What about baby signing?

Since we've used Baby Sign Language for Maria, Isabella and no-doubt for John, I'll say a few words about our experience of it here. 

Baby signing is a term that's used to teach pre-verbal children to communicate using signs instead of speech. A typical child can say a few words by the age of 1, has a small vocabulary by the age of 2 and can speak intelligibly by the age of 3. 

Personally I'd try baby signing as early as 9 months. At that age your baby is probably frustrated when it wants milk, food, a hug, the toilet or a nappy change but has no way of letting you know other than crying.

The Baby Sign Language system uses signs based on the native spoken language and uses the same ordering of hand signs as the spoken language. You'd be expected to speak each word as you sign. This way the sign system mimics the spoken language of the child's family and environment.  

Before Maria was formally diagnosed with RTS there was a period from the age of two to three years when I started to think about how to help Maria communicate. Naturally we concentrated on speech but eventually I came across the idea of using signs as a means of expression for Maria. She must have been three years old when I taught her some baby signs and it took her only half an hour to learn about ten signs. These were mostly animal signs since animals always got her excited. Important signs like toilet, milk, more, all gone, where?, book, biscuit, bed, brush teeth, bath, pain, sorry and thank you followed soon after. 

Maria was watching everything on the BBC Cbeebies TV channel from the age of one, so she must have watched Something Special. This TV series is designed for children with special needs who are learning Makaton. Thinking about it, maybe she already knew the signs I taught her from watching these programmes. Maybe all that happened when I showed her my signs was to give her 'permission' to use them at home.

When Maria was three years and five months old I bought on Amazon the first of the Sing & Sign DVDs by Sasha Felix. This particular Baby Sign Language system originated from Say it and Sign it (an obscure West Sussex sign system in the UK) but is now compatible with Makaton and Signalong. Maria loved the DVD so much, she almost wore it out by watching it at least a hundred times. Naturally she learnt all the signs and started to use them quite frequently. It soon became her first expressive language, together with babbling (I felt at the time that the babbling probably meant something but I just couldn't figure it out. Looking back, this wasn't very likely since Maria's babbling consisted of just a few different sounds).

Maria is now five years old. To this day Maria uses babbling with spoken English and Makaton signs to express herself. The good news is that spoken English is becoming more prominent and is slowly replacing Makaton. Ask Maria a question nowadays and instead of answering with Makaton, she'll try to say the words in English.

One concern that I had was the fear that learning Baby Sign Language might affect normal language development. Well, in the case of Maria it's impossible to tell but since we taught Isabella to baby sign too then I can only say that there's no discernible effect on her language development; she started to speak as expected. The important thing is that she can understand Maria's signing and even signs for emphasis or for fun. 

But the best thing about signing and speech is that our family is now bilingual. Sign language is an extension of our spoken language and has become part of the family culture. Our rare blend of communication modes is one of the things that unites us as a family. We intersect the cultures of the hearing, the Deaf and the disabled to form a new type of multi-cultural community that's barely recognised by the wider public. 

Which system should Maria use for signing?

Happy Daddy's Day!

Maria is five years old and English is her first receptive language and Makaton was her first expressive language; but since she started special school this year then things have changed; English is now slowly taking over as Maria's primary expressive language. 

Maria's school report says she uses Makaton a lot to express herself, together with babbling and English words. At home she largely babbles but uses more English words when encouraged, however there isn't much signing at home. That's probably because we don't sign much to Maria whereas her teachers do.

All this indicates that Maria's speech is slowly developing and it looks like spoken English will become her dominant expressive mode; so far Maria's record for the longest sentence is five words. She's got some way to go before she relies solely on English; in the meantime she needs a way to make herself understood, thereby reducing her frustration. So, back to the original question, which I'll rephrase as: which system should Maria use for signing?

Given Maria already understands English then the possible candidates for an expressive language include British English (BEL) and any of the sign systems we saw in the previous post. Indeed the only excluded choice is British Sign Language (BSL), apparently because of BSL grammar. Ironically, BSL is used by mute people yet Maria, who is in effect hearing-mute, is not advised by the 'experts' to use it. This can only be because they believe she is incapable of handling two grammars: English and BSL.

What's the problem with learning two grammars? After all, there are cases of bi-lingual and tri-lingual children with Down Syndrome. Come to  think of it, Maria already understands English and some Tagalog - the official language of the Philippines. 

Common sense dictates that children with developmental delay have enough trouble learning one grammar, let alone two. Although I've never accepted this premise in the past, I would so like Maria to have an expressive language that I'm sorely tempted now.  Common-sense and science don't always mix however, there's evidence that children with Down Syndrome do have difficulty learning grammar, whereas nouns and verbs are much easier master. 

