Often when someone raises the idea of using sign language for a child with apraxia, parents may experience confusion and even fear. After all, “The child can hear just fine! Why would we use sign language for a hearing child?” Or “But won’t using the sign mean my child won’t need to talk? Won’t it keep him/her from speaking?” Conversely, some parents report that their child’s speech language pathologist has told them that the child will rely on sign and thus not learn to speak. This article attempts to address many of these myths about signing.
First of all, in our mainstream culture it is true that we most often see images of sign language associated with people who are deaf or hard of hearing. However, that doesn’t mean that for some children – those with apraxia – that sign cannot help! For children with apraxia the sign can be used to assist and augment their verbal communication, sort of as a bridge to communication while they are learning to speak clearly. The use of signing with children who have apraxia has nothing to do with their ability to hear or understand the spoken word. Most children with apraxia have very good receptive language skills.
Secondly, it is rare that a child’s speech output is diminished by using sign language. To the contrary, therapists and parents alike nearly always report a heightened willingness to try new words and say more. Nearly all parents are actually quite relieved when their child starts to use some signs to help with communication. It makes life easier for the child and the parent!
For just a few children with apraxia of speech, sign may not be indicated. These children have additional severe motor planning difficulties with their arms and hands, making it extremely difficult for the child to use a fairly consistent manual sign to represent a word. However, it is possible that even these children can benefit from sign if the adult uses the sign as a form of visual cueing (explained in more detail below). And it is not necessary that the child’s sign is “perfect,” just that they can be fairly consistent with whatever approximation of a sign they can achieve.
Below are some reasons why you might want to consider using sign and verbal attempts for a child with apraxia:
- Reduce Frustration: Reduce frustration and have basic needs understood. Children who have access to sign language are at least able to communicate at some level, which usually results in decreased frustration on their part and yours.
- Symbolic Communication: Sign can be important to young children with little or no speech because it is symbolic communication. They are learning that they can label things and use the signs to communicate. This is important for all children. Those with typically developing speech are doing so with speech attempts – words. Our children with speech apraxia also need a way to do this so that this part of the process of acquiring language is not further delayed.
- Expansion of Expressive Speech: For children who have apraxia and who are really struggling to sequence sounds into words, sign can be a mechanism to insure that their expressive language development isn’t further impeded. Speech production is just that: producing speech. Expressive language is the ability to understand and properly use the rules of the language to construct sentences. So a child with apraxia is at risk, due to the speech production struggle, of also falling seriously behind in expressive language since they have no means to try out and practice how words go together to create meaningful and proper messages. Using sign assists children to keep expanding their expressive language. While they may not be able to speak a word or put two words together, they can still, by using sign, be doing this same thing in a different way.
- Successful Communication: Children with apraxia who use sign, may also use it as an assist for the listener when accompanied by their vocal attempts. They may be capable of, for example, three word sentences in which each word is an approximation, not properly articulated, and thus the listener may not understand their message. When the child uses sign, along with the vocal attempt, the listener (if they know the signs) can have a better chance of understanding the message and thus, the child is successful at communication. Our children very much need to feel successful in their attempts to use their voice to communicate. If when attempting to use their voice to communicate, no one ever understands, it is not uncommon for them to just stop trying to use their voice. When they are understood (perhaps because they also used sign) they are delighted to realize they were successful and are more likely to keep on trying.
- Controls Rate of Speech: You will notice that when the adult uses sign, and even when the child uses sign, it has the tendency of slowing down the rate of speech for most people (obviously not for interpreters perhaps!). For some children with apraxia, this is very helpful for them to have the additional time to allow for motoric transitions between words, etc. It gives them a better chance, in many cases, of also being able to imitate you. Many adults speak fast and that can have a negative effect on a child with apraxia’s ability to imitate you.
- Serves as Visual Cues: It is pretty much universally agreed that multi-sensory input is helpful to children with apraxia of speech. The literature is full of examples of “cues” from various modalities that, when consistently paired with verbal attempts, can trigger for the child access to the motor plan they need to produce the word, sound, or sound sequence correctly. One very powerful modality for many children with apraxia is visual (thus the term “visual cues”). When the adult is also using sign to “cue” the child, and an association between the visual cue and the word or sound has been made over time, just the sight of the “cue” can help the child produce the correct word. Sometimes a sign for an alphabet letter may be used in conjunction with a location to cue a sound (sign for “K” being held at the throat). As a child’s speech becomes more intelligible, they almost always drop their use of the signs. However, many parents and therapists will continue to use a sign themselves for the purpose of providing a visual cue for sound or word production when the child is struggling.
- Kinesthetic Reinforcement: Some people believe that the use of manual sign provides the kinesthetic reinforcement of volitional movements and sequencing when accompanying the verbal attempt.
Speech-language pathologists who successfully use sign language with children who have apraxia do not have the child using the signs in isolation. Instead, they are encouraging the child to use signs along with verbal attempts. Therapists and parents need to work together in partnership on all aspects of a child’s therapy, including the use of manual sign language to augment speech attempts.
Sharon Gretz, M.Ed.