Patti Hamaguchi, M.A., CCC-SLP
When I first began my career as a speech “correctionist” (that was the preferred term back then in the dark ages of the early ‘80s—yes, I’m that old!), there were so few children identified as having autism, that barely five minutes were spent during our graduate years in college learning about it. “Sign language” was what we were taught so that we could communicate with the hearing-impaired. In our school district of 3,500 children or so in NJ, two were sent by bus to a local regional center to attend a single autism class, where one speech pathologist served the entire county’s elementary autism population. I instead focused 90% of my case load on lisps and “r” distortions, as I had been trained to do.
As the 1980s came to a close I had moved to Connecticut and worked in the public schools there. We started finding that more than a few children were displaying the curious constellation of symptoms associated with autism—speech delayed, but often paired with some strengths in other areas such as reading, math, visual-perceptual skills, maps. They weren’t just “delayed”, they were different, and so the long-held bag of tricks we ‘speech therapists’ (that was the term that was used by that time) used with our other developmentally delayed children, simply didn’t work. Our special education teacher went to a number of in-service trainings and came back, encouraging us to use “signs” with these children.
Signs? As in “sign language”? I didn’t get it. I wasn’t hired to teach sign language, I was hired to help them talk. Besides, who would they speak to, using sign language? We didn’t have a ready supply of hearing-impaired children waiting to sign back. Why spend valuable therapy time doing that? So I didn’t. I kept plugging on, using all my know-how to help their mouth and their mind talk. I played, I rewarded, I engaged them in every kind of fun and motivational activity I could muster. And in many cases, it worked. But for the first time in my professional life, for some—it didn’t. Weeks turned into months and I realized that nothing I was doing was working. We now had 5 children under the age of 7 diagnosed with autism in our school district. As someone who prided herself in making great gains with her speech cases, I felt more and more…incompetent. Maybe we can say, “humbled”? I made it my mission to really and truly learn what made these kids tick and how to help them, because it seemed that every month that went by, there was yet another referral from a concerned parent whose child displayed the now-too-common set of symptoms we see in children with varying degrees of autism spectrum disorder.
So what did I find out? At that point, research on using signs was fairly non-existent for speech development in non-hearing impaired populations, and so the specialists were merely “information-sharing” and explaining what had helped anecdotally. So I tried it. I began using “signs” with these children, and paired them with speech. “Eat” was both a sign, and a verbal production that I supplied. Initially, the children were rewarded for allowing us to do “hand-over-hand” assistance in forming signs, even if they were simplified. In time, the initiation of the signs and use of the signs in context became the goal. Next, some kind of verbalization—anything—was the requirement, to accompany the sign. As we worked on motor planning, speech and production as well, the verbalizations became spontaneous and without rewards. And guess what? The signs were also spontaneously DROPPED. Just like the specialists in the trenches said they would. What’s more, because we had worked on some basic nouns (me, Mom, teacher, etc) and verbs (eat, play, go, etc) we already had some subject + verb sentence structures in place. They got it!
Since that time, there has been plenty of research and evidence that further supports the value in using signs for children who are speech delayed and perhaps not yet ready to verbalize. It’s not a cure-all, and for children with poor fine-motor skills, can add a level of complexity and frustration, so it’s important that the use of signs be carefully considered on an individual basis. It should be for the most part, a stepping-stone. In other words, it is a means to an end, with the ultimate goal of having the child speak.
Here are my top 5 reasons for using signs with pre-verbal children or those who are just beginning to talk:
Reduces Frustration – It bridges the gap between their thoughts and expression. They finally have a way to express to you what they want.
Encourages Interaction – It provides a vehicle for the child to interact with you to get what they want. For children on the autism spectrum, this intermediary step is critical. We know they can be very “independent” to get what they want, and this forced interaction and initiation helps work on these skills.
Builds Vocabulary – It helps us build a working vocabulary. Signs are indeed a “language” and so we are building language and accessing the language centers of the brain.
Helps With Sentence Formation – Once speech is achieved (hopefully, in most cases) it is far easier to string them together and form simple phrases and sentence. The signs are indeed dropped, as you will find, when the child is able to use speech to communicate.
Serves as Visual Support – It is a visual way for the child to “see” words. With many children on the autism spectrum, auditory processing is weak. They often tune out what people are saying. By using signs, we help them “see” the key words and associate what they hear with the concept. Signing builds language comprehension as well!
So if you are reading this and have a pre-verbal or new talker, you too may have been wondering why your child’s speech pathologist has been introducing the use of signs. It really is ok, and not a step backward in the speech acquisition process. But make sure that work on verbal skills continues on a parallel course, if appropriate. Sometimes the child simply isn’t cognitively, developmentally or orally “ready” to talk. We can’t rush it or we also risk frustrating your child so much that he/she hates therapy completely. This can in fact, can be counterproductive to the overall therapeutic process. So in answer to the question about signing, it generally helps the speech acquisition process for most children, but should be done in a hierarchical way, with continued support for the speech acquisition process if/when appropriate.
Patti Hamaguchi, M.A., CCC-SLP is a licensed speech-language pathologist and the Director at Hamaguchi & Associates Pediatric Speech-Language Pathologists Inc., (Cupertino) and the CEO of Hamaguchi Apps for Speech, Language & Auditory Development. She is the author of Childhood Speech, Language & Listening Problems: What Every Parent Should Know (Wily & Sons, 2010 3rd ed.), A Metacognitive Program for Treating Auditory Processing Problems (Pro-Ed, 2003) and It’s Time to Listen (Pro-Ed, 2002) as well as an expert on speech topics for BabyCenter.com. Currently, she and her colleague, Dr. Deborah Swain (Swain Center in Santa Rosa), are working with a major publisher to develop a standardized language assessment for children on the autism spectrum.
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