Now, you can interpret this difficulty of learning grammar in two ways: either reduce the number of grammars a child needs to learn or simplify the grammars. Reducing the number of grammars argues in favour of using Makaton and BEL since Makaton grammar is a subset of BEL grammar, meaning the child only learns one grammar. Simplifying the grammars argues in favour of BSL and Basic English since BSL grammar is simpler than Makaton (English) grammar and Basic English grammar is simpler than BEL grammar. Clearly the experts have opted for reducing the number of grammars. 

My personal preference would be to choose a sign system that's based on BSL. Ignoring FS2, CS and CA (they represent letters and sounds instead of concepts) then pretty much all the rest are indeed based on BSL, except for PGSS. I would prefer to have a sign system that doesn't alter the BSL signs as Maria has the ability to move her arms, hands and fingers reasonably well - only her fine motor skills need some work. 

Before choosing a sign language for Maria, I thought about the community of people she might communicate with. First is her family. Second is her school. Third are the neighbours and their children. Fourth is our church and the people we meet. Fifth is at the supermarket and sixth are our friends (in these austere times we see them much less). Apart from school, none of these people know BSL or Makaton. 

At home we normally speak to Maria and occasionally sign (although this is rare in practise). What if Maria reached the age of six and still couldn't speak legibly? Would she need a proper language like BSL? Who would she talk with: the British Deaf community? Seems unlikely since it took me over fifty years to meet a member of the Deaf community. All this means that Maria is going to lead a pretty isolated existence unless she learns to speak. What a bleak thought. Since Maria is probably going to live with us for some time as an adult then we'd better think carefully how we're going to communicate. Will it be English or will it be a sign system or even BSL?

An appreciation of the impact of all these sign systems has been witnessed first-hand by Frances Elton, a prominent member of the Deaf community, who summarises some of the experiments on deaf children by hearing officials during the past few decades and the impact they've had on the Deaf community. Here's the transcript of part of an interview she made in 2012: 

'The focus for the teaching was on deaf children understanding English. There was no template for this so various artificial language systems were created. The most commonly used is SSE (Sign Supported English), following the word order of English. A precursor of that was Signed English. Those were the two most-used in trying to develop English language skills. Then there was Paget Gorman, a sign system that was explored. Then Cued Speech as a way of helping develop spoken language. Makaton came in, really as a way to help the receiving of language, and is more suitable for those with learning difficulties. Then Total Communication, which was very prevalent and is now evolving into other ways. 

There are a number of artificial systems used in schools and these came about as teachers and educators considered what they thought best for deaf children, and prioritised speech as important. So from that the Cued Speech system was developed, the aim being to teach children how to articulate English and have a visual representation of the sound each articulation made. 

Paget Gorman was a sign system created to help develop the understanding of English word order, so the focus of signing and speaking was on word order. 

Signed English was to help with the reading of English, the grammar, how to recognise tense, that '-ed' represented the past and so on. 

Makaton was a created system that should have never really been used in schools [with deaf children]. It was suitable for those with learning difficulties or brain injury. Makaton borrows signs from BSL and then adapts them to facilitate simple communication with those with Down's Syndrome for example. It has been appropriated for BSL teaching and that should never really have happened. 

In most widespread use [in schools with deaf children] is SSE. Even if teachers are fluent in BSL, the focus of educators has always been on the acquisition of English to the same fluency. The idea being that on leaving school, the child would have the option to operate in BSL or English. It's helpful within the school environment to have written English but there needs to be a clarity and emphasis on the fact that the grammars of English and BSL are quite distinct and separate. 

Having gone through the education system I would say that most, on leaving school, revert to using BSL and all that implies, or remain isolated from the [Deaf] community. There is anecdotal evidence of this happening. One person for example, now is the most fluent of signers, grew using Cued Speech, Paget Gorman but that didn't impact on their sign language at all. They're fluent, they teach sign language. For others, their communication was more severely affected, particularly in communicating with other deaf people. The way they learnt through Paget Gorman was so restrictive, there was no ability to adapt and so causes isolation. 

These are not systems of the wise. They were created to benefit the hearing establishment, not the deaf children. There has been no profound or lasting benefit for the Deaf community; it has probably been a little damaging. A few lucky survivors have managed to retain and maintain fluency in BSL.' 

