Screening for Speech & Language Impairment

Well, it’s that time of year— fall is upon us. At UT, that means new students (and likely their parents) driving down San Antonio (a one way street) in the wrong direction. So far, I’ve spotted one driver doing this and it’s sure to increase as students move in and as classes start in a couple of weeks.

For those of you who work in elementary schools or preschool settings, screening may be part of the fall routine. I remember I worked for a few years in Head Start and we would screen children every fall. My first year (1984) I remember we just made up a screener. The SLPs and I got together and came up with a form and a few questions that we would talk to kids about while we observed their speech and language. Later on as there was less money to spend on things like screening, we relied on teacher referral. I did notice that often teachers made referrals if children had articulation errors but not much else. And many of the 3 year olds were being referred for typical developmental errors. So, we went to a modified screening procedure where we asked teachers to complete a form that focused their attention on aspects of speech and language that might be problematic for given ages. We would sit together to then determine if the child had more typical developmental errors or if a referral was really warranted. It also helped us to pick up on children who might have language-based impairment as well. Read the rest of this entry »

, , ,

Leave a comment

Does language and experience matter in NWR?

It is well known that different languages have different phonological structures. Some have lots of sounds put together in certain ways, other languages have fewer sounds and these go together perhaps in other ways. Comparing Spanish and English is interesting in the US context because Spanish is the second most common language after English. The majority of English language learners in the US speak Spanish as a first language.  Read the rest of this entry »

, ,

Leave a comment

Planning for between-language transfer

I don’t think that transfer (between languages) just happens. I think you have to plan for it. So, what kind of things transfer? How can we use what we know about language transfer to maximize transfer between two languages? Last time I talked a little about a study we had recently published in Seminars in Speech and Language s (I encourage you to read the whole issue btw, it’s a very nice set of papers). We saw improvement in both languages in semantics and narratives. Some kids demonstrated gains in morphosyntax but others did not. Read the rest of this entry »

, ,

Leave a comment

Intervention in Two Languages

What is the best way to do intervention with bilingual children with LI? It’s not always completely clear. Bilinguals are bilingual because they need both their languages to function in every day activities. With my colleagues, I’ve proposed for a while that in thinking about intervention we need to think about demands that are unique to L1 and L2 and those that are the same. This notion has been illustrated as a Venn diagram to show what overlaps and doesn’t. This figure comes from a chapter in Brian Goldstein’s book (now in it’s 2nd edition) where we postulated the kinds of demands a young child might need to meet in the semantic domain in Spanish vs. English.

venn

Other important questions are what transfers and what doesn’t? We usually want to maximize learning from one language to another. And we often assume that children can and do transfer knowledge from one language to the other. But how does this happen? In particular, how does this happen in children who have language impairment?

I think we can draw on some of the really excellent work that’s been done in bilingual education and in the area of reading. In addition there is emerging work on the topic of intervention with children who have language impairment.

We recently published a new paper in Seminars in Language Disorders, “Dual language intervention for bilinguals at risk for language impairment” by Lugo-Neris, Bedore, and Peña. In this paper 6 bilingual (Spanish-English) children with risk for language impairment participated in an intervention study. Three of the children received intervention in Spanish first for 12 sessions then 12 in English. The other three received intervention in English first, then in Spanish on the same schedule. The interventions focused on semantics, morphosyntax, and story grammar using a book-reading approach.

Testing in both languages was done at baseline and at the end of the study. Results demonstrated that children made gains in both languages on narratives and in Spanish on semantics. Examination of individual changes by first language of intervention shows some interesting patterns. Children who received intervention in Spanish first demonstrated greater gains in both languages in narratives compared to those who received English first intervention. On the other hand, children who received English first demonstrated greater gains in both languages in semantics while those who received Spanish first showed greater gains in Spanish and limited gains in English. So, it seems that the direction of transfer may be mediated by a combination of the target of intervention and the language of intervention. Of course we need to follow up with larger numbers of children to better understand how language of instruction, the child’s language experiences and the language targets together influence the kinds of gains that can be seen. We’re intrigued and excited by these findings and we hope that these will lead to more careful planning of intervention and selecting the language of intervention to maximize between language transfer.

