Speech-language pathologists' assessment and intervention practices with multilingual children

A survey of speech-language pathology service delivery in Australian schools

PURPOSE

Speech-language pathologists (SLPs) work in Australian schools yet, little is documented about their service delivery practices. This study therefore explores Australian speech-language pathology service delivery in schools, inclusive of work activities, caseloads, and assessment and intervention practices.

METHOD

An online survey comprising multiple choice, constant sum, Likert scale, and open text questions was completed by 105 SLPs. Quantitative data was analysed using descriptive statistics while open-text responses were analysed using content analysis.

RESULT

Participants were predominantly government education department employees working in multiple schools, and caseloads ranged from 10 to 240 students for full-time SLPs. While responses varied considerably, some general trends emerged. Most time was spent on intervention, followed by non-contact tasks, and assessments, with differences across employment sectors. Language was the most common student need, followed by literacy and speech. Frequently reported factors contributing to client complexity and intervention frequency were co-occurring presentations, severity of student needs, caseload size, and impact on learning. Caseload manageability was a concern for participants who reported larger caseloads, spent more time in assessment or less time in therapy than others, and worked in education departments.

CONCLUSION

Findings have implications for policy makers, professional bodies and employers, and provide direction for future systematic data collection.

Project Building Bridges: A Framework for Preparing Highly Qualified Speech-Language Pathologists to Serve Culturally and Linguistically Diverse Students With Augmentative and Alternative Communication Needs

PURPOSE

Project Building Bridges was funded by the U.S. Department of Education Office of Special Education Programs to address the shortage of speech-language pathologists qualified to serve students with complex communication needs who benefit from augmentative and alternative communication (AAC) and are culturally and linguistically diverse. The purpose was to train future speech-language pathologists in culturally responsive AAC practices through coursework and fieldwork in AAC integrated into the Master of Science degree in Speech, Language and Hearing Sciences.

METHOD

Fifty-seven graduate students completed the project. The scholars' curriculum consisted of two AAC courses, both on-campus and externship AAC clinical practicum experiences to provide services to multicultural and linguistically diverse students, a U.S. or international service-learning opportunity, and cumulative portfolio presentations.

RESULTS

Mixed-methods outcome measures consisted of four sets of pre- and postsurveys and qualitative feedback from exit interviews to assess changes in graduate student competencies. Significant differences were demonstrated between scholars' pre- and post-assessments of confidence ratings. Significant differences were also demonstrated in both scholars' and school mentors' pre- and post-assessments of competency ratings. No significant differences were found between evaluations of AAC preparation by Clinical Fellowship (CF) candidates and their CF mentors at 1 year postgraduation.

CONCLUSIONS

Project Building Bridges provides a framework for preparing highly qualified speech-language pathologists to serve culturally and linguistically diverse students who benefit from AAC as evidenced by pre- and postsurvey results. The project can serve as a model for other university programs in the development of preservice preparation programs focusing on culturally and linguistically diverse students with AAC needs.

Where to start: Use of the bilingual multidimensional ability scale (B-MAS) to identify developmental language disorder (DLD) in bilingual children

PURPOSE

The identification of developmental language disorder (DLD) is challenging for clinicians who assess bilinguals. This paper introduces a protocol-based approach, the Bilingual Multidimensional Ability Scale (B-MAS), for expert raters to identify DLD in bilinguals.

METHOD

Three bilingual speech-language pathologists (SLPs) reviewed 166 Spanish-English bilingual children's profiles, which included performance on direct (morphosyntax, semantics, and narrative tasks) and indirect (parent/teacher survey) measures in both languages. A multidimensional scale (0-5) was adopted to rate children's performance. A diagnosis of DLD was made if at least two raters assigned a summary rating of ≤2.

RESULT

Analysis of the scores on the B-MAS resulted in the identification of 21 children as having DLD. Though different strategies were employed to make decisions, the three SLPs demonstrated high inter-rater agreement across different ratings (intraclass correlation coefficient values ranged from .83 to .90).

CONCLUSION

For bilingual populations that are understudied and for which gold standards of assessment are not available, the B-MAS can be adopted as a starting point to study DLD or as a reference standard to develop new assessment tools in that population. Clinically, this protocol could be tailored and evaluated by a group of SLPs serving a large population of a particular bilingual group for diagnostic purposes.

Exploring Assumptions of the Bilingual Delay in Children With and Without Developmental Language Disorder

PURPOSE

Bilingual children are both over- and under-identified with developmental language disorder (DLD). We propose that this may be a function of monolingual approaches that fail to consider the dynamic nature of bilingualism as well as assumptions of bilingual delay. We explored the extent to which bilingual children with and without DLD demonstrated mixed dominance as a function of exposure to English. We document patterns of performance in bilingual children with and without DLD on the Bilingual English-Spanish Assessment or Bilingual English-Spanish Assessment-Middle Extension in Spanish, English, and their best language scores.

METHOD

A total of 595 (100 with DLD) Spanish-English bilingual children between the ages of 5 and 12 years were included in the analyses. We employed logistic regression to evaluate the probability of demonstrating mixed dominance across semantics and morphosyntax in Spanish and English by ability status. We then evaluated the association between English exposure and performance in Spanish, English, and the best language on semantics and morphosyntax measures.

RESULTS

There were similar typically developing and DLD probabilities of Spanish or English dominance associated with high degrees of Spanish and English exposure. Mixed dominance was associated with both ability and exposure. Children with DLD demonstrated more mixed dominance from 0% to 60% English exposure. The patterns of mixed dominance were similar by ability when they had more than 60% exposure to English. There were significant associations between single language testing in Spanish and English with percentage of exposure for children with and without DLD. When the best score (comparing English and Spanish) was used, there were no significant associations with exposure for semantics or morphosyntax.

CONCLUSIONS

These results inform researchers and clinicians about the nature of bilingual proficiency in children with and without DLD. Mixed dominance was observed in both groups but with different patterns at lower levels of English exposure in children with and without DLD. We also see that when children's best score is considered, all differences in performance along the bilingual continuum are related to ability not language exposure. This has implications for how to consider children's language test scores in making clinical decisions about bilingual children.

PRESENTATION VIDEO

https://doi.org/10.23641/asha.23929470.

Speech-Language Pathologists' Preparation, Practices, and Perspectives on Serving Indigenous Families and Children

PURPOSE

With the documented educational inequities that Indigenous children experience evidenced by disproportionate representation in special education and lower graduation rates, there is a need to better understand the backgrounds, training, professional perspectives, and clinical practices of speech-language pathologists (SLPs) serving this population. Therefore, the purpose of this study was to conduct a survey with SLPs from the Mountain West and High Plains region of the United States who serve Indigenous children to understand current patterns and to inform practices that SLPs can apply in addressing educational inequities.

METHOD

SLPs from the Mountain West and High Plains completed an online survey that gathered information about background, training, professional perspectives, and clinical practices.

RESULTS

Three hundred thirty-three SLPs completed the survey. Results revealed that respondents, for the most part, understood educational disparities that Indigenous children experience, and they valued Indigenous dialects of English and Indigenous languages. Patterns in practice revealed strong reliance on standardized measures for assessment and a small percentage of respondents using bidialectal or narrative-based strategies.

CONCLUSIONS

Very few respondents had training on serving Indigenous children and families, yet they had overall awareness of educational disparities experienced by this group. Respondents reported challenges with developing relationships and overcoming access barriers. Their clinical practices were not as tailored to the language and learning needs of Indigenous children, especially when compared to practices recommended in two recent scoping reviews. The Indigenous Connectedness Framework, the abundance model, and Indigenous pedagogies are presented as ways to initiate change and meaningful engagement with Indigenous families and communities.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24100863.

Assessing the speech production of multilingual children: A survey of speech-language therapists in French-speaking Belgium

BACKGROUND

Assessing the speech production of multilingual children is challenging for speech-language therapists (SLTs) around the world. Scientific recommendations to improve clinical practice are available, but their implementation has mostly been described in studies from English-speaking countries.

AIMS

This survey aimed to describe the perspectives and practices of SLTs in assessing the speech production of multilingual children in French-speaking Belgium.

METHODS & PROCEDURES

An online survey was completed by 134 SLTs in French-speaking Belgium.

OUTCOMES & RESULTS

SLTs predominantly used norm-referenced assessment approaches, which are not recommended for use with multilingual children, and lacked necessary training and resources to implement recommended practices in the assessment of speech production of multilingual children. The shift towards more appropriate practices with multilingual children seems to be in its infancy among SLTs in French-speaking Belgium. Some challenges identified by the SLTs were common to those in other countries and languages, such as the difficulty to distinguish between speech differences and speech disorders. Other challenges were specific to the French language and/or the Belgian context, such as the lack of appropriate tools in French.

