April 1, 2003 Feature

Serving Clients Who Use Sign Language

Many speech-language and hearing professionals now encounter clients who use sign languages as their primary mode of communication. Can these professionals serve these clients, or do they need to get interpreters or make referrals?

ASHA is committed to meeting the needs of culturally and linguistically diverse populations. All too often "linguistically diverse" is assumed to refer to users of spoken languages other than English. However, individuals who use a signed language, whether American Sign Language (ASL) or some other sign system, are also linguistically diverse.

It is difficult, if not impossible, to determine how many people in the United States use some form of sign language to communicate. It might be easier to try to determine the number of signing individuals that are seen in hearing and speech centers and in educational placements throughout the United States. In keeping with ASHA’s vision, it is important to ensure that there are an adequate number of speech-language and hearing professionals to serve this population. Although it may be necessary to use interpreters in some situations or locales or to make referrals to larger urban areas, programs, clinics, and schools throughout the country should be striving to better and more directly serve clients who use sign.

The Population

Clients who use a sign language/system are a very diverse population. Not only do these individuals differ in age, gender, race, ethnicity, national origin, religion, sexual orientation, and socio-economic status, but also in the sign language/system that they use.

Often the sign language/system used is determined by the individual’s identity or, in the case of a child, the educational placement. An individual who identifies as a member of the deaf community/culture in the United States will most likely use American Sign Language. Individuals who depend on their residual hearing and identify as hard of hearing or hearing impaired, will most likely use an invented sign system (i.e., SEE II, Signed English) or more English-based sign. Children who are deaf or hard of hearing may use ASL, a sign system, or English-based sign as determined by the school’s educational/communication philosophy (see sidebar for definitions).

Cultural and Linguistic Competence

Cultural and linguistic competence can enhance clinical practice by:

• increasing the bond/relationship between the clinician and the client and the client’s significant others

• demonstrating respect and sensitivity

• enhancing service provision

• facilitating achievement of goals and carryover/generalization of skills

And, importantly, it’s the right thing to do!

The National Center for Cultural Competence ( www.georgetown.edu/ research/gucdc/ nccc/faqs.html) has identified six overarching reasons why cultural competence is important to health care providers. In brief, they are:

1. To respond to current and projected demographic changes in the United States

2. To eliminate long-standing disparities in the health status of people of diverse racial, ethnic, and cultural backgrounds

3. To improve the quality of services and health outcomes

4. To meet legislative, regulatory, and accreditation mandates

5. To gain a competitive edge in the market place

6. To decrease the likelihood of liability/malpractice claims


Clinicians who are able to sign should apply the following strategies in order to meet the communication needs of their clients:

• Respect the communication mode of your clients. The clinician should try to match the client’s mode of communication.

• Be willing to admit when you do not understand. Try not to "bluff" or use a passive behavior. Speech-language-hearing professionals should model appropriate communication strategies such as confirmation and repair strategies when the clinician is not able to understand the client’s signs.

• Use facial expressions and body movements with signs. Facial expressions and body movements are fundamental features of ASL. In spoken English, speakers often signal a question by using a rising vocal intonation. In ASL, users do so by raising the eyebrows and widening the eyes. ASL users may ask a question by tilting their bodies forward while signaling with their eyes and eyebrows.

• Try to be conceptually correct in the use of signs. Choose signs that appropriately convey the information you are trying to communicate. Remember each sign in a signed language/system is composed of a specific, unique combination of a hand shape, movement, palm orientation, and location. Changing any one of these aspects of the sign changes the meaning of the sign. Always fingerspell technical terms (e.g., audiogram, frequency) first before assigning a "made up" sign (e.g., "A" hand shape circling in front of the ear + sign for graph = audiogram; "F" hand shape moving like a "wave" from left to right = frequency).

• Always use visual aids to supplement your signs. Use pictures of the ear and the "audiogram of familiar sounds" to help explain unfamiliar concepts (e.g., type of hearing loss; sounds the client may never have heard).

