Makaton User case study

September, 2015

The Communication Trust has worked with the Better Communication Research Programme to develop the What Works database of evidenced interventions to support children’s speech, language and communication. What Works is endorsed by the Royal College of Speech and Language Therapists.  For further information please visit:

Kathryn Jones recently submitted the following case study towards the  ‘interventions in practice’ section of the What Works site.

Case study – Using Makaton to develop a Total Communication environment

Kathryn Jones, Speech and Language Therapist (SaLT), Learning Talking Independent Practice (providing speech and language therapy to schools across London).

The setting

S was seen as part of a mainstream school caseload where the therapist was based in school 2 days per week. Intervention was indirect through 2 Learning Support Assistants (LSA), an Intervention Teacher (IT) and with some input to the Class Teacher (CT), sessions were modelled on a weekly basis. Makaton was modelled as a strategy to develop the Total Communication environment.

The SaLT had previously been on a certified 2 day Makaton training course. The client S (5 years old) was in Year 1. The SENCo requested indirect input to support small group literacy and maths lessons.

S had been diagnosed with a speech, language and communication disorder. Communication was mainly through echolalic phrases and behaviours that challenged (including spitting, swearing, hitting). S was interested in current pop stars, hair styling, dolls/babies and food, his interactions were limited to these topic areas. Previous intervention in school was an early communication group targeting attention and listening, social interactions and vocabulary.

Implementing the Makaton strategy

The SaLT and IT would work collaboratively to include Makaton into plans for literacy and maths sessions. In addition the SaLT would model at least one activity per week including Makaton. The SaLT also modelled approximately 3 functional signs to the LSA per week (e.g. finished, lunch), who incorporated these into daily routines. In modelled sessions the Salt would sign and sing e.g. Nursery rhymes, counting songs, and use signs and words to support attention and listening. Initially staff were wary of using signs, possibly due to confidence. The SaLT showed online videos, which S was highly motivated by. The SaLT would sign along with the video and S would attempt to copy, switching his attention between the video and SaLT. As staff saw this they also signed along and researched more Singing Hands materials including buying the DVDs. Singing Hands became part of the daily routine. Some staff members appeared more comfortable signing along to a video, particularly at first. As S’s spontaneous use of Makaton grew, staff began to increase their use of signing, including asking the SaLT for specific signs relating to the curriculum. Using online apps signs could be accessed instantly.

Outcomes and impact

By the end of the first term, S was participating in literacy and maths lessons using speech and sign. He was spontaneously forming speech and sign sentences about play and learning activities, and directing these to familiar adults. There was a general reduction in behaviours that challenged. Staff fed-back to to SaLT they felt Makaton supported S to access learning and achieve on the P-Levels. They took ownership of developing their own use of Makaton. Top Tips A key factor for staff uptake was the observable impact of Makaton use on S’s attention skills, behaviour and expressive language. The SaLT supported staff to identify this e.g. Pointing out increased looking when an adult was signing. The ongoing team approach to Makaton was beneficial for S and staff skill development. The use of multimedia e.g. Singing Hands and MyChoicePad app supported carryover of