CONCLUSIONS & IMPLICATIONS

Action is required to improve clinical practice in assessing the speech production of multilingual children in French-speaking contexts: better training for SLTs regarding linguistic diversity, more implementation research in the field of SLT, and advocacy for linguistic diversity with decision makers.

WHAT THIS PAPER ADDS

What is already known on this subject Existing research indicates that assessing the speech production of multilingual children is challenging for speech-language therapists (SLTs). Scientific recommendations for best practices have been published, and the shift to more appropriate assessment practices may be progressing differently across countries. SLTs' practices have been described in surveys, mostly conducted in English-speaking countries. Although French is the fifth most spoken language in the world, data about SLTs' perspectives and practices in French-speaking regions are scarce. What this study adds The implementation of recommended practices in assessing multilingual children's speech production was limited among SLTs in French-speaking Belgium. The norm-referenced approach to assessment was predominant and few SLTs used recommended practices (e.g., criterion-referenced measures, dynamic assessment, assessment of the child's speech production in the home language). Some challenges were identified that related specifically to practices in French-speaking contexts (e.g., lack of French tools) and Belgian context (e.g., health policies unfavourable to multilingualism). These findings confirm that specific understanding of a situation is needed to develop context- and/or language-specific solutions-and ultimately improve clinical practice. What are the clinical implications of this work? SLTs in French-speaking Belgium require specific training and support to provide appropriate assessment of speech production in multilingual children. Efforts to improve practices in French-speaking contexts should focus on increasing understanding and consideration of cultural and linguistic diversity at all levels of the child's environment. Evidence-based knowledge, assessment tools and multilingual resources are available to SLTs on websites in French and in English.

Exploring the attitudes and practices among student clinicians in India on multilingual issues in the field of speech-language pathology

PURPOSE

Student clinicians (graduates and undergraduates) in speech-language pathology deal with various multilingual issues while providing clinical services to individuals with language impairments. This study explores the attitudes and practices of undergraduate and graduate speech-language pathology students in India towards multilingualism and handling these issues.

METHODS

One hundred and twenty-eight students (71 graduates and 57 undergraduates) participated in the study. Phase 1 of the study included the development of a questionnaire to explore the attitudes and practices of student clinicians in speech-language pathology. The questionnaire was converted into an online survey in Phase 2. Phase 3 comprised data and statistical analysis to summarize and interpret collected data.

RESULTS

Graduate and undergraduate students significantly differed in their attitudes and perception toward multilingual issues (p<0.05). Most clinicians demanded a change in the current views on assessment/intervention, considering the linguistic background of the patient/caregivers. Other issues surrounding multilingualism included parents' education levels, lack of sufficient assessment tools, unavailability of translators/interpreters, and poor linguistic competency of clinicians.

CONCLUSION

These findings assist academic programs in planning and developing modules to aid students in handling the major multilingual issues encountered during clinical interactions.

Multilingual Speech Acquisition by Vietnamese-English-Speaking Children and Adult Family Members

PURPOSE

This article presents a large-scale example of culturally responsive assessment and analysis of multilingual Vietnamese-English-speaking children and their family members using the VietSpeech Protocol involving (a) examining all spoken languages, (b) comparing ambient phonology produced by family members, (c) including dialectal variants in the definition of accuracy, and (d) clustering participants with similar language experience.

METHOD

The VietSpeech participants (N = 154) comprised 69 children (2;0-8;10 [years;months]) and 85 adult family members with Vietnamese heritage living in Australia. Speech was sampled using the Vietnamese Speech Assessment (Vietnamese) and the Diagnostic Evaluation of Articulation and Phonology (English).

RESULTS

Children's Vietnamese consonant accuracy was significantly higher when dialectal variants were accepted (percentage of consonants correct-dialect [PCC-D]: M = 87.76, SD = 8.18), compared to when only Standard Vietnamese was accepted as the correct production (percentage of consonants correct-standard [PCC-S]: M = 70.34, SD = 8.78), Cohen's d = 3.55 (large effect). Vietnamese voiced plosives, nasals, semivowels, vowels, and tones were more often correct than voiceless plosives and fricatives. Children's Standard Australian English consonant accuracy (PCC-S) was 82.51 (SD = 15.57). English plosives, nasals, glides, and vowels were more often correct than fricatives and affricates. Vietnamese word-initial consonants had lower accuracy than word-final consonants, whereas English consonant accuracy was rarely influenced by word position. Consonant accuracy and intelligibility were highest for children with high proficiency in both Vietnamese and English. Children's consonant productions were most similar to their mothers' than other adults or siblings' productions. Adults' Vietnamese consonants, vowels, and tones were more likely to match Vietnamese targets than their children's productions.

CONCLUSIONS

Children's speech acquisition was influenced by cross-linguistic, dialectal, maturational, language experience, and environmental (ambient phonology) factors. Adults' pronunciation was influenced by dialectal and cross-linguistic factors. This study highlights the importance of including all spoken languages, adult family members, dialectal variants, and language proficiency to inform differential diagnosis of speech sound disorders and identify clinical markers in multilingual populations.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23290055.

Transcribing multilingual children's and adults' speech

Speech-language pathologists (SLPs) face challenges in transcription and diagnosis of speech sound disorders (SSD) in multilingual children due to ambient language influences and cross-linguistic transfer. The VietSpeech Multilingual Transcription Protocol, a 4-step process to undertake impressionistic transcription of multilingual speech was tested using data from Vietnamese-Australian children (n = 69) and adult family members (n = 85). The transcription team included an English-speaking SLP, a Vietnamese-English-speaking linguist and accredited interpreter, and two Vietnamese-English-speaking SLPs. (1) Training: The team completed training together in Vietnamese and English phonology. (2) Speech assessment: The participants were assessed using the Diagnostic Evaluation of Articulation and Phonology (DEAP) in English and the Vietnamese Speech Assessment (VSA). (3) Transcription comparison: Inter-rater reliability for 10 children and 12 adults was calculated using consonant-by-consonant agreement. For English the 3-way inter-rater agreement was 92.62% for children and 88.69% for adults. For Vietnamese the 4-way inter-rater agreement was 86.57% for children and 96.05% for adults. There was a significant correlation between speech accuracy and inter-rater reliability for children's consonants in English (r = 0.95) and Vietnamese (r = 0.91), and adults' consonants in English (r = 0.90), but not for Vietnamese (r = 0.49). Reliability was influenced by phoneme class and whether the target consonant was shared between languages. (4) Rule generation and consensus: Rules based on near functional equivalence were implemented to maintain consistency and reach consensus. SLPs who do not speak clients' home languages can be supported to transcribe multilingual speech by working with multilingual teams, and understanding personal limitations during multilingual speech assessments.

Sentence Diversity in Spanish-English Bilingual Toddlers

PURPOSE

There remain few available tools to assess language development in Spanish-English dual language learner (DLL) toddlers in the United States. Of interest is the development of early sentences as children move from producing single words to producing multiword utterances. This study is the first to extend sentence diversity to the context of Spanish-English DLLs by describing development from 24 to 30 months of age in children with and without language delays (LDs).

METHOD

Spontaneous language samples were collected from Spanish-dominant DLL children and their mothers as they were observed during a free-play interaction. Existing sentence diversity protocols were adapted for the DLL context to describe children's flexibility in combining subjects and verbs to form utterances in Spanish and English.

RESULTS

Children maintained an accurate separation in their grammars for subject-verb combinations in Spanish versus English. There was an overwhelming preference for Spanish subject-verb combinations with null subjects. The emergence of sentence diversity distinguished children with and without early LD unlike the emergence of word combinations.

CONCLUSIONS

Consistent with prior research, findings showed that DLLs did not confuse grammatical structures across languages. Instead, they showed a differential pattern of results in each language, such that the strongest grammatical skills were evinced first in the dominant language. Sentence diversity shows promise for assessment and progress monitoring in Spanish-English DLLs in the United States.

Culturally safe speech-language supports for First Nations children: Achieving Sustainable Development Goals 3, 4, 8 and 10

PURPOSE

Self-determination is foundational to health and well-being for First Nations people. Colonisation has undermined self-determination and widespread effects are observed as disparities in health and well-being. Chronic middle ear disease is more highly prevalent in First Nations children, is associated with delays in speech and language and lower levels of educational readiness. However, there is a paucity of culturally and linguistically sensitive speech-language assessments and habilitation services globally. Focussing on high-income colonial-settler countries (including United States, Canada, Australia and New Zealand), where health disparities are significant, we aim to discuss the importance of and the challenges in providing culturally safe care to First Nations children with communication disabilities.

