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.

CSD Students Use Their Skills in Ethiopia This Month

   

The CSD program at Teachers College Columbia University is in Ethiopia this month visiting schools for students with autism and a center for adults with intellectual disabilities. The TC Team—nine master’s students and three ASHA-certified SLPs: Lisa Edmonds, Jayne Miranda and I—used our experiences in Ghana and Bolivia to prepare for the trip.

At a vocational center for adults with intellectual disabilities the TC Team created “Seller’s Market Cards,” so the adults can independently sell their products. These low-tech Augmentative and Alternative Communication cards, laminated with packing tape, introduce the seller and list products for sale with their prices. We worked with the sellers to create the cards and then immediately tried them out at an impromptu market at the center!

At the Nehemiah Autism School, 20 teachers and our team spent the day collaborating to identify ways to bring more communication opportunities into an otherwise excellent school. We made 70 flash cards for weather, a large calendar, practiced social stories, and talked about ways to introduce literacy and math.

Right now, we’re presenting a five-day cleft palate speech institute at Yekatit 12 Hospital. Smile Train and Transforming Faces supported 14 cleft palate team professionals who attended from East and West Africa.

Please follow our adventures on the blog.  We love to see comments and are just halfway through our trip.

 

Catherine J. Crowley, CCC-SLP, JD, PhD, Distinguished Senior Lecturer in speech-language pathology at Teachers College Columbia University, founded and directs the bilingual/multicultural program focus, the Bilingual Extension Institute, and the Bolivia and Ghana programs. An experienced attorney, Crowley is working with NYCDOE on a multi-year project to improve the accuracy of disability evaluations. 

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.

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.

 

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.

Swallowing and Feeding Issues with Internationally Adopted Children

Vegetables in Whole Foods Market


Photo by Masahiro Ihara

My children were “picky eaters.” One would only eat peanut butter and jelly, frozen pizza, chicken nuggets or macaroni and cheese. The other one would only eat frozen pizza and hot dogs. Neither of them would eat any vegetables. If it was green, it was considered inedible! Needless to say, cooking for them was a challenge. Somehow they survived and are both healthy adults who eat more variety than I ever thought they would.

Many of our food preferences are based on our food experiences. Children residing in orphanages have feeding experiences that are affected by the number of staff available to feed large groups of infants and toddlers. Parents have reported observing children left in their cribs with bottles propped up to allow self-feeding, given plates of food too hot to eat without utensils to feed themselves, and children fed pureed instead of solid foods. These experiences may not only affect physical growth and nutrition but also adversely affect eating and swallowing development. Some researchers have reported a wide range of eating and swallowing problems from clinical samples including (a) chewing problems, (b) preoccupation with food availability, (c) gorging and (d) sometimes becoming omnivorous (Johnson & Dole, 1999). Others found that 15% (21 of 144 children adopted from Romania) continued to have chewing and swallowing problems at 6 years old, 2 to 5 years following adoption (Beckett, et al., 2002). Beckett and colleagues also found that if solid food was not introduced before the age of 1 year, more of these children had continued eating and swallowing problems. Many of the children seen at the Saint Louis University International Adoption Clinic present with eating and swallowing difficulty or unusual oral motor problems such as facial tics or intermittent velopharyngeal closure during speech and swallow.

Children adopted from abroad are at risk of having eating and swallowing problems. Practitioners are advised to explore the presence of oral motor sensitivity, eating and swallowing problems with the client or client’s family. If problems were observed or continue to occur, a thorough assessment of oral motor structures and function and possibly an assessment of eating and swallowing behaviors may be needed. If children demonstrate eating disorders related to mental health issues such as bulimia or anorexia, it is important to refer them to clinical psychologists or counseling and family therapists.

References

Beckett, C. M., Bredenkamp, D., Castle, J., Groothues, C., O’Connor T. G., Rutter, M., & the
English and Romanian Adoptees (ERA) Study Team. (2002). Behavior patterns associated with institutional deprivation: A study of children adopted from Romania. Journal of Developmental and Behavioral Pediatrics, 23(5), 297-303. http://journals.lww.com/jrnldbp/pages/default.aspx

Johnson, D. E., & Dole, K. (1999). International adoptions: Implications for early
intervention. Infants and Young Children, 11, 34-45. Retrieved from:
http://www.peds.umn.edu/iac/prod/groups/med/@pub/@med/documents/asset/me
d_49295.pdf

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.

