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Baby Signing

Research · April 2015

DOI: 10.13140/RG.2.1.3684.8161

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 BABY SIGNING:
CONTROVERSIAL PRACTICE IN SPEECH PATHOLOGY
AND AUDIOLOGY

Karen Levin, 2014 ©

The recent debates surrounding the practice of teaching typically developing

children in the first year of life to use formal sign language raises clinical, ethical, and
theoretical questions which demand attention. In this document, I propose that at this
juncture, the practice by speech pathologists and/or audiologists of teaching typically
developing babies to sign falls into the category of “controversial practice”. This article is
an exploratory analysis of teaching baby signing by speech language therapists and/or
audiologists, using a 10-condition model that could be used to define controversial
practice.

Alone, the conditions do not render a practice controversial; in combination, it is

easier to gain a perspective on whether a practice is not controversial. The adjective
‘controversial’ does not deem a practice unsafe, unacceptable, dangerous, unfair, to be
avoided, discriminatory; or bad. It also does not mean that a practice is unproven
because even proven-to-work practice can be controversial. It deems it to be arguable,
debatable, and worthy of deep deliberation by speech-language and audiology
professionals who are considering adopting the practice.
 Table 1: Ten conditions which could render a practice controversial

1. Practice which has a small base of solid evidence on which to base

decisions
2. Practice which lacks a substantial base of solid empirical evidence on
which to base decisions
3. Practice which is harmful or potentially harmful
4. Practice which is potentially commercially exploitative
5. Practice which is unnecessary
6. Practice which falls outside the scope of practice of the profession
7. Practice which is open
8. Practice which involves difficulty with the measurement of behavioural
changes
9. Practice which challenges ethical principles such as justice
10. Practice that is advertised and popularised

1. Practice which has a small base of solid evidence on which to base

decisions

We have a small base of evidence that baby signing is of benefit to hearing, typically
developing children. The range of researchers in the field is very small. The justification
for baby signing is based to a large extent on the work of Linda Acredolo and Susan
Goodwyn. (Acredelo, 1989; Acredelo & Goodwyn, 1985, 1988, 1990a, 1990b, 2000;
Goodwyn, Acredelo & Brown, 2000). Much influence has come from Joseph Garcia
(SIGN with your BABY®) and Marilyn Daniels at has published a little (Daniels,
1993,1994, 1996,1997). In a number of publications in credible scientific journals and
books edited by well-regarded academics, these researchers have demonstrated in a
small number of studies on typically developing normal hearing babies that
 a) babies spontaneously produce gestures

b) some babies produce a large range of gestures

c) babies can learn to use gestures through modeling

d). babies who learn signs might have a verbal language advantage

e) some babies who learned sign had higher IQs at age 8-years

As in the analysis of any efficacy study, we must ask some questions about the
research methodologies. These published studies are fairly strong, but there are no
randomized controlled studies that show unequivocally that baby signing is of significant
value. In a review of studies published to 2005, Johnston, Durieux-Smith and Bloom
(2005) searched databases, reference lists and the Internet for relevant documents
using a pre-determined search protocol. Only 17 reports met with the search criteria
and were evaluated. The review found no evidence that baby signing facilitates language
development. Of great importance is that the review based its conclusions on the fact
that the methodologies used to try to prove that baby signing works were markedly
insufficient. In addition, they found that the results across the studies were not
equivocal.

When reading the few studies that exist on the effectiveness of baby signing one
is tempted to question how these babies who were taught signs would compare to
babies enrolled in a ‘talk to your baby’ type programme. The question that arises is
whether the signing itself is responsible for the increased communicative competence,
or whether other variables came into play: the features of parents who enrolled in the
programme, the focus on communication; the consistency and compliance of parents
enrolled in a research programme, and so on. So, until the very small base of evidence
grows to the point where it provides stronger evidence, and more of it, as professionals
who base their work on scientific evidence we cannot be convinced that baby signing is
of value. We have to consider our role as a profession in seeking the evidence.
 2. Practice which lacks a substantial base of solid empirical evidence
on which to base decisions

Despite an enormous amount of anecdotal evidence (i.e. the hundreds of testimonies of

parents of babies who were taught to sign, published by the producers of the baby
signing programmes in their handouts and on their websites), there is very little
published data in scientific journals with regard to the goals and effectiveness of
teaching typically developing babies to sign. However, we do have a substantial
knowledge base with reference to infant gesture in general:

 We have a fairly substantial literature base which describes

gestures used by babies in the pre-lingual and early locutionary stages of
language development, and which provides well developed theories about the
role of gesture in language development. See, for example, the large body of
work of Goldin-Meadow and her colleagues (Goldin-Meadow, 1998; Goldin-
Meadow et al, 2007; Morford & Goldin-Meadow, 1992; Ozcaliskan & Goldin-
Meadow, 2005).