RESULT

To be effective, both cultural and linguistic diversity and cultural safety must be considered in all aspects of assessment and intervention. Furthermore, speech-language pathologists must be equipped to work with First Nations children with communication disorders.

CONCLUSION

To optimally support First Nations' children with communication disabilities, services need to be culturally safe, family-centred and strengths-based. This commentary focuses on the United Nations Sustainable Development Goals (SDGs)3, 4, 8 and 10.

Speech-Language Pathologists' Support for Parents of Young d/Deaf Multilingual Learners

Increasing cultural and linguistic diversity among children and families brings new challenges for early intervention professionals. The purpose of this study was to identify the specific roles and needs of speech-language pathologists (SLPs) who practice in early intervention settings with culturally and linguistically diverse families of d/Deaf multilingual learners (DMLs). Thirteen SLPs completed an online survey about their practices and needs. Interviews were conducted with five parents of DMLs. Results showed that SLPs have lower self-satisfaction with families of DMLs compared to mainstream families. Parents were highly satisfied with the support they received. Both groups of participants reported a need for specific tools or adaptations, especially if there was no shared language. Thematic analysis identified three themes: communication and partnership, professional resources for responding to diversity, and diversity of parental profiles. This article provides an insight into the perspectives of both professionals and culturally and linguistically diverse parents, and identifies specific aspects of early intervention services with parents of DMLs: developing partnership in the context of cultural and/or linguistic differences, discussing topics related to multilingualism, and providing highly adaptable family-centered services.

Clinicians' and Managers' Views and Experiences of Audiology and Speech-Language Pathology Service Provision for Culturally and Linguistically Diverse Families of Young Children With Hearing Loss

PURPOSE

This study aimed to gather the views and experiences of clinicians and managers on early intervention audiology and speech-language pathology services for culturally and linguistically diverse (CALD) families of children with hearing loss.

METHOD

This qualitative descriptive study involved 27 semistructured interviews with audiologists, speech-language pathologists, and managers working with CALD families of young children with hearing loss. Purposeful sampling was used to recruit participants from three hearing centers working with these families. Interviews were analyzed using thematic analysis.

RESULTS

Analysis of the data resulted in five themes: (a) There were perceived added complexities for CALD families in accessing and being involved in services and receiving information; (b) there were perceived family-provider relationship complexities, cultural differences, and service delivery challenges in working with CALD families; (c) clinicians and managers used various strategies for service provision of CALD families; (d) involving interpreters benefited service provision but was challenging at times; and (e) looking to the future and recommendations for clinical practice.

CONCLUSIONS

Current practices reflect some principles of family-centered care for CALD families of young children with hearing loss. Families and services may benefit from more support regarding family-provider partnerships, information materials and child assessments, working with interpreters, and center support for time and resources.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20044427.

Dynamic assessment of multilingual children's word learning

BACKGROUND

Teachers and clinicians may struggle to provide early identification to support multilingual children's language development. Dynamic assessments are a promising approach to identify and support children's language development.

AIMS

We developed and studied a novel word learning task that is dynamic and language neutral. It makes use of multilingual children's abilities to apply language transfer, fast mapping and socially embedded language to the learning of new words.

METHODS & PROCEDURES

A total of 26 children attending kindergarten in French participated in this study. Within this group, 13 different home languages were spoken. Children took part in a dynamic assessment task of their word learning that consisted of a test-teach-retest task. Children's scores on this task were compared with their language abilities reported by their parents, amount of language exposure and scores on standardized tests of vocabulary. All tasks were delivered in French.

OUTCOMES & RESULTS

Children had higher accuracy for known words as compared with new words in the task, which may suggest transfer of knowledge from their first language. They also showed increased accuracy in identifying and naming the new words across the three trials, suggesting fast mapping of these new vocabulary items. Finally, the scores on the dynamic task correlated to children's vocabulary scores on the standardized tests, but not parent report of language development, or the amount of exposure to the language of school.

CONCLUSIONS & IMPLICATIONS

This novel dynamic assessment task taps into the process of vocabulary learning, but is less influenced by prior language knowledge. Together, these findings provide insight into early word learning by young multilingual children and proposes a conceptual model for identifying strategies to support second language acquisition.

WHAT THIS PAPER ADDS

What is already known on the subject Many barriers exist with regards to assessing the language abilities of multilingual children when a clinician aims to assess their language abilities in both languages. An alternative approach is to measure children's language processing abilities. What this paper adds to existing knowledge A novel dynamic and multilingual task was developed and implemented in this study. This task builds on children's word learning abilities that include cross-language transfer, fast-mapping, and socially imbedded learning. This multilingual task was found to tap into vocabulary learning but was not influenced by prior language knowledge. What are the potential or actual clinical implications of this work? Applying a task that focuses on language processing abilities is a promising strategy to capture language abilities in multilingual children. In addition, the dynamic nature of this tasks allows a clinician to identify scaffolding strategies that best support children's word learning.

Speech acquisition within a 3-generation Vietnamese-English family: the influence of maturation and ambient phonology

The emergence approach to speech acquisition theorises the influence of intrinsic capabilities (e.g., maturation), interactional capabilities, and extrinsic contexts (e.g., ambient phonology). Intrinsic and extrinsic influences were examined via a case study of a 3-generation Vietnamese-English family with two brothers (C1 aged 5;6 and C2 aged 3;10), their mother (M), grandfather (GF) and grandmother (GM). Their speech was assessed using the Diagnostic Evaluation of Articulation and Phonology (DEAP) and the Vietnamese Speech Assessment (VSA). Standard Australian English/Standard Vietnamese productions were defined as 'correct', even though the adults spoke different Vietnamese dialects. Their percentage of standard consonants correct (PSCC) was: C1 (English:92.27%, Vietnamese:89.05%), C2 (E:86.47%, VN:86.13%), M (E:90.34%, VN:96.35%), GF (E:82.61%, VN:97.81%), GM (VN:99.27%). Percentages were higher when dialectal variants were included. C1 and C2 had more pronunciation matches with English (86.96%) than Vietnamese (79.56%). C1's pronunciation matched: M (E:85.02%, VN:83.94%), GF (E:79.23%, VN:77.37%), GM (VN:73.72%) and C2's pronunciation matched: M (E:79.23%, VN:73.72%), GF (E:73.91%, VN:75.18%), GM (VN:72.26%). There was evidence of ambient phonology influences and cross-linguistic transfer. For example, in Vietnamese 'r' is produced as /ʐ/ or /r/ , but was produced by C1 as [ɹ] (English approximant) and by C2 [w] (age-appropriate/ɹ/substitution). The children demonstrated maturation influences for late-occurring English consonants (e.g., English /θ/ →[f]). This study found evidence for the emergence approach and recommends knowledge of the ambient phonology augments traditional child-focused understandings of children's speech acquisition.

Can Dynamic Assessment Identify Language Disorder in Multilingual Children? Clinical Applications From a Systematic Review

PURPOSE

Multilingual children are disproportionately represented on speech pathology caseloads, in part due to the limited ability of traditional language assessments to accurately capture multilingual children's language abilities. This systematic review evaluates the evidence for identification of language disorder in multilingual children using dynamic assessment and considers clinical applications of the evidence.

METHOD

A systematic search of the Cumulative Index to Nursing and Allied Health Literature, Education Resources Information Centre, Education Source, Google Scholar, Linguistics, Medline, and PsycINFO databases produced 10 articles that met the inclusion criteria: between-groups comparison studies that used dynamic assessment to identify language disorder in children under 12 years old that spoke a different language at home to the majority society language. Articles were critically appraised using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) protocol.

RESULTS

Nine of the 10 studies reported that their dynamic assessment identified language disorder in multilingual children. However, small sample sizes, limited language pairs, variability in the reference standard, and design deficiencies resulted in poor ratings for all studies on QUADAS-2.

CONCLUSIONS

The studies in this review reflected an emergent area of research. Preliminary guidelines for clinical application indicate that dynamic assessment may be a suitable and time-efficient complementary method of diagnosis of language disorder in multilingual children. Further recommendations about age of use, language of instruction, and relevant scores are included.

Detecting Developmental Language Disorder in Monolingual and Bilingual Children: Comparison of Language-Specific and Crosslinguistic Nonword Repetition Tasks in French and Portuguese

PURPOSE

Over the last decades, many studies have documented the clinical potential of nonword repetition (NWR) tasks for detecting developmental language disorder in mono- (MON) and bilingual (BIL) children by unveiling their difficulties in short-term memory and phonological accuracy. However, the precise nature of the nonwords to be used and the best scoring methods remain under debate. Some authors (e.g., Gutiérrez-Clellen & Simon-Cereijido, 2010) support the use of "language-specific" nonwords designed for a given test language in standardized tests. Other authors (e.g., Chiat, 2015) advocate the use of "crosslinguistic" stimuli, thus allowing assessment independently of the languages spoken by the child.

