Signing and autistic children

Reproduced from Communication, 19(3), pp.9-12

The use of signing in the education even of the hearing-impaired remains a controversial matter. It may thus seem odd, or even perverse, to propose its use with a group of children who generally have perfectly adequate or seemingly sometimes over-sensitive hearing. Yet the use of signing with autistic children has been growing consistently since the early 70s. Creedons work with 30 autistic children in America was very influential in that it offered hope, not only that autistic children could be taught signing as an alternative mode of communication but that through signing a proportion of them at least would also acquire speech. Miller and Miller in 1973, using an admittedly unusual technique, also claimed similar success, and more recently Schaeffer (1980) also gained success but by giving specific training in verbal imitation as well as sign training. Mary Konstantareas and her colleagues have also had success with the teaching of signs to autistic children in Canada, and in Britain Chris Kiernans survey in 1983 showed that half of the fourteen schools for autistic children surveyed were using some form of sign system.

There are basically two motives for the use of signs with autistic children:

1. As an alternative system for communication when speech has failed to develop - often after extensive attempts at speech training; and
2. As an augmentative system designed to aid the development of speech.
   
   A way of characterising the difference in approach would be to think of (1) as trying an easier language when the first language has not been acquired and (2) as teaching signing as a first language alongside English in a bi-lingual situation in the hope that the easier sign language will provide a structure from which English can develop as a second language. These two different approaches have different consequences and implications but they both assume that sign language is in some way easier for autistic children to acquire. We need to consider why this is so and what advantages may arise from using a sign language.

Mary Konstantareas has suggested that three developments have led to the growth of signing in the education of autistic children:

1. The disappointment over Lovaas-style speech training programmes both in the protracted drilling necessary for speech acquisition and the lack of generalisation or further development of that speech once acquired.
2. The evidence of the particular information processing problems of autistic children which cause over-selectivity of the visual mode and so make it difficult for them to make visual/vocal or visual/auditory connections; this is obviously important for using and understanding speech.
3. The comparative ease with which some autistic children acquire signs once exposed to them.

The reasons why signing is easier are probably multiple. Certainly there is some evidence from work with mentally handicapped children (Reid 1984) and from studies of hearing-impaired children that signing itself may not only be easier to acquire for those children, but also makes it easier for them to go on to acquire speech. The modality preferences of autistic children and the fact that they are able to reproduce movements accurately once they have been guided are reasons for thinking this would also be true of autistic children. The neurophysiological findings of Hauser, De Long and Rossman (1975) suggest there may be differential disturbance of left-hemisphere brain functions in autistic children and there is some evidence (Battison and Makowitz, 1974; Neville, 1976) that signing may be processed in the right hemisphere of the brain. Sign language is also more iconic (i.e. resembles more what it refers to) than speech, and Konstantareas, Oxman and Webster (1978) have shown that autistic children learn iconic signs faster and retain them more readily than non-iconic ones.

There are also very practical reasons why teaching signs may be more successful. Prime among these is the fact that signs are promptable - they can be physically guided - whereas it is not really possible to force a child to speak even with sophisticated speech therapy or shaping techniques. Also, although signs do follow one another in sequence, each sign can be frozen in time to allow processing by the child, and remains visible during this period in a relatively undistorted form, whereas even slowing down speech to any significant extent can make it unintelligible. Spoken words are sequences of individual sounds which fade rapidly but have to be remembered and processed as a sequence before the totality of the word can be grasped. Nor may it be clear, from fluent speech, where one word ends and another begins unless one is aware of the prosodic (rhythmic and intonational) features of the language, which autistic children generally are not. It is easier to make individual signs distinct.

Of course, the success of signing may also lie as much in the way it is taught, as in the signs themselves. Both staff and children may have become frustrated over the failure of speech programmes and signing may be presented as a new activity - free from association with that experience of failure. It also seems clear from Chris Kiernans survey that schools that have adopted it are teaching it in a highly structured way whereas speech programmes may have relied on much looser styles of classroom teaching. Rutter and Bartak (1973) have shown how autistic children benefit from a more structured approach to teaching.

If signing can be taught successfully to otherwise mute autistic children, whatever the reason, then this is obviously advantageous. Even if a child only acquires a limited vocabulary of single signs, it gives the child a way of expressing his/her needs which may be more socially acceptable and more easily understood than the previous method. By learning a conventional system of signs the child perforce enters a system of social interactions which forces him or her to take account of others to some extent. All the studies report an increase in social awareness and a decrease in tantrums following the development of a system of communication. Certainly, you cannot get rid of undesirable behaviour unless you give the child an alternative strategy for obtaining his or her needs - which signing may do.

The final advantage may prove to be the most crucial - by acquiring a language as early as possible (and earlier than could reasonably be anticipated with speech) it is hoped that the child will learn to code his or her experiences and thus build up cognitive structures which are the basis for much later learning. In this way, some of the learning problems of autistic children may be lessened.

However, there are disadvantages. Although most studies have shown a facilitatory effect of signing on speech, none would claim that learning to sign invariably leads to speech. There is some experimental evidence (Oxman et al., 1979) that signing does not interfere with speech production and all the observational evidence supports that view. Nevertheless, it is a common and understandable fear among many parents, and some professionals, that once a child has acquired the easier sign language s/he will not bother with speech. It can be pointed out, of course, that a proper sign language such as B.S.L. (The British Sign Language - the natural language of the deaf) is just as valid a language as English but that is of small comfort when the child is living in an English-speaking community. Sign languages have low status in our community and are thought of as peculiar or as signifying stupidity; it is not surprising if parents are reluctant to add what may be regarded as another odd feature to their childs behaviour. Obviously, speech must remain the ultimate goal so that signing is not embarked on as an end in itself, although it may turn out to be so for any particular child. But this attitude leads to the teaching of sign only as a last ditch measure, when all attempts to teach speech have failed, and this mark of failure may make it even more difficult for parents to accept it. This is another reason for adopting signing as augmentative to speech training, rather than as an alternative.

