ASL & Sign

Pediatric Speech Language Pathologists working with children who present with delayed expressive language skills, particularly within the phase of early language learning, often introduce sign language to their young clients as an alternative method of eliciting language during the initial stages of therapy.

 Manual sign models and shaping is  usually paired with vocal models of target words, as both forms are presented simultaneously.  Use of signs in therapy provides therapists and the children, more importantly, with an immediately effective method of communication.  Not only do we find that children are responsive sooner, they are often shown to use vocal approximations in conjunction with their use of a sign.

Let’s say you are (an SLP) working with a 20-month-old boy who has strong receptive language skills, age-appropriate play skills, good attention, and strong imitation skills for gross motor movements (e.g., running, stomping feet), yet he is not showing the ability to imitate speech.  He has a very small expressive vocabulary per your observation and parent report, which consists of approximately 2-3 words. 

Let’s say that you have been seeing this client for 3-4 weeks in therapy and have worked tirelessly to elicit verbal communication, pulling out all the stops--providing LOUD, quiet, SILLY, playful language models, bombardment, and various other communication temptations, but still nothing...Now what?  I would say try sign. 

The purpose of sign is not to replace verbal communication.  It’s meant to provide an intermediary step for building these skills.  So, let’s say instead of spending the next 4-5 weeks continuing on the same therapeutic path, gambling with the odds of your client spontaneously imitating, you introduce sign.  In addition to modeling and bombarding your client with verbal models and the use of your target words, you give him manual assistance to use his hands to make some requests for a favorite food and a favorite toy. This is how it begins...         

What I like about sign:

It’s a 1:1 pairing

 While there are a whole host of alternative communication approaches (use of AAC devices, PECS, etc.),many of which are indicated for older clients or other diagnoses, sign provides a young child with a method of communicating that offers specific motor movements representing a specific vocabulary word.  For example, if I teach a child to sign and say "apple,"  the hand shape, placement, and movement put together would exclusively represent the fruit, apple. It does not mean or represent anything else for the child.  In the same way, when vocalizing, if I say the word "apple," the combinations of phonemes (sounds), mean apple.  A child’s ability to approximate these sounds or this word would only refer to the fruit, apple.  While of course there are variations and homonyms in our language, these more subtle nuances are not relevant to an early language learner in either sign or verbal language.    Sign targets can often be consistent with the words an SLP would target in more traditional therapy.  The targets should be selected carefully with respect to their relevance, frequency, and interest for the child to produce the target.  Starting with highly motivating food items and toys are an excellent "go-to" option in the beginning.  When considering the use of signs, there are additional variables that a therapist should consider in the selection, including the requirements for hand shape, movements, and the way that a sign looks in comparison to other signs you are teaching or common gestures within the child’s repertoire.  

It’s portable

A child can use a sign at any time, any place.  Once a child has established use of a sign, he can produce it whenever he wants.  He does not need adult-directed access to pictures or a device. 

It’s easy to learn

 For a child (as described above) with adequate imitation skills, signs can be modeled and imitated within 1 session.  A child’s ability to recall and re-use the sign is often very good , meaning that in only a session or 2 a child could be effectively expressing a particular vocabulary word.  The key to good instruction, though is selecting the right targets and using a systematic approach. A child who learns that using a sign ( "open") opens a jar or cookies for them or that signing "Elmo!" gives them access to an Elmo video on his mother’s iPad is more likely to repeat that again.  Once a child makes that connection and begins to sign purposely without support you have given that child the ability to readily communicate.  The principles used in teaching sign and language in general makes sense.  If you make a positive link between a behavior and a consequence and it’s a positive one, it’s more likely that it will occur again.  This provides a starting place for teaching language.  As adults, we behave in a similar way.  Just imagine standing at a slot machine at a casino and every single time you pull the lever, a $100 bill comes out.  You are likely to pull the lever again.  It’s the same idea.

It can be done with hand-over-hand support

For the child who is not yet imitative or who has more limited attention, you can begin sign instruction with hand-over-hand support (HOH).  This means that you can place your hands over the child’s hands and gently shape them for him.  You would use the same methodology for teaching signs to this child, but instead of relying first on imitation, you would provide them with several additional levels of support first.   Probably the most exciting part of using HOH support comes on the day that the child, in  anticipation of your support, begins to sign with a small prompting or even independently.

Considerations to using sign language

Signs can be used with many early language learners, but this approach would not be recommended for everyone.   Here are some special cases to consider:

  • If the child has an inability to form differentiated hand shapes with adult support, signs may not be the best approach.
  • Not everyone will immediately understand signs.  You’ll want to inform caregivers, teachers, and parents. 
  • An SLP should know the signs prior to teaching them and some signs may need modification for a child to use.

Signs can be an effective tool for any SLP.  Their use requires only minimal knowledge of sign; however, the methodology for how signs are introduced is important and often over looked even though signs are widely used.  ASLforSLPs provides a resource for signs, the framework for how an SLP can use signs effectively and appropriately by not only respecting the elements of American Sign Language, but also with more astute consideration to a particular child’s development and language needs. 


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