Do bilinguals have to be tested in both languages? Part 2

The answers are yes, no, maybe, it depends. Last time we talked about “yes.” This time let’s talk about:

• no

Easy and Hard Sounds

We have a new paper looking at the relationship between children’s dual-language exposure and age of English acquisition on production of early- middle- and late-acquired sounds. Previous work by Leah Fabiano-Smith & Brian Goldstein shows that children are most accurate on early developing sounds compared to later developing sounds. Further, bilinguals show the same pattern although they may be a little less accurate as a group compared to monolingual English and monolingual Spanish peers. In the current study, we wanted to explore the influence of children’s experience in Spanish and English and how this experience might influence sound production. We were also interested in how parent and teacher ratings lined up with children’s production accuracy given their level of experience in each language.

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.

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: 

BESA Research

I’ve been meaning to post some information about the Bilingual English Spanish Assessment and we have. Here, we respond to some FAQs. And here, I provided an overview of what it does, how it works, and its specificity/sensitivity data. In addition to this information and what is in the manual, we have written a number of papers over the years that led directly to what we included (and excluded) from the BESA. So, below I will provide some of the links to abstracts of papers we’ve written about earlier versions of the BESA. These are the studies that we conduced to refine the items and the test so that the final published version has a high degree of classification accuracy.

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.

STUPID TRANSLATION

When working with bilingual children, it is a matter of course that one will need to translate from one language to another. Children who are English language learners may need instructions or directions translated so that they can know what to do. Curricula may need to be translated to maximize learning. Tests are also translated for ease of assessment of knowledge in a given domain. In the area of speech and language assessment however, translation is not the best option. 

Looking Back, Looking Ahead

The other day I read a post by Nicholas Miller on the Speech and Language Sciences @ Newcastle University blog. He talked about the reprinting of his book, “Bilingualism and Language Disability” in psychology press’ classic revivals series. He reminisced about how the 1984 book came to be in the first place.

Analyzing Phonological Skills in Bilinguals: It’s a Buffet, Not a 7-Course Meal

I’ve often maintained that eliciting speech samples for phonological analysis (whether single or word or connected speech) does not take that much longer for bilinguals than it does for monolinguals (it is somewhat longer, for sure).  What does take longer, however, are the analyses of those samples.  Given that there are almost no standardized assessments for phonological skills of bilinguals, speech-language pathologists (SLPs) must complete a set of broad and deep analyses. 

 These analyses consist of both independent and relational analyses.  Independent analyses are those that do not relate the child’s productions to the adult target.  For example, the clinician should note the child’s phonetic inventory (arranged by place and manner or articulation) listing all the sounds that the child produces whether it’s produced correctly or not.  So, even is a child produces [t] instead of /k/, the child’s ability to produce [t] should be indicated.  After all, for this analysis, it’s what the child can/did do.  Other independent analyses might include:

• syllable types (e.g., CV, CVC, etc.)
• syllable shapes (how syllable types combine—CV$CV)
• word length (e.g., number of syllables per word)

 Relational analyses are those that compare the child’s production to the adult target and might include:

• Overall consonant accuracy
• Consonant accuracy by sound class
• Vowel accuracy
• Error types using a SODA format: Substitutions, Omissions, Distortions, Additions
• Percentage-of-occurrence of phonological patterns (e.g., final consonant deletion, stopping)
• Intelligibility
• Contextual effects (where does the error occur—initial position, final position, both?)
• Stimulability (can the child produce the target after a model?)

 SLPs are often overwhelmed initially by the number of analyses I suggest, as there are issues of time and efficiency.  I understand and appreciate those issues.  These analyses should be thought of as a buffet.  Choose the ones that are most satisfying to you.  However, I believe that completing this array of analyses leads to more reliable and valid diagnoses and link clearly and specifically to intervention targets.

Speech Sound Development in Bilinguals: It Depends…

I was recently interviewed for a national parents’ magazine on bilingualism (if it gets published, I’ll provide the reference and link).  The reporter was asking a relatively general question on language development in bilinguals compared to monolinguals.  First, I found it difficult to crystallize a complex issue into, literally, a 7-minute interview.  Second, it reinforced my notion about the myths about language development in bilinguals that still prevail.  When I responded that there is research to show that there are cases in which bilinguals can be more advanced than monolinguals, she interrupted me citing the fact that pediatricians tell parents that development in bilinguals is slower than monolinguals.  I interjected, “yes, but…it depends.”  It depends on the age of the child, how they came to acquire the two languages, how much input they receive, and output they produce, etc.  I know issues about proficiency have been written about on this blog before so I won’t repeat them here.  I will say, however, that we have looked at this issue in terms of speech sound development, and I will write about that in an upcoming post.  Suffice it to say that these variables clearly influence language development in bilinguals.  I tried, without much success, to tell the reporter this.  Anyway, we do know that bilingual children might show language skills that are more advanced, less advanced, or commensurate in comparison to monolinguals.  So, how does this relate to speech sound development in this group of children?