, ,

3 Comments

About the NPR News piece “Mexican-American Toddlers: Understanding The Achievement Gap”

Elizabeth D. Peña:

Something to think about– I haven’t read the paper, but I will and will also comment. The points raised here are important with respect to assessment of children from different cultures (whose culture is likely not represented on the test) and for bilinguals (who are likely also bicultural).

Originally posted on School for Linguists:

After reading this piece on the NPR website, as well as the research article it reports on, I felt I had to write to the ombudsman. The text of my letter follows.


Dear Ombudsman:

In the story “Mexican-American Toddlers: Understanding the Achievement Gap” on last week’s All Things Considered, I was disappointed not to hear a response to Bruce Fuller from an expert on bilingual and multicultural education. Including this perspective would have highlighted two significant problems with the piece: first, that Dr. Fuller’s research is framed in a highly anglocentric way, and second, that some of the claims he made on the radio are not supported by his research.

View original 523 more words

1 Comment

Bilingual Assessment and Language Dominance: We need to MOVE ON

A long time ago (about 25 to 30 years ago) I learned that bilingual children should be tested in their dominant or home language. The prevailing view then was that if you tested in the weaker language you wouldn’t be letting the child demonstrate what they knew. I think that this part is true. The other part of this perspective is that there wouldn’t be anything in the weaker language that wouldn’t be represented in the stronger language. I don’t believe that this part is true. It’s the 21st century… we know better.  Read the rest of this entry »

, , , , , ,

6 Comments

Stuttering and bilingualism: Considerations for differential diagnosis

In 2009, there was an article published in the Archives of Childhood Disease that was subsequently picked up by Science Daily wherein the authors stated, “…if a child uses a language other than English in the home, deferring the time when they learn English reduces the chance of starting to stutter and aids the chances of recovery later in childhood.” This notion of bilingualism posing an increased risk for the development and persistence of stuttering has resulted in many parents questioning whether or not they should delay exposure to a second language until after the pre-school years – arguably the most optimal time period for second language acquisition. I have personally fielded multiple phone calls from parents as well as SLPs of bilingual children and my response to all has been the same – bilingualism is not a risk factor for the development or persistence of stuttering, however, it does appear to be a risk factor for the mis-identification of stuttering in bilingual speakers who are typically fluent.

Why is this the case? There are at least a few critical reasons to consider.

First, we need to recognize that the relatively few studies that have been completed thus far with bilingual persons who stutter are compromised by the lack of specificity with regard to bilingualism. As we detail in Coalson, Pena, and Byrd (2012) across the limited bilingual stuttering studies that presently exist, a large majority fail to adequately describe the participant’s bilingualism – most simply refer to the participant as “bilingual,” with no further details regarding language history, function, use, etc. provided.

Second, we have assumed for quite some time that SLPs do not have to speak the language of the person who stutters in order to be able to accurately identify the presence of stuttering. From this assumption we have further assumed that we can easily identify stuttering in bilingual speakers whether we do or do not speak each of the languages the person speaks. A significant limitation to this line of thinking is the investigation of identification accuracy of stuttering in Spanish-English bilinguals (Lee, Robb, Olmond, & Blomgren, 2014) did not include foils (i.e., speakers who do not stutter) – rather the only requirement was analysis of speakers with confirmed stuttering.

With that in mind, what do we really know about the identification accuracy of stuttering when the SLP also has to listen for the presence of stuttering in a bilingual Spanish-English speaker who does not stutter?

