The Complementary Role of Therapist and Mother

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I was a speech language pathologist for seven years before I became a mother. I love our field and the chances I get to bring positive change to the lives of children and their families. As a parent, being an SLP helps me be more attuned to my children’s developmental milestones.

My professional skills also allow me to provide my children rich language input, particularly because they are growing up in a bilingual home. I consciously employed language strategies such as narration, expansions and recasts in our everyday interactions. So now, when my 6-year-old daughter says, “Mommy, I made an observation about rainbows today,” or when my 4 1/2-year-old son says, “Alvin was being irresponsible” when talking about Alvin the Chipmunk’s many mischievous behaviors, it affirms that, yes, purposeful, engaging play builds language! Yes, consistent book sharing experiences build vocabulary! Yes, attentive caregiving builds confidence in children!

As a mother, I’ve also stopped judging embarrassing tantrums, senseless meltdowns and stubborn non-compliance at the worse times. How easy it is to judge without experience. My recently learned lesson is aptly summarized by a mom whose son has autism. In her witty and honest blog, Carrie Cariello states, “I don’t want to focus so much on the what and when and where and how that I forget about the who.”

This reality is tested in my own life with my son, who began to stutter at around age three. As an SLP, I always try to convey to parents that what children are communicating is far more important than how they communicate it, and that who they are inside is far more valuable than any outward challenges. In other words, we seek to value and see the person, not the disorder. What an easy thing to say when it’s not your child.

A few months ago, I remember approaching our van in a Wal-Mart parking lot one afternoon feeling teary, overwhelmed, and helpless after hearing my son significantly struggle to communicate fluently. I looked at his sweet face with despair and thought, what if he doesn’t outgrow this? And in that moment, I realized the truth of what I’ve “preached” to parents for many years…the who is what matters.

If the stuttering persists, my son is still the same cuddly, sensitive, funny, smart, and active little boy I love. He’s still a gift I am privileged to enjoy every day. He’s still the one who follows me around the house and says for no apparent reason at the most random times, “Mama, I love you so much!” And even if he continues to stutter, he’ll know he’s loved, he’s special and that what he has to say is important to us.

Lastly, I realize more fully now how much effort it actually takes to make needed changes in the home in order to help our children when they struggle with communication. For my son, it forces us to slow down transitions, to give him needed thinking time as well as curb our tendency to interrupt his talking time, especially when his sweet and chatty sister frequently attempts to cut into his sentences. It means coaching my husband on altering his pace, reducing interruptions and valuing the message.

So when we as professionals make recommendations for environmental changes in the home or in communication styles, we must be very patient and really clear on what that actually looks like, because at the end of the day, the who is what matters.

 

Ana Paula G. Mumy, MS, CCC-SLP,  is a trilingual speech-language pathologist who provides school-based and private services.  The author of various continuing education eCourses, leveled storybooks and instructional therapy materials for speech/language intervention, Ana Paula also offers free resources for SLPs, educators, and parents on her website The Speech Stop. You can contact her at apmumy@gmail.com.

 

 

Of Language Barriers, Culture Gaps and e-Bridges

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It certainly isn’t news that our country is becoming increasingly diverse. What may surprise us is that some of the biggest growth is happening in non-border, less-urbanized states. California, Texas and Florida continue to have the most residents who were born in another country. However, Alabama, Arkansas, Delaware, North Carolina and Tennessee all saw more than a 70% increase in foreign-born residents between 2000 and 2012.

This means that ASHA members probably find themselves with more and more English-language learners on their caseloads. These audiologists and SLPs likely also live in areas where there may not be many resources for serving ELL students. Our Code of Ethics states that we should provide culturally and linguistically appropriate services. ASHA also acknowledges that the ideal situation for ELL clients is to work with a bilingual service provider with specific language and clinical skills.

Telepractice offers an elegant solution for connecting colleagues with these competencies to our clients that need them.

The versatility of telepractice makes it useful in different settings. A school district might use several Spanish-speaking telepractitioners to manage its entire ELL caseload. A rural health clinic may create a limited agreement with a bilingual audiologist for follow-up care of a patient who communicates in a less-commonly spoken language.

Telepractice can be used for more than intervention. We can assess patients—even formally—through telepractice. Formal assessment via telepractice is getting easier because many well-known tests are now digitized. Even when a certified professional is not available through telepractice, an onsite team can use technology to connect with interpreters and cultural brokers to help provide appropriate services.

Telepractice licensing, however, remains a hurdle for taking advantage of remote services or becoming a telepractitioner. Most states don’t currently have regulations on telepractice for our professions. ASHA and local associations, however, advocate for states to formulate and adapt guidelines permitting telepractice.

In the meantime, associations advise telepractitioners to verify requirements and policies, as well as hold all appropriate credentials, both in the state where we reside and where the client receives services. This applies also to special credentialing for bilingual telepractitioners.

ASHA doesn’t certify bilingual service providers, but it provides guidelines for those who represent themselves as such. For example, we are ethically-bound to ensure that we speak or sign another language with native or near-native proficiency, and possess various clinical competencies.

To my knowledge, only Illinois and New York have a type of credential for bilingual practitioners, and these are specific to professionals working in schools. However, because policy changes frequently (and is difficult to track), SLPs and audiologists should verify any bilingual-specific requirements in states where they might practice before providing services.

Telepractice holds a lot of promise for serving clients with diverse needs. Even when there is some red tape to figure out, using technology to build bridges to communities that may not have many resources is one of my most rewarding professional experiences!