So, those Deaf children who weren't given the opportunity to learn BSL found themselves isolated from their own Deaf community; SSE, Paget Gorman and Makaton effectively isolated them from the community that would have treated them as equal members. The attempts by hearing people to force Deaf children to join the hearing community were resented by the Deaf community in much the same way as people committing genocide are resented by those whose race, community and culture are being eradicated. In case you might think I'm going too far with that analogy, these sentiments are implied in a recent short film on BSL Zone called The End, and were actually expressed by Alexander Graham Bell according to another short film, Confession. 

To a hearing English speaker, BSL appears to be missing indispensable grammatical features; so how is it that BSL users appear to be able to communicate so effectively without them? Languages like BSL don't appear to need an intricate and complex visual grammar. BSL's grammar is not trivial, judging by some of my text books, but it seems to be a lot simpler than English. It's this simplicity that argues in favour of using BSL for children with developmental delay. Few educators address this point. The fact that the word order is different in BSL compared to English seems trivial compared to learning the intricate complexities of English grammar. This is one reason why I haven't ruled out BSL as a possible future language for Maria. In fact, the potential of BSL has been overlooked by both the Deaf community and the hearing community, who view BSL as either a native language or a foreign language respectively. Either way, BSL is dismissed as inappropriate for people like Maria who are, in effect, hearing-mute. My gut feeling has always been to let Maria learn BSL, regardless.

But getting back to the original question of which system to choose for Maria, I was considering sign systems based on BSL, which left me with four possible candidates:  
1. British Signed English (BSE)
2. Makaton 
3. Signalong
4. Sign Supported English (SSE).
But in my heart-of-hearts I really wanted British Sign Language (BSL). 

I don't know enough about Signalong to comment on it but I do know about Makaton, which looks like a simple and pretty flexible sign system, nowadays offering SSE mode, BSE mode and Function mode. I've yet to meet a BSL user who can recognise all the Makaton signs but ignoring this conundrum for a moment, Makaton seems to be popular and flourishing in the UK, particularly in Special Schools like Maria's. 

BSE strikes me as a bit long-winded and I don't feel it's that important for Maria to be grammatically perfect at this stage; she only needs to express herself in English and signs. That's why I'm interested in SSE, which uses BSL signs for key words but places them in English word order to reflect Maria's receptive language. 

Finding a happy medium between receptive and expressive language, I'd favour Maria learning SSE using unmodified BSL London and South East regional signs. Our family could be trilingual, using a mixture of English, SSE and BSL in whichever grammar was convenient. 

Looking at the sign systems supporting SSE, we have SSE itself and Makaton in SSE mode. If I were to choose Makaton then I'd want to substitute some of the Makaton signs with  commonly used BSL signs. 

Since Maria can grasp the idea of multiple signs for the same concept and given the popularity of Makaton and the fact Maria is already using it at school, it should be possible to add additional BSL signs to her existing Makaton vocabulary where necessary; I don't believe this would confuse her.   

So, in conclusion, it looks like the most practical approach is to choose Makaton in SSE mode but using the most prevalent BSL London and South East region signs in preference to the Makaton ones; that's going to be a lot of hard work. I can't help feeling it would be easier to just choose BSL. 

To help Maria's word articulation I'm happy with either CS or CA since neither is used for communication; Maria's special school uses CA.

Unfortunately none of my BSL dictionaries tell me in which UK region a sign is used, making it difficult to determine if a BSL sign is from the London and South East region or not; it would also help if they stated the UK prevalence of signs, so I could choose the most popular of several alternatives. 

Practically speaking, and to overcome the deficiencies in dictionaries I just mentioned, the best way for Maria to learn BSL is for the parents to learnt it first, preferably from a teacher who uses the London and South East regional dialect. So that's what I did. My teacher is Sandra Duguid and she runs a business called BSLworks. To digress a bit, a recent interview with Sandra in the UK Mirror newspaper sheds light on what happens in a country where the government of the day bails-out bankrupt banks but appears powerless to help disabled people running small but solvent businesses.

Which Sign Language?

What about baby signing?

So here's my concise tour of the sign systems and related languages of the UK. 

Imagine a colourful spectrum of languages with the British English Language (BEL) at one end of the spectrum and British Sign Language (BSL) at the other. Both are proper languages but one (BEL) uses sounds and intonation as a means of expression whereas the other (BSL) uses gestures and expressions. Each have their own unique sounds/signs and grammar and are used by the majority of people in their respective communities. Both languages have developed in the United Kingdom but have done so quite independently. That's roughly the relationship between BEL and BSL today. History however has a more colourful story to tell and it's only as recently as March 2003 that the British Government adopted BSL as one of the nation's official languages.

