What Is Makaton? A Guide to Visual Communication
Author: Ian C. Langtree - Writer/Editor for Disabled World (DW)
Published: 2026/02/15
Publication Type: Scholarly Paper
Category Topic: Journals - Papers - Related Publications
Page Content: Synopsis - Introduction - Main - Insights, Updates
Synopsis: Communication sits at the heart of what makes us human, yet for millions of people around the world, expressing even the simplest thought - asking for a glass of water, telling someone they feel unwell, or saying hello to a friend - remains an exhausting daily struggle. The Makaton Language Program, originally devised in the early 1970s at a Surrey hospital in England, has quietly grown into one of the most widely used augmentative communication systems on the planet, reaching over a million users in the United Kingdom alone and adapted for use in more than 40 countries. This paper examines what Makaton is, how it works, who benefits from it, and what honest criticisms surround its use. Whether you are a parent, a caregiver for an elderly relative, a teacher, a healthcare professional, or simply someone who wants to understand how communication barriers can be lowered, the story of Makaton is one worth knowing - Disabled World (DW).
- Definition: Makaton
Makaton is a communication program developed in the early 1970s in England that uses a combination of speech, hand signs borrowed from the sign language of the local Deaf community, and graphic symbols - simple pictures representing words and concepts - to help people who have difficulty communicating verbally. It is not a language in its own right; rather, it works alongside spoken language, with users speaking full sentences while signing only the most important keywords and, where useful, pointing to printed symbols. Built around a Core Vocabulary of roughly 450 essential concepts arranged in stages of increasing complexity, Makaton is used by children with speech delays, autism, and learning disabilities; by adults with intellectual disabilities, brain injuries, and conditions such as cerebral palsy; and increasingly by older adults living with dementia or recovering from stroke. The program has been adapted for use in more than 40 countries worldwide and is estimated to have over one million active users in the United Kingdom alone. At its heart, Makaton is a practical tool designed to give people a way to express their needs, make choices, and participate in the social world around them when spoken words alone are not enough.
Introduction
What Is Makaton?
Makaton is an augmentative and alternative communication (AAC) system that combines speech, manual signs drawn from the sign language of each country's Deaf community, and graphic symbols - simple line drawings that represent words or concepts. The program was created in 1972–1973 by speech and language therapist Margaret Walker, along with colleagues Kathy Johnston and Tony Cornforth, while all three were working at Botleys Park Hospital in Chertsey, Surrey, England (Cornforth, Johnston, & Walker, 1974). The name "Makaton" itself is a combination of their first names: Margaret, Kathy, and Tony.
At its core, Makaton is not a language in the way that British Sign Language (BSL) or American Sign Language (ASL) is a language. BSL has its own distinct grammar, syntax, and word order, independent of spoken English. Makaton, by contrast, follows spoken English word order and is always used alongside speech - never as a replacement for it. When a person uses Makaton, they speak a full sentence aloud but sign only the "keywords," the most essential information-carrying words, with their hands. This is why Makaton is sometimes called "keyword signing" (Walker & Armfield, 1987). For individuals who cannot sign, Makaton symbols - printed or drawn images - can be pointed to, placed on communication boards, or carried in booklets to support understanding and expression.
The program is structured around a Core Vocabulary of approximately 450 concepts, organized into eight stages of increasing complexity. Stage one begins with immediate, functional needs - words like "eat," "drink," "more," and "stop." Later stages introduce more abstract ideas such as time, emotions, and social concepts. Beyond the core, a much larger Resource Vocabulary of over 11,000 additional concepts provides signs and symbols for a wide range of life experiences, enabling users to expand communication as their skills develop (The Makaton Charity, n.d.).
Main Content
How Does Makaton Work in Practice?
Think of the way most people already communicate. When someone says "come here," they often gesture with their hand at the same time. When a toddler wants to be picked up, she lifts her arms before she has the words to ask. Makaton builds on this natural instinct by formalizing it - giving people a consistent set of signs and pictures that everyone around them can recognize.
A parent using Makaton at the breakfast table might say, "Do you want toast or cereal?" while signing the keywords toast and cereal. The child hears the full English sentence, which supports grammatical development, but also receives the visual reinforcement of the key signs, which helps with comprehension and memory. Research spanning several decades has consistently shown that using signs alongside speech accelerates language development rather than hindering it (Walker, 1978; Sheehy & Duffy, 2009).
