Posts Tagged stuttering
Stuttering and bilingualism: Considerations for differential diagnosis
Posted by courtneybyrdblog in assessment, child bilingualism, fluency on March 12, 2015
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.
Does Bilingualism Increase Stuttering?
Posted by Elizabeth D. Peña in child bilingualism, research on May 25, 2013
Maybe, but I don’t think so. What we do know is that we don’t really know enough about how bilingualism interacts with stuttering. We know that bilingualism doesn’t make autism worse; we know that bilingualism doesn’t increase the risk of language impairment, so consistent with these findings; I think that bilingualism shouldn’t make stuttering worse. There is one study that reports that children who start learning their second language later in childhood bilinguals are less likely to stutter than bilinguals who start using both their languages from an early age. As pointed out however, it seems that the prevalence of stuttering in bilinguals is no higher (or maybe less) than that of monolinguals. I think however we need to get a handle on what stuttering looks like in bilinguals to make accurate diagnosis. We know for example that bilinguals demonstrate more tip of the tongue phenomena and that mazes (pauses, hesitations, reformulations) are different in different languages. Read the rest of this entry »