Between the BEL and BSL bookends we have an array of sign systems that have developed for similar yet different reasons; all the sign systems discussed here are forms of Manually Coded English, meaning they combine signs with speech to teach English:

British English Language (BEL)
British English is the native language of the United Kingdom. It is primarily used by hearing people and bilingual (BSL and BEL) deaf people.

Origin: Britain 11th century
Hand signs: NO
Colour codes: NO
Fingerspelling: NO
Sentence structure: subject-verb-object
Grammatical markers: YES
Voiced:  YES
Mouth patterns: YES
Word order: English 
Key words only: NO
Graphic symbols: YES (English writing)
Usage: at least 62 million hearing and bilingual (BEL, BSL) deaf people in the UK.

Two-handed Fingerspelling (FS2)
FS2 uses both hands to make hand signs that represent the letters of the English alphabet. Not to be confused with One-handed Fingerspelling (FS1).

Origin: UK 1720
Hand signs: NO
Colour codes: NO
Fingerspelling: YES (FS2)
Sentence structure: none
Grammatical markers: NO
Voiced:  NO
Mouth patterns: NO
Word order: NO
Key words only: NO
Graphic symbols: YES (English alphabet)
Usage: Supplements most sign systems and sign languages.

Cued Speech (CS)
Cued Speech was created by Dr Orin Cornett of the US in 1966. He noticed the poor reading abilities of deaf children because they cannot hear spoken language and therefore cannot distinguish visually between sounds like /p/ and /b/. CS comprises 8 handshapes in 4 positions near the mouth as well as the lipshape of English speech. CS is best known in the US and is sometimes used in the UK by the English speaking BSL community.

Origin: US 1966 by Dr Orin Cornett
Hand signs: YES (handshapes & positions)
Colour codes: NO
Fingerspelling: NO
Sentence structure: subject-verb-object
Grammatical markers: NO
Voiced: YES
Mouth patterns: YES 
Word order: English
Key words only: NO
Graphic symbols: NO
Usage: US and UK bilingual deaf community.

Cued Articulation (CA)
Cued Articulation was created by Jane Passy of the UK in the early 1980s. She noticed the difficulty that speech and language impaired children had in producing and recalling speech sounds. CA comprises 49 speech sounds (phonemes) together with hand cues (signs) and colour codes. CA uses the International Phonetic Alphabet (IPA) to express the articulation of phonemes. There are 26 consonant speech sounds with colour codes and 23 vowel speech sounds (which have no colour codes). The system of hand gestures (cues) shows how and where each sound is made and if the sound is voiced or voiceless. For consonants, the position of the hand indicates where the sound is made; the shape and movement of the hand shows how the sound is made and the use of one finger or two indicates if the sound is voiceless or voiced respectively. For vowels, which are always voiced, the whole hand is used for cueing; the shape shows the degree of lip rounding or spreading; the movment shows if the sound is long or short and the direction of the hand shows whether the sound is made in the front, middle or back of the mouth. CA is best known in the UK, Ireland, South Africa and Australia where it is used in special and mainstream schools to help children become aware of how to articulate the sounds of English speech. It is not used widely among the British Deaf community. Maria's Special School uses CA.

Origin: UK early 1980s by Jane Passy
Hand signs: YES (hand cues)
Colour codes: YES
Fingerspelling: NO
Sentence structure: subject-verb-object
Grammatical markers: NO
Voiced: YES
Mouth patterns: YES 
Word order: English
Key words only: NO
Graphic symbols: NO
Usage: UK by people with hearing or speech impairment and those learning English.

Paget Gorman Sign Speech (PGSS)
Systematic Sign Language was first developed by Sir Richard Paget in the 1930s to teach deaf children to speak English. A new version called PGSS was released in 1964 by Lady Paget and Dr. Peter Gorman. PGSS comprises 37 basic-signs and 21 standard hand postures which roughly match English words to PGSS signs, although there are additional signs for grammatical markers (affixes) like '-er', '-ing' and '-ful'. PGSS uses English grammar and children are encouraged to speak as they sign, with facial expressions like that of a native English speaker. PGSS signs are not derived from any other sign system and it was forced on some children in Deaf schools from the 1960s to 1980s, after which it lost popularity to BSL. Nowadays PGSS is used mainly by children with speech disorders who do not have learning disabilities. 

Origin: UK 1930s by Sir Richard Paget; 1964 by Lady Paget & Dr Peter Gorman.
Hand signs: YES (PGSS)
Colour codes: NO
Fingerspelling: YES (FS2)
Sentence structure: subject-verb-object
Grammatical markers: YES
Voiced:  YES 
Mouth patterns: YES 
Word order: English
Key words only: NO
Graphic symbols: NO
Usage: UK by people with speech disorders but without learning disablities.