METHOD

This research note compares two language-specific tasks (French vs. Portuguese) and a crosslinguistic NWR task in a population of 5- to 7-year-old MON and BIL children. Group comparisons (children with vs. without developmental language disorder; MON vs. BIL children), an error analysis, sensitivity and specificity calculations (assessed according to the recommendations of Plante and Vance, 1994, and Youden, 1950) are reported.

RESULTS

All three tasks significantly differentiate children with and without developmental language disorder with large effect sizes but did not show an effect for bilingualism, which is encouraging for the BIL assessment. As expected, an influence of children's age and length and complexity of the stimuli was also found. The language-specific French task was found to be the most sensitive (max. 88%) and specific (max. 92%); the crosslinguistic task also reached good accuracy percentages for the BIL group (max. 82% sensitivity and 84% specificity).

CONCLUSION

This research note adds to the evidence that NWR tasks are promising tolls for the identification of MON and BIL children with developmental language disorder.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19111628.

SuperSpeech: Multilingual Speech and Language Maintenance Intervention for Vietnamese-Australian Children and Families via Telepractice

PURPOSE

The aim of this pilot feasibility study was to evaluate the effectiveness of the group VietSpeech SuperSpeech program targeting speech skills and home language maintenance via telepractice.

METHOD

In Stage 1, using a case-control design, 30 Vietnamese-English-speaking children were assessed in English and Vietnamese, and parents completed questionnaires about speech and language competency and practices. During Stage 2, children were allocated to intervention (n = 14) or control (n = 16) conditions. COVID-19 restrictions resulted in changes including nonrandom allocation. Online group intervention targeting speech, home language maintenance, and multilingualism as a superpower was delivered 1 hr/week for 8 weeks. For Stage 3, assessments were undertaken approximately 10 weeks after the pre-intervention assessment.

RESULTS

Parents in the intervention group significantly increased encouragement of their children to speak Vietnamese. The intervention group significantly increased intelligibility in English. Growth of Vietnamese vocabulary was faster for the control group. There was a moderate effect of intervention for children's perception of being happy talking in Vietnamese and English. There was no significant mean change from pre- to post-intervention compared with the control group for measures of speech sound accuracy in Vietnamese or English, Vietnamese intelligibility, English vocabulary, or hours of Vietnamese spoken each week.

CONCLUSIONS

This study presents preliminary evidence that this 8-hr online group program targeting speech skills and home language maintenance had some impact on Vietnamese-Australian children's speech and home language maintenance. Further research involving a randomized trial is warranted.

The role of age and timing in bilingual assessment: non-word repetition, subject-verb agreement and case marking in L1 and eL2 children with and without SLI

Diagnostics in bilingual children is challenging, due to an overlap of production patterns in typically developing (TD) bilingual children and monolingual children with specific language impairment (SLI). To screen bilingual children effectively, the Language Impairment Testing in Multilingual Settings (LITMUS) tools were developed in an international project. The present study tests three of these tools for their suitability and diagnostic accuracy for early second language learners (eL2) of German, aged six to eight years. The study focuses on the timing in first language (L1) TD acquisition, investigating early and late acquisition phenomena of the morphosyntactic domain (subject-verb agreement [SVA], and case marking), combined with a non-word repetition (NWR) task targeting phonological complexity. The study aims at evaluating these three LITMUS-tools regarding their diagnostic accuracy, compared to a standardised assessment tool (LiSe-DaZ).To this end, forty-two children were tested using the LITMUS-tools, namely, contrastive case marking (CCM), supplemented by an elicitation task for the prepositional case, SVA and NWR. Four groups of children participated: eL2 children with SLI (mean age 7;6, mean age of onset 3;1), eL2 children with TD (mean age 7;10, mean age of onset 2;11), L1 TD children (mean age 7;3) and L1 SLI children (mean age 7;2). Results show NWR and SVA as suitable markers and the LITMUS-tools as suitable screenings. Conversely, CCM does not disentangle SLI from TD in the investigated bilingual population by this age.

Assessment of minority language skills in English-Irish-speaking bilingual children: A survey of SLT perspectives and current practices

BACKGROUND

An increasing number of children in the UK and Ireland are growing up speaking more than one language. The many advantages of bilingualism are acknowledged; however, this increased linguistic diversity presents particular challenges for speech and language therapists (SLTs). The case is often more complex with speakers of minority languages such as Welsh and Irish, which are acquired almost exclusively in bilingual contexts. Lack of appropriate standardized assessments for bilinguals is a key issue for SLTs internationally; however, little is known about the practices, personal perspectives or wider challenges faced by SLTs in assessing minority language skills. We focus on SLTs working with English-Irish bilinguals across Northern Ireland (NI) and the Republic of Ireland (ROI) where status, use and exposure to Irish differ significantly.

AIMS

To investigate the perceptions and practices of SLTs in NI and the ROI in the assessment of bilingual English-Irish-speaking children.

METHODS & PROCEDURES

A 33-item online survey was distributed to SLTs working with children in community settings in NI and the ROI.

OUTCOMES & RESULTS

A total of 181 SLTs completed the survey. The majority of respondents had bilingual English-Irish-speaking children on their caseloads; however, less than one-quarter had assessed Irish language skills. Responses indicate confusion as to whether best-practice guidelines applied in this particular context where the majority of speakers have English as their first language and limited domains of exposure to Irish outside of the education system. Resources available to assess Irish language skills were found to be limited. Informal analysis of language samples emerged as the most popular assessment tool. SLTs in the ROI had a significantly higher level of competence in the Irish language than SLTs in NI. This reduced the challenge of assessment. Many SLTs reported scoring assessments standardized on monolingual populations when assessing English language skills in bilingual English-Irish-speaking children.

CONCLUSIONS & IMPLICATIONS

Our findings highlight the challenges faced by SLTs in meeting best-practice guidelines in the assessment of speakers of minority languages such as Irish. Further work is needed to ensure clinicians and other professionals have access to information and enhanced training on bilingual language acquisition in minority language contexts and implications for assessment and diagnosis. This study underlines the need for further research on the acquisition of minority languages as well as the development of alternative assessment tools to assist SLTs in meeting the needs of this population.

WHAT THIS PAPER ADDS

What is already known on the subject Existing research indicates that SLTs face challenges in assessing bilingual clients. Lack of assessment resources is a global issue, particularly with respect to minority languages. Emerging research indicates that SLTs and other professionals are dissatisfied with current resources for assessing Irish-speaking bilinguals and are struggling to meet best-practice guidelines. What this paper adds to existing knowledge The status of the Irish language differs significantly between NI and the ROI, while English is the dominant language in both areas. This study provides the first exploration of current assessment practices for bilingual English-Irish-speaking children as reported by SLTs across both regions. The challenges of assessing bilingual clients in many other countries are mirrored by SLTs in NI and the ROI. The majority of children acquiring Irish are doing so in a specific context: the immersion education setting. This raises uncertainty for SLTs about whether the definition of bilingualism actually applies. Despite clinicians and clients sharing the same majority language, the complexity of minority language assessment remains. What are the potential or actual clinical implications of this work? SLTs require specific support and resources to help them meet the assessment needs of bilingual English-Irish-speaking children. Ongoing education and training are required for clinicians and other professionals to facilitate understanding of the complexities surrounding bilingual speakers of minority languages and the application of best-practice guidelines. A greater understanding of the context in which children are acquiring Irish and the impact this may have on their acquisition of English would further support clinicians in identifying speech, language and communication needs in this population.

Barriers to access and utilization of healthcare services for minority-language speakers with neurodevelopmental disorders: A scoping review

INTRODUCTION

Minority-language speakers in the general population face barriers to accessing healthcare services. This scoping review aims to examine the barriers to healthcare access for minority-language speakers who have a neurodevelopmental disorder. Our goal is to inform healthcare practitioners and policy makers thus improving healthcare services for this population.

INCLUSION CRITERIA

Information was collected from studies whose participants include individuals with a neurodevelopmental disorder (NDD) who are minority-language speakers, their family members, and healthcare professionals who work with them. We examined access to healthcare services across both medical and para-medical services.

METHOD

Searches were completed using several databases. We included all types of experimental, quasi-experimental, observational and descriptive studies, as well as studies using qualitative methodologies. Evidence selection and data extraction was completed by two independent reviewers and compared. Data extraction focused on the barriers to accessing and to utilizing healthcare for minority-language speakers with NDDs. The search process and ensuing results were fully reported using a diagram from the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review.