 

Hearing Health and Development Following Adoption

LOUD speaker


Photo by woodleywonderworks

All my life I have been blessed with excellent hearing perception and health. Now due to my mold allergies, I have started to have fluid in my middle ear when the humidity and mold count rises above normal. The extra fluid in my ears has annoyingly affected my hearing acuity and balance. On one hand, I now understand how children feel when they have otitis media but on the other hand, I want to get rid of this ailment as quickly as I can! Naturally I sought the advice of an audiologist who completed impedance testing. As it turns out, my tympanograms showed only a small loss of flexibility in the tympanic membrane and fell in the low normal range. Typically most medical professionals would not treat a patient who exhibited these symptoms preferring to wait until the patient demonstrated consistent flat tympanograms or infection. Although I exhibit neither of these conditions, the small amount of fluid in my ear has significantly reduced my hearing acuity especially in noisy environments like the classroom. I wonder how can children focus and learn when they have fluid in the middle ear?

Children who reside in orphanages around the world may receive less than adequate medical care. Otitis media is often untreated and children’s hearing is not tested or monitored (Bledsoe & Johnston, 2004; Johnson, 2000). Due to the lack of attention to hearing health, it is not unusual for children to become accustomed to the symptoms of ear pain, imbalance, and poor hearing acuity. When parents adopt these children, they may expect the children to demonstrate behaviors of discomfort when ill. However, because of the lack of attention to hearing health, the children do not show symptoms of pain or lack of balance and the parents may not recognize when to seek medical care. At the International Adoption Clinic at Saint Louis University, I have seen children with undiagnosed hearing loss and ear infections, some of whom had previously seen a pediatrician the day before.

Additionally, children residing in orphanages are cared for by a rotation of adults where the child to adult ratio may be high. Johnson reported on conditions of care in Romanian orphanages where children were often left in their cribs/beds, received little if any social interaction from caregivers, and had few experiences with toys or educational stimulation. As a result, children’s hearing experiences were unmentored and they may not have learned which sounds were meaningful to attend to or what certain sounds meant.

Sometimes years after they were adopted, some children who passed a hearing screening and audiological evaluation did not alert to environmental sounds (whistles, knocks on the door, telephones, or their name being called). I have also seen children who have difficulty attending to and discriminating speech from noise as well as children with an undetected/undiagnosed hearing loss. Without careful assessment by professionals with expertise with internationally adopted children, these children may slip through the cracks and not receive appropriate services.

It is important to conduct a thorough evidence-based assessment when an internationally adopted child is referred or presents with hearing, speech, language, or attention problems. Hearing screenings including otoscopic evaluation, impedance audiometry and sound field or pure tone audiometry should be included unless the child has recently been evaluated by an audiologist. An in-depth case history of hearing, attention, speech and language behaviors and development should be collected. If the child passes all audiological measures, the speech-language pathologist should also assess the child’s knowledge of meaningful sounds as well as hearing discrimination and perception in quiet and noise and in some cases, additional audiological assessment for auditory processing disorder may be warranted.

References

Bledsoe, J. M., & Johnston, B. D. (2004). Preparing families for international adoption.
Pediatrics in Review, 25(7), 241-249. Retrieved from: http://bit.ly/kEy1iU

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
neurobehavioral development (Vol. 31, pp.113-162). Minnesota Symposium on
Child Psychology.

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.

Bolivia Bound

Market in Bolivia

 

This month, for the sixth year in a row, 16 master’s students from Teachers College Columbia University and four ASHA-certified SLPs travel to La Paz, Bolivia to provide free services to children with disabilities. The non-native Spanish speakers arrive a week early (May 22) for intensive Spanish classes at Instituto Exclusivo in La Paz. The next weekend (May 28) the six native Spanish speaking students and four ASHA-certified SLPs arrive. Beginning on May 31 and for the next three weeks, the students provide assessment and intervention services and offer workshops for parents, teachers, PTs, and doctors. The SLP students and the supervisors participate in an academic seminar to integrate their experiences with readings on anthropology, religion, politics, and educational policy.

Please follow our trip blog for what we hope will be an extraordinary journey. We would especially like to hear your comments.

Catherine (Cate) Crowley, J.D., Ph.D., CCC-SLP, is a lecturer in the program of SLP at Teachers College Columbia University where she coordinates the bilingual/multicultural program focus and directs the Bilingual Extension Institute. Cate has led TC students to Bolivia each year for five years and to Ghana for the past three years. She is on the steering committee of ASHA’s SIG 17 Global Issues in Communication Disorders.

