Background Augmentative and alternative communication (AAC) forms are used by people of all ages with special educational needs as a way of facilitating communication. One of the most popular AACs is Makaton, a system that incorporates sign language, graphic symbols, and speech. Makaton has been used for a number of years in various settings, however its efficacy is unknown and not backed by empirical evidence.

Objectives To perform a literature review of published articles assessing the effectiveness of Makaton in aiding communication and social interactions with children and young people. Evidence will be analysed in order to suggest the validity of its use, with a view to expand its integration in clinical environments.

Methods Fourteen databases were methodically searched from inception to 20th January 2020. Inclusion criteria included studies assessing the efficacy of Makaton with children and young people, in comparison to speech or another AACs, that were published in the English language.

Results Six studies met inclusion criteria and were critically appraised. Five studies showed Makaton increased basic communication, four found it initiated spoken language, and all six observed an increase in positive social interaction and behaviour. There were a total of 73 combined participants, ranging from the ages 2–16 years old. Most studies analysed participants with a certain disorder (Autism Spectrum Disorder, Down Syndrome, Cerebral Palsy, severe learning difficulties), with one evaluating Makaton use when teaching English as an additional language. It was also found that the majority of professionals support its application and find it subjectively effective, however it is seldom utilised beyond parents and teachers, and there is little homogeneity in frequency of use between participants. Each study was of a small sample size limited to population and disorder demographic, and may not be generalisable to external populations.

Conclusions Despite current literature lacking high quality methodologies and the need for caution when interpreting or extrapolating results, there is a clear general consensus that Makaton is effective in facilitating communication and social interaction in children and young people. It allows children flexibility in communicating in ways that suit them, increasing feelings of inclusivity, and leading to a better quality of life. Regardless of a lack of empirical data, many people and schools around the country and world are adopting the use of Makaton and there is an attitude shift towards one of inclusion and acceptance for children who sign. Makaton gives a voice, be it literal or not, to children who may otherwise not have been able to express themselves. More effort should be made to integrate signs and symbols into mainstream society, and in particular to educate medical students and health care professionals, to allow for more autonomy and patient-centred care for these individuals.