Stakeholders’ quantitative evaluation of Makaton sign and symbol options for representing ‘Autism’ in South Africa

Background: Makaton is a multimodal communication system which combines signs, symbols and speech. It is widely used in South African educational and healthcare settings to support individuals with communication challenges including autistic individuals. However, the system has no standardised sign or symbol options for representing ‘Autism’, and no research has examined stakeholders’ perspectives on appropriate representation options. Objectives: Guided by the Participation Model, this report presents the quantitative findings to evaluate stakeholders’ ratings and preferences on seven sign options and two symbol options for representing ‘Autism’. Method: A mixed methods survey was conducted with 64 South African Makaton stakeholders, including autistic individuals, parents, family members, education professionals, medical professionals, organisation representatives, who rated the sign and symbol options using 5-point Likert scales. Results: Sign option B had the highest rating (Mean = 3.4) and preference frequency (28.1%). Cultural inclusivity showed the largest stakeholder disagreement as indicated by a standard deviation of more than 1.10 across all options. Notably, 7.8% found no available sign options suitable for representing ‘Autism’. Symbol option B was preferred (Mean = 3.45) to option A (Mean = 2.55), although both showed English-text dependence barriers. Conclusion: This study demonstrates the necessity of amplifying stakeholder voice in the selection of augmentative and alternative communication (AAC) representation options. Although sign option B and symbol option B were preferred to represent ‘Autism’, complexities in achieving a single, acceptable sign and symbol across diverse stakeholder groups were revealed. Contribution: This study provides the first empirical evidence for ‘Autism’ representation in South African Makaton. The study also shows that cultural inclusivity drew the greatest stakeholder disagreement.