9. Communication Disorders in Multicultural Populations

Question 1

Achieving Cultural Competence

Answer 1

• Culturally competent SLP is…
  a) Actively in the process of being aware of her own assumptions
  b) Actively attempts to understand the worldview of her culturally diverse clients and families
  c) Actively develops and practices culturally relevant, sensitive, and appropriate service delivery skills/practices
• Important to recognize cultural tendencies but not overgeneralize/stereotype; must keep in mind heterogeneity w/in cultural groups
• Learn specific geographic or cultural group and use its name (E.g., Mexican not Hispanic; Filipino not Asian)

Question 2

ASHA Guidelines Re: Multicultural Issues

Answer 2

LOOK INTO THESE

Question 3

Dialects of American English (10)

Answer 3

New York City
Eastern New England
Western Pennsylvania
Appalachian
Southern
Middle Atlantic
Central Midland
Southwest
Northwest
North Central

Question 4

African American English

Answer 4

• Considered a dialect of Mainstream American English
• Do not have to be black to speak AAE
• Alternate forms of assessment recommended, incl. language sample analysis, contrastive analysis, and descriptions of functional comm. skills

Question 5

Spanish-Language Characteristics and Considerations

Answer 5

• 2 dialects: Southwestern (e.g., Mexican) and Carribean (e.g., Puerto Rico)
• Differ from MAE in artic and morphology

Question 6

English Influenced by Asian Languages

Answer 6

*Asians originate from 3 regions:
Southeast Asia (e.g., Philippines, Thailand, Vietnam)
South Asia (Sri Lanka, Pakistan, India)
East Asia (Japan, China, Korea)
*Some groups have no written lang and rely on oral trad.
*Tonal langs (tonemes): Vietnamese, Chinese, Laotion
*Japanese, Korean, and Khmer are not tonal lang
*Some Asian speakers may sound hypernasal in MAE
*Prosody/intonation may be “choppy” to MAE speakers

Question 7

How can you tell if a bilingual student has an LLD (vs language difference)?

Answer 7

• Children who speak more than one language can only be properly diagnosed as having an LLD if they manifest language-learning difficulties in both their primary language and English; Legally, it must be proven that the LLD underlies both languages (i.e., illegal for CLD kids w/ a difference to receive special edu services, e.g. speech tx)
• If student has normal abilities in primary language but has difficulty with English, then he/she needs services such as bilingual edu. and ESL programs to facilitate English-lang. learning (not special edu. services such as speech tx)

Question 8

Typical Processes of Second-Language Acquisition (4)

Answer 8

• Inference or transfer: refers to an error in a student’s second language (L2) that is directly produced by the influence of L1
• Silent period: period where there is much listening and comprehension and little output, usu. lasts bet. 3-6 mos
• Code-switching: alternating/switching bet. 2 langs
• Language loss: L1 lang loss as L2 is aquired; can make student appear low in both langs and SLPs may confuse it as LLD when it is actually a result of a loss of L1

Question 9

Considerations for Second-Language Acquisition in Internationally Adopted Children

Answer 9

• 20% thrive, 60% delays w/ partial improvement, 20% moderate to major delays w/ little to no improvement
• Some kids w/ delays in primary lang due to environment, orphanage (little cognitive-linguisitic stim)

Additional factors:

• Age of adoption
• Before 12 mos, lang development pretty typical to MAE baby; toddlers will have rapid English development but not as fast as same-age peers by preschool
• Their lang should be assessed immediately after they arrive in U.S. and at regular intervals to eval progress
• Loss L1 happens quickly (freq starts underdeveloped)

Question 10

Basic Interpersonal Communication Skills (BICS)

and Cognitive-Academic Language Proficiency (CALP)

Answer 10

Model of language proficiency that is useful in working with CLD children (distinguishes BICS from CALPS)

Question 11

Development of BICS and CALP

and the BICS-CALP gap

Answer 11

*According to Cummins (1992, 2002), in CLD children, BICS takes approximately 2 years (in an ideal situation) to develop to a level commensurate with that of native speakers of L2
[“Context-Embedded Face-to-Face Communicative Proficiency”]

*CALP takes 5-7 years to develop to a native-like level– and that frame is common for students from enriched backgrounds
[“Context-Reduced (Academic) Communicative Proficiency”]

Question 12

BICS

Answer 12

• Involves face-to-face communication in which conversational participants can actively negotiate meaning and have a shared reality
• BICS communication is typical of that found in the everyday world outside the classroom, where language is supported by a wide range of meaningful situational and paralinguistic gestures

