multilingual matters disclosure statements for clinicians

Multilingual Matters for Clinicians

What all professionals need to know working with minority-language speakers

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Teresa M. Signorelli, PhD, CCC-SLP

Marymount Manhattan College | June 2016

Signorelli (2016)

Teresa Signorelli, PhD, CCC-SLP

• Financial Disclosures: Teresa Signorelli is employed by Marymount Manhattan College but is receiving no stipend for this talk

• Non-Financial Disclosures: Teresa Signorelli is seeding the scholarship for a Marymount Manhattan student being promoted at the event

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Disclosure Statements

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Yeah…Not So Much

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How would you feel…?

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• What You Need to Know

• What You Need to Do

• Case Studies

• Additional Resources

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Agenda

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• Who speaks a language other than English?

• Who is teaching bilinguals and/or ESL Children?

• Who is teaching students from different socio-economic or cultural backgrounds?

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Who’s Doin’ What?

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INDIVIDUALS WITH

DISABILITIES EDUCATIONIMPROVEMENT ACT

(IDEA)2004

Considerations for Culturally and Linguistically

Diverse Speakers

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Federal & State Regulations

• IDEA Part B Issue Brief (ASHA): • No racially or culturally discriminatory assessment

• Use native language for assessment unless it is clearly not feasible

• Lack of English proficiency is not consideration for disability

• Use Interpreters Individualized Education Plan (IEP) meetings as needed

• Develop IEPs with sensitivity to language needs regarding limited proficiency in English

http://www.asha.org/Advocacy/federal/idea/IDEA-Part-B-Issue-Brief-Culturally-and-Linguistically-Diverse-Students/

• State Regulations: Bilingual Extension of the TSSLD in NY State• http://www.op.nysed.gov/prof/slpa/speechcredential.htm

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National Standards for Culturally and Linguistically Appropriate Services (CLAS)

in Health Care

FINAL REPORT

U.S. Department of Health and Human Services,

OPHS Office of Minority Health

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http://minorityhealth.hhs.gov/assets/pdf/checked/finalreport.pdf

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CLAS Final Report

• “Because culture and language are vital factors in how health care and education services are delivered and received, it is important [to] understand and respond with sensitivity to the needs and preferences that culturally and linguistically diverse patients/consumers bring to the health encounter.” (pg. 1)

• The standards are also intended for use by: • Policymakers, accreditation and credentialing agencies, purchasers,

patients, advocates, educators, and the general health care community. (pg. 4)

• There are 14 standards falling into mandated,guideline, and recommendation categories

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CLAS Final Report

Four Mandated Standards (4, 5, 6, & 7) Based on Title VI of the Civil Rights Act (1964)

• Standard 4. Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation.

• Standard 5. Health care organizations must provide to patients/consumers in their preferred language both verbal offers and written notices informing them of their right to receive language assistance services.

• Standard 6. Health care organizations must assure the competence of language assistance provided to limited English proficient patients/consumers by interpreters and bilingual staff. Family and friends should not be used to provide interpretation services (except on request by the patient/consumer).

• Standard 7. Health care organizations must make available easily understoodpatient-related materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service area.

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“MODEL PROGRAMS FOR LEP/ELLs:

CLOSING THE ACHIEVEMENT GAP”

New York Statehttp://www.p12.nysed.gov/mgtserv/C4E/htm/ModelPrgmsfor

LEP-ELLs8-08.html

Limited English Proficient (LEP)English Language Learners (ELLs)

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NYS Model Programs for LEP & ELLs

GOAL: Close achievement gap for LEP/ELLs

• NY State suggests implementing nationally proven programs

• Use their Contract for Excellence (C4E) funding

• Assist LEP/ELLs to attain English proficiency

• Meet State academic and student achievement standardshttp://www.p12.nysed.gov/mgtserv/C4E/htm/ModelPrgmsforLEP-ELLs8-08.html

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• Model Programs can address program areas and services: – class size reduction– time on task– teacher/principal quality initiatives; – middle and high school restructuring; – full-day Pre-kindergarten and Kindergarten

– model programs for English Language Learners

– experimental programs.

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• School districts are obligated to run LEP/ELL programs and services– No Child Left Behind Act– New York State (NYS) laws and regulations

• Regulations of the Commissioner C.R. Part 117, C.R. Part 100, C.R. Part 200, C.R. Part 154, C.R. Part 80, Education Laws 3204 and 3602, and Article VII in New York State.