 

Nate Cornish, M.S., CCC-SLP is a bilingual (English/Spanish) SLP and clinical director for VocoVision and Bilingual Therapies.  He is the professional development manager for SIG 18: Telepractice, a member of ASHA’s Multicultural Issues Board, and a past president and vice-president of the Hispanic Caucus.  Cornish provides clinical support to monolingual and bilingual telepractitioners around the country.  He also organizes and presents at various continuing education events, including an annual symposium on bilingualism.  Contact him at nate.cornish@vocovision.com.

Tips for Assessing Bilingual Children As a Monolingual SLP

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There are an estimated 337 different languages used (spoken, written, and/or signed) in the United States. Even bilingual speech-language pathologists will encounter situations in which the client’s primary language is unknown.  There are standardized, evidence-based tests for the Spanish-English population. But what about Russian, Vietnamese, German and so on? What do you do?

Here are some key practices that can aid any SLP evaluating a child who speaks an unfamiliar language:

  • Conduct a family/caregiver interview, which can help minimize cultural and linguistic biases. Understanding how others in the family view the client’s communication gives insight into expectations and the possibility for deficits. Is the client able to meet these expectations? If not, why and how? Do they differ significantly from others in that communication circle?
  • Use an interpreter. Meet with the interpreter prior to any contact with the family to review the process, terminology, and what you want him or her to do. If possible, use someone outside the child’s family and circle of friends to reduce the possibility of bias. Interpreters can provide key information, such as, “It was very hard for me to understand him,” or, “He doesn’t use prepositions correctly.” Using such information, along with additional testing measures can help support or negate a true disorder.
  • Use highly pragmatic tests if formal/standardized testing is not available in the child’s primary language. These tests will help determine the client’s grasp of conversational language, which is the first building block to more complex language. The same is true in monolinguals—that the first language we learn is social in nature. We e acquire more complex understanding and use of language by building on social language. You cannot report standard scores when using standardized testing not normed for that language. You can use the information as qualitative data to support the rest of your findings. I personally like administering the Oral and Written Language Scales (OWLS), now a second edition, for this population. It is relatively easy and quick to administer.
  • Employ Dynamic Assessment, which  involves pretest of a skill, an intervention to address that skill, and then a post-test to determine if there was progress. This method of assessment can be useful for evaluating multilingual individuals. If intense intervention is needed, this can indicate  impairment. Review the ASHA website for more information on Dynamic Assessment.
  • Include a communication sample in any communication evaluation. How does the child use language? It often includes either a conversation or story retell. See Portland State University’s website, Multicultural Topics in Communication Sciences & Disorders, for links to typical English when influenced by different languages.

Things to be mindful of regarding typical bilingual language development include the following.

  • The silent period occurs when a client is first exposed to a new language. Typically this period ends between six months to a year. Some common misidentifications in this phase are Autism Spectrum Disorder, Selective Mutism, and language delay. It has also been noted that with a significant change in school, family situation and the like can trigger some children to revert to the silent period. This is why family and caregiver interviewing is so essential to diagnosing a language disorder.
  • Bilingual development is recognized in two stages. Basic Interpersonal Communication Skills (BICS), also known as “conversational language,” typically takes two to three years to acquire. Cognitive Academic Language Proficiency (CALP), also known as “academic language,” takes five to seven years to develop. Some common misidentifications during these phrases are Language Disorder and Specific Learning Disability. Be careful that the years refer to a 12-month period of constant and consistent exposure. Our academic calendars are typically nine months, so it may take more academic years to acquire conversational and academic language.

Remember when evaluating any child that there is variety among the “same” cultures and languages.
What additional information do you, or would you, include in an evaluation?

Leisha Vogl, MS, CCC-SLP, is a speech-language pathologist with Sensible Speech-Language Pathology, LLC, in Salem, Oregon. She can be reached at leisha@sensiblespeech.com.

 

On the Brink of Kindergarten: Placement of Bilingual Students

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As a preschool-based speech-language pathologist in New York City, I get a number of bilingual children on my caseload every year. Many of them are sequential bilingual learners, with English being their second language (L2). It is also not uncommon for these sequential bilinguals to first begin to acquire their L2 here at the preschool. Speech-language and overall cognitive functioning of these children varies greatly, often a function of how much exposure to English they had to prior to preschool. During the Turning Five meetings, these students’ overall speech-language progress becomes especially salient.

At these meetings, I find that for some of our bilingual students, particularly the sequential bilinguals, the kindergarten setting recommended by the evaluation team tends to be smaller (for example, a classroom size of 12). This type of educational environment is often recommended for children with severe delays and disorders such as autism spectrum disorders, learning disability and childhood apraxia of speech.

During one of these meetings, a graduating student I will call Andy was described as extremely slow to progress and retain information. All team members agreed he requires a lot of support to comprehend basic in-context commands in therapy sessions and the classroom, and presents with minimal use of words. However, we also know that he is from a home where the primary language is not English. In addition, the student only joined the program at the age of 4, not at 3, which would probably have made a big difference. The speech-language evaluation in the child’s file indicates a severe delay in English (I bet I would be severely delayed in a language to which I had minimal or no exposure) but no mention of the skills present in L1. Communication with the family has been limited due to a language barrier.

There are many bilingual children in the New York City school system that follow Andy’s path. Hence, it should always be alarming to us, the educators, when a bilingual student in whom L1 is not English but there are no known global delays transitions into a kindergarten setting of 12. Additionally, a kindergarten special education classroom includes students with a variety of diagnoses and behaviors, with the more severely impaired students not providing a model for appropriate social skills and verbal communication.

