Makaton for Positive Behaviour Support in Learning Disability Services
Makaton can strengthen Positive Behaviour Support in learning disability services when it gives people clearer ways to communicate distress, ask for help, request a pause or understand what staff are doing. PBS should not rely only on staff interpreting behaviour after distress has escalated. Where Makaton works for the person, signs and symbols can support earlier communication and more predictable staff responses.
Strong providers include Makaton within wider communication and accessibility in learning disability support and connect it with learning disability service pathways and support models. This matters because behaviour support is more respectful and effective when people can show what they need before crisis points are reached.
Concept explained clearly
Makaton uses signs, symbols and speech together to support understanding and expression. In PBS, it may help people communicate stop, wait, help, finished, worried, pain, quiet, home, more or break. These signs can be built into proactive support, early intervention, calming routines and recovery planning.
The aim is not to make Makaton a behaviour management tool. The aim is to improve communication so staff respond earlier, more consistently and with greater respect for the person’s experience.
Why it matters in real services
Distress can escalate when people have no clear way to say they are overwhelmed, confused, in pain or needing space. Staff may record incidents without identifying the missed communication that came first.
Providers should be able to evidence that Makaton supports prevention, choice and emotional regulation, not only that staff know signs.
What good looks like
Good Makaton use in PBS is proactive. Staff teach and practise signs during calm periods, use them consistently during early signs of distress and record whether the person uses or understands them.
Strong services demonstrate a clear line of sight from Makaton use to earlier support, reduced escalation and better recovery.
Operational Example 1: Using Makaton to request a break
Context: A person in supported living often became distressed during busy communal periods. Staff usually responded once the person shouted or left the room abruptly.
Support approach: The provider added Makaton signs for break, quiet, help, stop and finished into the person’s PBS plan.
Five practical steps:
- Staff reviewed incident records to identify early signs before escalation.
- The team introduced break and quiet signs during calm one-to-one time.
- Workers used the same signs when the lounge became noisy.
- Staff responded immediately when the person used or approximated the break sign.
- Managers reviewed incident frequency, recovery time and staff consistency.
Day-to-day delivery detail: The person began lifting both hands in an adapted break sign when the room became loud. Staff supported them to move to the kitchen table with headphones instead of waiting for shouting to begin.
How effectiveness was evidenced: Distress episodes reduced during communal periods. Records showed earlier communication, faster staff response and fewer incidents requiring post-incident review.
Deepening PBS through total communication
Makaton should sit within total communication beyond spoken language. A person may combine signs with movement, facial expression, vocalisation, objects, photos, posture or avoidance. Staff should understand the whole pattern rather than waiting for a formal sign.
This means PBS plans should describe both the agreed signs and the person’s own communication style. Staff need to know what to do when a sign appears, not just what the sign means.
Operational Example 2: Supporting early pain communication
Context: A person’s behaviour changed suddenly during evening routines. Staff initially thought this was linked to tiredness, but records showed increased agitation after meals and during toothbrushing.
Support approach: The provider introduced Makaton signs for pain, mouth, help and stop within the PBS review, alongside health monitoring.
Five practical steps:
- The PBS lead reviewed patterns across incident, meal and personal care records.
- Staff introduced pain signs with a simple body-map symbol.
- Workers recorded when the person used mouth-related communication.
- The provider escalated concerns to dental services with communication evidence.
- The PBS plan was reviewed after treatment to confirm whether distress reduced.
Day-to-day delivery detail: When staff signed pain, the person repeatedly touched the mouth symbol and pushed away the toothbrush. Staff paused the routine and arranged dental review rather than continuing to treat the behaviour as resistance.
How effectiveness was evidenced: Dental treatment identified an issue requiring intervention. Evening distress reduced afterwards, and the PBS plan was updated to include health-related Makaton prompts.
Systems, workforce and consistency
Makaton must be built into PBS training, handovers, supervision and review. Staff should know which signs support prevention, which signs indicate escalation risk and what action is required when the person uses them.
Supervision should test whether staff are using Makaton before distress escalates. Handovers should include any new signs, increased use of known signs or changes in the person’s communication pattern.
Operational Example 3: Using Makaton in recovery after distress
Context: A person often needed long recovery periods after distress. Staff were unsure when to reintroduce interaction or routine, leading to either too much space or too much prompting.
Support approach: The provider added Makaton recovery signs into the PBS plan, aligned with accessible information standards in learning disability services. Signs included quiet, drink, help, finished, music and ready.
Five practical steps:
- The team identified what helped the person recover after distress.
- Staff introduced recovery signs during settled times first.
- Workers used low-arousal signing after incidents, with minimal speech.
- The person’s responses guided whether staff offered space, drink or music.
- Recovery time and repeat escalation were reviewed monthly.
Day-to-day delivery detail: After one incident, staff signed quiet and drink. The person accepted the drink symbol but rejected music. Staff waited nearby without questioning, then signed ready before returning to the routine.
How effectiveness was evidenced: Recovery became more predictable, and repeat escalation reduced. Records showed that Makaton supported post-incident communication without overwhelming the person.
Governance and evidence
The audit trail may include PBS plans, communication profiles, Makaton sign lists, incident records, health escalation notes, staff observation, supervision notes and outcome reviews.
Data may show fewer incidents, earlier help-seeking, reduced recovery time, improved personal care tolerance or better health escalation. Qualitative evidence should explain how Makaton changed staff response and the person’s communication.
Commissioner and CQC expectations
Commissioners expect PBS to be proactive, personalised and evidence-led. Makaton can help demonstrate that communication support is used to prevent distress rather than simply respond to behaviour.
CQC expects safe, person-centred care, effective communication, skilled staff and good governance. Inspectors may look at whether staff understand distress and whether communication methods are embedded in behaviour support.
Common pitfalls
- Using Makaton only during incidents rather than during calm teaching.
- Failing to link signs to clear staff responses.
- Ignoring adapted signs because they are not formally accurate.
- Recording behaviour without analysing missed communication.
- Leaving Makaton out of PBS reviews.
- Not sharing PBS-related signs with agency, respite or health staff.
Conclusion
Makaton can make PBS more preventative, respectful and person-led when it gives people clearer ways to communicate distress and support needs. Strong providers demonstrate that signs and symbols are used before, during and after escalation in ways that improve understanding and outcomes. When Makaton is embedded into PBS governance, behaviour support becomes more consistent and easier to evidence.