 – Yes;
2 – No
4.5.3.5ANGAACNoWhy not? 
4.5.3.6ANGAACDeny2If you were denied a form of AAC therapy, what reason was given for this?1 – Not making progress;
2 – They were told the individual with AS was not a candidate for AAC;
3 – Need to work on skills before introducing AAC;
4 – Not ready for AAC;
5 – Other
4.5.3.7ANGAACDenyOthPlease state 
4.5.3.8ANGAACLocWhere does your child/ adult use AAC?
(Select all that apply)
1 – Home;
2 – School;
3 – Speech therapy;
4 – Other
4.5.3.9ANGAACLocOthPlease state 
4.5.3.10ANGAACHomeHow often do you estimate that they use AAC to communicate at Home?1 – All of the time;
2 – Some of the time;
3 – Rarely;
4 – Never
4.5.3.10aANGAACHomeTypeWhat type of AAC does your child/ adult use to communicate at home?2 – Gestures;
3 – Signing;
4 – Visual pictures;
5 – Eye tracking devices;
6 – Low tech AAC (light tech or paper based, e.g. PODD books, core vocab boards, aided language displays);
7 – Mid tech (big mack switches, tech talks or voice output);
8 – High tech AAC (e.g. Dynamic display, iPad, Novachat Tobii);
9-Other
4.5.3.10bANGAACHomeOtherIf other, please describe 
4.5.3.11ANGAACSchoolHow often do you estimate that they use AAC to communicate at School?1 – All of the time;
2 – Some of the time;
3 – Rarely;
4 – Never
4.5.3.11aANGAACSchoolTypeWhat type of AAC does your child/ adult use to communicate at school?2 – Gestures;
3 – Signing;
4 – Visual pictures;
5 – Eye tracking devices;
6 – Low tech AAC (light tech or paper based, e.g. PODD books, core vocab boards, aided language displays);
7 – Mid tech (big mack switches, tech talks or voice output);
8 – High tech AAC (e.g. Dynamic display, iPad, Novachat Tobii);
9-Other
4.5.3.11bANGAACSchoolOtherIf other, please describe 
4.5.3.12ANGAACSTHow often do you estimate that they use AAC to communicate at Speech Therapy?1 – All of the time;
2 – Some of the time;
3 – Rarely;
4 – Never
4.5.3.12aANGAACSpeechTypeWhat type of AAC does your child/ adult use to communicate at speech therapy?2 – Gestures;
3 – Signing;
4 – Visual pictures;
5 – Eye tracking devices;
6 – Low tech AAC (light tech or paper based, e.g. PODD books, core vocab boards, aided language displays);
7 – Mid tech (big mack switches, tech talks or voice output);
8 – High tech AAC (e.g. Dynamic display, iPad, Novachat Tobii);
9-Other
4.5.3.12bANGAACSpeechOtherIf other, please describe 
4.5.3.13ANGAACHearHow did you hear about AAC? Select all that apply.1 – Online;
2 – At a conference;
3 – From another parent;
4 – From a teacher;
5 – From a speech therapist;
6 – From another therapist;
7 – From behavioral services;
8 – From genetics/medical doctor;
9 – Can’t remember/Unknown
4.5.3.14ANGAACStartHow long after diagnosis did you start using AAC?1 – Upon diagnosis;
2 – Less than three months after diagnosis;
3 – 3-6 months after diagnosis;
4 – 7-24 months after diagnosis;
5 – 2 – 4 years after diagnosis;
6 – 5+ years after diagnosis
4.5.3.15ANGAACFunctionFor what function of communication does your child/ adult use AAC with you? Select all that apply.1 – Make requests;
2 – Reject/refuse;
3 – Make comments ;
4 Express emotional and physical states ;
5 – Label ;
6 – Answer questions;
7 – Call someone ;
8 – Assert independence ;
9 – Greet;
10 – Ask questions;
11 – Direct other’s actions ;
12 – Share personal experiences ;
13 – Share thoughts and ideas;
14 – Express manners
4.5.3.16ANGAACDeviceDoes your child/ adult use an electronic communication device for other purposes than AAC? Select all that apply.1 – Watching videos ;
2 -Listening to music;
3 – Playing games;
4 – Other
4.5.3.17ANGAACDevOthPlease specify 
4.5.3.18ANGAACDurCOMOn a typical day, how many hours do they spend using the device for AAC purposes?1 – Less than 2 hours;
2 – Between 2 and 4 hours;
3 – More than 4 hours
4.5.3.19ANGAACDurOthOn a typical day, how many hours do they spend using the device for other purposes than AAC?1 – Less than 2 hours;
2 – Between 2 and 4 hours;
3 – More than 4 hours
4.5.4 Assisted and Augmented Communication (AAC) Usage by Others (ANGCOMACCOTH)
NoCodeQuestionResponse
4.5.4.1ANGAACPersonWho else uses the AAC to communicate with your child/ adult?
Select all that apply.
1 – Family members;
2 – Friends;
3 – School teachers;
4 – Speech therapists;
5 – Caregivers;
6 – Other
4.5.4.2ANGAACPerOthPlease specify. 
4.5.4.3ANGAACTrainDid you, as a caregiver, receive training on how to use AAC with your child/ adult?1 – Yes;
2 – No
4.5.4.4ANGAACTrainWhoPlease give details of who provided the AAC training to you.
Select all that apply.
1 – School;
2 – AAC company directly;
3 – General AAC workshops;
4 – Online training;
5 – Speech therapist;
6 -Other (AACTraining)
4.5.4.5ANGAACTrainOthPlease specify. 
4.5.4.6ANGAACTrainDurHow much training have you, as a caregiver, had on using AAC?1 – None;
2 – Self-trained via e.g. YouTube training;
3 – Up to 1 hour;
4 – Up to 8 hour (1-full day training);
5 – Several days of training
4.5.4.7ANGAACConfidentHow confident/comfortable are you, as a caregiver, in using AAC with your child/ adult?1 – Limited;
2 – Confident;
3 – Highly-confident
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