RESULTS

Following the database search, a total of 28 articles met our final selection criteria and two articles were hand-picked based on our knowledge of the literature, for a total of 30 articles. These studies revealed that minority-language speakers with NDDs and their families experience several barriers to accessing and utilizing healthcare services. These barriers, identified at the Systems, Provider and Family Experience levels, have important consequences on children's outcomes and families' well-being.

DISCUSSION

While our review outlined several barriers to access and utilization of healthcare services for minority-language speakers with NDDs and their families, our findings give rise to concrete solutions. These solutions have the potential to mitigate the identified barriers, including development and implementation of policies and guidelines that support minority-language speakers, practitioner training, availability of referral pathways to appropriate services, access to tools and other resources such as interpretation services, and partnership with caregivers. Further research needs to shift from describing barriers to examining the efficacy of the proposed solutions in mitigating and eliminating identified barriers, and ensuring equity in healthcare for minority-language speakers with NDDs.

Accent, Comprehensibility, and Confidence in Second and Third Languages of Adolescents: How Do They Relate to Language Proficiency and Language Interactions?

PURPOSE

This study examines the degree to which adolescents in Iceland are judged by native Icelandic speakers to have a foreign accent both in Icelandic and in English, two languages that are learned under different conditions, as the community and school language, and through school and incidental exposure.

METHOD

Fifty-eight adolescents, 27 with Icelandic as their first language (L1), 21 as their second language (L2), and 10 as one of two L1s read passages in Icelandic and English. Twelve untrained native speakers of Icelandic rated the degree of foreign accent, comprehensibility, and confidence level and selected from multiple-choice options what they thought was the L1 of the speakers.

RESULTS

Significant group differences were found in Icelandic but not in English. L2 speakers had a significantly greater foreign accent than the other groups in Icelandic; however, there was substantial overlap with some L2 speakers judged to be native and some L1 speakers judged as nonnative. All groups had a significantly greater accent in English than in Icelandic. Accent was judged more sternly than comprehensibility and confidence and related differently to vocabulary proficiency.

CONCLUSIONS

Accent is typically not considered in studies of bilingual attainment in children for purposes of clinical assessment or educational placement but should be given closer attention. The study confirms previous findings that many young L2 learners have a detectable foreign accent. The overlap with L1 speakers also raises questions about the ideal of a native accent. More research is needed on how accent relates to bilingual and multilingual proficiency and on its impacts on comfort level, ease of communication, choice of language, and language exposure.

Consensus on Terminology for Describing Child Language Interventions: A Delphi Study

Purpose Language intervention for children with language disorder may be effective; however, lack of detailed and consistent terminology for describing language interventions poses barriers for advancement within the field. This study aimed to develop consensus from speech-language pathologists (SLPs) in Australia on a taxonomy with terminology for describing language interventions for school-aged children and investigate SLPs' application of taxonomy terminology when describing child language interventions. Method A taxonomy with terms for describing interventions was developed with reference to contemporary literature and presented to clinicians and researchers with expertise in child language disorders in a three-round Delphi study. We asked Delphi participants to indicate agreement with the taxonomy or propose changes. Application of the taxonomy was investigated by asking participants to use taxonomy terminology to describe interventions presented in two case studies. Results The taxonomy consists of five aspects across which interventions may be described: modality/domain, purpose, delivery, form, and teaching techniques. Consensus on the taxonomy was established in both Round 1 (55 participants) and Round 2 (43 participants), with 100% of SLPs strongly agreeing or agreeing with the overall structure of the taxonomy and at least 87.3% of SLPs strongly agreeing or agreeing with each aspect. In Round 3 (32 participants), consensus was reached on 45/54 taxonomy categories (4/12 of the components) for Case Study 1 and 45/54 taxonomy categories (7/12 of the components) for Case Study 2. Conclusions Consensus on a taxonomy with terminology for describing language interventions represents a significant advancement in the field of child language intervention. Future actions may be needed to facilitate consistent application of taxonomy terms. Supplemental Material https://doi.org/10.23641/asha.16435290.

Scoping review: Language assessment practices for Aboriginal and Torres Strait Islander children in Australia and guidelines for clinical practice

INTRODUCTION

Speech pathologists play an important role in differentiating language difference from disorder in Aboriginal and Torres Strait Islander children. However, speech pathologists report that they lack culturally appropriate resources and feel under-prepared, which suggests that culturally safe ways of working and available evidence often do not align.

OBJECTIVE

The aim of this scoping review was to explore how the language abilities of Aboriginal and Torres Strait Islander children are being assessed, the ways in which assessments are being adapted and the context in which results are being interpreted within the published literature. The studies were also evaluated for components of cultural safety using the Cultural Formulation model.

DESIGN

A comprehensive and systematic search of the literature was undertaken; hand searching was also conducted. To be eligible for inclusion, studies needed to have been conducted in Australia and include receptive and/or expressive language assessment of Aboriginal and Torres Strait Islander children.

FINDINGS

Combined, the identified studies included 438 Aboriginal and Torres Strait Islander children, though only 419 were independent samples. A total of 352 studies were initially identified, 10 of which were retained for this review. Data extraction included participant characteristics, assessment tools and procedures, reported outcomes and factors related to cultural safety according to the Cultural Formulation model.

CONCLUSION

Overall, studies showed that standardised language assessments do not accurately represent the language abilities of Aboriginal and Torres Strait Islander children. If used, they should be used alongside other non-standardised tasks and/or scoring should be adapted. Considerations for increasing cultural safety when assessing the language abilities of Aboriginal and Torres Strait Islander children are outlined.

Reliability of judgments of stuttering-related variables: The effect of language familiarity

Previous studies demonstrate mixed results and some methodological limitations regarding judges' ability to reliably assess stuttering-related variables in an unfamiliar language. The present study examined intra- and inter-rater reliability for percent syllables stuttered (%SS), stuttering severity (SEV), syllables per minute (SPM), and speech naturalness (NAT) when English-speaking judges viewed speech samples in English and in a language with which they had no or minimal familiarity (Spanish). Over two time periods, 21 judges viewed eight videos of four bilingual persons who stutter. Data were analyzed for relative and absolute intra- and inter-rater reliability as well as for an effect of language on time period differences. Intra- and inter-rater relative reliability were good or excellent for all measures in both languages, with the exception of inter-rater relative reliability for NAT in both languages and %SS in Spanish. Intra-rater absolute reliability was acceptable in both languages for NAT and SEV and unacceptable in both for SPM and %SS. Inter-rater absolute reliability in both languages was unacceptable for all measures, even with judges with the same training. There was a clinically significant effect of language on %SS scores, but, despite a statistically significant effect of language for SPM and SEV, the differences were not clinically significant. Results indicate that reliability across and within languages varies by measure and is impacted by intra- vs. inter-rater reliability, relative vs. absolute reliability, and language familiarity. Modifications in training may be able to address some of the limitations found, particularly with regard to SPM and NAT.

Validity, reliability, and transcultural adaptations of the Bayley Scales of Infant and Toddler Development (BSID-III-NL) for children in Suriname

BACKGROUND

A valid and reliable measure of infant neurodevelopment is needed in Suriname, South America. The Bayley Scales of Infant and Toddler Development, 3rd edition (BSID-III), was created for evaluation of United States infants and toddlers and subsequently validated for use in Dutch speaking infants of the Netherlands (BSID-III-NL). Given that Suriname was a previous Dutch colony and Dutch remains the national language of Suriname, this study sought to evaluate the psychometric properties of the BSID-III-NL in Suriname.

AIMS

Given that the cultural context differs between Suriname, the United States, and the Netherlands, the aims of this study were to determine if any cultural adaptations of the BSID-III-NL were needed for Surinamese infants and to evaluate its psychometric properties.

METHODS

Two hundred and ninety-nine infants between the ages of 10 to 26 months were assessed in three geographic regions of Suriname between May 2018 and July 2019. Minor adaptations to the BSID-III-NL imagery were made based on the input of Surinamese pediatricians and neuropsychologists who were also involved in the administration of the BSID-III-NL in Suriname. Raw scores were collected for the cognitive, communicative, and motor subscales of the BSID-III-NL. Factor structure was evaluated with exploratory factor analysis and cluster analysis, and reliability of internal consistency was assessed using Cronbach's alpha coefficient for each subscale.

RESULTS

Content validity was endorsed by pediatricians and neuropsychologists in Suriname who participated in the administration of the BSID-III-NL. Construct validity was demonstrated through agreement of items from cluster analysis where at least 81.56% of all variability was explained by clustering with correct or incorrect responses and mean raw scores in subscales increased with age group. Cronbach's alpha coefficient was above 0.77 for all subscales.

