Featured Image: Untitled byA Pasquier/CC2.0
Introduction and description
The Makaton vocabulary is a signing system based on a ‘specific developmental vocabulary’11 which begins with a core vocabulary12 (around 350 signs11). This is systematically taught and expanded upon via a well-described process arranged through communicative priority as well as complexity12. It was designed to follow the natural order of speech acquisition in children without a disability and can be adapted to the user’s specific communication needs. The learning process moves from basic needs and teaching the structure of interactions through both vocabulary acquisition and more complex communicative behaviour11,13 and as Makaton is always taught with speech11 the intention is that vocal communication skills will, in time, be learned.
Although it began originally as a project to teach deaf adults with additional learning difficulties to use sign language as a means of primary communication in 197211,12,13, it has since expanded and is now used for both children and adults with hearing impairments and any physical, learning or communication difficulties particularly children with ASD.
Aims of aid
The aim of the Makaton vocabulary as used in young, autistic children is as a stepping stone to speech11, it aims to facilitate everyday social interactions and interactive behaviours without the need for any verbal skill or understanding with the intention that these will lead on to functional communication12. One big advantage of the system is the fact that the signs look like what they mean (for instance the sign for cat looks like a cat’s whiskers), it has a supportive, rather than a metaphorical nature. This makes Makaton easy to learn and may also have a particular advantage for users with ASD who can find abstract meanings difficult to grasp.
How commonly it’s used
Sign language training has been successfully used in developing both receptive and expressive language in pre-verbal children with autism for a number of years14. The Makaton vocabulary itself is now so well established that it is used as a control for testing other communication aids in development trials15,16 and included as a first language option on the national census17.
Many special needs schools these days use Makaton symbols to support both speech therapy and everyday classroom communication for children with varying levels of speech18 who have ASD and other learning difficulties.
User Appropriateness
The Makaton vocabulary is altered depending on the user; there exists a ‘heavy duty’ vocabulary for those with ‘limited linguistic potential’13 allowing users to communicate their most basic needs e.g. food, people19. There is also an optional and variable stage 9 vocabulary pool which can be added to expand any learner’s vocabulary and make it more specific for that person’s everyday life12.
It can be very difficult for children with motor difficulties to learn to sign11. This is relevant because some autistic children are also diagnosed with dyspraxia. However, Makaton is only ever used with speech; the signs match up to important milestones in the sentence. For instance when saying ‘Do you want to go to the park?’, you would sign ‘you-go-park’ or even just ‘you-park’. This multimedia approach opens up two channels of communication and allows the child to choose their preferred medium. So the combination of speaking and signing simultaneously may offset the problems autistic children can have with gestural development (communicating meaning and emotion through hand movements) and dyspraxia.
Ease of training
There are plenty of workshops around the UK which cost ~£100 per session so this is the cheapest communication aid and, once the basic skills have been learned, it is free to use and develop Makaton skills.
Makaton is not a practical means of interacting socially with new people from outside a home or school environment. This is because the communication partner must also have a prior knowledge of the vocabulary as successful communicative interaction requires a common language12.
Advantages and disadvantages
Some have said that having a core vocabulary will restrict the user, not allowing for personal language development12 and therefore will limit both the present and the future language of the user. But it has been shown that language naturally develops around a core vocabulary12. It is also this core vocabulary allows consistency and continuity between different institutions and users in the community.
Evidence base
It has been shown that children with ASD often find it difficult to learn from verbal feedback20. This explains the design of Makaton with a core vocabulary of practical words such as food items so that children will be motivated by practical rewards of successful communication and thus the learning process will be reinforced.
Makaton training seems to be more effective when carried out in a familiar environment, such as the home, than an artificial one21. This evidence is supported by another scheme: the Makaton peer tutoring initiative. This began in 1986 with a group of 8 peer tutors who were taught ways of furthering the communication skills of some of their less able peers. This has been viewed as positive for the tutors, the learners, and the institutions in which the system was implemented and 10 years later there were 164 trained tutors at 23 establishments in the UK21. One problem with looking at the evidence base for Makaton signing is that a lot of the resources have been written by, or contain contributions from, Margaret Walker who was one of the researchers to design the system11,12,13,21. This information is therefore not impartial and may contain some bias. This applies to the peer tutoring audit mentioned above. However, the questionnaire seems to have been well written and fairly carried out; including all the relevant parties of tutors, facilitators and managers.
It is very difficult to find relevant and recent research on the efficacy of Makaton signing as a communication aid. This poses the interesting point that even though Makaton is being widely used, research has stopped and its efficacy may have been assumed. Just because something is accepted and widespread practice that does not mean that it is good practice, it still must be critically assessed to gain independent evidence from well designed studies. In fact those really great quality studies were never done in the first place. We therefore need to take a step back from everyday practice and evaluate it properly. It would be interesting and beneficial for instance to look at gestural ability in children with a diagnosis of ASD and collate this with the learning of Makaton to find out whether or not gestural ability is an important factor in learning Makaton signing.
Conclusion
The Makaton vocabulary is a useful tool in developing communicative behaviour in pre-verbal children with a diagnosis of ASD, it is relatively cheap to implement and widely used in both home and school settings. The main downfall of Makaton signing lies in the fact that the communication partner must also be a speaker of Makaton. Its similarities to BSL widen the number of people who will understand certain parts but Makaton is not an appropriate form of communication to use in everyday social situations. Having said this, Makaton was never meant to be a communication end in itself but rather a stepping stone to speech and as this stepping stone it has been shown to improve social interactions and communicative behaviours in young children with ASD who have yet to develop speech.
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