In working with the family of a young child who has complex needs which include, at present, motor limitations, I had the opportunity to really reflect on my thoughts around using sign language and/or gestures.  These particular excerpts were taken from email communications I was having with the parent.  I believe these principles are also valid for older individuals who are at beginning levels of communication as well though.

“I would say that as a general principle of early intervention, I am strongly in favor of multi-modal communication — that is, using a variety of methods to communicate.  Relative to sign language vocabulary, I want to clarify that at this point I primarily meant incorporating key word references — not signing every single word that is spoken, and not using the grammar structure of American Sign Language (ASL) which is different than English.  The videos on the “Success Stories” section of the AAC Kids PSU website (http://aackids.psu.edu/index.php/page/show/id/2), do a nice job of illustrating what the research at Penn State has focused on with respect to multi-modal communication.  Particularly with the stories for “Genevieve” and “Lili”, you can see Dr. Janice Light (my boss), using speech, some specific sign language vocabulary references, as well as sophisticated voice output technologies with very young kids who have complex needs.

I believe that the benefits of incorporating sign language vocabulary when talking with young children with complex needs include:
+ supports his/her understanding of what is being said to them,
+ supports hearing by adding a visual component,
+ supports learning cause and effect of symbolic expression; that is, the child learns to associate a behavior as a reference to an item or activity and this behavior becomes part of vocabulary he or she understands even if they are not yet using it.
+ at a neurological level, builds networks about language in a different way; that is, s/he may well understand a word that is just spoken, but also learning that word through a gesture can only help the developing mind build more and more connections.
+ presents the opportunity for young children with complex needs to develop a method of expression through imitating what s/he sees, even if just an approximation,
+ as a result of increased opportunities for expanding on a child’s expression (that is, how he or she responds and the complexity of response), it builds his or her sense of interactions with others,
+ if the child develops signs or gestures in their options for communicating, seeing others also sign builds new vocabulary, and shared experience.
+ signs go with the individual every where they go, it is a complete and ‘unaided’ system of communication that works even in a bathtub or swimming pool, without batteries or charging, does not need to be turned on or require maintenance, does not need to be held or presented or carried by someone else, etc.

There are no negatives, and no risks.
-> It will not harm the child.
-> Research has been clear that incorporating signs (&/or other forms of support like pictures or technologies) in addition to spoken vocabulary will not in any way compromise a child’s ability or interest in speaking, or using other means.

When children develop effective speech, they naturally drop off using signs.  If the child’s speech does not meet their full needs, the sign ~can~ be used to support their efforts (for example, to clarify), particularly in situations when using a technology may not be as fast or may not work well (such as at the beach).  If a child was going to primarily rely on sign language to communicate, there is an incredible body of research, communities, and resources to support on-going learning — however, in my personal experience, this piece has never happened for a child who was not Deaf.

All of this is not at all to suggest that I think I know what is best for your child and your family!  I hear you re: the motor demands and complexity of some signs — I agree completely that coordinating the physical movements and timing are things that should be considered.  I also know for sure that nobody knows your child and family the way you do!  I just wanted to share some of my own thought process around this question because there is no one-approach-fits-all-situations solution.  So we are always invested in a range of strategies to include “no-tech” (does not require any other ‘thing’), “low tech” (supports which are not technology based), and “high tech” (technology based supports).

For this reason, I’d like to share some additional resources you *may* consider helpful.  I truly respect how full life is, so I do not mean to keep adding to the “To Do” list.  If you are not able to get to these kinds of things, I completely understand.

One of my favorite tools is from Siegel & Cress (2002) — The Communication Signal Inventory.  They go into more detail in their book chapter, Overview of the emergence of early AAC behaviors: Progression from communicative to symbolic skills.  (Siegel, E., & Cress, C. J. (2002) In J. Reichle, D. R. Beukelman, & J. C. Light (Eds.), Exemplary Practices for Beginning Communicators: Im- plications for AAC, (pp. 25–57). Baltimore, MD: Brookes. ).  The Communication Signal Inventory is a simple and powerful table for observing and documenting any behavior that an individual does which can be interpreted by partners as an indication of the person’s state of being, convey interest, express specific wants/needs, show rejection of an unwanted item/activity, etc.  There are three columns:  what was observed, what partners think it means, and how partners should respond.

For example:

Behavior:  “Davey’s” muscle tone relaxes, he may slump to one side slightly, his eye gaze may shift down.
We think it means:  “Davey” is tired and may need a break.
Partners should say:  “I see you, “Davey”.  Your body is soft.  Do you want 1 more ball (sign “ball” and pause), or all done  for a break?  (sign “all done” and pause.)  Watch his body and eye gaze — if he shifts and looks toward the ball, say:  “I see you.  You’re telling me 1 more ball (sign “ball”).”  If his muscle tone remains soft and eyes down, say, “I see you.  You’re telling me we’re all done (sign “all done”) for a break.”

Research has found that families often use their knowledge of the person and his schedule/routines, their strong sense of mood/well-being/interests, and remarkably sensitive observation of changes in behavior to meet the needs and engage in social interactions with young children who have complex needs.  The Communication Signal Inventory can be an opportunity to share that knowledge among all partners, to build cause and effect and add more symbolic expression, and to identify needed vocabulary.  I feel like it can work well with the Communication Matrix in documenting the signals and methods familiar partners pick up on, and the reasons the individual communicates/interacts (for example, to make requests, to be social, to get attention, to refuse, etc.).

I would also like to talk with you in more detail about the research of Stephen Calculator (2002), who looked at what he called “Enhanced Natural Gestures.”  He worked with parents of kids with significant disabilities to identify and build on gestures which were not formal signs — often they were shaping existing behaviors to be more consistent and more associated symbolically with an object or event.  An example might hypothetically be if there was a particular side of the high chair a child liked to drop things off of, to really reinforce and praise a small wave at that spot to mean, essentially, “I want something to drop!”  Just like when speaking children are first learning to talk and may say a set of sounds that are only meaningful to a small group of knowledgeable people, it matters less if a sign or gesture is precise than if it is consistently reinforced as symbolic.  Methods like this and using gestures which pantomime what a child does within a familiar routine/activity, or approximations of signs (however closely they get), can be documented on the Signal Inventory so that all partners are able to recognize the attempt and honor the communicative intention.

In any case:  thank you for all you are doing to support our assessment process in addition to all you are doing for your family!”

End blip.