The paper describes the Makaton Vocabulary as an alternative communication mode for children and adults with communication and language difficulties. The language program comprises the following components: a core vocabulary based on concepts/items needed to express essential needs and experiences; the use of signs and/or symbols always associated with speech; and a specific structured set of teaching procedures. The core vocabulary is organized into eight sequential stages of increasing complexity and communication priority and can be personalized by elimination of irrelevant items and addition of other concepts. The teaching procedure has six steps: (1) setting up acts of communication; (2) establishing a learning pattern; (3) using vocabulary in the context of real objects and events; (4) teaching a range of functions; (5) teaching new concepts; and (6) teaching understanding and use of phrases. The Makaton Vocabulary is widely used in the United Kingdom. Makaton resource centers outside the United Kingdom are listed, and a bibliography of 31 items provided. (DB)