Using signs to assist communication and support language development

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The advantages of signing

It is important to use natural gestures with babies with Down syndrome from birth and to learn to use specific signs with words from 7 to 8 months of age. Gestures hold the baby’s attention and help them to understand what is being said. It is important to understand that signs are to be used as a bridge to support the development of spoken language. The research evidence shows that children with Down syndrome do not learn words easily from speech input on its own and that those who have been in sign supported therapy programmes have bigger spoken vocabularies at 5 years.

All babies use signs such as pointing and waving, before they use words, so that in using more specific signs, we are extending a natural stage of development rather than introducing something that is not seen in typical development. Almost all children with Down syndrome will use spoken language as their main means of communication from 3 or 4 years onwards. The signs used to help them are keyword signs to support the learning of words. Signs are not being taught as a sign language, to be used instead of a spoken language, as might be the case for a deaf child. In particular, signs help children with Down syndrome to communicate effectively and show that they understand words at the stage when they cannot yet produce the sounds due to difficulties with speech production skills. This overcomes frustration and, most importantly, allows their comprehension of new words and therefore their cognitive (mental) development to proceed at a faster rate than if we waited for spoken words.

Practitioners have advocated the use of augmentative signing with babies with Down syndrome since the early 1980s and evidence for its effectiveness in accelerating both comprehension and production of language has accumulated steadily.

Signing can help babies and children to understand words in a number of ways.

If parents sign as they speak:-

In other words, signing may help to structure more effective language learning situations.

For infants, signing can increase their productive vocabularies as they can usually sign words before being able to say them - they know what they want to say but cannot yet produce the words.

At this stage, signing increases effective communication, and this enables language learning to continue at a greater rate until spoken language develops. Signing will reduce frustration and increase communication opportunities. However, it is essential to keep up activities to encourage sound and speech production alongside the use of signing, if children are to move into using spoken words as early as possible. In our experience, most children are able to drop the use of sign slowly from around four to five years of age, although they should not be discouraged from using sign at any age as a repair strategy when their speech is not understood and they will continue to benefit from the use of sign to teach new words and sentence structures.

How to begin to use signs - advice for parents

Remember that signs are being used as a natural support for your spoken words. If signs are used like gestures (and indeed many of them are just that) then they can explain to the baby what is being said or taught, and they are a means for the baby to tell you that they have understood or to ask for what they wants.

A very simple example of teaching gesture happens in every family when a parent is helping their child to say “good-bye.” The parent takes the child’s hand and, while waving it, says “wave bye-bye.” The parent also imitates the action and ‘waves bye-bye’ as they say “bye-bye”. Gradually the child copies and uses the action and in time says “bye-bye” too. There is never any thought that using the gesture first will stop the words from coming, or that it looks unnatural.

Signs are used in exactly the same way with children with Down syndrome, many of whom are not going to find the skills of speech easy, and therefore may need signs for longer - but success in communicating with sign encourages all children to try the words.

What are these signs, and how do we use them?

If you think of signs as an extension of the ordinary sort of gestures that you use every day, then you will not go far wrong. If you remember that you are signing to explain what your child is seeing in her/his little world, then you won’t ask too much of either yourself or your child. As a baby, they will not need the ways of the whole world explained, such as the difference between a rhinoceros or a hippopotamus, but only the ways of her/his world. For example, your baby will want to be asked if they are thirsty, to be shown where the toys are, to know that they are going to have a bath, and that you are going to put socks on her/his feet. Your baby will love to point out the light to you and to listen when Grandma is on the phone. He/she may wish to watch the video, or eat an apple or banana, and your baby would like to tell you her/his choice (without having to scream in annoyance when you give her/him the wrong one!). Your baby will want to know when the other members of the family are coming home, and which of them is expected. Your baby will want a name for her/his favourite toy (even if it is a piece of blanket or a rather bedraggled toy!).

If you make sure that your baby can see what you are talking about, and that they do not have things just happen to her/him, if you point out where your baby’s toy is on the floor before naming it and they are looking at it, then you will be doing a great deal to help the baby to learn. By adding the extra simple gestures/signs to explain daily life, then you are helping your baby even more.

Simple signing means:

These examples show that signing is about doing what you are doing already, but remembering that you are going to show your baby what is happening a bit more. By signing you are helping your baby to learn to watch for clues to the meaning of things in her/his world as well as to listen. As your baby learns to look to you for clues to her/his world, and to use signs, you will want to give your baby more information, and will therefore need to learn some more signs.

