Purpose of review <p>This review examines current approaches and tools used to assess the communication abilities of individuals with severe to profound intellectual disability.</p> Recent findings <p>People with severe to profound intellectual disability are a heterogeneous group which requires clinicians to be familiar with a broad range of tools that could be informant-report tools, observational methods, and direct engagement. Best practice assessment needs to evaluate across a tri-focus that includes consideration of the individual, their communication partners and their environments. The sparse literature includes studies that survey clinicians or report on individual tools but there is a lack of clarity guiding clinicians to a gold standard suite of tools. Given heterogeneity of communication skills in this population, clinicians will need to select tools carefully and to integrate tool availability and their own expertise into the assessment process alongside real-world service pressures such as a fixed budget for assessment or a service policy about which tools are used.</p> Summary <p>Triangulation of information is essential to successfully determine the skills of this tri-focus (the individual, their communication partners and environments). Assessment needs to go beyond identifying the persons level of communication but to clearly evaluate which aspects the individual communicator, their communication partners and environments could be modified to improve the daily participation of the individual.</p>