So why do these students continue to get placed into smaller, more restrictive educational settings? Most obviously because of concern that they will not be able to function in a larger setting. But what could we be doing instead? Each child’s case would need to be studied individually. Specifically, we would need to review all the relevant cultural and linguistic background information starting at birth, such as the amount of L1 and L2 exposure in and out of home, history of speech- language delays, and the level of education in the family, to name a few. Other variables to consider are: 1) the amount of time that the bilingual student has spent in an all-English formal academic setting, 2) the presence of “problem” behaviors that significantly maintain the overall delays and reduce time the student is actually learning, and 3) the lack of sufficient, if any, L1 support (Spanish/ Bengali/Arabic) received in the school setting, including from an assigned SLP.

The latter one is of particular interest to me, as I am a bilingually certified English/Russian speech-language pathologist. However, I have little practical language skill to offer to my Arabic-, Spanish-, Bengali- or Albanian-speaking students. In such cases we, for the lack of a better word, “exercise,” our nonverbal communication skills and teach English as a second language.

Sure, an ongoing collaboration and a close relationship with the child’s family can potentially shed light on the speech-language and cognitive skills of the student. However, my experience has been that, due to communication barriers, the family yields little information that can guide me. Therefore, in most cases, I cannot reliably pinpoint speech-language deficits present in languages other than English or Russian.

This is an ongoing issue of inappropriate services to and settings for our bilingual special education students. Research is full of examples of typically developing bilingual students taking longer to learn and acquire L2 skills. This is even more consequential for children with special needs, whose speech- language and/or cognition is already delayed. Subtractive bilingualism is the term Fred Genesee and colleagues use in their book “Dual Language Development and Disorders” (2004) to describe this language-learning dilemma and the danger of “switching” our culturally diverse students to English only. According to the literature, the problem with monolingual (English-only) placements is that many of our already delayed bilingual children can’t “catch up” to their monolingual peers. Therefore, the all-English classroom setting of 12 carries a rather pessimistic long-term implication for overall academic success.

But what if every bilingual child with special needs received enough L1 support? Would that change the outcome? What if we had enough bilingual certified SLPs representing a variety of cultures and languages to help our culturally diverse students? Would the bilingual children still be placed into restrictive settings with no L1 support and with communicative interactions that offer few appropriate models? I believe that if these students received speech-language services in both the L1 and L2, they would make significantly more progress and at a much higher rate.

It would certainly further expedite their progress and make the instruction more holistic and ethical. Of course, today, more than ever, we have major problems with budget cuts that affect the number and the size of special education classrooms available to us, as well as the amount and the type of services we can offer. In fact, in recent years it has become much more difficult to qualify a child for related services even in the presence of notable deficits. Greater still is the cost of not delivering appropriate and culturally/linguistically ethical services to our bilingual children. We might be in far greater need of special education services years down the line when trying to remediate difficulties that were further compromised due to lack of appropriate language support. Just something to think about!

Natalie Romanchukevich, MS, CCC-SLP, is a bilingual Russian speech-language pathologist at the Children’s Center for Early Learning in New York City. This post is adapted from a guest post Natalie Romanchukevich wrote for Tatyana Elleseff’s blog Smart Speech Therapy. Natalie can be reached at natalieslp@gmail.com.

It Really is a “Brave New World” for Speech-Language Pathology!

In 1931, Aldous Huxley’s novel A Brave New World told us a tale of what society in the distant future would look like… a place of advanced technology, new social structures and radical changes in how humanity interacts with each other… sound familiar?

Well, arranging the Georgia Speech-Language Hearing Association’s (GSHA) short course offerings has opened my eyes to how very fast the role of being an SLP is changing from year to year. We are now serving highly diverse populations of multiple nationalities, utilizing technology that just 10 years ago was science fiction and becoming more and more an integrated part of the healthcare community in general. From NICU to hospice, home health care to the public schools, SLPs are involved with communication and swallowing disorders across the lifespan. We are providing these services in a cost effective, evidence based manner that is making real and measurable change in the populations we serve.

It is with this “Brave New World” in mind, that GSHA would like to present to our fellow convention-goers three short course opportunities that are sure to make a positive impact on the clients, patients and students we all serve. ASHA has given the Georgia association the wonderful opportunity to provide ticketed pre-convention and convention related short courses on November 14th and 15th. Please join us on November 14th for-

Barbara Fernandes, M.S., CCC-SLP The iPad and Your Therapy – Apps, Accessories, Accessibility and Features

Jose Galarza, M.A., CCC-SLP Spanish Influenced English: What Every SLP Should Know

and on November 15th for-

Kate Krival, Ph. D. CCC-SLP Anticipation: Neural Bases and Clinical Implications in Swallowing in Adults

Our pre-convention activities on November 14th will include presentations from Barbara Fernandes, M.S, CCC-SLP and Jose Galarza, M.A. CCC-SLP. Barbara (better known as GeekSLP) will be presenting on all things Apple, Ipad and App related. Bring your Ipad and/or Iphone to her presentation and you will leave better understanding how to use it with your respective population. Jose’s presentation will address the needs of monolingual SLPs working with bilingual children in the school setting. Since school SLPs are increasingly faced with the communication needs of Hispanic children, his presentation is especially relevant to the English speaker attempting evaluation and treatment of those children. Barbara and Jose are both experts in their respective areas and will highly impact the attendee in a positive manner.

On November 15th, join GSHA in welcoming Kate Krival, Ph. D., CCC/SLP. Dr. Krival directs the Swallowing Research Lab at Kent State University and she is a Research Investigator in the Head and Neck Neural Interface Lab at Louis Stokes Veterans Administration Medical Center in Cleveland, OH. She is particularly interested in clinical research targeting sensory-based interventions for swallowing disorders in adults with neurogenic dysphagia. If dysphagia is your area of interest, Kate will leave you with tons of evidenced based ideas for use with your patients!