CONCLUSIONS

This internationally validated developmental measure was found to be valid and reliable in assessing neurodevelopment of infants in Suriname.

The impact of linguistic bias upon speech-language pathologists' attitudes towards non-standard dialects of English

Dialectal variations are present in all languages, originating from cultural, geographic and socioeconomic diversity. This study investigates speech-language pathologists' (SLPs) linguistic bias towards non-standard language forms and dialects, and factors that may impact on these attitudes. Language attitude studies reveal that negative attitudes towards variation can lead to bias against speakers of non-standard dialects. If SLPs hold linguistic bias towards speakers of non-standard dialects, this has the potential to impact upon their clinical judgement of difference vs. disorder and lead to inequality of service provision. A total of 129 Australian SLPs completed an online survey, which involved ranking 28 attitudinal statements regarding language variation on a 5-point scale from strongly disagree to strongly agree. The survey data were analysed using a factor analysis in SPSS to identify latent factors that identified attitudes towards non-standard dialects followed by inferential analyses to investigate how attitudes were related to the demographic data of participants. Results identified five key factors from the survey, these were (1) Use of non-standard English, (2) Language impurity, (3) Diversity in form, (4) Social acceptability, and (5) Prescriptive language rules. SLPs held generally positive attitudes towards the use of non-standard forms and the socially determined acceptability of language. SLPs were more neutral in their attitudes towards diversity in form and the need for prescriptive rules and generally held negative views towards language purity (e.g., the use of "youse" as a plural form of you). A significantly positive association was found between professional development (PD) on cultural and linguistic diversity and positive attitudes towards Factors 1 and 3. Years of practice were significantly related to Factor 2, with less experienced SLPs holding more negative views relating to language purity. While many SLPs identify the value of language variation and its reflection of a person's cultural and linguistic diversity, negative attitudes towards non-standard forms and variation in school and occupational settings have the potential to negatively impact differential diagnosis, goal setting and the delivery of culturally responsive speech-language pathology services to speakers of non-standard dialects.

Cultural and Linguistic Adaptations of Early Language Interventions: Recommendations for Advancing Research and Practice

Purpose Speech-language pathologists are responsible for providing culturally and linguistically responsive early language intervention services for legal, ethical, and economic reasons. Yet, speech-language pathologists face challenges in meeting this directive when children are from racial, ethnic, or linguistic backgrounds that differ from their own. Guidance is needed to support adaptation of evidence-based interventions to account for children's home culture(s) and language(s). This review article (a) describes a systematic review of the adaptation processes applied in early language interventions delivered to culturally and linguistically diverse populations in the current literature and (b) offers a robust example of an adaptation of an early language intervention for families of Spanish-speaking Mexican immigrant origin. Method Thirty-three studies of early language interventions adapted for culturally and linguistically diverse children ages 6 years and younger were reviewed. Codes were applied to describe to what extent studies document the purpose of the adaptation, the adaptation process, the adapted components, and the evaluation of the adapted intervention. Results Most studies specified the purpose of adaptations to the intervention evaluation, content, or delivery, which typically addressed children's language(s) but not culture. Study authors provided limited information about who made the adaptations, how, and when. Few studies detailed translation processes or included pilot testing. Only one used a comprehensive framework to guide adaptation. A case study extensively documents the adaptation process of the Language and Play Every Day en español program. Conclusions Future early language intervention adaptations should focus on both linguistic and cultural factors and include detailed descriptions of intervention development, evaluation, and replication. The case study presented here may serve as an example. Increased access to such information can support research on early language interventions for diverse populations and, ultimately, responsive service provision.

What Influences Speech-Language Pathologists' Use of Different Types of Language Assessments for Elementary School-Age Children?

Purpose This study reports on data from a survey of speech-language pathologists' (SLPs) language assessment practices for elementary school-age children. The objective was to investigate the regularity with which SLPs use different types of assessments (described across data types, task types, environmental contexts, and dynamic features). This study also investigated factors that influence assessment practice, the main sources from which SLPs obtain information on language assessment and the main challenges reported by SLPs in relation to language assessment. Method A web-based survey was used to collect information from 407 Australian SLPs regarding the types of assessments they use. Factors that influenced the regularity with which different types of assessments were used were investigated using regression analysis. Results Most SLPs regularly used assessments that are norm-referenced, decontextualized, and conducted in a clinical context and less regularly used other types of assessments. Service agency, Australian state, and SLPs' years of experience were found to influence the regularity with which some types of assessments were used. Informal discussions with colleagues were the most frequently identified source of information on assessment practice. Main challenges related to limited time, lack of assessment materials, and lack of confidence in assessing children from culturally and linguistically diverse backgrounds. Conclusions SLPs could improve current language assessment practice for elementary school-age children through more regular use of some types of assessments. Actions to facilitate evidence-based assessment practice should consider the contextual differences that exist between service agencies and states and address challenges that SLPs experience in relation to language assessment. Supplemental Material https://doi.org/10.23641/asha.14378948.

A Survey of Assessment and Additional Teaching Support in Irish Immersion Education

This study investigates the assessment methods used in Irish immersion schools to identify students for additional teaching support. An overview is provided of the percentage of students receiving additional teaching support in this context and whether there is a higher rate of students accessing additional teaching support in Irish immersion schools than English-medium schools. The challenges of assessment through Irish as a second language are evaluated. In addition, this study investigates the language used by educational professionals when assessing and/or providing interventions for these students. A quantitative research approach was adopted for this investigation, with a random stratified sample of 20% (N = 29) of Irish immersion schools in the Republic of Ireland completing an online questionnaire. SPSS was used to analyse the data. The findings of the present research contribute to the limited body of knowledge available on the types of assessment used in immersion education to identify students for additional teaching support. These findings are significant as there has been limited research undertaken on this aspect in immersion education and the findings of this study may have implications for immersion education contexts in other countries.

Orofacial Myofunctional Therapy and Myofunctional Devices Used in Speech Pathology Treatment: A Systematic Quantitative Review of the Literature

Purpose A growing number of speech-language pathologists (SLPs) are using orofacial myofunctional therapy (OMT) and/or myofunctional devices (MDs) in the treatment of their clients. However, governing bodies suggest SLPs carefully consider the availability and quality of evidence in the utilization of these therapies in speech-language pathology treatment. The purpose of this study was to review the existing evidence for OMT and MDs used by SLPs. Method A systematic quantitative review was conducted using key search terms in three electronic platforms housing multiple databases, along with a hand search, to identify additional literature. All studies published in English in full text were included if they reported pre- and posttreatment data of OMT and/or MDs provided by an SLP. Data were extracted and analyzed by the first author and confirmed by the co-authors. Results Twenty-eight studies met the criteria for inclusion in the review. Two thirds were published in the last decade and involved the use of OMT/MDs targeting multiple areas of speech pathology intervention within the same study, that is, swallowing, breathing, oral hygiene, and speech production. Majority of studies were rated as low level of evidence. All studies used OMT, with very few using MDs. While the assessment, treatment protocols, and outcome measures were highly variable, all of the studies reported an improvement in the function of the orofacial systems posttreatment. Few studies reported long-term follow-up data. Almost half of the studies recommended the use of OMT/MDs in a multidisciplinary/interdisciplinary team or in conjunction with other therapy. Conclusions There has been an increase in literature over the last decade in SLPs' use of OMT; however, there are only a small number of studies to date that explore the use of MDs. There is a growing body of evidence to support the use of OMT and MDs within a multidisciplinary team for people with communication and swallow difficulties. However, development of future research should consider investigating assessment and outcome measures, optimal dosage, and service delivery.

School-Based Speech-Language Pathologists' Adherence to Practice Guidelines for Assessment of English Learners

Purpose The purpose of this study was to ascertain the extent to which school-based speech-language pathologists' (SLPs) assessment practices with individual English learners (ELs) align with federal legislation and professional practice guidelines. Specifically, we were interested in examining SLPs' use of multiple tools during individual EL assessments, as well as relationships between practices and number of types of training experiences. Method School-based SLPs in a Midwestern state were recruited in person or via e-mail to complete an online survey pertaining to assessment. Of the 562 respondents who completed the survey, 222 (39.5%) indicated past or present experience with ELs, and thus, their data were included in the analyses. The questionnaire solicited information about respondent's demographics, caseload composition, perceived knowledge and skills and training experiences pertaining to working with ELs (e.g., graduate school, self-teaching, professional conferences), and assessment practices used in schools. Results The majority of respondents reported using multiple tools rather than a single tool with each EL they assess. Case history and observation were tools used often or always by the largest number of participants. SLPs who used multiple tools reported using both direct (e.g., standardized tests, dynamic assessment) and indirect tools (e.g., case history, interviews). Analyses revealed low to moderate positive associations between tools, as well as the use of speech-language samples and number of types of training experiences. Conclusions School-based SLPs in the current study reported using EL assessment practices that comply with federal legislation and professional practice guidelines for EL assessment. These results enhance our understanding of school-based SLPs' assessment practices with ELs and may be indicative of a positive shift toward evidence-based practice.