Working With an Interpreter

If necessary, it may be best to obtain the services of a certified interpreter for the deaf. Certified interpreters follow a strict Code of Ethics developed by the Registry of Interpreters of the Deaf (RID). Interpreters can hold different types of RID certification. For example, a CI (Certificate of Interpretation) certificate indicates the interpreter can sign from English to ASL and ASL to English. A CT (Certificate of Transliteration) certificate means the interpreter has been evaluated and is proficient in interpreting from spoken English to a more English-based sign and vice versa. Some RID interpreters hold both certificates.

In addition, the National Association of the Deaf also certifies interpreters using a system with varying skill levels. Finally, some states also have certification programs and tests for interpreters. It is essential to find out what is required in your area and obtain the services of qualified interpreters.

When working with an interpreter, speech-language or hearing professionals should remember that they are consumers of interpreting services. Be sure to establish what you and your signing client need from the interpreter. For example, some signing individuals have intelligible speech and the interpreter would not need to voice what the signer expresses. Other times the speech may not be intelligible enough and the interpreter may need to voice the intent of the signing client.

Finally, it is important to remember that the interpreter is a conduit of information between the clinician and the client. The signing client is addressed directly. The client should not be addressed through the interpreter (i.e., "Tell her..."). Instead the professional should speak directly to the client and allow the interpreter to convey the information.

To facilitate this, it is often helpful to position the interpreter next to the hearing or speech-language professional and across from the signing client. This allows for a good visual environment. The signing client can see the interpreter and the professional. During interactions as much eye contact as possible should be maintained with the client. The signing client will need to divide the visual attention between the professional and the interpreter but the professional should remain focused on the client.

Susanne Scott, is a supervising aural rehabilitationist in the department of audiology and speech-language pathology at Gallaudet University. In addition to clinical supervision, she teaches the Clinical Applications of Sign Communication classes to students in the clinical doctorate of audiology program. Contact her by e-mail at susanne.scott@gallaudet.edu.

James H. Lee, is a clinical supervisor in the department of audiology and speech-language pathology at Gallaudet University. In addition to clinical supervision, he teaches Clinical Applications of Sign Communication to speech-language pathology graduate students. Contact him by e-mail at james.lee@gallaudet.edu.

cite as: Scott, S.  & Lee, J. H. (2003, April 01). Serving Clients Who Use Sign Language. The ASHA Leader.


American Sign Language (ASL)

ASL is a complete, complex language that incorporates the use of hand shapes, position, palm orientation and movement, facial expressions, body movements and postures, and gestures and other visual cues to form its words. It is completely separate from English. ASL has its own rules for grammar, morphology, and sentence order. It is the first language of many North Americans who are deaf and is the fourth most commonly used language in the United States (www.aslinfo.com).

Deaf Community/Culture

A multi-cultural group of individuals who identify themselves as Deaf, as an ethnic identity, and not a physical condition. The Deaf community is composed of people who use American Sign Language as their primary means of communication. The Deaf Community considers itself a linguistic minority group, a separate entity because of its unique culture, language, and social norms. It is separate from other disability consumer groups by the virtue of communication process, not physical disabilities (www.signmedia.com/info/adc.htm).

Finger Spelling (Dactylology) and Invented Sign Systems

Finger spelling uses hand shapes to represent the letters of the English alphabet.

Invented Sign Systems (Signing Exact English [SEE] and Signed English [SE]) use manual codes (use of the hands) to represent the structure of English.

English-Based Signing

English-based signing entails signing a combination of both English and ASL features executed in English word order. The language proficiency of the signer will determine the use of the features from either language. It is different from the invented sign systems because it does not follow a clear-cut set of principles. In the past, this type of signing has been labeled pidgin signed English (PSE) and more recently referred to as sign English or conceptually accurate sign English (CASE). It was not intended to model English or be used in an educational context or to teach English. Its purpose is for social communication. 


Print Publications

Paul, P. V. (2001). Language and Deafness (3rd ed.). San Diego, CA: Thomson Learning.

Vold, F. C., Kinsella-Meier, M., & Hughes Hilley, M. C. (1990). Signing with your client: A practical manual for audiologists and speech/language pathologists. Washington DC: Gallaudet University Press.






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