So, Join GSHA and ASHA in facing this Brave New World of ours with the confidence that these courses will keep you informed, up to date and ahead of the curve!!! See you in Atlanta…

 

Edgar V. (Vince) Clark, M. Ed., CCC/SLP, advocates for the importance of state association participation whenever possible. He is currently the GSHA to ASHA Liason for the 2012 convention, current GSHA CEU chair and is a past-president of GSHA. Professionally, he is interested in adult dysphagia, all things technology, and the use of social media for promoting the professions.

 

The ASHA Convention is quickly approaching! If you haven’t already registered, don’t delay–register today! Stay tuned to ASHAsphere in the weeks leading up to the ASHA Convention for posts by the official Convention bloggers–Jeremy LegaspiTiffani Wallace and Katie Millican. Not an official Convention blogger but want to write a post about it for ASHAsphere? No problem! Send posts to Maggie McGary at mmcgary@asha.org and it could be featured here.

Relationship and Communication Development in Children Adopted From Abroad

When my grand-daughter was born, I made a conscious decision to visit her every month. Not only did I want to observe her development on a regular basis, I also wanted her to interact with me consistently so we could build a close and loving relationship. She is now 5 years old and we enjoy a wonderfully close relationship. When her brother was born, she had to share her mother and father with him but she was unwilling to share me. She expected her grandfather to play with her brother so that I could spend all of my time with her. Naturally, our grandson developed a close and loving relationship with his grandfather. To this day when we arrive at their house, he first asks “Where is Grandpa?” and seeks to reconnect with his grandfather before he will interact with me. Now they have a new younger brother and it will be interesting to see how his relationship with both grandparents develops.

Infants learn to communicate within the context of contingent, consistent and sensitive face-to-face communication with their caregivers. They are born expecting developmentally appropriate and nurturing care. In fact, they are dependent upon such care to thrive and survive. Through consistent, appropriate and individually sensitive interactions, infants learn how to trust their caregivers, share emotions, regulate negative emotions, and associate nonverbal communication such as facial expressions and tone of voice with certain emotions (Baldwin & Moses, 1994; Butterworth, 1994; Moses, Baldwin, Rosicky, & Tidball, 2001; Smith, 2005). These early interactions help infants learn that when they are uncomfortable they can cry and most often an adult will make them feel better. Eventually they learn to regulate their distress at the sight of the caregiver’s smiling face, when they hear their caregiver’s calming voice, or as soon as the caregiver picks them up. Infants develop trusting relationships based on the consistent and contingent care they receive from sensitive caregivers and through these relationships they learn to draw inferences from their communicative, cognitive and social interactions.

Unfortunately not all children receive positive, contingent and consistent care. Many children experience maltreatment during their infancy or toddlerhood with the majority of maltreatment cases involving neglect (Children’s Bureau, 2011). The U.S. Department of Health and Human Services describes maltreatment to include: a) physical abuse, b) sexual abuse, c) emotional abuse, or d) child neglect. Physical abuse can be physical harm of a child or placing a child at risk of being harmed such as witnessing spousal abuse. Neglect can include not meeting the child’s physical, educational, health care, or emotional needs (Hildegard & Wolfe, 2002).

Research on maltreated children provides evidence that maltreatment results in poor developmental outcomes (Wolfe, 1999). Children experiencing maltreatment have been reported to demonstrate poorer cognitive, receptive and expressive language performance and social-emotional development when compared with their peers (Culp et al., 1991; Eigsti & Cicchetti, 2004; Hildegard & Wolfe, 2002; Wolfe, 1999). Although placement into foster care families moves children into safer environments, children continue to display weaker social-emotional development and language performance and children who experience more transitions in care tend to demonstrate poorer performance (Pears & Fisher, 2005; Windsor, Glaze, Koga & the Bucharest Early Intervention Project Team, 2007).

Children who are raised in orphanages experience maltreatment (Johnson, 2000, 2005; Miller, 2005) and when adopted by families from a different country, the children often experience disrupted language acquisition.  Orphanage care in countries with few resources or poor economies, provide less than adequate care. Many orphanages operate with large child to adult ratios and provide limited health care, poor nutrition, and little to no social or educational stimulation. Once children are adopted, many of the adopted families do not speak the children’s birth language and may not have resources to provide continued instruction in the child’s birth language. Thus, the children quickly stop speaking and listening to their birth language and become monolingual speakers of their adopted language (Hwa-Froelich, 2009, 2012). Research has documented rapid acquisition of the adopted language (for a review see Hwa-Froelich, 2012). However, recent research provides longitudinal evidence of expressive language delays (Cohen, Lojkasek, Zadeh, Pugliese, & Kiefer, 2008; Gauthier & Genesee, 2011; Glennen, 2007). In a recent meta-analysis, Scott and colleagues (2011) report that international adoptees demonstrate poorer language performance on behavioral measures than on survey measures and when compared with peers rather than standardized test norms. They found that while there was great variability in language performance during the preschool ages, children adopted from abroad were not significantly different from their nonadopted peers. However, there was a greater likelihood of poorer language outcomes at school-age or older ages. In other words, maltreatment and disruption in language acquisition may place internationally adopted children at increased risk of language problems.

Early maltreatment and poor relationship development can have persistent effects on children’s communication development. Therefore, it is important for professionals to recognize, identify and report cases of maltreatment early and persistently to prevent and stop maltreatment of children. Agencies and professionals must try to provide safe and consistent caregiving environments for children removed from their families and children living in orphanages. Once children have experienced maltreatment, professionals must work closely together with children and their caregivers to facilitate the development of close, safe, and loving relationships as well as the children’s cognitive, communication, and social-emotional development. Consistent assessments to evaluate cognitive, communication, and social-emotional development longitudinally are needed. If children demonstrate developmental delays then early intervention may benefit children exposed to maltreatment and disrupted language acquisition, such as children adopted from abroad.

