Better Communication Together CIC

From Hand-Over-Hand to Hand-Under-Hand to Modelling

When my son was younger, we were advised by his Speech and Language Therapist to use hand-over-hand signing — physically guiding his hands to make the signs. That was common practice at the time. The advice came from a good place: he found it hard to coordinate his movements, and we wanted to help him experience what each sign felt like.

There are reasons why this approach was once recommended. Some Makaton users benefit from additional sensory feedback because of differences in proprioception — the body’s internal sense of position and movement. Proprioception helps us know where our hands are, how our fingers are shaped, and how to control them without constantly looking. If someone struggles with this, they might not instinctively know how to form a sign, even if they can see it clearly.

In this context, haptic feedback — the sensory information we get through touch and movement — can play a role in learning. Feeling the motion of a sign can help the brain make connections between what’s seen, felt, and meant. For example, feeling the gentle placement of hand on fist for more can give additional sensory input alongside the visual model.

From Hand-Over-Hand to Hand-Under-Hand

Over time, our understanding — and practice — changed. We moved from hand-over-hand to hand-under-hand.

This might sound like a small shift, but it represented a much bigger change in thinking. With hand-under-hand, the adult’s hands sit underneath, providing support if wanted — but the Makaton user remains in control. They can rest their hands on yours, feel the movement if they wish, or move away entirely.

This subtle difference communicates something powerful: “You’re in charge of your own body.” It gives the person choice and control. It turns touch into an invitation, not an instruction.

But even with this gentler approach, there’s still physical contact — and that means we must think carefully about body autonomy.

What is Body Autonomy — and Why Does it Matter?

Body autonomy means having the right and freedom to make choices about your own body — including who touches you, when, and how.

For many Makaton users, this principle is especially important. They often experience more hands-on help than their peers — for example, with dressing, feeding, mobility, or therapy activities. Over time, if people touch or move them without asking or explaining, they may learn that they don’t have a say over what happens to their body.

Respecting body autonomy means:

• Always asking permission before touching or guiding someone

• Watching for non-verbal cues of comfort or discomfort

• Offering choice (“Would you like to hold my hands while we sign?”) rather than assuming consent

• Teaching that “no” or pulling away is always respected

The Story Massage approach beautifully demonstrates this principle. Before beginning any story or massage movement, practitioners always ask permission — even if the person can’t respond verbally. A pause is given to watch for signs of agreement or refusal. This moment of asking isn’t just polite; it reinforces that every individual has ownership over their body. The same principle applies to signing and communication support: touch should never be automatic. It should always be offered, never assumed.

When we apply these principles to signing or communication teaching, it helps Makaton users understand that their body belongs to them. It builds trust, safety, and mutual respect — the foundations for real communication.

Supporting body autonomy doesn’t mean avoiding help altogether; it means making sure that any support is done with the person, not to them.

Why We Now Focus on Modelling

Today, we rarely use physical support at all. Instead, we focus on modelling — signing ourselves clearly, consistently, and meaningfully in everyday interactions.

Modelling means showing. It’s about using signs naturally while talking, so the Makaton user sees them in real communication — not just in practice. For example:

• Signing more while offering another biscuit or turn on the swing

• Signing finished when tidying up or putting something away

• Signing drink, or book as those things are happening

• Signing food whenever it’s meaningful — when preparing, offering, eating — so the sign is always linked to real experiences.

This approach allows the Makaton user to see the signs being used for genuine reasons, with clear links between the sign, the word, the action, and the emotion.

Over time, consistent modelling helps to:

Build understanding (receptive communication) long before expressive signing develops

Develop confidence, because there’s no pressure or correction

Notice patterns, repetition, and meaningful contexts — the building blocks of real language

Build motivation to communicate, because attempts are understood and valued.

Physical prompting, by contrast, can unintentionally create dependency. If someone learns that another person will move their hands, they may wait for that prompt instead of initiating communication themselves. It can also blur the boundaries of consent and touch — especially for people who already find personal space or body awareness difficult.

That’s why any physical prompting should only ever be used with great caution. Even if done kindly, it can undermine a person’s sense of control and ownership of their body — and ultimately slow down the journey toward spontaneous, autonomous communication.

Most Makaton users develop their signing skills through exposure, repetition, and real interaction. If we respond positivel to every attempt — even unclear or partial signs — they learn that communication works. From there, accuracy and fluency grow naturally.

(And if a Makaton user indicates “Help my hands do it,” that’s a completely different situation. When the request comes from them, it becomes part of their communication. My own son often does this — he’ll guide my hands to show what he means or to make his message clearer when his own hands can’t. In those moments, the touch is purposeful and led by him. It’s not about teaching or prompting; it’s about connection, collaboration, and helping him be understood.)

A Better Approach

Model signs often and in real situations – show rather than tell.
Use hand-under-hand only if needed, and only with consent or clear comfort.
Trust the process – people learn by watching, feeling safe, and being understood.
Prioritise body autonomy – every Makaton user deserves control over their own body.

Real communication isn’t about perfect signing; it’s about connection, understanding, and respect.