Is Phonological Awareness Related to Pitch, Rhythm, and Speech-in-Noise Discrimination in Young Children?

Purpose Phonological awareness (PA) requires the complex integration of language, speech, and auditory processing abilities. Enhanced pitch and rhythm discrimination have been shown to improve PA and speech-in-noise (SiN) discrimination. The screening of pitch and rhythm discrimination, if nonlinguistic correlates of these abilities, could contribute to screening procedures prior to diagnostic assessment. This research aimed to determine the association of PA abilities with pitch, rhythm, and SiN discrimination in children aged 5-7 years old. Method Forty-one participants' pitch, rhythm, and SiN discrimination and PA abilities were evaluated. To control for confounding factors, including biological and environmental risk exposure and gender differences, typically developing male children from high socioeconomic statuses were selected. Pearson correlation was used to identify associations between variables, and stepwise regression analysis was used to identify possible predictors of PA. Results Correlations of medium strength were identified between PA and pitch, rhythm, and SiN discrimination. Pitch and diotic digit-in-noise discrimination formed the strongest regression model (adjusted R ² = .4213, r = .649) for phoneme-grapheme correspondence. Conclusions The current study demonstrates predictive relationships between the complex auditory discrimination skills of pitch, rhythm, and diotic digit-in-noise recognition and foundational phonemic awareness and phonic skills in young males from high socioeconomic statuses. Pitch, rhythm, and digit-in-noise discrimination measures hold potential as screening measures for delays in phonemic awareness and phonic difficulties and as components of stimulation programs.

Current practices of New Zealand speech-language pathologists working with multilingual children

Purpose: This study aimed to identify the current practices of New Zealand speech-language pathologists (SLPs) working with multilingual children, to compare these with best practice guidelines and make recommendations for training and service development.Method: An online survey was sent to SLPs working with children in New Zealand, asking questions about their training, languages spoken and management of multilingual children.Result: Responses from 146 SLPs were analysed. While 28% reported over 25% of children on their caseloads were multilingual, most SLPs felt under-trained to work with these clients. In accordance with best practice guidelines, SLPs supported retention of home languages for their multilingual children. Half of the children seen were assessed and treated in all languages, despite the majority of SLPs being monolingual English speakers. However contrary to best practice recommendations, parents were used as interpreters more frequently than professional interpreters. The SLPs reported a lack of resources for assessment and treatment of multilingual children. Informal assessments were frequently used, but dynamic assessment and peer-child comparisons were under-utilised.Conclusion: There were marked differences between SLPs' current practice with multilingual children and best practice guidelines. Increased training opportunities along with resource development in languages commonly spoken in New Zealand are required.

Insights Into Category Sorting Flexibility in Bilingual Children: Results of a Cognitive Lab Study

Purpose The purpose of this study was to explore how bilingual children shift sets to gain flexibility when forming categories. Using a cognitive lab approach focused on understanding how learners approach problems, we asked children to sort 10 sets of pictures representing common objects in two different ways and to explain their rationale for the sort. We explored the relationship between age and language use on their performance. Method Forty-six typically developing Spanish-English bilingual children (25 girls, 21 boys) participated in the study. They ranged in age from 4;0 to 10;11 (years;months). Receptive and expressive responses to a novel category sorting task were collected. Results Forty-four of the 46 children tested were able to perform the category sorting task. Within language, receptive and expressive category sorting scores were positively and significantly correlated while only expressive scores were significantly associated across languages. There were significant correlations between the sorting scores and age and language output and input. Children's ability to provide expressive responses explaining their sort strategy was moderately correlated with their language experience, especially English output. Conclusions The category sorting task proved useful in eliciting sorting behaviors and naming from the children tested. The age effect suggests that sorting may reflect their general developmental experience rather than their language-specific experience. The cognitive lab approach allowed us to understand how children shift sets and verbalize their understanding of the categorization process. Knowing how children approach this task can inform future work to develop ways to strategically select language intervention goals and document progress.

Which Measures Better Discriminate Language Minority Bilingual Children With and Without Developmental Language Disorder? A Study Testing a Combined Protocol of First and Second Language Assessment

Purpose This study aimed to assess a protocol for the evaluation of developmental language disorder (DLD) in language minority bilingual children (LMBC). The specific aims were (a) to test group differences, (b) to evaluate the discriminant validity of single measures included in the protocol, and (c) to define which model of combined variables had the best results in terms of efficacy and efficiency. Method Two groups of LMBC were involved, one with typical development (n = 35) selected from mainstream schools and one with DLD (n = 20). The study protocol included the collection of demographic information and linguistic history; a battery of standardized tests in their second language (Italian), including nonword repetition, morphosyntactic comprehension and production, and vocabulary and narrative skills; and direct (children's evaluation) and indirect (parents' questionnaire) assessment of linguistic skills in their first language. Results Results showed that the two groups differed in almost all linguistic measures. None of the single measures reached good specificity/sensitivity scores. A combined model that included direct and indirect assessment of first language skills, morphosyntactic comprehension and production, and nonword repetition reached good discriminant validity, with 94.5% of cases correctly classified. Discussion The study defines a complex picture of the linguistic profile in bilingual children with DLD, compared to typically developing bilingual peers. The results reinforce the idea that no single measure can be considered optimal in distinguishing children with DLD from typical peers. The study offers a concrete example of an effective and efficient protocol with which to discriminate LMBC with and without DLD.

Story-telling abilities of young Indigenous and non-Indigenous Australian children across three protocols

Purpose: Little is documented about the story-telling skills of Indigenous Australian children. Therefore, this study explores the complexity of stories produced by Indigenous and non-Indigenous Australian children in their first year of school.Method: An observational design allowed comparison across cultural groups and story protocols. Three stories were elicited from 49 Indigenous and non-Indigenous children aged 4;10 to 6;5. Stories were analysed using the Index of Narrative Complexity (INC) to generate scores for each story element. Story elements were further categorised and evaluated for level of use across participants. Story protocol and cultural group effects were explored using ANOVA.Result: Participant stories featured high use of characters, initiating events, attempts, and consequences; and little use of internal plans, formulaic markers, causal adverbial markers and evaluations. Story complexity scores did not differ between the Indigenous and non-Indigenous children, but significant differences were evident among the three, story protocols.Conclusion: Findings suggest that story elicitation protocols and analysis methods used in this study may be appropriate for use with both Indigenous and non-Indigenous children from urban contexts. However, caution is needed when making diagnostic decisions based on story complexity without well-developed, culturally appropriate protocols and normative data.

Identifying developmental language disorder in bilingual children from diverse linguistic backgrounds

Purpose: To investigate an assessment approach that incorporates a parent questionnaire (ALDeQ) and two language processing tasks (nonword repetition [NWR] and recalling sentences [RS]) administered in English to differentiate bilingual children with Developmental Language Disorder (DLD) from typically developing (TD) bilingual children.Method: Participants were 42 typically developing bilingual children (biTD) and 19 bilingual children with DLD (biDLD). Groups were matched for age (M = 5;10) socioeconomic status (M = 1,023 SEIFA) and length of exposure to English (M = 33.4 months). Children were given a NWR and RS task. Parents completed the ALDeQ.Result: BiDLD had significantly (p < 0.005) lower average scores than biTD on all three assessment tools. The ALDeQ provided the highest diagnostic accuracy (100% sensitivity, 95.2% specificity, area under the curve [AUC] = 0.991). Two other combinations also provided good diagnostic accuracy (above 80% sensitivity and 80% specificity): combination of ALDeQ and NWR; scores below the cut-offline on any combination of assessment tools.Conclusion: Correct identification of DLD among bilingual children using an all English approach is possible. This approach has the potential to provide a practical and evidence-based solution for English speaking speech-language pathologists (SLPs) working with bilingual children.