Disclosure: Some of the information included in this blog was taken from Hwa-Froelich, D. A. (2012). Childhood maltreatment and communication development. Perspectives on School-based Issues, 13(1), 43-53. The author discloses financial benefit from book sales.

References

Baldwin, D. A., & Moses, L. J. (1994). Early understanding of referential intent and attentional focus: Evidence from language and emotion. In C. Lewis & P. Mitchell (Eds.) Children’s early understanding of mind. Origins and development (pp. 133-156). Hillsdale, NJ: Erlbaum.

Butterworth, G. (1994). Theory of Mind and the facts of embodiment. In C. Lewis & P. Mitchell (Eds.) Children’s early understanding of mind. Origins and development (pp. 115-132). Hillsdale, NJ: Erlbaum.

Children’s Bureau. (2011). Child maltreatment 2010. Retrieved from http://www.acf.hhs.gov/programs/cb/stats_research/index.htm#can

Cohen, N. J., Lojkasek, M., Zadeh, Z. Y., Pugliese, M., & Kiefer, H. (2008). Children adopted from China: a prospective study of their growth and development. The Journal of Child Psychology and Psychiatry, 49(4), 458-468. doi:10.1111/j.1469-7610.2007.01853.x

Eigsti, I-M., & Cicchett, D. (2004). The impact of child maltreatment on expressive syntax at 60 months. Developmental Science, 7(1), 88-102.

Gauthier, K., & Genesee, F. (2011). Language development in internationally adopted children: A special case of early second language learning. Child Development, 82(3), 887-901. doi:10.1111/j1467-8624.2011.01578.x

Glennen, S. (2007). Predicting language outcomes for internationally adopted children. Journal of Speech, Language and Hearing Research, 50, 529-548. doi:10.1044/1092-4388(2007/036)

Hildeyard, K. L., & Wolfe, D. A. (2002). Child neglect: developmental issues and outcomes. Child Abuse & Neglect, 26, 679-695.

Hwa-Froelich, D. A. (2009). Communication development in infants and toddlers adopted from abroad. Topics in Language Disorders, 29(1), 27-44. doi:10.1097/01.TLD.0000346060.63964.c2

Hwa-Froelich, D. A. (2012). Supporting development in internationally adopted children. Baltimore: Paul H. Brookes.

Johnson, D. E. (2000). Medical and developmental sequelae of early childhood institutionalization in Eastern European adoptees. In C. A. Nelson (Ed.). The Minnesota Symposia on child psychology: The effects of early adversity on neurobiological development: Vol. 31. Minnesota Symposium on Child Psychology (pp. 113-162). Minneapolis: University of Minnesota Press.

Johnson, D. E. (2005). International adoption: What is fact, what is fiction, and what is the future? Pediatric Clinics of North America, 52, 1221-1246. doi:10.1016j.pel.2005.06.008

Miller, L. (2005). The handbook of international adoption medicine. NY: Oxford University Press.

Moses L. J., Baldwin, D. A., Rosicky, J. G., & Tidball, G. (2001). Evidence for referential understanding in the emotions domain at twelve and eighteen months. Child Development, 72(3), 718-735. http://www.jstor.org/

Pears, K., & Fisher, P. A. (2005). Developmental, cognitive, and neuropsychological functioning in preschool-aged foster children: Associations with prior maltreatment and placement history. Developmental and Behavioral Pediatrics, 26(2), 112-122.

Smith, A. D. (2005). The inferential transmission of language. Adaptive Behavior, 13(4), 311-324. doi:10.1177/105971230501300402

Windsor, J., Glaze, L. E., Koga, S. F., & the Bucharest Early Intervention Project Core Group. (2007). Language acquisition with limited input: Romanian institution and foster care. Journal of Speech-Language-Hearing Research, 50, 1365-1381. doi:10.1044/1092-4388(2007/095)

Wolfe, D. A. (1999). Child abuse: Implications for child development and psychopathology. Thousand Oaks, CA: Sage.

 

Deborah Hwa-Froelich, Ph.D., CCC-SLP, is a Saint Louis University professor and Director of the International Adoption Clinic with interests in social effects on communication such as culture, poverty, parent-child interaction, maternal/child health, and disrupted development.

 

Tips for Parents Raising Bilingual Children: When the Home Language Differs From the Community Language

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Photo by agreste3000

Be Intentional

  • Realize that everyday activities such as mealtimes, getting dressed, bath time, and playtime are all opportunities for talking, teaching, and providing quality language exposure. Be intentional about ongoing verbal interactions about things, routines and events in your child’s life.
  • Arrange for varied opportunities for your child to have diverse contexts for engaging in the minority language such as book sharing and reading experiences, singing, educational videos, children’s shows, play groups, family visits and trips. It is important for your child to have access to other speakers of the minority language as much as possible.
  • When your child uses incorrect words or grammar, simply model the correct vocabulary and/or sentence structure in response to the child’s utterance.
  • When appropriate, expand your child’s utterances by first affirming what he/she said and then by adding to what was said if the vocabulary or grammar usage was lacking.
  • Even if your child is tending to speak more in the majority language, continue speaking to him/her in the minority language. When appropriate, recast the utterance, or present it in a different or changed structure while maintaining its meaning. For example, if your child utters a phrase or sentence partly or entirely in the majority language, recast the utterance in the minority language, modeling correct usage where any vocabulary or grammatical gaps were noted.
  • Instill in your child a sense of pride and “need” for the minority language by keeping it relevant and constant in his/her everyday life. Children will inevitably discard a language they do not feel they need.
  • Consider teaching your child to read and write in the minority language. The more competencies your child develops in the minority language, the more internally relevant and important that language will become.

