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Communication options for deaf children with additional needs

The term ‘additional need’ refers to a health or developmental condition which impacts on a child’s daily life. We use the term ‘additional need’ to mean any disability or long-term health condition other than deafness. If your child is deaf and has an additional need, you may wonder how this might affect their communication choices.

In many cases, deaf children with additional needs can communicate effectively using the same communication methods as deaf children without additional needs. Many children with additional needs thrive using sign language, spoken language, or a combination of both. Don’t feel that your child’s additional needs mean that one or more of these approaches won’t work for you.

However, some children with additional needs will need to use a more specialised communication method. On this page, we explore some of the specialised communication methods which deaf children with additional needs might find useful.

If your child uses a specialised approach in the early years, keep in mind that they might ‘outgrow’ this approach. As they get older, you may need to change to a different approach to ensure they’re enabled to reach their full potential. For example, if your child’s nursery uses Makaton, you might need to consider finding a school which uses British Sign Language (BSL) in the future.

Whichever approach or combination of methods you choose, keep an open mind and be flexible about your child’s changing needs. The most important thing is that, like all children, your child has the best support to learn from and influence the world around them, to make choices and to enjoy relationships with you and others. Different children can do this in different ways.

Total communication

Total communication is a way of communicating using any methods available to your child. This might include methods like signing, speech, vocalisations (noises which aren’t recognisable speech sounds), facial expressions, body language, touch, written words, symbols, objects, behaviour, or assistive devices like eye-gaze technology and iPads.

Using a total communication approach means families and professionals can work with a child’s individual strengths to find the best way to communicate. For example, if your child understands signing but finds it difficult to sign back, they might use a different communication method, such as gestures and eye movements, to express themselves. If your child uses total communication, it may be helpful to list their preferred communication methods on a personal passport, as a reminder to professionals working with them.

Jennie, mum to Connie (5) who is profoundly deaf and has cerebral palsy.

“We’ve decided to send her to a special school because of the barriers she has to communication. She’s what we call a total communicator. Her understanding of spoken language is within the expected range for her age, so she’s semi-verbal and uses speech, British Sign Language (BSL), which is slightly hindered by her cerebral palsy, a lot of facial expressions and a communication aid as well.”

Olive's choice

Olive is profoundly deaf and has cerebral palsy, making choosing the right hearing technology and communication approach an important decision for the family. Mum Jennie explains how they make Total Communication work for them.

Read Olive's story.

Intensive interaction

Intensive interaction was designed for children and adults with severe, profound or complex learning difficulties or autism. It treats all behaviours as a form of communication, encouraging the individual to communicate in way which is natural to them.

In intensive interaction, the person with learning difficulties or autism takes the lead. Their communication partner pays close attention to their behaviour, mirroring or copying them, or taking it in turns to make a particular noise or movement, led by the person. This can help to develop elements of communication like taking turns, negotiating and making eye contact. This may eventually lead to more formal communication.

Visit Intensive Interaction for more information.

Communication aids

Communication aids can help a person to communicate in addition to, or instead of, speaking or signing. There are lots of different communication aids available. From low-tech aided language displays (ALDs) and E-Tran frames (where a person uses their eyes to point at different letters, pictures or symbols on a board), to high-tech computer systems and software, such as a speech output device. These are often called augmentative and alternative communication (AAC) tools.

Using a communication aid takes time and practise, both for the child or young person using the device and the people they’re communicating with. More high-tech AAC devices can also be very expensive. If you think your child would benefit from using a communication aid, a speech and language therapist can assess your child to identify the type of communication aid they might find useful.

Visit Ability Net for more information about the different types of communication aids available.

Picture Exchange Communication system (PECs)

PECs is an AAC system which uses pictures to help children with communication or learning needs to initiate communication and make choices. Children are encouraged to make simple requests by choosing a picturing of the thing they want and need, with the aim of building up to more complex sentences.

For more information, visit the PECs website.

Sign systems

Sign systems like Makaton and Signalong are communication programmes which use signs and symbols to support speech. They’re often used as an early intervention strategy for children with speech and language difficulties, and may also be used to support older children, young people and adults with learning difficulties or developmental delays. Although British sign systems are based on signs taken from British Sign Language (BSL), they’re not sign languages and may not be suitable for deaf children who are likely to use BSL in the future.

If you're considering using a sign system with your child, it's important that both you and the professionals who work with your child understand the differences between sign languages and sign systems. For more information, read our webpage on sign systems.

Tactile signing

Tactile signing is a way of signing which uses touch. This can allow deafblind children, or deaf children with visual impairments, to access sign language, sign systems or fingerspelling. In the UK, tactile signing is usually based on BSL. Visit our webpage for more information about tactile signing.

Sense’s website has more information on tactile signing and other methods of communication for children and people with complex disabilities.