Although sign languages were first developed as a means of communication for the deaf (e.g., British Sign Language – BSL), they have been also used to teach people with developmental disabilities communication skills.

However, it is necessary to distinguish between the natural sign languages used by the deaf community and the invented sign-based codes that are often used as teaching tools and that are not natural languages. One of these sign-based codes is Makaton [named after three speech therapists who participated in the development of the programme: Margaret Walker, Katherine Johnson and Tony Cornforth – from the Royal Association for Deaf people] which was developed in the 1970s for children with severe learning difficulties.

The Makaton signs are accompanied by speech, facial expressions, body language, and often visual means. If children have problems with imitation, a hand-over-hand approach to learning signs is recommended.

Sign language may be introduced either as an augmentative system to facilitate the development of speech for those who understand verbal language but have problems with expression [(e.g., echolalia)] or as an alternative system for communication for those whose receptive language is good but whose expressive language is absent ( mutism).

The advantages of sign language for children with developmental disabilities are as follows:

  • Signing is both visual and a kinaesthetic system of communication. This means it can be helpful for those who learn about the world through visual or kinaesthetic systems. A child understands the meaning of words through movements of his hands and his whole body.
  • Signs can be taught through physical prompts and shaping that is beneficial for children with executive function problems (but not with tactile hypersensitivity!).
  • Sign language is very ‘portable’ and doesn’t need any equipment, communication books or objects.
  • Sign language is a linguistic system and may stimulate acquisition of a verbal language.

The disadvantage of sign language is that it is not understood by many people.

Sign language is used alongside speech (to make a connection between the word and the sign) and, sometimes with graphic symbols.

One should remember, however, that autistic children tend to process any language literally, signed language included. That is why we need to modify the Makaton (or any other sign language), or replace it with miming to avoid misunderstanding of sign words and phrases. For instance, signing the squeezing of cow teats to ask for ‘milk’ seems pointless to Donna Williams, as for her, with only a literal level of processing, this would be more likely to be interpreted as: ‘Do you want to see a cow milked?’ After all, one doesn’t see cow teats when milk is being poured into a cup.

Sign language is not successful with many autistic individuals. Research has shown that, in a study sample, although none of the nearly 70 (autistic) subject failed to acquire at least one sign, the final outcome, in terms of each individual’s linguistic performance, appeared to vary widely. Some of the children, after acquiring facility in sign language, learned to use spoken English. For those who progressed in speech as well as sign, the progress in sign language appeared crucial as a foundation for the changes in speech skills. On the other hand, a number of children never learned and remained mute (Bonvillian and Nelson).

Sign language may be difficult for those who do not understand verbal language and are poor visualizers whose inner images are based on kinaesthesia. Signs for these ‘kinaesthetic-speaking’ children should be modified to closer match these inner images (miming).


Kinaesthetic language: Children learn about things through the physical movements of their body. Each thing or event is identified by certain pattern of body movements. They know places and distances by the amount and pattern of the body. They may bite objects and even people if they store the information by the way it feels when bitten.

Many autistic individuals, even without having been taught, use mime signs (they are not always conventional signs). Some autistic individuals (with kinaesthetic language) use mimes as a supportive means for translating verbal words (both receptive and expressive), as they often make better sense of what has been said through the movements. Thus, when they listen or speak, they might aid their understanding and expression by using physical or mental signs in order to make better connections. For autistic children with kinaesthetic inner language, verbal language can be taught through action songs and rhymes. When used as one single action per word, mimes can make linear sentences.

“I personally prefer mime to using spoken language alone. It is less physically exhausting for me and I feel better connected to drawing my words through my hands than connecting to something so far removed and abstract as a collection of throat and lung exercises that are called speech. I have basically little trust of speech. I always keep checking to see whether I’m being understood…With sign, I can see they have seen my meaning and I trust that more and can keep better track of my own expression. I also find the physical connections easier, quicker and more concise … I know that the signing I use is more concrete than symbolic and quicker to process for meaning than more symbolic signing… Mime-signing has an advantage over things like picture pointing because it is more transportable, widely understood and can, like sign language for the deaf, be used to form simple sentences and to hold a simple conversation” (Williams).

Miming helps the child to make connections between spoken words and body reactions; it is a sort of ‘body mapping’ (Williams). If the child ‘speaks kinaesthetic’, label the mime with the word, so that the child can connect the experience of the movement with its verbal label. If you teach a child the world ‘jump’, make him jump; if you teach him the word ‘run’, make him run, etc. If you give the child the directions or instructions, help him to translate them into the body language; e.g., you say ‘go to the left’, then turn to the left; or you say ‘pick up your things and put them on the chair’, then let him imitate the actions. Helping children to ‘map their body’ could make many tasks easier for them.

Talk to your child about what you are doing. Encourage her to imitate (to ‘translate into kinaesthetic’). If the child has problems with imitation, help her to form the movement. Some autistic children were taught to draw and to write by someone holding their hands and guiding them to draw shapes, figures, letters.

Some autistic individuals use these miming strategies to understand what they are told better. Paradoxically, we often interpret these attempts at translation as bizarre autistic behaviours and prevent them from learning (of course, with the best intentions – ‘Stop fidgeting, stand still and listen to what I am telling you’).


Bonvillian, J.D. and Nelson, K.E. (1978) ‘Development of sign language in autistic children and other language-handicapped individuals.’

Williams, D. (1996) Autism: An Inside-Out Approach. Jessica Kingsley Publishers.

Written by Olga Bogdashina on behalf of Integrated Treatment Services