We recently published a study (Byrd, Watson, Bedore, & Mullis, in press) that demonstrates that, as expected, most SLPs are able to accurately identify stuttering in bilingual children with confirmed stuttering. What was unexpected given the assumption that identification of stuttering should be easy even if you do not speak the language, is that most SLPs mis-identified the presence of stuttering in the bilingual Spanish-English speaking children who are typically fluent. When these SLPs were asked why they thought the typically fluent bilingual speaker was a stutterer, almost all referred to the high frequency of speech disfluencies the child produced. A crucial consideration that none of the SLPs acknowledged is that their measure of what they considered to be high is based on guidelines derived from monolingual English speaking children who stutter. This raises the question – can these monolingual guidelines be applied to bilingual speakers?

In another newly published study (Byrd, Bedore, & Ramos, 2015) we demonstrate that the application of these monolingual guidelines to the bilingual speaker would result in the mis-identification of stuttering. In fact, the typically fluent Spanish-English bilingual children whose speech output we analyzed produced stuttering-like disfluencies at rates well above the 3% guideline, with some producing frequencies as high as 38%. These bilingual children who again were not stutterers also produced a mean number of iterations (repetition of the disfluent moment) that was markedly higher than what has been reported in monolingual English-speaking children who stutter. Why are these speakers so disfluent? Consider that the bilingual speaker is navigating many more motor and linguistic decisions than the monolingual speaker – the more potential decisions to make, the higher the likelihood for revisions or what we hear as speech disfluency.

Upon consideration of these findings, how can we differentiate a bilingual child who stutters from a bilingual child who does not?

Additional research is needed but our preliminary data suggest that clinicians should consider the quality not the quantity with regard to the speech disfluencies produced. For example, the production of monosyllabic word repetitions drove the frequency of stuttering-like disfluencies well above the 3% guideline. These bilingual children also produced high rates of sound repetitions and syllable repetitions – all of which are classically considered to be stuttering-like behaviors when produced above 3%. However, none of the typically fluent bilingual children we examined produced atypical prolonging of sounds – this finding suggests that the tension of the disfluent moment may be another differentiating factor. The typically fluent bilingual children we examined produced easy, effortless repetitions – no atypical tension characteristic of stuttering was observed. We also suggest that clinicians consider the rhythm as opposed to the number of iterations – is each repetition rhythmic in nature or is it highly arrhythmic? The latter would be indicative of stuttering. Our data also indicate that parent concern may be a differentiating factor. From a cultural perspective parent concern may be better evaluated as degree of concern rather than presence or absence but regardless among our cohort of bilingual children who do not stutter there was no present or past parent concern of stuttering to any degree.

Together, our data suggest clinicians should take caution when identifying stuttering in bilingual speakers. Even with monolingual speakers, the presence of stuttering should never be confirmed based solely on frequency, but with the frequency rates being so high in bilingual speakers, clinicians need to be extra careful not to be erroneously swayed by numbers that in monolingual speakers would be considered highly atypical as what is atypical for monolinguals may in fact be typical for bilinguals.

, , , ,

1 Comment

Can Semantics Testing be used to Determine Language Impairment in Bilinguals?

As you know, there is a lack of appropriate standardized instruments to appropriately determine language impairment in bilingual children. We have made strides though in assessment Spanish-English bilinguals, which is the biggest bilingual group of kids here in the US especially in the area of morphosyntax. Work by BedoreRestrepo, Gutierrez-Clellen, demonstrates the kinds of errors that Spanish speaker and bilingual Spanish-English speakers with language impairment make. But, there isn’t quite as much in the area of semantics. Read the rest of this entry »