Apps for Bilingual SLPs and English-speaking speech therapists working with Spanish-speaking children.

I am a bilingual speech pathologist, and for those of you who work with Spanish-speaking children you know how frustrating it can be trying to get ready for therapy. Most of the time we are limited to two options: live translation of English materials or spending hours creating our own Spanish materials. The limited resources in Spanish pushes us to creating our own materials on a daily basis. This can be very difficult for us with an already very limited time on our hands to serve so many children. Thanks to the iPad and the iPhone, developers all around the world are creating apps. This allows us to take advantage of the apps produced in Spanish that can be purchased anywhere. The number of apps in Spanish is still very limited in comparison to apps in English. However, the ease of development of the apps makes it a lot easier for us therapists to access products in other languages. Here are my top 5 apps in Spanish that can be used in therapy:

1. Spanish Articulation Probes

Bilingual slp app logoThis app allows therapists and parents to work on specific sounds. It works like flashcards. It contains over 500 flashcards in it separated by specific phonemes, mode of articulation, and phonological processes. This is a very useful app not only for bilingual therapists, but also for English-speaking clinicians who should work on speech errors in both languages when treating children with articulation delays.

2. Learn Spanish and Play

Learn and play app logoThis is an app for working on basic vocabulary and even categorization. Choose from one of (the) 8 scenes: “granja, Zoologico, Insectos, Mar, Frutas, Hortalizas, Colores and Familia”. There is a teaching and a testing component to this application. Once you have worked on the vocabulary you can go to play game mode and test for learning of vocabulary.

3. Play2learn

Play2learn app logoThis Spanish app is part of a family of apps in several languages, including Russian, Italian, French and other languages. It is very useful if your caseload comprises of students coming from several countries and you want to work on some basic vocabulary on their first language. Play2learn is also an app for basic vocabulary, but with a few more options than Learn Spanish and Play. It contains concepts such as body parts, clothing items, toys, colors, technology vocabulary and many more. It also has a component for verifying learning with coloring activities.

4. Conjugation Nation

conjugation nation logo
This is an app for more advanced learners working on subject-verb agreement in Spanish. The user is given a verb and a pronoun and must type the correct verb conjugation. This is a basic app but is one of the best tools I have ever seen for working on subject-verb agreement: a very prominent feature of Spanish grammar.

5. Spanish Grammar: Ser/Estar

Spanish grammar app logoThis app, despite being a bit difficult to set up is very useful for teaching the differences between “ser/estar” both translated as “to be”(“to/be”) in English but used differently in Spanish. This app gives users lots of ways in which each can be used.

I hope you enjoyed this post. If you have any suggestions of apps in Spanish please send me an e-mail to geekslp@yahoo.com. I would love to post it on my blog. Also keep in mind that any of these apps can also be very useful for English-speaking clinicians trying to brush up or start up on their Spanish skills.

Barbara Fernandes is a trilingual speech and language pathologist. She is the director of Smarty Ears and the face behind GeekSLP TV, a blog and video podcast focusing on the use of technology in speech therapy. Barbara has also been a practicing speech therapist both in Brazil and in the United States. She is a an active participant of the Texas Speech and Hearing Association as a member of the TSHA Culturally and linguistically diverse issues task force. Barbara has created over 15 applications for speech therapists.

Gone to Ghana

Students in Ghana
Each year, masters’ students from the Teachers College Columbia University program in speech language pathology travel to Ghana to provide services and share skills and understanding with Ghanaian colleagues. I am the program director, Miriam Baigorri is clinical director, and Dorothy Leone is clinical supervisor of the Ghana program. Students work at the two major teaching hospitals within ENT, cleft palate, and craniofacial departments, and with the unit schools for students with disabilities.

We documented our trip by blogging live from Ghana, and rather than excerpt posts from that blog for ASHAsphere, we invite you to read all about our experiences on the trip blog.

Catherine (Cate) Crowley, J.D., Ph.D., CCC-SLP, is a lecturer in the program of SLP at Teachers College Columbia University where she coordinates the bilingual/multicultural program focus and directs the Bilingual Extension Institute. Cate has led TC students to Bolivia each year for five years and to Ghana for the past three years. She is on the steering committee of ASHA’s SIG 17 Global Issues in Communication Disorders.