 We have some literature which has examined the gestures that

mothers use when communicating with their babies and young children, with a
range of theories offering explanations for the meaning of maternal gestures.
See, for example, Falk (2004) and O’Neill et al. (2005)

 We have information with regard to the ability of deaf and/or

hard of hearing babies to learn formalized sign languages, from a fairly extensive
literature on sign language. There is a growing body of research surrounding sign
language used by hearing children of deaf parents.
  There is a substantial literature from the AAC base that
unequivocally demonstrates the benefits of manual communication for the
development of speech, language and communication in babies and children
who are challenged in their development of typical modes of communication.

Unfortunately, many commercial baby sign language companies use this diverse
range of research to justify baby signing with typically developing babies. There is no
doubt that babies spontaneously use and learn gesture and that mothers gesture to
them; there is evidence that babies of deaf parents use sign early, and no one doubts
the value of teaching signs to communicatively impaired or at risk babies. However, one
cannot use this associated research alone to justify teaching typically developing babies
to sign. The fields of enquiry and practice are associated; they are not linked.

3. Practice which is harmful or potentially harmful

Can teaching babies to sign do harm? Grove, Herman, Morgan and Woll (2004) of the
Department of Language and Communication Sciences, City University, London wrote
“We know of at least one case (from a colleague at City University) where a mother’s
decision to focus entirely on teaching baby sign and to ignore vocalisations has actually
retarded her son’s spoken language development”. Anecdotal evidence is not
demonstrated evidence. Children of caregivers who are encouraged to communicate
more with their children and/or who are actively involved in a communication
programme with their children will benefit in both the short and the long term in terms
of language and cognitive development. But the question arises as to whether it is
harmful to replace oral communication or place emphasis on manual communication. At
this juncture, we have no evidence to show that baby signing is harmful with regard to
the speech-language development of typically developing children.

Harm comes in many forms. The popularity of anything ‘baby-good’ in more

developed contexts and more resourced communities is testimony to the inherent
desire for caregivers to promote the development of their children. Consider the
popularity of programmes that promote baby exercise, massage, early book reading,
clambering and climbing, special music DVDs that claim to promote higher intellectual
development, and so on. The question posed under this condition is what message they
send to caregivers in contemporary society in many of the world’s communities in which
communication and language skills of young children are valued. The popularity of baby
signing programmes throughout the world might not be due to the efficacy of the
programmes, but due to the societal pressure under which modern parents are placed
with regard to the development of their children. We as a profession must consider
whether any of our practices collude with these processes.

4. Practice which is unnecessary

Proponents of baby signing claim that early signing has a range of benefits. Examples of
the claims of a local organization are provided in table 2. There is no doubt that parents
in societies that promote infant development would wish for these benefits. We do not
have evidence to support most of the claims made by the proponents of baby signing,
but even if we did have evidence to support claims such as ‘accelerated verbal language
development’, or ‘promotes bilingualism’, or ‘ improves vocabulary’, one must ask
whether this encouragement of precocity is necessary. Many arguments could be put
forward in either direction, but the question must be approached by us as a group of
professionals trained in cognitive and psycholinguistic development and communication
pathology.