Be Consistent

  • If you are the primary source of language input for your child in the minority language, consistently speak to your child in that language whether at home or out in the community.
  • Though code mixing, or alternating between two languages while speaking, is completely normal and appropriate for bilinguals, in order to clearly draw a line between the two languages in your child’s linguistic environment, limit code mixing as much as possible at least at the beginning stages.

Be Persistent

  • Don’t lose heart or give up even if your child’s language proficiency or skills seem to fluctuate over time in his/her two languages. Some fluctuation is normal as children learn to navigate between both languages.
  • Don’t allow for interruptions or long periods of little or no exposure to the minority language. • When it seems hard and laborious, remember the long-term benefits and rewards you are bestowing upon your child by raising him/her to be bilingual.
  • Relatives, friends, and community members may misunderstand or even disagree with your decision to raise your child bilingually for various reasons. If you can, kindly educate them about your decision, but if not, politely stand your ground based on what’s best for your child. Your dedication, consistency and persistence will pay off in the end!

“The bilingualism of children should be a source of joy, both for parents and children, even if there are occasional moments of difficulties.” François Grosjean

(This post originally appeared on The Speech Stop)

 

Ana Paula G. Mumy, MS, CCC-SLP,  is a trilingual speech-language pathologist and the author of various continuing education eCourses, leveled storybooks, and instructional therapy materials for speech/language intervention, as well as the co-author of her latest eSongbook which features songs for speech, language and hearing goals.  She has provided school-based and pediatric home health care services for nearly 12 years and thoroughly enjoys providing resources for SLPs, educators and parents on her website The Speech Stop.

Knitting Multiple Modalities

Knitted owl hat

Photo by Burstyriffic

Before becoming a mom I taught K-12 classes, starting in second language classrooms. It felt like I was at home because I grew up as a simultaneous bilingual — a person who was presented with two languages from birth in an immigrant household. My parents met in an ESL classroom in the Mission district of San Francisco, so I grew up learning in ways that helped all of us which meant using all modalities — visual, tactile, auditory, kinesthetic. Hearing wasn’t enough — it’s so subjective. Are you saying ‘b’ de burro or ‘v’ de vaca? This image helps one to establish in the mind that very fast sounds are distinguished by so little when coarticulation is involved. It also seems so fast when learning a second language, so physically moving or tapping out the sounds really helps. And of course, there must be a reason why so much of the motor strip targets the hands — I feel therefore I learn. In my own studying, it is not enough for me to just hear. If I can touch it, feel it, sign it — I feel like I own it like the way a toddler mouths a book or a toy.

Using multiple modalities also made me think of a fairly recent experience. Two summers ago I wanted to knit a playmat for my kids, so I took a beginning knitting class co-taught by two women in my area. One woman relied on auditory teaching skills — I was so lost. Knit one pearl two — what!?! She went regular speed, thinking that’s what she needed to model so that we could learn to knit correctly. There were a group of us (20 total in the class) who were just not getting it. She kept coming to our group to retell us what she had already told the larger group. Repeating didn’t help. Still lost. She showed us again at her regular speed. Stressed. So contrary to what knitting addicts profess. “Way over-rated,” I thought of knitting, as my shoulders elevated toward my ears from the stress.

Then the other teacher came to us and gently placed her hands on ours to physically guide us in the pattern. She also made the pattern slower, much more exaggerated and larger in movement than the other teacher. BINGO!!!! Our eyes and minds that had previously felt as if they were on a fast spinning merry-go-round that didn’t give us a chance to hop on finally were able to catch up and get on. We got it! And not only did this small group of auditory strugglers get it, we outlasted the larger group and stayed with the project while many others dropped out. Ahhh…knitting wasn’t over-rated after all, but much more like a catnip invoked endeavor…

This experience reinforced something I intuitively knew from growing up in a household of second language learners, from teaching second language learners, and teaching my son who has special needs including severe dysarthria, severe CAS and ASD: all modalities help. I saw this espoused at ASHA’s 2011 conference in sessions regarding ASD. Also, it’s not just the modality but the speed and the size of the movement of these modalities which also help to get those neural networks firing and wiring for a meaningful experience.

So when I think of multiple modalities for our client population — I can’t help but think knitting….

 

Liz Guerrini has been a K-12 and college teacher for the past 18 years and is entering her final graduate year in Communicative Disorders at CSUN. She’s an Olympian who finds many applications of her sport world to the teaching and therapy worlds. She home-schools her bright and beautiful son who lives with trisomy 2, severe dysarthria, severe CAS, hearing loss, ASD and hypotonia. She is a member of ASHA’s Minority Student Leadership Program. Liz blogs at  Christopher Days, SLP to-Be and the Signing Time Academy.

Recommending Monolingualism to Multilinguals – Why, and Why Not

Multilingual christmas lights in Barcelona


Photo by Oh-Barcelona.com

In cases of suspected or confirmed clinical disorder among bilingual/multilingual children, one common recommendation is to have the children “switch to one language.” This advice comes both from monolingual SLPs, who are trained in and for monolingual settings, and from multilingual SLPs, including those working in multilingual contexts. I would like to offer a few thoughts on the practical feasibility of this advice, the reasons that may motivate it, and whether those reasons match what we know about multilingualism and speech-language disorders.

