Maintenance Notice

Due to necessary scheduled maintenance, the JMIR Publications website will be unavailable from Monday, March 11, 2019 at 4:00 PM to 4:30 PM EST. We apologize in advance for any inconvenience this may cause you.

Who will be affected?


Currently submitted to: JMIR Pediatrics and Parenting

Date Submitted: Jul 3, 2019
Open Peer Review Period: Jul 3, 2019 - Aug 28, 2019
(currently open for review)

Use of sign language in hearing children to improve listening, understanding, speaking and behaviour: An evaluation of Sign 4 Little Talkers

  • Gurch Randhawa



Gaining age-appropriate proficiency in speech and language in the early years is crucial to later life chances, however a significant proportion of children fail to meet these standards when they start school. Factors influencing development of language and communication include low income, gender, and having English as an additional language (EAL).


Sign 4 Little Talkers (S4LT) was developed to address gaps in attainment in vocabulary and communication in pre-school children, identified through routine monitoring of early years outcomes. Signs were adapted and incorporated into storybooks to improve vocabulary, communication and behaviour in hearing children.


An evaluation of S4LT was conducted measuring key outcomes pre and post intervention in eight early years settings in Luton, UK. RR2-10.2196/10075


Statistically significant results were found for all measures tested: Words spoken and understood, speaking, managing feelings and behaviour, understanding, listening and attention, and wellbeing. Approximately two thirds of children made expected progress or better, often progressing multiple steps in attainment after being assessed as developmentally behind at baseline.


The findings reported here suggest that S4LT may help children to catch up with their peers at a crucial stage in development, and help them to become ‘school ready’ by improving command of language and communication as well as learning social skills. Our analysis also highlights specific groups of children who are not responding as well as expected, namely boys with EAL, and who require additional, tailored support. Clinical Trial: Davidson, R. & Randhawa, G. (2018). Improving speech, language and communication in pre-school children: implementation and effectiveness of the Sign 4 Programme, Luton, UK. ISRCTN.


Please cite as:

Randhawa G

Use of sign language in hearing children to improve listening, understanding, speaking and behaviour: An evaluation of Sign 4 Little Talkers

JMIR Preprints. 03/07/2019:15348

DOI: 10.2196/preprints.15348


Request queued. Please wait while the file is being generated. It may take some time.

© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.