Question 13

CALPS

Answer 13

• Involves grasping the fundamentals of written language and adopting key literacy habits
• Does not assume a shared reality
• It may rely exclusively on linguistic cues for meaning and is more typical of the classroom
• CALP is characteristic of situations where knowledge is not automatized and the student must actively use cognitive strategies to perform a task (e.g., writing an essay in a foreign language, conduction a chemistry experiment, solving word problems in math)

Question 14

Types of Bilingual Acquisition (2)

Answer 14

Simultaneous: 2 langs acquired simultaneously from infancy; aka infant bilinguality; development closely parallels monolingual development; little interference

Sequential: some students may acquire L2 w/ minimal interference, others may experience difficulties;
*“Limited bilingualism” if student does not fully develop either lang (since L2 is partially a function of L1) and may appear to have LLD
*If student appears to be low functioning, IMPORTANT to ask how both langs were developed–simultaneously or sequentially?
*if sequential, was L1 (the underlying system of L2)
stable so acquisition of L2 was beneficial?

Question 15

CLD Assessment: Individuals w/ Disabilities Education Act (IDEA, 2004)

Answer 15

• All children are entitled to an appropriate and free edu.
• Testing and evaluation materials/procedures may not be racially or culturally discriminatory
• Testing/eval materials must be provided and administered in lang. in which the child is most proficient
• Tests must be administered to a child…so as to reflect accurately the child’s ability in the area tested (vs child’s impaired comm. skill or limited English skill)
• Multicultural edu. is to be considered in guaranteeing equal edu. opportunities for minorities w/ handicaps

Question 16

Formal Test Assumptions and Cultural Considerations

Answer 16

• Some students come from cultural b/g where it is considered to be respectful to be silent in the presence of an unfamiliar adult (may not fully display abilities)
• Rules of interaction may differ, e.g., African American speech comm. has greater tolerance for overlapping speech (i.e., it would not be appropriate to label black child as having turn-taking probs)
• Many tests assume child came from a narrative literate tradition, which expects speaker to inform listener but African American and Native American kids come from oral narrative traditions where listener knowledge is assumed and speaker’s job is to entertain (SLPs might mislabel these kid w/ a lang prob if they don’t produce narratives according to a literate tradition)
• Test may not possess “ecological validity” for CLD kids (i.e,, the extent to which it reflects child’s actual, daily environment and life experience)
• *Best avoid translated versions of standardized tests
• Prob w/ tests developed in primary langs: heterogeneity of various minorities; little developmental data available for langs other than English

Question 17

Selecting Standardized Tests

Answer 17

When considering which tests to use with CLD students, they must keep in mind:

• Purpose of the test (screening or in-depth eval?)
• Construct validity (theories behind it? appropriate?)
• Appropriateness of test content (can have native speakers review test; can delete items most kids miss)
• Adequacy of norms (how was standardized sample selected? representative sample for student?)

Question 18

Administering Standardized Tests

Answer 18

There are ways in which tests can be altered so CLD kids will perform in ways that reflect true abilities:

• Omit biased items that student will probably miss
• Test beyond ceiling
• Complete assessment over several sessions
• Have parent/diff. adult administer items w/ supervision
• Give instructions in both English and L1
• Rephrase confusing instructions
• Give extra examples, demonstrations, and practice items
• Give student extra time to respond
• Repeat items when necessary
• If wrong answer, ask student to explain (score item as correct if answer is correct in their culture)

Question 19

Interpreting Standardized Tests

Answer 19

Ways to interpret tests to effectively reduce bias:

• Review results w/ family and other people from student’s culture to gain more info re: performance
• Interpret overall results in team setting
• Don’t ID a student as needing special edu. solely off test scores; use informal measures to supplement
• Determine if errors are typical of others w/ similar b/g
• When writing assessment reports, incl. cautions and disclaimers re: any dispartures from standardized testing procedures and discuss how student’s b/g may influence results

Question 20

Alternatives to Standardized Tests

Answer 20

• Advantage: can be matched to student’s curriculum
• Assessment wheel of a team approach to comprehensive assessment illustrates necessity of combining informal assessment strategies w/ more formal testing for CLD students; Imp to include case hx, language proficiency testing, environmental observations, and dynamic assessment
• Assessments must have ecological validity
• Interpreters can be a valuable part of this process

Question 21

Specific Alternatives to Standardized Assessments (10)

Answer 21

• Thorough case hx of development in all domains
• Observations in a variety of naturalistic contexts
• Questionnaires
• Authentic assessment (performances w/ edu. value)
• Use narratives appropriate to student’s b/g
• Portfolio method (samples of work gathered over time)
• Language samples
• School records of achievement and performance
• *Dynamic approach (student evaluated over time in a test-teach-reteach format; assesses ability to learn ehrn provided instruction; if does poorly, may have LLD); *Response to intervention (RtI) is a pop. form of dynamic assessment (one component of RtI involves above-and-beyond instruction in class for struggling students; if do not do well, they are referred for special edu. eval)