I will examine one of the claims made to explain this point. One of the
motivations for teaching baby signing is that babies experience frustration because they
cannot communicate. We must consider why and how babies make their needs known,
and why the promoters of baby signing posit that babies experience tremendous
frustration at their inability to communicate.
 From a theoretical perspective, consider the role of linguistic responsivity in
language development. In a significant body of research and theory on early language
development, the role of the caregiver’s early interpretation of her child’s behaviours
has been delineated as an important developmental precursor to language
development. In a nutshell, a range of researchers have suggested that in the
perlocutionary stage, caregivers interpret their babies’ behaviours as if they are of
communicative value. These researchers further hypothesize that these attempts
gradually come to shape the baby’s communication so that meaning comes to be
consistently and jointly interpreted (Owens, 2005). The caregivers come to be
responsive to their babies’ needs; linguistic responsivity develops over time; and this
responsivity takes on different forms. It is this linguistic responsivity on the part of the
adult that is hypothesized to support the child in his or her stepping into the world of
words. For example, when babies start to generate their own gestures, mothers
translate their children’s gestures into words, providing timely models for how one- and
two-word ideas can be expressed (Goldin-Meadow et al., 2007). This responsivity is a
developmentally important precursor to later communication and socio-emotional
development (See, for example, Girolametto et al, 2002; Girolametto & Weitzman,
2002; Girolametto, Weitzman and Greenberg, 2003). So are babies frustrated? Well,
babies certainly indicate that they want something; maybe their crying and or lack of
specificity is read as ‘frustration’ by some; by others, it may read as the child’s natural
form of expression that calls attention to itself, and as a result, enforces the responsivity
of the caregiver.

Thus we have to ask ourselves whether it necessary to teach them signs to make
their needs known in a more direct and specific manner. The answer is not simple.
Thompson et al. (2007) taught four infants ranging in age from 6 to 10 months a simple
sign using delayed prompting and reinforcement. One of their findings was that crying
and whining were replaced with signing when sign training was implemented in
combination with extinction. But this is only one study, conducted under laboratory
conditions. Millions of babies in various linguistic groups across the globe have learned
language without learning signs. But does learning signs lessen the ‘frustration’, making
communication easier for both caregiver and child? At this time there is no hard
evidence to show that the babies of parents who are linguistically responsive are more
frustrated than babies of parents who taught them to sign; we also do not have any
evidence that teaching sign is harmful to the development of linguistic responsiveness.

Table 2: The benefits of teaching sign language to a pre-verbal baby according

to Baby Hands SA

 Accelerates Verbal Language Development

 Enables preverbal children to communicate their wants

and needs much earlier in their life.

 Reduces frustration for babies and their caregivers

 Gain insight into your baby’s world

 Strengthens the parent-infant bond

 Stimulates intellectual development, (research shows a

higher IQ level)

 Enhance infant’s self-esteem

 Improves English vocabulary

 Promotes bilingualism

 Encourages an early interest in books and reading

5. Practice which involves difficulty with the measurement of

behavioural changes

One of the hallmarks of scientific practice is the measurement of change. Every therapy
session involves determining which behaviours to target to change, the selection of valid
standardized or non-standardised measures to employ, baseline measurement, and
outcome measurement. In fact, the ability to carry out effectiveness and efficacy
research studies is fundamental to successful clinical practice. Only then can a practicing
clinician justify intervention and continued intervention with a client. At this juncture,
we have sufficient knowledge regarding infant development so as to be able to develop
sensitive and valid measures of developmental change. The difficulty lies with the choice
of what to measure. We usually describe and define the communication problem, set
hypotheses, employ techniques to encourage behavioural change, and test our
hypotheses. What would the goals be of employing baby signing?

6. Practice which is potentially commercially exploitative

Baby signing programmes are not free. They are commercially viable business projects.
There are many baby signing programmes and franchises available both internationally
and locally. Although we bemoan our relatively limited income possibilities as speech
pathologists and/or audiologists in South Africa, we cannot sell our services within a
traditional business model; we have to operate within the confines imposed on our
practice by our professional belonging. Can we charge per half hour for a Baby Signing
Class? As we charge for a timed stuttering session? This is certainly possible. However, if
we are to incorporate baby signing in our professional scope, then we have to consider
our role in relation to the extensive baby signing business models that exist.

7. Practice which falls outside the scope of practice of the

profession

Is our profession limited to the provision of services to people with communication

disorders? In traditional models, the answer is a firm yes. However, one may argue that
the provision of communication enhancement programmes to typically developing
children is justified by two main points.
 The first point is that children in contemporary society are vulnerable and at risk
of developmental delays including communication disorders due to modern
environmental and social risk factors, and that any measures that can put into place to
prevent developmental delay, no matter how severe, are necessary.

The other argument is that our profession is self limiting in its growth unless it
adopts a broader view of communication. Some argue that we should not confine our
services to people with traditionally defined communication disorders. To the same end,
should our scope of practice include the training of people who do not have
communication disorders to communicate better, such as in business presentations and
classroom teaching (what has come to be known by some as “commercial speech
pathology”)?