Makaton is designed to be flexible. Some individuals use it as a stepping stone, eventually dropping the signs as their spoken language catches up. Others use it as a lifelong communication system. The multimodal approach - where speech, signs, and symbols each reinforce the others - means that communication partners can select whichever combination works best for a given person and situation (The Makaton Charity, n.d.).
Who Uses Makaton?
One of the most common misconceptions about Makaton is that it is only for young children or for people with severe disabilities. In reality, the program serves a remarkably wide range of people, and its user base has expanded well beyond its original clinical setting.
Children and Early Language Development
Makaton has become enormously popular in early-years education across the United Kingdom, and increasingly in other countries. Many mainstream nurseries and primary schools now use Makaton with all children - not just those with diagnosed conditions - because the visual and physical reinforcement of signs helps young learners grasp new vocabulary more quickly. The BBC's long-running children's program Something Special, presented by Justin Fletcher as "Mr Tumble," has been instrumental in bringing Makaton into millions of homes and normalizing its use (LD Network, 2024). Children with conditions such as autism spectrum disorder, Down syndrome, developmental language disorder, and verbal dyspraxia frequently benefit from Makaton as a bridge to spoken language.
Adults with Disabilities
Makaton was, in fact, originally designed for adults. Margaret Walker's first pilot study involved fourteen deaf adults with cognitive impairments living in a long-stay hospital (Cornforth, Johnston, & Walker, 1974). Today, adults with intellectual disabilities, acquired brain injuries, or conditions such as cerebral palsy continue to use Makaton as a primary or supplementary means of communication. In supported-living environments and day centers, staff trained in Makaton can interact more meaningfully with the people they support, which has been shown to reduce frustration and improve quality of life (Vinales, 2013).
Seniors and Age-Related Communication Loss
Perhaps the least discussed - but increasingly important - application of Makaton is with older adults. As populations age around the world, the number of people living with dementia, post-stroke aphasia, and other neurological conditions that erode the ability to speak is climbing sharply. The Alzheimer's Association notes that dementia progressively diminishes a person's ability to find the right words, organize thoughts logically, and maintain a train of conversation. Over time, many individuals with advanced dementia shift from relying on speech to relying almost entirely on gestures (Alzheimer's Association, n.d.).
This is precisely where Makaton can step in. Because the system uses simple, iconic signs and clear visual symbols, it can provide a bridge when speech fails. A care-home resident with dementia who can no longer reliably say "I'm in pain" might still be able to sign it, or point to a symbol on a communication board. Family members and professional caregivers who learn even a handful of core Makaton signs - for concepts like drink, eat, pain, toilet, happy, sad - can dramatically improve day-to-day interactions and reduce the isolation that so often accompanies communication loss in later life. The Alzheimer's Society in the United Kingdom has specifically acknowledged that simple signed communication, including Makaton, can be helpful for non-verbal interaction with people living with dementia (Alzheimer's Society, 2020).
Similarly, stroke survivors who experience aphasia - a condition in which language comprehension or production is impaired, often while cognitive ability remains intact - may find that Makaton symbols or signs offer a way to communicate needs and preferences during rehabilitation and beyond. The visual, gestural nature of the system bypasses many of the neurological pathways damaged by stroke, offering an alternative route to meaningful exchange.
The General Population
Makaton is also increasingly used by people who have no diagnosed communication difficulty at all. Parents of typically developing toddlers use it to reduce frustration during the pre-verbal stage. Teachers in mainstream classrooms use it to reinforce instructions for all students, including those learning English as an additional language (EAL). Libraries, courts, and public institutions have adopted Makaton symbols on signage to make spaces more accessible. With over one million users in the United Kingdom alone, Makaton has moved well beyond the specialist world of speech therapy into something approaching mainstream visibility (LD Network, 2024).
Advantages of the Makaton program
Makaton has persisted and grown for more than fifty years, and that longevity speaks to real strengths. Among its most commonly cited advantages are the following.
Supports rather than replaces speech
One of the most persistent fears among parents and caregivers is that introducing signs will discourage a child - or an adult - from learning to talk. Decades of research have put this concern to rest. Using signs alongside speech provides multisensory reinforcement that actually promotes spoken language development (Walker, 1978). Many children who begin with Makaton go on to drop the signs entirely once their speech catches up.
