Total communication

Also called TC, Total communication approach, Total communication environment

Speech, sign, symbol, gesture, writing, objects, all at once, and whichever gets through is the right one.

What it is

Total communication is an approach, not a method: the partner uses every means available at the same time, and accepts every means the person uses back. You say the word, sign it, show the symbol and point at the thing. The person replies with a sound, a sign, a look at a picture or a hand on your arm, and all of them count.

It grew up in Deaf education in the 1960s and 70s as a rejection of oral-only teaching, and it has since become the everyday philosophy of most learning disability services, special schools and many care homes. A total communication environment is one where all of this is normal and nobody has to ask for it.

Who it can help

People with a learning disability, people with profound and multiple learning disabilities, people with dementia, and anyone whose understanding of speech alone is unreliable. It's the default approach in Makaton and Signalong settings.

For Deaf people whose language is BSL, total communication is a contested term: a mix of speech and sign is not BSL, and the British Deaf Association argues for full language access rather than a blend. This entry is about learning disability and care contexts, where the argument is different.

How it works

Every message goes out in several channels at once, so the person can take it from whichever channel works for them that day. Speech carries the words; a sign carries the key one; a symbol or object makes it visible and lasting; gesture and face carry the tone. Redundancy is the whole idea. If the person didn't catch the speech, they may catch the sign, and the symbol is still there when both have gone.

Coming back the other way, the partner's job is to accept whatever mode the person uses and respond in kind, then add the others. A reach for the cup gets "Drink" spoken, the DRINK sign and the symbol shown. Over time the person picks up whichever mode suits them, which is why total communication so often leads into multi-modal communication for the individual.

A total communication environment adds the setting: labelled cupboards with symbols, visual timetables on the wall, objects of reference for activities, staff who sign as they speak, and time built in to wait.

Getting started

Learn ten signs this week, the ones for the person's day: drink, eat, toilet, more, finished, help, home, bed, good, bad. Use them every time you say the word, whether or not the person signs back.

Put a symbol on the outside of the three cupboards that matter and the door to the bathroom.

Open the Talk board on the kitchen tablet and touch the card as you sign and speak. Three channels, no extra effort.

Where to get help

The Makaton Charity and Signalong both train families and staff in sign-supported total communication. Mencap and BILD describe what a total communication environment looks like in adult services. Your local NHS learning disability speech and language therapy team can audit a setting and train the staff.