We Can’t WAIT!

There’s been a lot of discussion concerning COVID19 and schooling from home. In the special education domain, at least in speech-language pathology, we seem to be all over the place. Not that it’s easy it’s not. But, I hear a lot of comments and reports that school districts are suspending special education testing:

• till schools open again
• because standardized tests aren’t standardized for on-line administration
• because we’re not comfortable
• because we think that it can’t be valid

Do bilinguals have to be tested in both languages?

Yes, no, maybe, it depends. 

You Tube Channel

John Consalvi from LinguaHealth interviewed me last summer about the BESA’s development and use. Here is the You Tube channel. In time for Valentine’s Day!

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.

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.

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?

Dear School Professionals Please Be Aware of This

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 effectiveness. There are a few studies so far that use the BESA, and I hope soon there will be more. Here is what I think is only a partial list: 

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.

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.

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.