There remains the problem of what system of signing to teach, and how to teach it. The enormous growth in signing in non hearing-impaired populations in this country has been greatly aided by the systematic training of teachers in the use of the Makaton vocabulary, which is a graded vocabulary of signs taken from B.S.L. A few schools for autistic children teach the Paget-Gorman Sign System which is an artificial language created to mirror the structure of English. There are problems with Makaton in its limitations both in terms of vocabulary and structure, and there are problems with Paget in its artificiality and the fact that it is not widely known. B.S.L. is attractive since it is concept-based (which should make it easier to understand) and widely used in the deaf community, but it has its own grammar which is incompatible with English in many respects. An alternative is to use an adapted form of B.S.L. now being used in many schools for the deaf called Signed English; this system is in use in Radlett School for Autistic Children, with some success. It enables English to be spoken as a direct accompaniment to signing and allows a steady progression from single key signs to pick out important words in a sentence, to full grammatical signed structures as the language develops. It is also important that the vocabulary is not limited so that each child can be taught signs that have some functional meaning for him or her. The aim is to get the child to use his or her language (however limited) as soon as possible in real-life situations outside the teaching session.

Most practitioners adopt what is known as a total communication approach where speech and sign are used in parallel. This is usually done on an insurance policy basis in the hope that speech will be picked up alongside the sign. Kiernan has pointed out that the work of Schaeffer and others shows that autistic children do not pick up speech in this incidental way but that it needs specific training as well. We continue to accompany signing with speech, but we also give speech imitation training and use other methods to encourage vocal production at other times. Our results at Radlett are not quantifiable since we have no controls (i.e. comparison groups), but they are at least mildly encouraging. Some previously mute children have acquired speech and have almost invariably started to speak as an accompaniment to sign. Others have increased their understanding of speech, whilst still not being able to produce speech themselves.

However, signing is not a panacea. Many of the problems that occur in the spoken language of autistic children also occur in signing. Thus echopraxia seems to serve the same function as echolalia, and there are as many problems in getting appropriate use of signs as there are in getting appropriate use of speech. Only in a few areas (e.g. pronoun reversal) do the actions involved in signing seem to help the development of the appropriate concept. If a child already speaks, or develops useable speech, we naturally do not subject him or her to a full sign-training programme. Yet signs can be used to help children concentrate on specific grammatical features they might otherwise omit from their speech. They may also be used to deal with certain seeming blocks in word-finding which affect some children. Above all, it is important to demonstrate the purpose of signing as communication, so signs must be part of a genuine communicative environment. Speaking children should be taught enough signs to communicate with their non-speaking peers (and they usually pick up signing more readily than their mute peers, anyway) and this can be a great help in their own social and language development - forcing them to consider the role of the listener in their conversations, in deciding whether or not to add signs to their speech at mealtimes, for example. There are exciting possibilities for signing if it can be lifted from its Cinderella role as the alternative language for those who have failed to learn speech. What was once seen as a symbol of the isolation of the deaf community may help destroy the isolation of the autistic one.

Creedon, M. P. 1973 Language development in Non-verbal Autistic children using a simultaneous communication system. Paper presented at The Society for Research in Child Development Meeting. Philadelphia, March 1973.

Hauser, S. L., De Long, G. T. and Rosman, N. P. 1975. Pneumographic findings in the infantile autism syndrome: a correlation with Temporal Lobe disease. In: Brain, 98, pp.667-688.

Kiernan, C. C., Reid, B. D. and Jones L. M. 1982. Signs and Symbols: A review of Literature and Survey of Use of Non-Vocal Communication Systems. London: University of London Institute of Education Studies in Education No. 11. Heineman.

Konstantareas, M. M. 1981. Simultaneous Communication, Signs as an aid to speech, Combining Techniques'. In:  Autism: A Primer, Konstantareas, M. M., Blackstock, E. G. and Webster, C. Montreal. The Quebec Society for Autistic Children.

Konstantareas, M. M., Oxman, J. and Webster, C. 1978. Iconicity: Effects on the Acquisition of Sign Language by Autistic and other Severely Dysfunctional Children. In Siple, P. (Ed.) Understanding Language Through Sign Language Research. New York: Academic Press.

Oxman, J., Konstantareas, M. M. and Lerbovitz-Jojn, S. F., 1979. Simultaneous Communication Training and Vocal Respondings in Non-verbal Autistic and Autistic-like Children. International Journal of Rehabilitation Research, 2(3), pp.394-396.

Reid, B. D. 1984. The Acquisition and Recall of Signs and Words by Mentally Handicapped Children in J. Berg (Ed.) Perspectives and Progress in Mental Retardation: Volume 1. Social, Psychological and Educational Aspects. Baltimore. Md. University Park Press.

Rutter, M. and Bartak, L. 1973. Special Educational Treatment of Autistic Children: A Comparative Study - II Follow up Findings and Implications for Services. In:  Journal for Child Psychology and Psychiatry, 14, pp.241-2.

Schaeffer, B., Kollinzas, G., Musil, A. and McDowell, P. 1977 Spontaneous Verbal Language for Autistic Children through Signed Speech. In:  Sign Language Studies, 17, pp.287-328.

Schaeffer, B., Musil, A. and Kollinzas, G. 1980. Total Communication: A Signed Speech Program for Non-verbal Children. Champaign, Illinois Research Press.