However, given the current description of our scope of practice, providing

intervention to children who do not present with any known risk to communication
development might be construed as beyond the scope of practice, and would therefore
be unacceptable. Unacceptable practice is not controversial practice. Practice beyond
the scope of practice is wrong. But, we must also consider whether we ought to
challenge the prescribed, traditional and current scope of practice.

8. Practice which is open

When practice is closed, it lacks transparency. Consider neurodevelopmental (or

Bobath) therapy and Sensory Integration Therapy (Ayres). Both of these therapy
approaches are based on highly specialized training. NDT can be learned and practiced
by speech-language, occupational and physiotherapists. Sensory Integration Therapy
can be practiced by occupational therapists only. This exclusivity renders these practices
controversial. Conversely, practice that is open is also controversial. Consider the role of
the commercial speech and drama teacher, who runs a business concerned with
communication skills in the workplace, which is not regulated. This person is entitled to
enroll a person who stutters in a programme to help the person to manage his
stuttering in the workplace. There is no doubt that our profession is uncomfortable with
such open practice, but the scenario does not render what we do as controversial. If we
were to incorporate teaching baby signing into our scope of practice, we would have to
be very careful with regard to how we align ourselves with people who provide the
same or similar services but without professional regulation.

9. Practice which challenges the ethical principle of distributive justice

service provision.

The provision of baby signing to typically developing children raises ethical dilemmas for
our profession. Offering the services of scarce professions to children who do not need
intervention defies the ethical principle of justice. In contexts such as South Africa,
where the availability of speech-language therapy services is significantly limited, the
profession has to justify its actions against a background of distributive justice. In simple
terms, distributive justice is fairness in distributing goods, services or amenities to
people in such a way that those most disadvantaged receive a greater share.
Considering the number of people in South Africa who experience communication
impairments, the profession must examine very carefully its ethical responsibilities with
regard to providing services to babies who do not require intervention per se. In
resourced communities, and even in wealthier countries, healthcare and education
systems are feeling the economic pinch. Perhaps we have to consider moving from the
ethic of individual rights (on which our profession is built) to an ethic of the common
good, in order to function more effectively as a scarce profession.
 10. Practice that is advertised and popularized

Baby signing is made to look unbelievably appealing and fun. The marketing
strategies are designed to sell the product (i.e. the baby signing programme). Websites
are colourful, full of anecdotes, replete with claims some of which are outrageous and
some which are possible but untested. In the movie ‘Meet the Fockers’, Little Jack, the
baby grandson of Jack (played by Robert De Niro) is taught American Sign Language. The
signing is not only amusing but forms a central theme to the plot. Joseph Garcia’s book,
SIGN with your BABY®, was featured in the movie.

There is no doubt as to the popularity of baby signing – it is heavily marketed,

and is coupled with appeal (i.e. parents being attracted to engaging in a novel and fun
activity with their children). Unfortunately, we also have to look carefully at the claims
which are made, some of which are disingenuous. The claims suggest that parents are
not nurturing their children well unless they teach them to sign. Parents are told in the
advertising and promotional literature that their babies are frustrated; and that they will
not grow up to be as clever as those who sign. This message is strong and is exploited in
order to sell the idea of baby signing.

As a profession, we do not market our work. We do not try to convince people to

‘buy’ what we do from a commercial perspective nor from a belief perspective. We do
not market any one particular approach to any aspect of our work. No one programme,
technique or theory is adhered to. We select the method to suit the individual’s need.
Hence, we must deliberate on our goodness of fit with a practice that is heavily
marketed.
 Conclusion

We simply do not know if there are significant gains to be made by typically developing
babies who are taught to sign. In time, there might emerge a body of evidence that will
show unequivocally the gains to be had from baby signing. Until then, the practice of
baby signing by speech-language pathologists in under-resourced contexts or in
contexts in which healthcare and education systems are financially pressed cannot be
endorsed without deep deliberation. We must consider carefully our involvement in
what is potentially commercially exploitative business. We must, however, guard against
being overly skeptical or prescriptive such that possible gains to be made from baby
signing are overlooked. For example, it may be that the study of the learning of signs by
typically developing babies may shed light on the learning of signs by the children who
present with communication disorders; it may reveal more information with regard to
infant linguistic knowledge and processing. We must be open to change and growth, but
we must be careful.

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