• See Appendix for resources in Model Programsdocumenthttp://www.p12.nysed.gov/mgtserv/C4E/htm/ModelPrgmsforLEP-ELLs8-08.html

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Why We Have Special Considerations for

Culturally and Linguistically Diverse Speakers

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Mistakes from Marketing

http://www.slideshare.net/prince_dj_81/international-marketing-mistakes16Signorelli (2016)





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Higher Stakes with Children Relative to Business

http://evolveconsciousness.org/intentions/Signorelli (2016)

Monolingual & Multilingual Speaker Differences

• Ignorance has led to

– poor, if not mal-practice in education and rehabilitation

– unbalanced referral of minority language speakers

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• Many Americans are not bilingual– Unfamiliar with the phenomenon – Struggled learning a second language | Late start.

• “Less-than-Positive” Consequences of Bilingualism (Bialystok, 2009)– Unequal Lexicon Across Languages

• Children may look delayed if only one language is considered

– Adults often lower in rapid recall tasks• Competition between languages for attention

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Bilingualism Myths and Why They Exist

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Dispelling the Myths: Did you know…?

• Globally Monolingualism is atypical | Multilingualism is the norm

• Bi- and monolinguals develop language at the same general way and rate

• Multilingualism Does Not Cause Delays or Disorders– Maintaining bilingualism:

• Does not inhibit language improvement in communicatively impaired or delayed children

• Has been shown to facilitate the most improvement in communication (De Houwer, 1999)

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• Minority language children learn English BETTER

AND FASTER if parents use the home language

• Multilingual ≠ equal proficiency in all languages– Different languages | Different settings

• Code Switching = Normal, sophisticated, and pragmatically appropriate in many (BUT not all) bilingual communities

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Relative to monolinguals, bilingual children have increased or better…• cognitive strategies

• cognitive flexibility

• perceptual skills – (e.g., find something in the background)

• classification skills

• (i.e., earlier) understanding of symbolism – (e.g., that words are symbols for objects, concepts,

feelings; tokens can have multiple names)

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(Marian et al., 2009) Signorelli (2016)

Bilingualism and Cognitive Development

Positive Consequences of Bilingualism

• Bilingualism is related to better problem solving skills (Bamford & Mizokawa, 1991)

• Knowledge of foreign languages promotes knowledge of native language structure and vocabulary (Curtain & Dahlberg, 2004)

• Research with adults suggests that bilingualism facilitates word learning (Papagano and Vallar, 1995)

• Increased years of foreign language study correspond to increased math and verbal SAT scores (The College Board SAT, 2004)

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Positive Consequences of Bilingualism

• Better ability to manage (inhibit) irrelevant information (Bialystok, Craik, Klein, and Viswanathan, 2004)

• Clinical Relevance– Inhibition is linked to a number of disorders

– Potential relevance for attention deficits, frontal lobe impairments

– Alzheimer’s Dementia delayed in bilinguals up to 4+ years relative to monolinguals (Craik, Bialystock, and Freedman, 2010)

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Who is an appropriate provider? All Clinicians… Potentially…

• Services in Child’s Dominant Language– Provider must have…• Native or native-like proficiency• Knowledge and skills • Meet legal requirements

• Services in Child’s Second Language– Provider must have• Knowledge of features and developmental

characteristics of language and dialect/s• Knowledge of cultural and linguistic influences• Collaboration with appropriately trained

interpreters/translators27Signorelli (2016)

Requisite Competencies

• Cultural Competence• Language Competencies• Language, Socio-

linguistic, & Cultural influences

• Articulation & Phonology

• Resonance, Voice, & Fluency

• Swallowing• Hearing & Balance

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“ASHA Knowledge and Skills Needed by Speech-Language Pathologists and Audiologists to Provide Culturally and

Linguistically Appropriate Services” (2004)

http://www.asha.org/policy/KS2004-00215.htm

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Requisite Competencies

• Identification & Assessment

– Foundational Content

–Assessment Tools–Differential

Diagnosis

• Management

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“ASHA Knowledge and Skills Needed by Speech-Language Pathologists and Audiologists to Provide Culturally and

