MAKATON Makaton is a form of Augmentative and Alternative Communication (AAC) used with children and adults who are unable to speak or whose speech is difficult to understand (Bloomberg, 1998). As presented in the Basic Makaton Workshop (Milton, 2005), Makaton is a key word signing system that aims to provide a basic means of communication and encourage language development. Makaton comprises of a small vocabulary derived from Australasian Signed English and Australian Sign Language (AUSLAN) . The signs used in Makaton are concepts/ideas selected in accordance to what is considered to be most appropriate for the needs of children with communication and language difficulties. When using Makaton, normal grammatical speech is spoken with key words signed in word order. This aids the child’s ability to communicate by supplementing spoken language via a visual means. This process allows the child to understand information and encourages the development of spoken language (Milton, 2005). AUTISM AND MAKATON Many children with autism present with little or no verbal output (Chan, Chan, Cheung, Leung, & Cheung, 2005), as such an AAC system can be introduced as an alternative means of communication on either a temporary basis, until speech develops, or on a permanent basis (Beukelman & Mirenda, 1998). However, Beukelman and Mirenda (1998) also note that it is necessary to remember that a child with autism’s inability to develop their communication is not a result of difficulty with output mode but rather communicative intent and comprehension of language and communication itself. Hence it is likely a child with autism will develop the ability to use simple signs to request wants and needs rather than signing for extensive communication (Paul, 2001). Beukelman & Mirenda (1998) reported when working with children with autism it is important to begin at the child’s level of social, communicative and cognitive development and naturally progress from there. As children with autism frequently have an uneven distribution of skills, intervention should primarily target their linguistic and social abilities. Signs introduced should be selected in relation to the child’s individual ability and needs (Makaton Australia, 2005). Using Makaton principles with a child who has autism may aid their receptive communication . Makaton provides a visual cue, which the child may learn to associate to instructions. This is particularly important for children with autism as their visual-memory skills are often stronger than language ability (Beukelman & Mirenda, 1998). IMPLEMENTATION OF MAKATON People learn to use signs through modelling and experience in their environment. It is recommended that family, friends and support workers, e.g., preschool and/or kindergarten teachers all learn to use Makaton signs effectively with the child. Teaching methods can be introduced and reinforced during Speech Pathology sessions; however these sessions should involve getting the primary caregiver to practice with the child and providing them feedback on how they are using sign with their child. Additionally, as stipulated on the Makaton Australia website formal teaching is of no value unless the signs are practiced in everyday settings. Selecting a signing vocabulary to be taught is done on an individual basis. Many children with autism have a significant delay or a total lack in the development of communicative language (Chan et al., 2005), therefore initially introduce signs that are functional and can be generalised to many situations. For example, you may introduce ‘more.’ ‘More’ can be used in many daily routines such as meal times or playtime and through its introduction you can teach a child to communicate requests . For instance give the child part of a biscuit, when they have finished ask ‘Want more?’ signing the sign for ‘more’. If the child attempts to reach for the biscuit manipulate their reach into the sign ‘more’. Reward any attempt at signing by giving them some of the biscuit. Continue the interaction encouraging them to sign ‘more’. Nouns such as drink and dinner are also concrete and could be introduced in this way. It may also be relevant to introduce signs with simple instructions, e.g., ‘stop’, ‘sit down’ and ‘wait’ and social responses such as ‘hello’ and ‘goodbye’. This will aid comprehension, provide a model for the child to learn from and allow the child to be socially more appropriate. RECEPTIVE LANGUAGE AND MAKATON Using Makaton sign aids a child’s ability to understand verbal communication as: Speech is accompanied by a visual cue. When using Makaton principles the speaker generally slows down, simplifies their language and uses more repetitive speech (Makaton Workshop, 2005). This gives the child more time for auditory processing of shorter instructions. Children learn about communicative intents and the relevance of communication. EXPRESSIVE LANGUAGE AND MAKATON Makaton can supplement speech attempts thereby improving message intelligibility (Makaton Australia, 2005). Sign can be used as an alternative form of communication for a child with no or little speech which is a common presentation in children with autism (Chan et al., 2005) PRAGMATICS AND MAKATON The introduction and teaching of signs may assist the child to develop communication skills such as: Turn taking Initiation Requesting PROFESSIONAL TRAINING It is recommended Speech Pathologists complete a Makaton Workshop before commencing using Makaton as a form of intervention. The workshops enable participants to develop some basic signing skills and practice signing in short phrases (Scope, 2005). TRAINING PROGRAMS Makaton training programs are run by Makaton Victoria in various locations throughout Melbourne and rural Victoria. Alternatively on-site workshops can be arranged to suit individual needs. For more information see the Makaton Australia website: http://www.newcastle.edu.au/centre/sed/makaton RESOURCES Resources have been designed for use following attendance at a professionally presented Makaton Workshop (Refer to Training Programs). It is recommended Speech Pathologists have access to the Makaton Vocabulary which combines pictures and explanations of signs and refer to it before teaching signs to maintain accuracy. The following resources are available through Makaton Victoria: Communication Resource Centre, 830 Whitehorse Rd, Box Hill, 3128. The Makaton Vocabulary: Auslan Edition. Key Signs: A supplement to the Makaton Vocabulary. Makaton Auslan Edition CD-ROM. Sign & Sing with Me. ADVANTAGES OF MAKATON Makaton is a visual approach. Visual-memory skills are generally an area of strength for children with autism (Beukelman & Mirenda, 1998). Training and resources are relatively inexpensive. Learning to use Makaton does not only benefit children with autism, the principles can be applied to aid communication in people with a range of disabilities (Grove & Walker, 1990). The complexity and amount of signs taught can be manipulated depending on the ability of the child. DISADVANTAGES OF MAKATON There is little research specific to the success of using Makaton with children with autism. The child needs to have some social, imitative, and communicative intent before communication can develop (Beukelman & Mirenda, 1998). EFFICACY OF MAKATON This information was sourced from AAC textbooks, websites relating to Makaton and a Makaton training program, knowledge obtained from clinical experience was also incorporated. The evidence cited is level IV (Refer to Evidence Table). Little formal research has been conducted relating specifically to the use of Makaton with children with autism. However, the nature of autism would suggest implementing Makaton with a non-verbal child may enable them to communicate basic intents.