Recommending monolingualism to multilinguals seems to draw on a conviction that multilingualism either causes or worsens speech-language and related disorders or, conversely, that monolingualism either blocks or alleviates them. Speech disorders (such as stuttering), language disorders (such as SLI), and developmental disorders (such as autism) do affect language, in that linguistic development relates to physical, cognitive, social and emotional development. But language development can be typical or atypical regardless of the number of languages in a child’s repertoire. Speech-language and developmental clinical conditions affect multilinguals and monolinguals alike, which means that there is no correlation between multilingualism, or monolingualism, and disorder. In the absence of a correlation, there can be no legitimate conclusion that using one language vs. using more than one has predictable effects upon disorder. The unwarranted conviction that number of languages is a relevant factor of speech-language disorder rests on a number of beliefs, as follows.

First, the belief that healthy linguistic and related development can only be achieved in a single language. Multilingual children naturally develop linguistically in all the languages that they need to use for everyday purposes. Cognitive, social and emotional development follows suit, through each of the contexts in which the languages of a multilingual are relevant. Multilinguals, big and small, use each of their languages in different ways. This is in fact why they are multilinguals: if a single language served all their purposes, they would be monolinguals.

Each of the languages of a multilingual naturally reflects the specific uses that it serves, and each will develop accordingly, at its own pace. If a child uses, say, one language with mum, another one with dad, and yet another one in school, each language will naturally show evidence of mum-related, dad-related and school-related accent, vocabulary, grammar and pragmatics. Having different words or a different number of words in each language, for example, or preferring to use one language rather than another for specific topics or with different people, is typical of multilingualism, not a sign of atypical linguistic competence. A less developed language of a multilingual is therefore not a symptom of a clinical condition such as ‘language delay’, but reflects instead less use of that language than of another. If there are concerns about the development of a particular language of a multilingual, the child may be appropriately referred to a language tutor, not to an SLP.

Second, the belief that using more than one language results in diminished proficiency both in each language and in other proficiency. This belief draws on subtractive views of the human brain, which have it as a computer-like processor featuring limited storage capacity, organised into computer-like modules and processing modes. On this view, ‘brain space’ allocated to each language disrupts other brain space, by encroaching upon it in ways similar to zero-sum situations, where the gains and losses of one ‘module’ exactly match the losses and gains of another, respectively. Computer analogies of the human brain gained popularity by the middle of last century, but current findings about inherent brain plasticity prove their inadequacy to model brain organisation, activity and power.

Third, the belief that using one particular language in one setting will promote development of that language in other settings. The recommendation to switch to one language often means ‘switch to exclusive use of the mainstream language at home.’ Even in cases where it might be viable to change or amend the home language practices in which a child has been brought up, switching to a mainstream language at home, or making it the only home language, will not necessarily impact uses of that language elsewhere, for example in school. The converse is also true: academic uses of a language, say, do not automatically transfer to home uses of the same language, because these uses belong to different registers.

“Register” is a term used in linguistics to describe the differential ways in which we all use our languages to fit specific contexts and specific people. Monolingual children (and adults) switch among the registers that they have learnt to be appropriate at home, in school, at work, or with peers, juniors and elders. Multilinguals do likewise: they switch register in each of their languages, in order to match the participants and the context of an interaction in a particular language, and they switch language, again where participants and context so require. The ability to switch uses of language appropriately constitutes proof of linguistic competence, because it shows understanding of how different registers and/or different languages serve different purposes. A home language, or a home register, develops for home-use purposes, which do not and cannot match academic and other uses of it. The way to promote development of languages or registers in a specific context is to use them in that context.

Finally, the belief that language disorder is best addressed through a single language of intervention. The mainstream language favoured by recommendations of monolingualism often coincides with the language of education, that the child may, in addition, happen to share with the clinician. This raises the question of whether the recommendations are indeed meant to favour monolingualism, or to favour monolingualism in a particular language, the language in which assessment instruments are likely to be more readily available. Whichever the case may be, current research on clinical work with multilingual children shows that intervention which targets the whole of a child’s linguistic repertoire increases both the chances and the pace of recovery. Addressing linguistic repertoires for purposes of intervention makes good overall sense, in that language disorders affect the whole of a child’s linguistic repertoire, regardless of the number of languages involved. Diagnosis must take the whole child into account, so that intervention can start from where the child’s abilities are, whether these abilities are monolingual or multilingual.

Depending on the context of specific interactions, typical monolinguals and multilinguals alike make proficient use of their linguistic repertoires, which means differential use of linguistic resources. The whole linguistic repertoire of a monolingual child translates into resources drawn from a single language, but the whole linguistic repertoire of a multilingual child does not. Beliefs and convictions to the contrary, such as the ones sketched above, rest on a misconception of monolingualism as “norm” of language use, which has spawned related misconceptions that take proficiency in a single language for linguistic health, and lack of proficiency in a single language for symptom of language disorder. Being multilingual involves differential proficiency in more than one language, whose interplay with social, cognitive and emotional development can only be ascertained from observation of the child’s abilities in each appropriate context.

The take-home message that I would like to leave here is that multilingualism is neither a disorder nor a factor of disorder. In cases of suspected or confirmed clinical disorder among bilingual/multilingual children, switching to a single language will not address the disorder. It will simply create a monolingual child with a disorder.

 

Madalena Cruz-Ferreira, PhD in Linguistics and Phonetics (University of Manchester, UK), researches multilingualism and child language. One section of her book Multilingual Norms addresses multilingual clinical assessment. Her blog Being Multilingual deals with the use of several languages at home, in school and in clinic.

Recommending Monolingualism to Multilinguals – Why, and Why Not

Multilingual christmas lights in Barcelona


Photo by Oh-Barcelona.com

In cases of suspected or confirmed clinical disorder among bilingual/multilingual children, one common recommendation is to have the children “switch to one language.” This advice comes both from monolingual SLPs, who are trained in and for monolingual settings, and from multilingual SLPs, including those working in multilingual contexts. I would like to offer a few thoughts on the practical feasibility of this advice, the reasons that may motivate it, and whether those reasons match what we know about multilingualism and speech-language disorders.

