Friday, May 16, 2014

The Limitations of Sign Language for Children With Speech Delays

Once upon a time, when Maya was little (a few months old) we started signing with her. Not because she had special needs, but because many people use sign language with little kids, who are often able to produce expressive signs before they can produce the same words verbally. We waited months for her to start signing back, which she eventually did---much to our delight! She learned many signs in the months (all the way up until she was 2.5, I think) that followed, we used baby sign language dvds, I even made a "Maya Sign Language" video dictionary that I sent to her preschool teachers so that they would understand her. Signing was great, because without it we would have had no way for her to communicate with us and her teachers. 

I look at that paragraph now and all of the shortcomings of sign language jump out at me (it took months for her expressive signs to come, she only learned dozens-not hundreds-of signs, despite having expressive signs I still had to make a translation video for her school staff to understand her). And before I start discussing the limitations of sign language for kids with speech delays, I need to be clear about a few things. Here are my disclaimers: First, ASL (American Sign Language) is an absolutely beautiful, complete language. For families who are a part of the Deaf community, ASL makes complete sense. This article is completely irrelevant to that experience. Second, I think it is valid for children to learn sign language, and I think sign language can be a great component of communication. I'll get to where it fits in below. 

But children who are slow to develop language, who have "speech delays", who have "complex communication needs", who are "nonverbal", who have apraxia/dyspraxia/oral motor planning difficulties, who have CP or autism or genetic syndromes, children who will NOT be attending a school for the deaf or supported in the Deaf community----these children should not rely on sign language as an alternative method of communication. 

Here's why:

1. Most people don't understand sign language. Children need to be able to speak to EVERYONE they meet (well, if they want to). Grandparents, cousins, the guy who works at the deli that you go to on Thursdays, their bus driver, the secretary at their school, the kid that he just met at the playground who has Spider-Man on his shirt, the nurse in the doctor's office, the doctor, the grandparents of a friend at a birthday party, the lady in front of you in the Starbucks line who is asking about whether she likes the movie Frozen, the teacher, the substitute teacher, the gym teacher. These people do not all understand sign language. Which leads to . . . 

2. A child should not need to rely on a translator. (Even if that translator is you, and you are awesome.) Here's why: it forces them into the backseat of their own conversations. Imagine if you went out with your spouse (or best friend) and every time someone spoke to you, you signed and your partner had to speak back for you. You're one-step-removed. Kids who are struggling with language issues, who are learning the ebb and flow of conversation, need to be empowered with a way to speak up, to step in to conversation, to join. (Passivity is a big personality trait that develops among kids who have speech delays---they're used to other people speaking for them. As a side note, the other big trait is anger/tantrums because they have no other ways to get their points across, and behavior becomes their method of communicating.) On top of that, our kids (who often have multiple challenges) are already shadowed by their parents enough. I didn't want to have to be all up in every conversation that Maya ever has.

3. Fine motor issues lead to garbled signs. Maya does not have the dexterity to move her fingers in ways that would allow for the clean, clear formation of the vast majority of signs (hence the "Maya Sign Language" translation video---even people who speak fluent ASL wouldn't understand her signs). Teaching sign language to nonverbal children with fine motor issues as their primary means of communication is basically spending hours helping them learn a language that effectively no one (besides you and your child) speaks. It doesn't make sense.

4. I think that AAC is faster to learn than sign. (Please note the "I think", as this one is totally anecdotal.) I learned ASL alongside of Maya, and then I learned to be an AAC user alongside of Maya. AAC is, in our experience, much faster. I wondered if this was because Maya's motor challenges make it difficult for her to execute new movements, but then I realized that I'm able to learn words via AAC more quickly as well. Her app can hold over 13,000 words. I don't think I would be able to remember that many signs. 

Will (19 months) is learning to speak. He is also learning sign language. He is also learning AAC. This type of multimodal whole-language approach is, I believe, where ASL fits appropriately for children who have complex communication needs. It's great to have a child who has multiple ways of communicating, and there's no downside to teaching ASL in conjunction with using a more-universally-understood AAC device/app.  But, in my mind, the AAC is not optional. 

See for yourself:

The criticism: Here are the most common complaints that I hear from people when I share my thoughts on the limitations of signing:

1. Signing is better because kids always have their hands with them, you don't need a cumbersome binder of cards or an iPad. And what about places like the bathtub where a kid can't have an iPad anyway? Maya's iPad mini isn't cumbersome, and there are several option now (like a waterproof electronics camping bag) that would make it fully submersible in a bathtub. But that's totally beside the point, because signing is great for you to use with your kid----as long as you're also providing them with a way to communicate with the non-signing population.

2. My child loves sign language and has learned over 200 signs! That's so great! But most 3 year olds already speak over 200 words, and by age 4 we're well into the thousands. That's a lot more than 200. Keep signing but make sure there is another way for her to express the thousands of words that she likely understands but does not know how to sign.