One of the most rewarding events is when your child can tell you that they not only understands what is going on, but can make her/his own comment about it. If your baby can use a sign to do so then the learning of the whole process of language has taken a great step forward. If you sign with your baby with Down syndrome then they will probably reach this point many months earlier than they could have done if relying on you understanding his speech.

Signs should always be used with natural speech, they are there to explain what you are saying and should never be used as an alternative to speech.

If they are used in this way, then they can be used as you would use any gesture, as naturally as possible. You don’t want to have to think about how you are going to find the right gestures to explain your baby’s world to her/him. There are books and courses to help you to learn signs, but you should choose signs based on what you think your child needs, and what you can use comfortably in your busy life. Having to stop and think how to ‘talk’ to your baby is difficult and could distort the natural way you talk to your baby. Choose a few signs at a time to use in your everyday communications to start with and add more as you feel at ease with signing.

Early signs to use when talking to your baby

The first signs will support the things that you want to say to your child such as “hello”, “up you come”, “give me”, “bye-bye”, “all gone”, “off we go”, “what’s that/this?”, “do you want some more?”, “look at (this)”, “wait a minute”, “where is it?”, “(baby) do it”, “good (boy/girl)”, “put it there”, “we’re going to wash your (hands, face…)”, and “night-night”.

The next signs will be words that you are teaching your child to understand and say based on the vocabulary checklists such as “Mummy”, “Daddy”, “drink”, “cup”, “eat”, “food”, “biscuit”, “crisp”, “spoon”, “bed”, “car”, “teddy”, “home”, “light”, “telephone”, “toys”, “play”, “no”, “please”, “I”, “you”, “we”, “boy”, and “girl”.

In our experience, most children with Down syndrome will not need to learn more than 50 to 100 signs before they are moving on to using words as their main means of communication. As they can begin to say a word, they usually drop the sign for that word and use the spoken word. This should be encouraged, as the spoken word will only become clearer with practice. However, sign can still support the learning of new vocabulary, as we know this will speed up learning to understand and use the new words.

Children will join signs together at the ‘two-word’ stage of language development and this is fine, but they should be encouraged to practice saying the words and reading the words. If children are still entirely dependent on signs when trying to put 2 and 3 words together, then their speech sound skills should be reviewed as they may be in need of extra help with speech sound production.

The use of sign at four years and older

By four years of age, the amount of signing a child needs will need to be judged on an individual basis. Some children will be moving to use speech confidently as their main mode of communication, others will still be dependent on signs and should be taught new signs. The critical issue will be the child’s speech sound skills and spoken language, those with better sound production skills will be talking and those with more sound production difficulties and restricted vocabulary will need more signs. A speech and language therapist will be able to advise, but it is essential to take a careful look at the use of signing for each child. Speech is difficult for children with Down syndrome and their speech will only become clearer if they practice speaking. Few children with Down syndrome require a signing environment, where all spoken language is supported by signing, in the long term.

Used appropriately, with individual planning, signs continue to be an important aid at school age. Many individual case examples from parents and practitioners indicate that signing often helps the school age child with Down syndrome to find the word they want and to speak more clearly. Signs for sounds can help production of initial and end sounds in words and signs for grammatical markers can help to teach grammar.

However, it is essential that speaking is encouraged as the main mode of communication by four years of age and that every child is working on speech sounds. In our view, it is not appropriate to send every classroom assistant on a signing course because a child with Down syndrome is coming to the preschool or school. Some children will be reading and talking and these should be the main modes of communication and they should be used to continue to promote their speech and language development. Other children will still be very dependent on sign and someone confident with an early signing vocabulary should support communication with them.

In summary, all children with Down syndrome benefit from the use of up to 100 signs, always used with the spoken words, to establish an early spoken vocabulary, but speech sound work must continue alongside the use of signs. The amount of signing that it is appropriate to use once a child understands and uses 100 or more words/signs needs to be judged on an individual basis. Signs used to support new words, sentences, sounds and grammar can help every child. In our view, most children with Down syndrome should be encouraged to speak as their main mode of communication from four years of age, with reading as the main support system for learning new words and practising words and sentences. Too much use of unplanned signing when it is no longer necessary may hold back clear speech. However, a significant minority of four year olds (perhaps 25%) and older children will still need to use signs as their main mode of communication and should be taught new signs, alongside speech and reading work.

We suggest that parents may be the best judge of the sign/spoken word balance as they will know how best their child learns to understand new words and how best they communicate in everyday situations.

The benefits of using signs as a bridge to talking

Research studies have shown that signing acts as an important bridge to speaking for children with Down syndrome, especially in their preschool years. They learn to understand and to use new words faster if they are accompanied by a sign and, in addition can often sign the word spontaneously before they can say it.