Recommending monolingualism to multilinguals seems to draw on a conviction that multilingualism either causes or worsens speech-language and related disorders or, conversely, that monolingualism either blocks or alleviates them. Speech disorders (such as stuttering), language disorders (such as SLI), and developmental disorders (such as autism) do affect language, in that linguistic development relates to physical, cognitive, social and emotional development. But language development can be typical or atypical regardless of the number of languages in a child’s repertoire. Speech-language and developmental clinical conditions affect multilinguals and monolinguals alike, which means that there is no correlation between multilingualism, or monolingualism, and disorder. In the absence of a correlation, there can be no legitimate conclusion that using one language vs. using more than one has predictable effects upon disorder. The unwarranted conviction that number of languages is a relevant factor of speech-language disorder rests on a number of beliefs, as follows.

First, the belief that healthy linguistic and related development can only be achieved in a single language. Multilingual children naturally develop linguistically in all the languages that they need to use for everyday purposes. Cognitive, social and emotional development follows suit, through each of the contexts in which the languages of a multilingual are relevant. Multilinguals, big and small, use each of their languages in different ways. This is in fact why they are multilinguals: if a single language served all their purposes, they would be monolinguals.

Each of the languages of a multilingual naturally reflects the specific uses that it serves, and each will develop accordingly, at its own pace. If a child uses, say, one language with mum, another one with dad, and yet another one in school, each language will naturally show evidence of mum-related, dad-related and school-related accent, vocabulary, grammar and pragmatics. Having different words or a different number of words in each language, for example, or preferring to use one language rather than another for specific topics or with different people, is typical of multilingualism, not a sign of atypical linguistic competence. A less developed language of a multilingual is therefore not a symptom of a clinical condition such as ‘language delay’, but reflects instead less use of that language than of another. If there are concerns about the development of a particular language of a multilingual, the child may be appropriately referred to a language tutor, not to an SLP.

Second, the belief that using more than one language results in diminished proficiency both in each language and in other proficiency. This belief draws on subtractive views of the human brain, which have it as a computer-like processor featuring limited storage capacity, organised into computer-like modules and processing modes. On this view, ‘brain space’ allocated to each language disrupts other brain space, by encroaching upon it in ways similar to zero-sum situations, where the gains and losses of one ‘module’ exactly match the losses and gains of another, respectively. Computer analogies of the human brain gained popularity by the middle of last century, but current findings about inherent brain plasticity prove their inadequacy to model brain organisation, activity and power.

Third, the belief that using one particular language in one setting will promote development of that language in other settings. The recommendation to switch to one language often means ‘switch to exclusive use of the mainstream language at home.’ Even in cases where it might be viable to change or amend the home language practices in which a child has been brought up, switching to a mainstream language at home, or making it the only home language, will not necessarily impact uses of that language elsewhere, for example in school. The converse is also true: academic uses of a language, say, do not automatically transfer to home uses of the same language, because these uses belong to different registers.

“Register” is a term used in linguistics to describe the differential ways in which we all use our languages to fit specific contexts and specific people. Monolingual children (and adults) switch among the registers that they have learnt to be appropriate at home, in school, at work, or with peers, juniors and elders. Multilinguals do likewise: they switch register in each of their languages, in order to match the participants and the context of an interaction in a particular language, and they switch language, again where participants and context so require. The ability to switch uses of language appropriately constitutes proof of linguistic competence, because it shows understanding of how different registers and/or different languages serve different purposes. A home language, or a home register, develops for home-use purposes, which do not and cannot match academic and other uses of it. The way to promote development of languages or registers in a specific context is to use them in that context.

Finally, the belief that language disorder is best addressed through a single language of intervention. The mainstream language favoured by recommendations of monolingualism often coincides with the language of education, that the child may, in addition, happen to share with the clinician. This raises the question of whether the recommendations are indeed meant to favour monolingualism, or to favour monolingualism in a particular language, the language in which assessment instruments are likely to be more readily available. Whichever the case may be, current research on clinical work with multilingual children shows that intervention which targets the whole of a child’s linguistic repertoire increases both the chances and the pace of recovery. Addressing linguistic repertoires for purposes of intervention makes good overall sense, in that language disorders affect the whole of a child’s linguistic repertoire, regardless of the number of languages involved. Diagnosis must take the whole child into account, so that intervention can start from where the child’s abilities are, whether these abilities are monolingual or multilingual.

Depending on the context of specific interactions, typical monolinguals and multilinguals alike make proficient use of their linguistic repertoires, which means differential use of linguistic resources. The whole linguistic repertoire of a monolingual child translates into resources drawn from a single language, but the whole linguistic repertoire of a multilingual child does not. Beliefs and convictions to the contrary, such as the ones sketched above, rest on a misconception of monolingualism as “norm” of language use, which has spawned related misconceptions that take proficiency in a single language for linguistic health, and lack of proficiency in a single language for symptom of language disorder. Being multilingual involves differential proficiency in more than one language, whose interplay with social, cognitive and emotional development can only be ascertained from observation of the child’s abilities in each appropriate context.

The take-home message that I would like to leave here is that multilingualism is neither a disorder nor a factor of disorder. In cases of suspected or confirmed clinical disorder among bilingual/multilingual children, switching to a single language will not address the disorder. It will simply create a monolingual child with a disorder.

 

Madalena Cruz-Ferreira, PhD in Linguistics and Phonetics (University of Manchester, UK), researches multilingualism and child language. One section of her book Multilingual Norms addresses multilingual clinical assessment. Her blog Being Multilingual deals with the use of several languages at home, in school and in clinic.