3. It's his choice to use sign language. I'm certainly not going to argue with the choice of a child who has communication challenges. Obviously, how he communicates will be his choice. But (in my humble opinion) he needs consistent exposure to multiple modes of communication. My kid is going through a cartoon phase and has gained buttons in her device for nearly 100 characters in the past few weeks----it's all that she talks about, to anyone who listens. She would never be able to learn and imitate this many signs this quickly, and no one that she spoke to would know the obscure signs for "Jiminy Cricket" or "Handy Manny" or whatever. I think that multiple modes should be taught and encouraged, and the child can use a combination of them to get their points across to a diverse field of communication partners.

Our kids with complex communication needs need the same early access to AAC that many of them have to sign language. Sign language is a great component of multimodal communication, but without an AAC option that can be universally understood we are limiting their ability to independently interact with peers, family, friends, and professionals.


Kerith Stull said...

The beauty of communication for all of is that it's never just one mode. Communication comes in many forms -- verbal, non-verbal, digital, etc. Any way we can get our kids to communicate is a good thing for so many reasons.

My 18yo daughter with moderate cerebral palsy can't speak but has normal hearing. And I totally get all of your points here. Totally. She uses ACC almost exclusively at school. But, at home, where she and I are both fluent in sign (actually SEE not ASL), we use sign. But, I also totally get the complaints about signing. My husband is not fluent, so I either interpret or she grabs her iPad. I can't always look at her hands while I'm driving or in a dark theater. If she hasn't learned the sign for something, she has to spell it out (using sign of her ACC). But on the whole, signing at home works for us just as using ACC in public works. She switches back and forth seamlessly and understands why she uses each one.

Signing is who she is, but so is ACC. It doesn't have to be one or the other. There's room for both. Just my (humble) opinion. :)

roxs81 said...

I work with two kids who are severally autistic who have ben taught a few ASL sign but what happens is as soon as they are taught a new one they forget the old ones

Catherine said...

Why would sign language be right for those who are deaf when they too would have the same issues of communicating with others that do not understand ASL? I've always wondered about that, but there are many in the deaf community who are fierce in protecting the relevance of sign language. Have you thought about having Maya entrenched in a deaf community? Would she learn to sign well eventually? She'd have an advantage over many deaf kid since she is able to hear. I would think she'd benefit greatly from the focus on communicating that a curriculum for the deaf would present.

Rachel said...

My daughter is four with a chromosome disorder (called Digeorge syndrome), we use both English and ASL, and were first influenced to do this by her speech therapist when we found out about her chromosome disorder. If it wasn't for sign language, I couldn't imagine how frustrated we would still be.

As for learning sign, it is great that you worked with her very early, but you shouldn't have expected immediate results so soon! Its a language, it takes years and patience, even deaf children from deaf families go through "sign babbeling" phases like hearing children do with speech. Plus, young children learn by repetition and imitation, if the parents aren't communicating in sign on a regular basis, it take longer for the child to pick it up (just like speech, imagine how long it would take for a child to use a language that they don't hear be spoken everyday by their parents). As for Deaf communities, Deaf adults and children that I've met are very accepting of hearing children that use ASL, there's parent groups that provide social opportunities for children that sign.

Also, the reason why we first started with ASL was because based on current research has been proven to help children with speech difficulties, its not a crutch, kids tend to drop it once they get a little older, but if the parent encourages it, they will continue. Learning ASL also promotes development in other area as well, here's an article that explains all the benefits for especially pre-school aged children:

To each their own, but I know many people who don't use any electronic devises for communication, pen and paper is fine if needed. Your hands don't run low on batteries or need to be plugged in or accidently forgotten at home... but I can see using these devises as a temporary thing in public, but at home I'd much prefer everybody being able to communicate. My daughter's father was slower to learn ASL too, but after attending a Deaf event with me, he's become more excited about it, and the more I use sign, the more he does with my daughter. Its hard to learn a new language, but I think its totally worth it to be able to have totally effective communication between everybody in the family.

Dana said...

Hi Rachel,

First, I'm so glad that you've found a system that is working for your family. However, I definitely stand by the original post and feel that ASL is an amazing communication tool to have in her toolbox, but that unless she will be attending a Deaf school and be raising in the Deaf culture (which is quite possible, since you mentioned attending a Deaf event) that she should also have access and support for a speech generating device, for the reasons outlined above. I mentioned at the start that if you're plugged into the Deaf community, this article isn't really relevant---that's a whole different situation that trying to use ASL as a primary language for a nonspeaking child in mainstream schools, etc. To respond to a few more detailed points:

"As for learning sign, it is great that you worked with her very early, but you shouldn't have expected immediate results so soon! . . . Plus, young children learn by repetition and imitation, if the parents aren't communicating in sign on a regular basis, it take longer for the child to pick it up." Well, this isn't really fair--trust that I signed consistently and often, and that I did so enthusiastically and without expectation of output for many, many months. I'm familiar with language development and the receptive steps that happen prior to expressive language appearing.