In our experience, most children with Down syndrome will not need to learn more than 50 to 100 signs before they are moving on to using words as their main means of communication. As they can begin to say a word, they usually drop the sign for that word and use the spoken word. This should be encouraged, as the spoken word will only become clearer with practice. However, sign can still support the learning of new vocabulary, as we know this will speed up learning to understand and use the new words.

Some children will join signs together in primary school years, as they move to using sentences and this is fine, but they should be encouraged to practice saying the words and reading the words in these sentences. If children are still entirely dependent on signs when trying to put 2 and 3 words together, then their speech sound skills should be reviewed as they may be in need of extra help with speech sound production.

The use of sign at four years and older

By four years of age, the amount of signing a child needs will need to be judged on an individual basis. Some children will be moving to use speech confidently as their main mode of communication, others will still be dependent on signs and should be taught new signs. The critical issue will be the child’s speech sound skills and spoken language; those with better sound production skills will be talking and those with more sound production difficulties and restricted vocabulary will need more signs. A speech and language therapist will be able to advise, but it is essential to take a careful look at the use of signing for each child. Speech is difficult for children with Down syndrome and their speech will only become clearer if they practice speaking. Few children with Down syndrome require a signing environment, where all spoken language is supported by signing, in the long term.

Used appropriately, with individual planning, signs continue to be an important aid at school age. Many individual case examples from parents and practitioners indicate that signing often helps the school age child with Down syndrome to find the word they want and to speak more clearly. Signs for sounds can help the production of initial and end sounds in words and signs for grammatical markers can help to teach grammar.

However, it is essential that speaking is encouraged as the main mode of communication by four years of age and that every child is working on speech sounds. In our view, it is not appropriate to send every classroom assistant on a signing course because a child with Down syndrome is coming to the school. Some children will be already reading and talking and these should be the main modes of communication and they should be used to continue to promote their speech and language development. Other children will still be very dependent on sign and someone confident with an early signing vocabulary should support communication with them.

In summary, all children with Down syndrome benefit from the use of up to 100 signs, always used with the spoken words, to establish a spoken vocabulary, but speech sound work must continue alongside the use of signs. The amount of signing that it is appropriate to use once a child understands and uses 100 or more words/signs needs to be judged on an individual basis. Signs used to support new words, sentences, sounds and grammar can help every child. In our view, most children with Down syndrome should be encouraged to speak as their main mode of communication from four years of age, with reading as the main support system for learning new words and practising words and sentences.Too much use of unplanned signing when it is no longer necessary may hold back clear speech. However, a significant minority of four year olds (perhaps 25%) and older children will still need to use signs as their main mode of communication and should be taught new signs, alongside speech and reading work.

We suggest that parents may be the best judge of the sign/spoken word balance as they will know how best their child learns to understand new words and how best they communicate in everyday situations.

Non-verbal communication and signing

Research studies have shown that signing acts as an important bridge to speaking for individuals with Down syndrome. They learn to understand and to use new words faster if they are accompanied by a sign or a visual cue and, in addition can often sign the word spontaneously before they can say it.

In our experience, most young people with Down syndrome will not need to learn more than 50 to 100 signs before they are moving on to using words as their main means of communication. As they can begin to say a word, they usually drop the sign for that word and use the spoken word. This should be encouraged, as the spoken word will only become clearer with practice. However, sign can still support the learning of new vocabulary, as we know this will speed up learning to understand and use the new words.

The use of sign during the teenage years

By eleven years of age, the amount of signing a young person needs will need to be judged on an individual basis. Most teenagers will be using speech confidently as their main mode of communication, but others (about 10%) will still be dependent on signs and should be taught new signs. The critical issue will be the young person’s speech sound skills and spoken language; those with better sound production skills will be talking and those with more sound production difficulties and restricted vocabulary will need more signs. A speech and language therapist will be able to advise, but it is essential to take a careful look at the use of signing for each young person. Speech is difficult for individuals with Down syndrome and their speech will only become clearer if they practise speaking. However, being able to be understood using signs may reduce the need to improve speech clarity and delay improvement in intelligible speech.

The issues are complex however, as research and personal experience indicates that some teenagers and young adults with Down syndrome speak more clearly when they sign at the same time. [TODO: references 54] This may be because recalling signs is easier than retrieving spoken words for these young people, therefore the signs actually help them to retrieve the words and say the words in order.

We suggest that parents may be the best judge of the sign/spoken word balance as they will know how best their teenager learns to understand new words and how best they communicate in everyday situations. Only a small number (5 - 10%) of teenagers with Down syndrome will require a signing environment, where all spoken language is supported by signing, in the long term.

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