Linguistically Appropriate Services” (2004)

http://www.asha.org/policy/KS2004-00215.htm

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Cultural Competence

• Language and culture are inextricably linked

• Cultures differ as languages differ

• ASHA Calls for Professionals to:– be sensitive to cultural and linguistic differences that

affect assessment, diagnosis, and teaching/learning

– understand the influence of traditions, customs, values, and beliefs might have on educational outcomes

– realize potential impact acculturation (or lack thereof) on assessment, diagnosis, and teaching/learning

– be present to one’s own limitations, values, and potential biases 30Signorelli (2016)

Cultural Competence

• ASHA Calls for Professionals to:– ensure strategies and materials do not

violate families values

–bridge the gap between home culture and the learning environment

–consult with related professionalshaving the appropriate cultural-linguistic background as needed

– uphold ethical obligation regarding culturally and linguistically appropriate services

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Interpreters may significantly affect scores (e.g., Casas et al., 2012)

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Interpreters & Translators with Appropriate Knowledge and Skills

• Accurate translations/interpretation

• Familiarity with and respect for culture, linguistic community, and communicative environment

• Proper interview techniques

• Professional ethics. Understanding of privacy and confidentiality (e.g., FERPA, HIPAA)

• Principals of assessment/intervention for test validity

Suggested ResourceLanguage Interpreters and Translators Bridging Communication With Clients and Families (Langdon, 2002)

http://www.asha.org/Publications/leader/2002/020402/020402g.htm

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• Sociolinguistic and Cultural Considerations– Note potential for Bias– Ethnographic Interviewing– Family/community perspective

• Speech & Language Considerations– Bilingual Development– Normal Errors & Shared Characteristics w/

Language Impairment– Basic Interpersonal Communication Skills (BICS)– Cognitive Academic Language Proficiency (CALP)

• Proper Assessment – Federal and Local Mandates– Best Practices

• Pit falls with formal and translated tests• Alternative assessment methods

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Distinguishing Typical From Disordered

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• Understand bilingual language development– Every bilingual experience is unique– Variability in the amount and quality of exposure– Types of experiences

• Definition: Bilingualism is commonly defined as the use of at least two languages byan individual. It is a fluctuating system in children and adultswhereby use of and proficiency in two languages may change depending on theopportunities to use the languages and exposure to other users of the languages.It is a dynamic and fluid process across a number ofdomains, including experience, tasks, topics, and time. (ASHA 2004)

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Distinguishing Typical From Disordered Language & Linguistics

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• Simultaneous Bilingualism– occurs when a young child has had significant and meaningful

exposure to two languages from birth. Ideally, the child will have equal, quality experiences with both languages.

• Sequential Bilingualism– occurs when an individual has had significant and meaningful

exposure to a second language, usually after the age of 3 and after the first language is well established. These second language learners are referred to as "English language learners" in U.S. schools.

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Types of Bilingualism (ASHA)

Distinguishing Typical From Disordered Language & Linguistics

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Sequential Bilinguals: Second Language Learners (L2)

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Language & Linguistics

• Basic Interpersonal Communication Skills (BICS)• Everyday language/conversation• Can take 3 to 5 years to master• Benefit of Context (facilitate communication)

Distinguishing Typical From Disordered Performance

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Sequential Bilinguals: Second Language Learners (L2)

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• Cognitive Academic Language Proficiency (CALP)• Language of academics/higher order functions• Can take 5 to 7 years to master• Challenge: Reduced context. Communication more difficult


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BICS & CALP Suggested Resource• See work by Jim Cummins

– Cummins, J., (1999) BICS and CALP: Clarifying the Distinction.

• http://www.eric.ed.gov/PDFS/ED438551.pdf

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There are very normal language behaviors L2 speakers exhibit that mimic disordered language behaviors

We must be aware of these “false positives” for disordered language

– INTERFERENCE or TRANSFER from L1 to L2English: I am hungry

Spanish: Tengo hambre(I have) (hunger)

Bilingual child says: “I have hunger”

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Distinguishing Typical From DisorderedLanguage & Linguistics

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We must be aware of these “false positives” for disordered language

– SILENT PERIOD

• Children often focus on listening and comprehension when first exposed to a language

• Verbal output may decrease notably as a result

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More potential “false positives”…

– CODE-SWITCHING: Changing languages within and across phrases or sentences

• “Tengo mucha hambre. I can’t wait to eat!”

