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Additional needs

Photo: There are a range of communication techniques especially for deaf children with additional needs

AAC is the term used to describe ways of communicating which can be added to, or substituted for, spoken English, British Sign Language (BSL) or writing when a person needs extra or different ways to help them communicate to the best of their ability. AAC can be a way to help your child understand, as well as express themselves, and is divided into two types of communicating: unaided and aided communication.

Unaided communication

Unaided communication is communication that does not use any extra equipment. It can include:

  • signing systems such as BSL
  • vocalisations
  • gestures
  • facial expressions
  • pointing.

Aided communication

Aided methods of augmentative communication may be ‘low-tech’ or 'high-tech’.

Low-tech communication systems can be anything you use which does require power to work, such as a pen and paper, alphabet charts or books with picture symbols or photos.

High-tech communication systems are devices requiring at least a battery to operate: such as pointer boards, electronic books or toys, specialised computers and software programs, electronic devices that speak and/or print.

You can find out more about AAC on the Communication Matters website.

Makaton is a communication programme which uses signs, symbols and everyday speech to support communication. 

With Makaton, parents and professionals speak and sign or point to symbols at the same time, and the signs and symbols provide visual support for the key words you are saying. The signs and symbols are used until your child has learned them and then they are dropped.

Makaton symbols have been specifically designed to support the written word in the same way that the signs support speech. In this way Makaton can help a child not only to learn language and communication but also support the development of literacy.

Makaton is often used together with a wide variety of early intervention strategies and communication approaches for children with additional and complex needs such as TEACCH, PECS and DLS and is also used to support older children, young people and adults according to their need. 

You can find out more about Makaton by speaking to your child’s speech and language therapist or Teacher of the Deaf. Also, The Makaton Charity has a network of tutors providing training and support for families and practitioners across the UK.

Blissymbolics are meaning-based symbols which help those people with severe physical or learning difficulties who cannot communicate through speech or sign language. This approach is used with children at school rather than in the home.

Blissymbolics is a ‘language’ of some 3,000 symbols which has a wide vocabulary and its own grammar.

Like all parents of deaf children, however, you need to gather information about your possible choices. Then in discussion with the professionals who support you, others who know your child well, and in the light of your own expert knowledge of your child, you can make informed choices. The right to informed choice is the same for all parents. Remember that no choice is for life: choices can be refined and remade if they don’t support your child’s best progress and another would be better.

Equally, in the case of a child with additional needs, if you are using a specialised approach in the early years, your child may ‘outgrow’ the approach and you may need to change to one that offers a fuller language to ensure you are enabling them to reach his potential. For example, your child may need to ‘move up’ from Makaton to British Sign Language.

The most important thing is that, like all children, your child has the best support both to learn from and to influence the world around them, to make choices and to enjoy relationships with you and others. Different children can do this in different ways. Many children with additional needs thrive using Sign Bilingual, or Auditory-Oral methods. Don’t feel that because your child has other needs in addition to deafness that one or more of these approaches cannot work for you. For others, more specialised or technological support may be needed.

Whichever approach or combination of methods you choose, keep an open mind, be flexible about your child’s changing needs and always keep in mind how your child can be supported to reach their full communication potential.

For more information see the Blissymbolics Communication International website


Hands-on signing is based on British Sign Language. A deafblind person follows the signs by putting their hands over a signing person’s hands and feeling the signs being made.

Using the deafblind manual alphabet, words are spelled out onto a deaf person’s hand. It is of course necessary to know the language being used and how words are spelled to be able to use this approach, in the same way as it is for ordinary fingerspelling.

The Picture Exchange Communication system (PECs) uses pictures to help children with autism and severe communication needs to initiate communication and to make choices. Initially the child is able to make simple requests, but with intensive support, it is possible to communicate in more complex sentences.

The use of PECs can be combined with other modes of communication and its main aim is to support everyday communication interaction rather than ‘language’ or curriculum targets. In order to use PECs, adults and teachers need to be trained on a two-day PECs course.

For more information, visit the PECs website