Signs of Progress: Sign Language and Autism

Courtesy Autism Digest 2011

The following is an article I published in the January-February 2011 edition of Autism-Asperger's Digest, about the use of sign language with nonverbal autistic students. With the increasing prevalence of sign language education in the media, I thought it might be of interest to educators and parents who missed it the first time around.
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"Signs of Progress" pg. 34
Before sign language, James1 was a runner. Each day upon his arrival he took to a figure-eight path, starting at the rear of the classroom, arching around the snack table toward the main door, then back again. He didn’t try to leave the room or run away; he just needed to move. As he ran, he screamed. While not particularly loud or disturbing it was undoubtedly a scream of displeasure, though the exact reason for his anger was difficult to pinpoint. 
At five years old, James had strong receptive skills but absolutely no expressive language.
He had a Picture Exchange Communication System (PECS2) book, which he could apply independently to request a small repertoire of reinforcers, but he utilized the PECS only a few times a day, flipping through the pages indifferently until something caught his eye. Most of the time the PEC book lay abandoned on his desk. He wasn’t interested. He preferred to run.

Running and screaming were not conducive to the strict intensive teaching model upheld in the Applied Behavior Analysis classroom. At first, we encouraged James to use his words and make a choice. But after a while it became clear… he didn’t know what he wanted. Following ABA protocol, we began mand training, teaching James signs he could use to request reinforcing activities, the idea being he would become highly motivated to ask and participate. He learned the sign “tickle” first, then “walk” and “cookie.” Initially the work was tedious. I formed and reformed his unsure hands through hundreds of trials before he could replicate the signs correctly. To learn the sign “bounce” I sat him in my lap on a big blue therapy ball, modeled the sign, physically prompted his hands to form the sign, and delivered reinforcement. We spent hours bouncing. Eventually he didn’t need any prompts. He asked; we bounced. Signing provided a faster and more efficient way for James to make requests. And, reinforcement arrived so quickly he didn’t have time to run.

            Within a few weeks of introducing sign language, it became James’ primary mode of communication. His PEC book remained available but James chose to make requests only via American Sign Language (ASL).  The autism spectrum is diverse, and some children respond better to the physical involvement that sign language provides.  It gives a level of sensory feedback to the brain that doesn’t exist with verbal or visual picture communication.  However, James’ use of manual communication would not be functional if he was inconsistent with his ability to discriminate between, or correctly produce, the signs learned. I developed a spreadsheet to track the accuracy of his spontaneous sign production. I monitored his signs based on the four main parameters governing ASL -- palm orientation, handshape, movement, and location -- recording data only on signs he produced initially without my physical prompts or corrections. On my first day of data collection, James had knowledge of eight signs and produced them with an average of 74% accuracy. Now, approximately three months later, he has over 40 signs and produces them with 90% accuracy – a testament that sign language was a communication method well aligned with James and his style of learning.

            But much more exciting than the facts or figures of signs themselves is the rapid progress James is making in related areas. For James, sign language flipped a linguistic switch other forms of communication, like PECS, did not. He now wants to make a choice. James makes out-of-sight requests independently of any prompts, including indirect ones he would have received had he been required to flip through pages of pictures to find what he was looking for. James has also moved on from simply requesting items to being able to label and describe pictures and objects with sign. He has learned to describe and compare things using adjectives like “big,” “small,” “clean” and “dirty.” He also makes abstract requests like “help” and “more” and responds appropriately in conversations by introducing himself using his name sign, and saying “thank you” to those who’ve fulfilled his requests. Without instruction, James has begun to combine signs to make short sentences. When asked, “What do you want?” he has discovered he can string together pairs of signs like “open water bottle,” “open lunchbox,” or “eat cookie.”

Additionally, James has learned to pair signs with their initial sounds. Though he is incapable of producing some speech sounds, he uses the sounds he can make. For instance, when James is shown a picture of his parents and asked, “Who is it?” he will respond by pairing the sounds “mama” and “dada” with the signs “mother” and “father.” He also matches sounds with his own spontaneous signs. The more sounds he learns, the less he screams. 

As James’ use of ASL increases, his hands fan the flames of expressive thought and communication within. With good generalization skills, James is able to utilize his signs to tact nonidentical objects, shrinking the number of things around him without names. James can also answer intraverbal questions using sign (for instance, “James, what do you like to eat?”), making associations between objects and ideas without visual cues, another skill impossible to test using PECS.

James still uses his PECS sometimes if he wants to request something he doesn’t know how to sign. But after he hands me the picture he puts his hands in mine, eager for me to show him how to form the sign. He still runs sometimes, too. Usually after lunch he sprints back into the classroom and dives face first onto the bright yellow trampoline, then rolls over onto his back and looks up at me. “Tickle!” he signs, a smile spreading across his face before I’ve even moved to complete his request. “Tickle? You want me to tickle you!?” I say, feigning surprise. I flop down beside him and tickle his belly until we both laugh. Then before I know it he hops to his feet again, asking to blow bubbles or play a game, ready to move onto something new.

1 The names of students have been changed to protect their privacy in adherence to educational confidentiality laws.

2 Picture Exchange Communication System (PECS) refers to a method of augmentative communication in which students are taught to use pictures to request desired items.

-Written by Sara Blažić. Copyright Autism Digest 2011.