British Signed English (BSE)
Signed English (SE) was originally developed by Harry Bornstein in 1974 to teach deaf children to speak English. The British variant, called British Signed English (BSE), has a vocabulary of BSL or generated signs (sign words), fingerspelling (FS2) and grammatical markers (sign markers) like '-er', '-ing' and 'un-'. BSE is presented with normal speech to convey the full BEL grammar. BSE is not intended for everyday communication because it is slow but is used to teach English grammar. It's not clear how many still use BSE in the UK, possibly some bilingual Deaf people.

Origin: US 1974 by Harry Bornstein
Hand signs: YES (sign words: BSL and generated signs)
Colour codes: NO
Fingerspelling: YES (FS2)
Sentence structure: subject-verb-object
Grammatical markers: YES (sign markers)
Voiced:  YES 
Mouth patterns: YES 
Word order: English
Key words only: NO
Graphic symbols: NO
Usage: possibly some UK bilingual Deaf people

Makaton
Makaton was first developed by Margaret Walker around 1972 to help cognitively impaired deaf adults to communicate. The original Makaton Vocabulary comprised 145 signs but was revised in 1976 by the Revised Makaton Vocabulary project to 350 signs. Eventually the Makaton Vocabulary Development Project (MVDP) came under pressure from groups like Signalong to expand the vocabulary to around 2500 signs. Currently the Makaton Vocabulary has a Core Vocabulary of 450 concepts and a Resource Vocabulary of over 11,000 concepts covering topics like: money, sport, food & drink, religion & custom, sexuality and grammatical elements; each concept is represented by both a sign and a symbol. Signs are usually based on BSL from the London and South East England region; sometimes these are simplified. Some signs are generated. 
Nowadays Makaton signs  and symbols can be used in three ways (the names of the modes are mine, not Makaton's): 
1. BSE mode: to represent every word in a sentence; e.g. the man is eating an orange.
2. SSE mode: to represent the key words in a sentence; e.g. man eating orange. 
3. Function mode: to represent the whole sentence; e.g. eating
The English mouth patterns are always voiced. Makaton is used mainly in schools where children have speech and language disorders; Maria's special school uses Makaton. However, users beware; The Makaton Charity has copyrighted the Makaton system. 

Origin: UK 1972 by Margaret Walker.
Hand signs: YES (BSL, simplified BSL and generated signs)
Colour codes: NO
Fingerspelling: officially NO; unofficially YES (FS2)
Sentence structure: subject-verb-object
Grammatical markers: YES (BSE mode); NO (SSE mode)
Voiced:  YES
Mouth patterns: YES
Word order: English
Key words only: NO (BSE mode); YES (SSE mode) 
Graphic symbols: YES
Usage: children and adults with speech disorders who have learning difficulties.

Signalong
Signalong was founded by Gill Kennard and Thelma Grove in 1992 at the National Autistic Society special school in Kent, UK after the Makaton Vocabulary Development Project (MVDP) failed to expand their vocabulary sufficiently. Signalong is now managed by The Signalong Group charity and the Signalong sign system contains over 15,000 signs, most based on BSL but some are simplified and other signs are generated. I haven't been able to find out much about this signing system based on publicly available sources. It would help their cause if they offered more free information on how their system works; and someone in the Group should write a really good article in Wikipedia about their origins, history, philosophy and implementation of the sign system itself. Maria's new school in South Wales uses Signalong instead of Makaton; any differences between the two systems seem to have escaped Maria. 

Origin: UK 1992 by The Signalong Group.
Hand signs: YES (BSL, simplified BSL and generated signs)
Colour codes: NO
Fingerspelling: unknown
Sentence structure: subject-verb-object
Grammatical markers: NO
Voiced:  YES
Mouth patterns: YES
Word order: English
Key words only: YES
Graphic symbols: NO
Usage: children and adults with speech disorders who have learning difficulties.

Baby Sign Language
Baby Sign Language was first developed by Dr Joseph Garcia in 1987 in order to help babies and young children to communicate with their hearing parents. Garcia was an American Sign Language (ASL) interpreter. He noticed that the children of his deaf friends were communicating in ASL with their parents as early as six months; these children had quite developed vocabularies by the age of nine months. In contrast, hearing children typically speak a few words at the age of one year and have a small vocabulary at the age of two years. The early language development of so called 'handicapped' Deaf children was noticed as early as the 19th century by the American linguist and Yale professor William Dwight Whitney.  