, , , , , , ,

2 Comments

Too bad 30 years ago

I participated in a twitter chat on Latino Early Childhood with @LatinoUSA and @spanglishbaby to talk #bilingualkids. Most participants, as expected, were bilingual Spanish-English speakers, proud to raise their children in a supporting bilingual environment. They emphasized the advantages of bilingualism: cognitive and socio-emotional skills, tolerance and openness, traditions and family. Plus the obvious: speaking two languages!
I was also happy to read that language use and opportunities to hear and speak Spanish seriously concern parents. They want to make sure they “resist” the period in which their own children appear to prefer English. They shared some nice anecdotes about children changing their minds as they get older, children becoming proud of their bilingualism. One mom said “¡No hay que tirar la toalla!”
Interestingly, one participant sent this tweet:
Curious to hear medical opinions. My cousin was told her son was beginning to stutter speaking both.
9:53 AM – 21 Jan 2015
I was surprised by, first, the desire to hear a medical opinion, and, second, by the hypothesis that bilingualism would cause a speech impairment. Other participants referred to bilingual research in their comments. This participant, however, wanted to hear from a medical doctor. Why would he assume a medical doctor knows more about bilingual development than experts? In addition, I sound naïve, but this is the first time I clearly read a worrisome admonition of bilingualism. I twitted this person to consult with a BILINGUAL speech-language pathologist. He responded the following:
Too bad 30 years ago that was the medical opinion. It was ridiculous.
10:53 AM – 21 Jan 2015
My heart sank. I cannot imagine how his cousin felt when she heard that doctor’s comment. I am so grateful to be part of a community and a profession that is changing, becoming more tolerant, and moving forward.

, , ,

2 Comments

Are dominance and proficiency the same?

This is a question that comes up from time to time, and I see some people using it interchangeably, I see this in the scientific literature and I see it in every day conversations and practice. So, what gives?

Let’s first look at the dictionary definitions:

Dominant: (from the learners dictionary by Merriam-Webster)

[more dominant; most dominant]

: more important, powerful, or successful than most or all others

  • The company is now dominant in the market

most common

  •  The dominant [=prevailing] language/religion of the country

biology : causing or relating to a characteristic or condition that a child will have if one of the child’s parents has it

  • dominant genes

Proficient: (also from the learners dictionary)

[more proficient; most proficient]

 : good at doing something : skillful

  • proficient reader
  • He has become very proficient at computer programming.
  • She is proficient in two foreign languages.

So, these aren’t exactly the same. In the work that I have done in language and language impairment, my collaborators and I try to distinguish between the two. Why does it matter?

I think especially in research and clinical work in language impairment it’s important to separate out the two. Children with typical development may demonstrate dominance in one language or another (or both), and at the same time they may have high levels of proficiency in both their languages. That is, they can be highly proficient users of both their languages at yet have MORE dominance in one of their languages.

In contrast children with language impairment demonstrate low proficiency in both their languages (not in every domain of course, they may show relative strengths in some aspects of language). At the same time they can be stronger (within their own performance) in their first language or in their second language or in both of their languages.

I think we can get into trouble when we assume that low proficiency in one language means dominance in the other. It doesn’t. We CAN have kids who show low proficiency in L1 and high proficiency in L2 and are dominant in L2. We can also have kids who show low proficiency in both and have dominance in only one language. We can have those who have high proficiency in both and be more dominance in one. The danger with conflating the two terms (and therefore measures) is that it could lead to bad decisions.

If the assumption is that a child with low proficiency in one language is therefore dominant in the other, it could lead to delaying of services (RTI, speech or language intervention, reading intervention) if they have a true impairment. It might be assumed that low proficiency in one  language equals low proficiency overall, and this assumption might lead to a diagnosis of a language impairment even if the child actually does NOT have an impairment (and is actually highly proficient in the other language). If a child is not very proficient in either language, this may lead people to say something like, they have no language (I totally hate that, unless they are in a coma, I don’t know how this could be). This assumption might lead to giving parents suggestions like only using one language because the child has incomplete language acquisition in both. Like monolingualism would be the cure for language impairment. UGH!

So, don’t get rid of one term. We need both proficiency (to measure how good children are at each language) and dominance (to determine which is the stronger of the two languages for a given bilingual child).

, , , , ,

3 Comments

Follow

Get every new post delivered to your Inbox.

Join 1,915 other followers