Posts Tagged assessment

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.

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On Internationally Adopted Children

Came across this blog post on speech/language referrals of children who are adopted internationally. Are these kids bilingual? Do we need to evaluate their first language?

http://www.smartspeechtherapy.com/dear-school-professionals-please-be-aware-of-this/

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Independent Research using the BESA

My collaborators and I did a number of studies of morphosyntax, semantics, phonology and pragmatics that informed development of the final version of the BESA. We’ve since done other studies using the BESA as an indicator of language impairment or phonological impairment. In addition, it is important to have independent studies of the BESA that evaluate its effectivness. There are a few studies so far that use the BESA, and I hope soon there will be more. Here is what I hope is only a partial list:  Read the rest of this entry »

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Testing Speech in Languages other than English: What’s the Evidence?

There’s a new paper out in AJSLP by Sharynne McLeod and Sarah Verdon.  I think it’s a great resource for those of us who do bilingual assessment. Additionally, I think it’s an excellent example of how to review and select tests to use for diagnostic purposes. Over the last 10 or so years, there’s been a growing emphasis on evidence-based practice in speech-language pathology. We can’t simply use the tests we’ve always used because we are familiar and comfortable with them. We need to be able to justify our selections, and make our selections based on the best available scientific evidence. Read the rest of this entry »

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The Bilingual English Spanish Assessment

We’re very excited to let everyone know that now, after a number of years of development and testing the BESA is available to speech-language pathologists.

WHAT IS THE BESA? WHAT DOES IT DO?

My co-authors and I developed the Bilingual English Spanish Assessment (BESA) in response to a critical need for valid, reliable instruments to assessment of speech and language ability in Spanish-English bilingual children. It focuses on children (ages 4 years, 0 months through 6 years, 11 months) who have varying levels of Spanish-English bilingualism. BESA was specifically developed to determine if speech and/or language errors observed in some young children were due to limited exposure to English or to a language impairment. We know that with time, children with typical development will learn a second language. But, at the same time, early intervention for children who have speech and language impairment is critical.

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Testing bilinguals in English: Do we get any useful information?

I think the title says it all, and it’s an important question. There’s no doubt that the best way to determine if a child has a language impairment is to test them in their language. For bilinguals, that usually means two languages– in the US context, their home language and English. But, there aren’t enough bilingual speech-language pathologists available nationally; and bilingual speech-language pathologists don’t speak every language represented by the clients in their area. So, one of the questions we’ve had is whether we can get any useful information from testing children who are bilingual in English only. The quick answer is yes, no, and it depends. The longer answer follows. Read the rest of this entry »

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BESA Fan Page

We made a BESA fan page: https://www.facebook.com/besabilingual

BESA coverWhen the test is ready to pre-order, when it’s published, or when we have other news we’ll post in the fan page. So, like it and you’ll be able to keep up with what’s going on with the BESA.

 

 

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Inspriation

From time to time (should be more often) I”m reminded of why I do the work I do. It’s so easy to get caught up with thinking about getting out the next paper, the details of the job, getting ready for presentations, teaching and so on that I loose sight of what I’m doing ultimately. What I aim to do is to make a difference in the every day lives of kids who are bilingual.

Today I got an e-mail from a bilingual SLP who had read a post written by Lisa Bedore and me in the Asha Leader, in which we argue that bilingual children need to be tested in both languages because they so often have “mixed” dominance. In my e-mail, the SLP wanted to know what measure we used to measure dominance and stated that in her district county officials wanted “score and numbers” in order to determine dominance. It’s so great when I learn someone is actually reading this work and trying to apply it in practice. This is exactly what keeps me going, especially on days that I’m feeling like I’m putting out this stuff and no one cares. Read the rest of this entry »

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Bilingual Test Development

Before, I wrote about different purposes for test development. Given those different test functions an implication is that the way we then develop tests for these should be different. Read the rest of this entry »

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Is the Grass Greener??

The workshop on assessment of bilinguals in Gregynog was really interesting. There were researchers, students, and practitioners representing several disciplines including: speech-language pathology, psychology, linguistics, and reading. They were from different countries including: England, Wales, United States, Spain, Ireland, Netherlands, Greece among others. Many of these counties have official bilingual language policies (e.g., the Basque Country of Spain and Wales). One of the things that really struck me was that the challenges involved in assessment of bilinguals are very similar to what we face in the U.S. Somehow, I’d always assumed that the Europeans had it all figured out, especially since bilingualism is much more common than it is in the U.S. Read the rest of this entry »

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