Origin: US 1987 by Dr Joseph Garcia.
Hand signs: YES (ASL or BSL with simplified BSL)
Colour codes: NO
Fingerspelling: YES (FS2)
Sentence structure: subject-verb-object
Grammatical markers: NO
Voiced:  YES
Mouth patterns: YES
Word order: English
Key words only: YES 
Graphic symbols: NO
Usage: typically infants of 9 months to 3 year old toddlers.

Sign Supported English (SSE)
Sign Supported English (SSE), also known as Signs Supporting English, was developed at Meldreth Manor School, Hertfordshire in the 1960s by the Deaf community themselves to help children with profound and multiple learning difficulties and complex needs. SSE uses BSL signs and fingerspelling to sign the key words of an English sentence using BEL word order. SSE doesn't use grammatical markers like BSE and does not require knowledge of BSL grammar. The English mouth patterns can be either voiced or unvoiced.  SSE is used in mainstream schools where deaf children are taught alongside hearing children and also for children with learning disabilities.

Origin: UK 1960s at Meldreth Manor School in Hertfordshire
Hand signs: YES (BSL)
Colour codes: NO
Fingerspelling: YES (FS2)
Sentence structure: subject-verb-object
Grammatical markers: NO
Voiced:  YES
Mouth patterns: YES
Word order: English
Key words only: YES
Graphic symbols: NO
Usage: hearing people who subsequently become deaf or Deaf people who engage with hearing people. Also used by people with learning disabilities.

British Sign Language (BSL)

BSL uses native BSL signs together with fingerspelling to express BSL sentences in BSL grammar. The words are always unvoiced. In BSL 'name you what?' means in English 'what is your name?'. There are around 50,000 deaf people in the UK. BSL is the first language of the UK Deaf community. BSL was officially recognised by the British Government as being a full, independent language in March 2003. BSL can also be used by mute people; previously, Maria fell into this category.

Origin: Britain 1570
Hand signs: YES (BSL)
Colour codes: NO
Fingerspelling: YES (FS2)
Sentence structure: topic-comment
Grammatical markers: NO
Voiced: NO 
Mouth patterns: YES
Word order: BSL
Key words only: YES
Graphic symbols: YES (notation system for shape (dez), place (tab) and movement (sig))
Usage: mainly people who were born profoundly deaf, although mute people also use BSL to express themselves.

Key
Hand signs: does this system use hand signs? The term simplified BSL means the signs are based on BSL but are adapted for the user. The term generated means the signs are created for the particular sign system.
Colour codes: does this system use colour coding to help identify sounds?
Fingerspelling: does this system use fingerspelling? It can be of either one-handed (FS1) or two-handed (FS2) fingerspelling.
Sentence structure: the most typical type form of sentence. It can be subject-verb-object (e.g. Have you been to France?) or topic-comment (e.g. France been?)
Grammatical markers: does this system use signs to mark the endings of words e.g. '-s' for plural.
Voiced: does this system require the signer to voice the words? Note that unvoiced words are written as crossed out e.g. you (in BSL you would simply point, without saying the word).
Mouth patterns: does this system require the signer to mouth the words?
Word order: which language order does this system use: BSL or BEL?
Key words only: does this system require the signer to sign only key words?
Graphic symbols: does this system also include additional graphic/iconic symbols?

References
1. 'Sign Language: The study of deaf people and their language' by J.G. Kyle and B Woll (1985). The book is dated but much of the information is still relevant, particularly chapter 13.
2. 'Sign In Sight: A Step into the Deaf World' by Cath Smith (1992)
3. 'Words In Hand: A structural analysis of the signs of the British Sign Language' by Mary Brennan, Martin D Colville and Lilian K Lawson (1984).
4. 'Dictionary of British Sign Language/English' edited by David Brien (1992). 
5. 'Makaton Core Vocabulary Signs', The Makaton Charity (2010).
6. 'British Sign Language: London and South East Regional Signs' by Frances Elton and Linda Squelch (2009).
7. 'Manual Communication: Implications for Education' edited by Harry Bornstein (1990).
8. 'The Linguistics of British Sign Language: An Introduction' by Rachel Sutton-Spence and Bencie Woll (1999).
9. 'The Comprehensive Signed English Dictionary' edited by Harry Bornstein, Karen L Saulnier and Lillian B Hamilton (1983).
10. 'Sing and Sign Vocabulary Book' by Sasha Felix (2005).
11. 'Let's Sign Dictionary: Everyday BSL for Learners' by Cath Smith (2009).
12. Signed Systems by Frances Elton.
13: 'Hidden Histories: Deaf Education in the Seventies'.