Question 22

If a CLD student does qualify for special education services, incl. speech therapy, the following service delivery models can be considered

Answer 22

• A bilingual special education classroom
• A monolingual, English, special edu. class w/ primary lang support through a bilingual teacher, tutor, or others
• Pull-out services (sp-lang tx, resource support, both) in the primary language
• Pull-out services in English with primary-lang support
• Consultative, collaborative service provision in which CLD child remains in the regular classroom and teacher receives assistance from special edu personnel or ESL or bilingual staff (RtI)
• Placement in a regular bilingual edu or ESL classroom w/ support from special edu. treatment principles
• *If student is more proficient in L1, carrying out tx in L1 is more efficient and effective
• *CLD kids with LLD can learn 2 langs effectively and it is advantageous to be exposed to the two languages!

Question 23

Intervention Activities Should… (7)

Answer 23

• Focus on content vs mastery of grammatical forms
• Include reading, writing, listening and talking; literacy should always be incorporated
• Be built around whole themes, experiences, and events that have meaning to students
• Promote effective comm. and interaction among students
• Be related to the classroom curriculum
• Acknowledge students’ cultural and linguistic b/g and experiences, and promote self-esteem
• Support students in learning the academic lang that will help them be successful in school setting (imp. for intervention to also take place in classroom; clinicians must collaborate w/ teachers)

Question 24

CLD adults have a higher prevalence of Neurological Impairments. The leading cause of Neurological Impairments are Strokes. Strokes are associated with:
(7)

Answer 24

Hypertension (may result in hemorrhagic strokes)
Arteriosclerosis (associated w/ high cholesterol, fat, salt)
Sickle cell anemia (areas of brain don’t get enough O2)
Diabetes (affects Hispanics the most)
AIDS
Alcohol abuse
Drug abuse

Question 25

Theories Re: Stroke Recovery in Bilinguals (4)

Answer 25

Synergistic and Differential Recovery Theory
*Both langs are impaired, but not necessarily to the same degree; both langs may recover but not necessarily at same rate; most common type of recovery (95-98%)

Antagonistic Recovery Theory
*One lang returns at the expense of another prev. recovered lang (e.g., spanish recovered and then english, but when english returns, spanish is lost)

Successive Recovery Theory
*One lang returns only after another has been completely restored

Selective Recovery Theory
*One of the pt’s langs never recovers and remains impaired, even when the other langs have recovered

Question 26

Sociocultural Considerations in Rehab: Implications for Assessment and Treatment

Answer 26

• Imp. to consider pt’s premorbid status as well as their functional needs w/in their personal life contexts. E.g., many older African Americans have strong church connections; tx could address comm. centered around church activities
• Clinicians must evaluate family’s culture in terms of appropriateness of the rehab goal of independence for the pt. Encouragement of independence may be offensive in some cultures. E.g., Hispanic families may believe it is their duty to take care of neurologically impaired pt so requiring pt to attend rehab and become independent would be seen as disrespectful and would cause great shame to the family
• SES impacts CLD pts’ utilization of rehab services; Many elderly CLD pts have little money/insurance; E.g., many Mexican Americans have low rates of health insurance b/c many are employed in low-paid sectors of the workforce that are not likely to provide coverage
• Family relationships are an imp. consideration. E.g., African Americans tend to be more involved than whites in providing help across generations, and the extended family network is much greater; Asian families tend to be highly involved in caring for ill/infirm fam. members; Clinicians can use fam. members for support

Question 27

Sociocultural Considerations in Rehab: Implications for Assessment and Treatment

CONT’D

Answer 27

• Imp to assess premorbid edu. levels and vocational attainment of pts, b/c these impact assessment and treatment; E.g., Elderly hispanics are 6-7x more likely to be functionally illiterate than non-Hispanics and ~73% of elderly Hispanics have an edu. attainment of 8th grade or less, compared to 35% of all elderly individuals
• SES and educational attainment impact pts’ acceptance of and belief in conventional rehab, esp. that involving technology
• Religion may play a role in pts’ and families’ acceptance of rehab. Some families believe in folk healers, not traditional medicine. Other families believe that a disability cased by a stroke, for example, is the will of a supreme being, and thus rehab would counter their religious beliefs
• When assessing bilingual pts, imperative that the clinician assess skills in both the primary lang and English. Assessment should be carried out as soon as possible and should focus on the most dominant lang
• For cts with swallowing disorders, clinicians must ascertain their food preferences and possible religious restrictions pertaining to consumption of food and beverages. E.g., during month of Ramadan, many Muslims do not take food or liquid between sunrise and sunset