Reduces frustration and challenging behavior
When a person cannot express what they want or need, frustration is inevitable. In young children, this may manifest as tantrums; in adults with disabilities or dementia, it can appear as agitation or self-injury. Giving individuals a functional way to communicate - even at a very basic level - has been shown to reduce these behaviors significantly (Sheehy & Duffy, 2009).
Flexible and adaptable
Makaton can be scaled up or down depending on an individual's needs. A person with profound disabilities might use only a few core signs, while a higher-functioning individual might draw on hundreds of signs and symbols. The program can also be tailored to different cultural and linguistic contexts; it has been adapted for use in over 40 countries, using signs from each nation's own Deaf community (The Makaton Charity, n.d.).
Easy to learn at a basic level
Unlike learning a full sign language, which requires months or years of dedicated study, the basics of Makaton can be picked up relatively quickly. This makes it accessible to family members, teaching assistants, care workers, and even peers and siblings with minimal training.
Promotes inclusion
When Makaton is used in mainstream settings - schools, libraries, community centers - it benefits everyone, not just those with communication difficulties. It creates a more inclusive environment where differences in communication ability are normalized rather than stigmatized. Research conducted in UK schools found that typically developing children were enthusiastic about learning Makaton and that its presence helped foster a more inclusive school culture (Potts, 2021).
Applicable across the lifespan
As discussed above, Makaton is not limited to one age group. Its potential use spans from infancy through old age, making it relevant for families, schools, adult services, hospitals, and care homes alike.
Disadvantages and Criticisms of the Makaton program
No communication system is perfect, and Makaton has attracted a number of legitimate criticisms over its five decades of use.
Limited vocabulary compared to full language
With a Core Vocabulary of around 450 concepts, Makaton cannot express the full range of human thought and feeling that spoken or signed languages can. While the Resource Vocabulary extends this considerably, critics have argued that the staged structure may actually restrict the naturalness and individuality of language development for some users (Byler, 1985; Wells, 1981).
Limited recognition outside specialist settings
Although Makaton has over a million users in the UK, most members of the general public still do not know the signs. This means that a Makaton user venturing into a shop, a doctor's office, or any setting where staff are untrained may find the system essentially useless. Communication only works when both parties understand the system, and Makaton's reach, while growing, remains limited in everyday public life.
Criticism from the Deaf community
Members of the Deaf community, including the British Deaf Association (BDA), have expressed strong concerns about Makaton. In a 2022 statement, the BDA criticized the growing use of sign-supported communication systems like Makaton on social media, arguing that these simplified systems are not true languages and that their popularity could undermine the status and teaching of British Sign Language. The BDA's position is that if hearing people are going to learn any signs at all, they would be better served learning actual BSL, which would allow them to communicate with Deaf people rather than using a system that Deaf individuals may not recognize or use (British Deaf Association, 2022).
Insufficient rigorous evaluation
Although Makaton has been in widespread use since the mid-1970s, some researchers have noted that the program was adopted on a massive scale without being subjected to the kind of thorough, controlled evaluation that would normally be expected of an intervention with such broad reach. Kiernan (1982) and Byler (1985) raised these concerns early on, and while the evidence base has grown since then, some scholars still feel that the research supporting Makaton has not fully kept pace with its popularity (Sheehy & Duffy, 2009).
Risk of dependency
While the evidence generally shows that Makaton promotes speech development, there is a theoretical concern that some individuals may become overly reliant on signs or symbols and have reduced motivation to develop verbal speech. This risk appears to be small in practice, but it is worth noting, particularly in cases where a program is not carefully monitored by a qualified speech and language therapist.
Training and consistency challenges
For Makaton to work effectively, the people surrounding the user - family, teachers, carers, and peers - all need to know and consistently use the same signs. In practice, achieving this level of consistency can be difficult. Research into the Irish equivalent of Makaton, Lámh, found that staff in adult services frequently reported using signs rarely or never, even when their clients depended on them, often due to insufficient training or organizational support (Findings cited in Sheehy & Duffy, 2009).
Social stigma
Despite growing awareness, using Makaton in public can still attract unwanted attention or make the user feel conspicuous. Some individuals or families worry that signing may label the person as "different" or "less competent," particularly in social situations where communication differences are not well understood.