Should Maria be signing in Makaton or BSL?

I've met several children with RTS who have the same problem as Maria: they can understand spoken language but they have difficulty speaking it. This is usually expressed as good receptive but poor expressive language skills.

In situations like these it's common for the experts (Educational Psychologist, Speech and Language Therapist) to recommend other modes of language expression (the jargon is augmentative and alternative communication, abbreviated to AAC) which include sign systems (like Makaton and Singalong) and symbolic systems (like PECS and Proloquo2go). These systems are not as nuanced as a full language but they do provide a basic means of communication. Also sign systems are much quicker to use than symbolic systems when communicating with someone.

It's quite common nowadays for parents to use baby sign language from the age of one onwards. This helps young childen express basic needs such as hunger, thirst and toilet well before they can speak. Maria was about three years old when she started to baby sign and was very keen to learn, picking up her first ten signs in less than thirty minutes. We used the inspirational Sing and Sign DVDs by Sasha Felix which teach a mixture of Makaton and Signalong signs. Maria and Isabella loved to watch these DVDs and Maria knew them backwards (she could turn her back to the TV and sign any bit of the video). It was no accident that I bought these DVDs; at the age of two I could sense Maria's need to express herself and by three years she was clearly getting frustrated. At age three she'd been babbling for over a year and was using gestures to communicate, so signing seemed a natural extension of this behaviour.  Little did I realise just how important Makaton would become as Maria's first expressive language.

I knew from Cathy Stevens (2011) that at least 15% of adults with RTS develop no speech. At that time (2 to 4 years old) Maria was showing little aptitude for speech and so I decided to have a backup plan just in case she became one of the 15% that never learnt to speak. Baby signing followed by Makaton seemed like a good choice for now but what if Maria reached the age of six and still couldn't speak? Was she supposed to use Makaton for the rest of her life? Didn't Maria deserve to be taught a proper language to express herself? If so then which language should it be?

The main sign language of the UK is British Sign Language (BSL) but when I suggested using this to the 'experts' (the Educational Psychologist, the LEA Head of SEN and the London deaf school) they all said 'no' for different reasons.The Educational Psychologist thought it was the wrong choice and insisted it should be Makaton (but was sure Maria would speak anyway). The LEA Head of SEN told me that only deaf children are permitted access to BSL schools; and the London deaf school told me they only take deaf children. 

All these opinions got me researching some of the sign systems and sign languages used by people in the UK to see which was the best choice for Maria in her later years, should she never develop speech.

What is the best school for Maria: mainstream or special?

The decision to send Maria to a Special School was much easier than I'd expected. 

I'd been reading the book 'Working with Hannah: a special girl in a mainstream school' by Liz Wise and Chris Glass, and I was ready to fight for a place for Maria in one of our local mainstream schools. 

One day in July 2012, we'd arranged two appointments that morning. The second was to meet with the Head of SEN to discuss Maria's Statement of SEN. Fortunately, just before that meeting Joan and I went to visit our local Special School. The deputy head showed us around and answered all our questions mainly with honesty but also with a touch of diplomacy.

The more I saw, the more impressed I became and soon realised that Maria would flourish in a place that completely understood her needs, without having to fight for concessions,  provisions and equality. 

By the time we arrived for the appointment with the Head of SEN, all I wanted was to get a place for Maria at the school. The deputy head told us of a shortage of places and how oversubscribed they were. To make things worse, we were applying late; I couldn't see how Maria would get a place. 

After our meeting with the Head of SEN, he said he'd speak to the school. Within a week we received a letter offering us a place at the school! Maybe the Head of SEN wasn't all bad after all! 

One year on as our intuitions about the school proved right. Maria has thrived and developed wonderfully. She's enjoyed every minute and there's no doubt it's the right place for her to be at present. 

The school Ofsted reports only rated it as 'Good' but, according to the same report, parents rate it highly. I can see why; it's hard to imagine a better environment for Maria. As far as I'm concerned it's an 'Outstanding' school.  

I feel a bit guilty because I've given the Head Teacher a hard time this year while I've learnt how the school system operates. The school has tried hard to improve its communication with parents and, one year on, I'm beginning to see the benefits of having made the right choice: the sheer joy on Maria's face when she goes to school each morning and returns home with stories of what happened that day (expressed in babble, English and Makaton) and Maria's significant educational achievements make us appreciate how much the school has done for her this year. 

What are Maria's educational needs?

Teacher Maria

How do you work out the educational needs of a child with RTS? With so few 'experts' and specialists of RTS, what at the chances we're getting the right advice?