"Also, the reason why we first started with ASL was because based on current research has been proven to help children with speech difficulties, its not a crutch, kids tend to drop it once they get a little older, but if the parent encourages it, they will continue."

All of that is exactly true for children who use speech generating devices as well. There was also a recent study done about how SGDs actually speed up the acquisition of spoken words for some children (likely due to the access of the audio model and ability to repeat it and practice).

"To each their own, but I know many people who don't use any electronic devises for communication, pen and paper is fine if needed." My daughter is 6 now, and still can't write because her fine motor skills don't allow her to hold and manipulate a pencil. But she uses language with her talker that I've never even taught her (because she can overhear the words and find them in her device on her own). The other day she used the word "cubicle"---and it amazed the people in the room. It reminded them to have high expectations of her, and that's huge.


Dana said...

"at home I'd much prefer everybody being able to communicate. My daughter's father was slower to learn ASL too, but after attending a Deaf event with me, he's become more excited about it." I'm unclear on this---in my home, everyone does communicate, through a beautiful mish mash of speech, AAC, gestures, signs, expressions, etc. We communicate the same way when we're not at home. You mention the work and slowness of learning ASL, and with AAC there is also a learning curve but the bang-for-your-buck is bigger. 14,000 words, instantly (if your system has a good search feature) is pretty amazing. Grandparents, cousins you only see twice a year, the lady behind the counter at starbucks, the new friend at the playground---they can all understand every word she says---even the weird ones like cubicle--without a translator. Being able to assert yourself in communication without having mom (or an assistant) translate is a big deal.

Again, you seem to be happy with your plan and it's working for you---and you mentioned "Deaf" a few times, which is awesome (and so important) if you're going to be raising a speaker of ASL. I will say that historically when I've written posts like this I get the most push-back from two groups: parents of older nonverbal children who use sign (who didn't really have high tech options) and parents of children learning sign who are not yet in elementary school, where communication systems that have been established at home get the test of standing on their own with new adults and children.

And none of this was written in an attempt to evaluate your set-up, question the path that you've chosen, or convince you that you're incorrect. I've simply written this response to address a few points that you made so that if new readers come along and see your post they aren't thinking "I wonder what Dana would say in response to those points."

Best of luck to you and your family, and thanks for taking the time to share your thoughts!

Anonymous said...

Understandable, valid reasoning....but this is rather i found this by searching for asl for toddlers with speech delays. The asl is used by speech therapists to help bridge the gap between signing, and verbal communication. All other attempts have failed thus far. By now, my toddler is frustrated and beginning to hit....which is not him. I comment this to encourage others that may be searching as well. Asl is a useful tool to use to help bridge the gap. Maybe they use it longer than desired. Maybe the teacher can't decipher what's going on, or the hotdog stand man....but your baby is COMMUNICATING! Not all parents would just leave at that. My plan of action is to use this tool as a way of communication that he needs....then as my baby gets a deeper concept of this new empowerment, we can tackle the verbal language. For now, the ASL is the bridge that gets us there.
-from a mom with a toddler with speech delay.

Dana said...

It shouldn't be discouraging: sign is a great tool to start using at home to increase the communicative toolbox of your toddler. It should help to illuminate the fact that sign will not help your child very much in a year or two when they are starting preschool. It should emphasize the fact that voice output AAC is accessible to toddlers and should be introduced as well: in the same way that you emphasize "your baby is COMMUNICATING!" I would say "with AAC your baby can be COMMUNICATING with ANYONE!" (not just the parents and other family members/close friends who learn some signs) With ASL and AAC it doesn't have to be either/or, but it should be both :)

Anonymous said...

I love your posts- thank you!
I am a parent of a child newly using AAC, but also a pediatric occupational therapist. I wanted to add one point about the use of "core words."

We pushed signing hard with my toddler and we achieved "hundreds" of words, but it wasn't able to keep up with her language needs. When I read more about the normal development of language skills and learned that toddlers and preschoolers speak mostly in "core words" (things like it, in, is, some, the) (see Banajee M. (2003) in Augmentative and Alternative Communications). I realized that the "hundreds" of words my daughter had learned to sign were not helping her acquire language in the typical pathway. Signing was an important step in her language development, but she had out-grown it. We thought very hard about the choice to use AAC vs full immersion in an ASL program, and our personal choice was AAC. We needed a choice that allowed full language access and would allow her to develop language skills in her natural environment- AAC best met those needs for our family.