Makaton in Healthcare and Professional Settings
There is a growing argument that Makaton training should be embedded in healthcare education. A 2024 article in a nursing journal proposed that Makaton be integrated into pre-registration nurse education across all fields, not just learning-disability nursing, on the grounds that effective communication skills are essential for all healthcare professionals and that many patients across a range of settings struggle with verbal expression (Enhancing the Use of Makaton in Nurse Education and Practice, 2024). Earlier work by Vinales (2013) similarly found that children's nursing students who received basic Makaton training reported increased confidence in communicating with young patients who had learning disabilities.
In hospital and residential-care environments, Makaton symbols placed on communication boards can help patients indicate pain levels, request assistance, or make choices about their care. This is particularly valuable for elderly patients following surgery, individuals on ventilators who cannot speak, and people with progressive neurological conditions.
Conclusion
The Makaton Language program occupies an unusual and important space in the world of communication support. It is not a full language, and it does not pretend to be. What it offers instead is a practical, flexible, and widely accessible tool that can give voice to people who might otherwise be locked out of the conversations that shape their daily lives. From toddlers just beginning to find words, to adults with lifelong disabilities, to elderly people slipping into the silence of dementia, Makaton provides a shared system of signs, symbols, and speech that can ease frustration, foster independence, and maintain human connection.
Its limitations are real - the vocabulary is finite, public awareness is still patchy, and the Deaf community's objections deserve careful consideration. But for the people who use it and the families and professionals who learn it, Makaton remains one of the most valuable tools available for bridging the gap between silence and expression.
References
Alzheimer's Association. (n.d.). Communication and Alzheimer's. Alzheimer's Association.
Alzheimer's Society. (2020). Non-verbal communication and dementia. Alzheimer's Society.
British Deaf Association. (2022). Statement on sign-supported communication systems.
Byler, J. K. (1985). The Makaton Vocabulary: An analysis based on recent research. British Journal of Special Education, 12(3), 113–120.
Cornforth, A., Johnston, K., & Walker, M. (1974). Teaching sign language to deaf mentally handicapped adults. Apex: Journal of the British Institute of Mental Handicap, 2(1), 23–25.
Kiernan, C. (1982). The use of nonvocal communication techniques with autistic individuals. Journal of Child Psychology and Psychiatry, 24(3), 339–375.
LD Network. (2024). The power of Makaton: Communication beyond words. LD Network.
Potts, K. P. (2021). How can Makaton be embedded in the school community? [Doctoral thesis, Canterbury Christ Church University].
Sheehy, K., & Duffy, H. (2009). Attitudes to Makaton in the ages on integration and inclusion. International Journal of Special Education, 24(2), 91–102.
The Makaton Charity. (n.d.). About Makaton. The Makaton Charity.
Vinales, J. J. (2013). Evaluation of Makaton in practice by children's nursing students. Nursing Children and Young People, 25(3), 14–17.
Walker, M. (1978). The Makaton Vocabulary. In T. Tebbs (Ed.), Ways and Means. Basingstoke: Globe Education.
Walker, M., & Armfield, I. A. (1987). What is the Makaton Vocabulary? Special Education: Forward Trends, 8(3), 19–20.
Wells, G. (1981). Learning through interaction: The study of language development. Cambridge University Press.
Insights, Analysis, and Developments
Editorial Note: In a world that often measures people by their ability to speak fluently and quickly, Makaton serves as a powerful reminder that communication is far more than words. It is gesture, image, expression, and intention - all working together. The program is not without its flaws, and thoughtful critiques from linguists, educators, and the Deaf community should continue to shape its evolution. But for the child who signs "more" for the first time at the dinner table, for the elderly woman in a care home who points to a symbol to tell a nurse she is thirsty, and for the stroke survivor who uses a handful of signs to reconnect with a spouse, Makaton is not an abstract academic debate. It is a lifeline. As our aging societies confront rising rates of dementia and neurological decline, and as our schools strive toward genuine inclusion, the need for practical, flexible communication tools will only grow. Makaton, imperfect as it may be, has earned its place in that conversation - Disabled World (DW).
Author Credentials: Ian is the founder and Editor-in-Chief of Disabled World, a leading resource for news and information on disability issues. With a global perspective shaped by years of travel and lived experience, Ian is a committed proponent of the Social Model of Disability-a transformative framework developed by disabled activists in the 1970s that emphasizes dismantling societal barriers rather than focusing solely on individual impairments. His work reflects a deep commitment to disability rights, accessibility, and social inclusion. To learn more about Ian's background, expertise, and accomplishments, visit his full biography.