That's the $64,000 question. The fact is that each child with RTS (or any other syndrome for that matter) is a unique person with unique challenges. Experts and school teachers are very good at recognising the common symptoms and applying remedies. Quite often techniques that work for one syndrome can be applied to another. 

For example, many syndromes result in speech delay.  The usual solution is to use several simultaneous methods of expressive communication: a manual system like Makaton together with a visual system like PECS and an oral system like Cued Articulation with speech therapy. 

When this approach is extended even further to include areas like music, touch and body movement then the system is called Total Communication. The aim is to try every major method of expression to see which works best for that individual. Bear in mind that different solutions may be dominant at different stages of development. 

For example, Maria used a manual system at the age of three but is progressing to an oral system now she is five. She uses visual systems mainly at school for organising her day, but for other children the visual system may be a vital entry point into communication.

Getting back to the question of Maria's educational needs. These were determined by a group of 'experts' specialising in different fields, who gave their opinion on Maria's current and future state. They made recommendations in their reports which fed into Maria's Special Educational Needs (SEN) statement, which has the status of a legal document, compeling the Local Education Authority (LEA) to provide the services that Maria needs at school. 

For example, the first expert was a geneticist, who confirmed Maria's diagnosis of RTS. The next was the educational psychologist who assessed Maria's mental state  and concluded she was delayed in specific areas, recommending, among other things, using Makaton; Maria was almost four years old and was about to start school. Then came the speech & language therapist with her report. Then the occupational therapist. Then the paediatrician who collated all of Maria's medical reports from other specialists, namely: the orthodontist (dentist), the gastroenterologist (throat and stomach), the ophthalmologist (eyesight), the audiologist (hearing), the kidney ultrasound specialist, the skin & eczema consultant, the cardiologist, the clinical imaging team (to check Maria's swallowing and gagging) and the orthopaedics consultant. Some of these appointments were attended several times, and that's not including all the times we attended the General Practitioner's (GP) clinic in order to be referred to these specialists!

All the reports fed into Maria's SEN statement, compiled initially by the Head of SEN at the LEA. He worked out what provisions Maria needed and sent us a copy of the first draft for approval. This is a crucial stage. Don't agree to this draft if you're not happy with the provisions. Normally the document will reflect the opinions of the experts, so unless you can find an expert to support your views then you'll find it difficult to simply insert your own comments in the crucial parts 2 and 3 of the Statement. We met up with the Head of SEN to discuss a few issues, particularly that of teaching Maria BSL rather than Makaton, but he wasn't sympathetic to our views and basically told us that BSL is only provided for children with severe hearing problems. Finally we agree some revisions to the statement and soon after received a copy of the Final Statement of Special Educational Needs. That was to become the document that would define what help Maria would get at school.   

Of course the LEA is strapped for cash and won't give a child anything it doesn't deem essential. By essential they mean whatever the experts recommend. It's not that long ago that speech & language therapy (SALT) was viewed by them as unnecessary, After parents fought and won that battle, it then became the turn of the occupational therapist (OT) to establish their place. Now that both these services are more established (although Maria's Head Teacher told me the LEA only gives OT to autistic children at her school) there are other services that still need wide acceptance by the LEA; one is music therapy. Only in exceptional circumstances does the LEA fund this hocus-pocus treatment. In fact, the last time I spoke to the Head of SEN he told me that music therapy for Maria 'is not an educational need'. What did he mean by that? When I asked him, he simply dodged the question. He wasn't going to educate me sufficiently to allow me to challenge his view. I also knew that I would need a fairly strong argument to challenge his view at a Tribunal. 

But what did he mean by 'not an educational need'? My guess is he meant that if it's not in Part 3 of the Statement of SEN then, by definition, it's not an educational need. The way to get it into Part 3 is to get an expert to make a recommendation that is accepted in Part 2 and then translated into an educational need in Part 3. This 'translation' is initially done by the Head of SEN but can be challenged at a Tribunal. Usually it doesn't get to that stage because the LEA thinks hard before letting it get that far. So, being a determined and switched-on parent is the only way to help your child. If you have the expert backup then don't take no for an answer. 

Joan and I are the only true advocates of Maria. The school and the LEA have their own agendas; too often constrained by finances, their motives should always be questioned by parents. 

Like all concerned parents, we observe Maria and take note of her needs and interests. This knowledge can be used to help motivate Maria to learn new things. Maria loves to dance and sing; this enthusiasm on Maria's part can be used to help develop her speech, her gross and fine motor skills and her attention span.