Language assessment of monolingual and multilingual children using non-word and sentence repetition tasks

The number of children speaking more than one language as well as the number of languages spoken in Ireland has increased significantly posing a problem for timely identification of children with language disorder. The current study aims to profile performance of monolingual and multilingual children on language processing tasks: non-word repetition (NWR) and sentence repetition (SR). We used: (1) Crosslinguistic (CL) and English Language-Specific (LS) NWR and (2) SR in English, Polish and Russian. Children's socioeconomic status, language emergence, the age of exposure (AoE) to English and the percentage of English spoken at home were recorded. The study included 88 children age 5-8 attending a school in a disadvantaged area.CL and LS NWR yielded similar distribution of scores for monolinguals and multilinguals. The tasks identified small number of children who performed significantly lower than the mean while there were no significant differences between the groups. In English SR, monolinguals significantly outperformed multilinguals. Comparison of SR in English and Polish/Russian indicated that some children showed balanced performance in both of their languages while others showed marked differences performing better in either Polish/Russian or English depending on their AoE to English and percentage of English spoken at home.The pilot study suggests that CL-NWR is a promising screening tool for identifying monolingual and multilingual children with language disorder while SR provides more detailed information on children's language performance relative to their language exposure. SR task is recommended to be used only if comparable tasks are available in all of children's languages.

The cat on a hot tin roof? Critical considerations in multilingual language assessments

Background

In speech-language pathology (SLP), there is a paucity of resources to provide just and equitable services to South Africa’s culturally and linguistically diverse population. Although South Africa is a multilingual country, English remains the dominant language. However, there is limited research on resources for English additional language (EAL) speakers.

Objectives

This article addresses this gap by presenting the results of a critique of a commonly used language screening tool, the Renfrew Action Picture Test (RAPT), on EAL speakers.

Method

This tool is used as an example to broadly critique the use of culturally biased assessment instruments with EAL speakers from an indigenous linguistic and cultural background. It is administered to children who are EAL speakers and then critiqued by the children too. Their voice, often ignored in research, is central to the research. A mixed methods approach is used, including focus groups and test administration. This article is based on the results of the thematic analysis used to closely examine the patterns that emerge.

Results

A key finding is that the cultural and linguistic background of the child assessed cannot be disregarded, as it plays a crucial role in understanding the response of the child. The interpretation of the response of the child to the presented material of the language assessment tool significantly influences the result of the assessment.

Conclusion

The speech language therapist has a responsibility to avoid skewed results based on uninformed interpretation of the response of the child. These findings provide useful insights for clinicians regarding culture-fair assessment.

Identifying risk for language impairment in children from linguistically diverse low-income schools

PURPOSE

To improve screening procedures for children in a linguistically diverse context, we combined tasks known to reveal grammatical deficits in children with language impairment (LI) with training to facilitate performance on a verb elicitation task.

METHOD

Sixty-four first grade children participated. The objective grammatical measures included elicitation of 12 past tense regular verbs preceded by a teaching phase (teach-test), the sentence recall (SR) subtest of the Clinical evaluation of language fundamentals (CELF-4), and a tally of all conjugated verbs from a narrative retell task. Given the widespread reliance on teacher observation for the referral of children suspected of having LI, we compared our results to the spoken language portion of the CELF-4 teacher observational rating scale (ORS).

RESULT

Using teacher observation as a reference for comparison, the past tense elicitation task and the SR task yielded strong discriminating power, but the verb tally was relatively weak. However, combining the three tasks yielded the highest levels of sensitivity (75%) and specificity (92%) than any single measure on its own.

CONCLUSION

This study contributes to alternative assessment practices by highlighting the potential utility of adding a teaching component prior to administering informal grammatical probes.

Standardized Tests and the Diagnosis of Speech Sound Disorders

Purpose

The purpose of this tutorial is to provide speech-language pathologists with the knowledge and tools to (a) evaluate standardized tests of articulation and phonology and (b) utilize criterion-referenced approaches to assessment in the absence of psychometrically strong standardized tests.

Method

Relevant literature on psychometrics of standardized tests used to diagnose speech sound disorders in children is discussed. Norm-referenced and criterion-referenced approaches to assessment are reviewed, and a step-by-step guide to a criterion-referenced assessment is provided. Published criterion references are provided as a quick and easy resource guide for professionals.

Results

Few psychometrically strong standardized tests exist for the evaluation of speech sound disorders for monolingual and bilingual populations. The use of criterion-referenced testing is encouraged to avoid diagnostic pitfalls.

Discussion

Speech-language pathologists who increase their use of criterion-referenced measures and decrease their use of standardized tests will arrive at more accurate diagnoses of speech sound disorders.

Children's Consonant Acquisition in 27 Languages: A Cross-Linguistic Review

PURPOSE

The aim of this study was to provide a cross-linguistic review of acquisition of consonant phonemes to inform speech-language pathologists' expectations of children's developmental capacity by (a) identifying characteristics of studies of consonant acquisition, (b) describing general principles of consonant acquisition, and (c) providing case studies for English, Japanese, Korean, and Spanish.

METHOD

A cross-linguistic review was undertaken of 60 articles describing 64 studies of consonant acquisition by 26,007 children from 31 countries in 27 languages: Afrikaans, Arabic, Cantonese, Danish, Dutch, English, French, German, Greek, Haitian Creole, Hebrew, Hungarian, Icelandic, Italian, Jamaican Creole, Japanese, Korean, Malay, Maltese, Mandarin (Putonghua), Portuguese, Setswana (Tswana), Slovenian, Spanish, Swahili, Turkish, and Xhosa.

RESULTS

Most studies were cross-sectional and examined single word production. Combining data from 27 languages, most of the world's consonants were acquired by 5;0 years;months old. By 5;0, children produced at least 93% of consonants correctly. Plosives, nasals, and nonpulmonic consonants (e.g., clicks) were acquired earlier than trills, flaps, fricatives, and affricates. Most labial, pharyngeal, and posterior lingual consonants were acquired earlier than consonants with anterior tongue placement. However, there was an interaction between place and manner where plosives and nasals produced with anterior tongue placement were acquired earlier than anterior trills, fricatives, and affricates.

CONCLUSIONS

Children across the world acquire consonants at a young age. Five-year-old children have acquired most consonants within their ambient language; however, individual variability should be considered.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.6972857.

Academic outcomes of multilingual children in Australia

PURPOSE

The Australian educational system is increasingly challenged to meet the needs of multilingual students, who comprise a fifth of the student population. Within the context of a monolingual English curriculum, multilingual children who enter school not yet English proficient may be at risk of experiencing inequitable educational outcomes.

METHOD

We examined the relationship between the timing of multilingual children's acquisition of receptive English vocabulary skills and subsequent reading and numeracy outcomes, as well as factors associated with earlier versus later timing of acquisition. Data were drawn from the Kindergarten-cohort (n = 4983) of the Longitudinal Study of Australian Children - a nationally representative, community sample of Australian children.

RESULT

Linear regression analyses revealed that multilingual children who begin school with proficient receptive English vocabulary skills, or who acquire proficiency early in schooling, are indistinguishable from their monolingual peers in literacy and numeracy outcomes by 10-11 years. However, later acquisition of receptive English vocabulary skills (i.e. after 6-7 years) was associated with poorer literacy outcomes. In turn, socioeconomic disadvantage and broader language or learning problems predicted this later acquisition of receptive English vocabulary skills.

CONCLUSION

All children need to be supported during the early years of school to reach their full educational potential.

Difficulties Using Standardized Tests to Identify the Receptive Expressive Gap in Bilingual Children's Vocabularies

Receptive standardized vocabulary scores have been found to be much higher than expressive standardized vocabulary scores in children with Spanish as L1, learning L2 (English) in school (Gibson et al., 2012). Here we present evidence suggesting the receptive-expressive gap may be harder to evaluate than previously thought because widely-used standardized tests may not offer comparable normed scores. Furthermore monolingual Spanish-speaking children tested in Mexico and monolingual English-speaking children in the US showed other, yet different statistically significant discrepancies between receptive and expressive scores. Results suggest comparisons across widely used standardized tests in attempts to assess a receptive-expressive gap are precarious.

Bilingualism, a human right in times of anxiety: Lessons from California

Article 19 of the Universal Declaration of Human Rights refers to the individual's right of expression without interference, "through any media and regardless of frontiers". Currently, in some nations across the world, there is decreasing interest in cross-cultural interactions and a new interest in nationalism and assimilation, in communication within frontiers and in a specific medium: the national language. Speech-language pathologists (SLPs) advocate for individuals with communication disorders that interfere with their comprehension and expression. The profession promotes communication as a human right. Unfortunately, many clients and their families continue to report instances in which we, SLPs, limit their human right of expression by ignoring their home languages and recommending the exclusive use of the national language. Real progress requires reflection and action on language policy. In 1998, Californians passed Proposition 227, which eliminated bilingual public education. Then, in 2016, California voters approved Proposition 58 allowing the creation of multilingual and biliteracy programs. A discussion about the presentation of these two propositions to the public may hopefully help bilingual SLPs and advocates protect our multilingual clients' human right of expression in these times of anxiety.