– LANGUAGE LOSS: L1 skills are lost if not reinforced

• This subtractive bilingualism can harmful– Cognitively– Linguistically– Social-emotionally

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Normal Simultaneous Bilingual behaviors may provoke “false positives”

Bilinguals often experience unequal distribution of languages use- Topic A in Language 1 - Topic B in Language 2

- Meals in Language 1 - Bath time in Language 2- Home in Language 1 - School in Language 2

Developmental Mixing(*)

• “Blow it” + “sopla” (blow) “Soplit”

• “Put on” + “pantalones” (pants) “Putelone”

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* Examples courtesy of Sylvia Y. Walters


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Shared Characteristics of Normal L2 and Language Impaired Speakers (Seitel & Garcia, ASHA 2009)

• Short attention• Distractibility• Daydreams• Appears confused• Uses gestures

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Seitel & Garcia referenced Ortiz & Maldonado (1986, as cited in Kayser, 1998) and Roseberry-McKibben (1995)


• Infrequently output• Speaks in single

words or phrases• Difficulty sequencing

ideas/events

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• Comments inappropriately

• Poor recall• Poor comprehension• Poor vocabulary

• Poor syntax• Poor pronunciation• Confuses similar

sounding words

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How We Distinguish Typical From Disordered Communication

Seitel & Garcia referenced Ortiz & Maldonado (1986, as cited in Kayser, 1998) and Roseberry-McKibben (1995)

Shared Characteristics of Normal L2 and Language Impaired Speakers (Seitel & Garcia, ASHA 2009)


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• Understand the speech community’s feelings and definitions of typical relative to disordered communication

• Critical Elements of Parent/Caregiver Interview Regard:– Family history

• Detailed Language History

– Skills relative to peers• Can weigh heavily in diagnosis decisions

– Premorbid status in case of brain injury45



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• TRADITIONAL APPROACH:• Professional drives the agenda

• Professional viewed to know what information is important to collect

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The Ethnographic Interview

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• ETHNOGRAPHIC APPROACH:• Fosters patient/family setting agenda• Understanding a patient's cultural perspective

• Family has valuable information of which clinician may be unaware.

• Open ended questioning– Clear descriptions of daily life experiences

– Facilitates good decision making

• Explain purpose for the interview to family– Build rapport– Help assure the best data are collected

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The Ethnographic Interview

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Ethnographic Q&A Principals

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• Use over Meaning– Instead of saying, “What do you mean that it’s hard to

comprehend people in conversation?”

– Say “Describe the environments in which having conversations is difficult?”

• Be Open Ended– Instead of saying, “Does your daughter use words to

communicate?”

– Say, “In what ways does your daughter tell you her wants and needs?”

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• Restate. Don’t Rephrase or Interpret. Restating may prompt more detailed information.

If parent says, “All my free time is spent tending to my son’s needs”…

– Instead of saying, “That must be difficult.”

– Say, “Your son’s needs take up a lot of your free time.”

– Parent may add, “Yes, I can’t help my other children with their homework, get the laundry done or dinner prepared.”

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Question & Asking Principals

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• Summarize to Validate Understanding and Direct Accurate Intervention Planning

– Say, “Before we move to the next topic, I want to make sure I understand your concerns. You said …”


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• Beware of Bombarding with Question Sequence

– Instead of saying, “You mentioned reading with your child at home is difficult. Is this all the time? Can you change your schedule to find some down-time? Do you have books to read? Do you have a library card? Are there other people who can read with him?”

– Say, “You mentioned reading with your child at home is difficult. Would you describe the situations that are difficult for you.”


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• Beware of Leading Questions. Beware, Yes/No queries can often be leading

If a student tells you they are struggling with an activity…

– Instead of saying, “What don’t you like about the activity?”

– Say, “Tell me what you think about this activity?”

• Beware of “Why” Questions. They can sound presumptive and critical– Instead of saying, “Why is your son absent from school?”

– Say, “What keeps your son from attending school regularly?”


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• ALWAYS, ALWAYS include information about the languages and/or dialects a child uses. Report: – Exposure by gross percent

• 70 : 30 :: Spanish : English

– With whom• Spanish with Parents and grandparents daily• English with 7 y/o cousin who visits on weekends• Hears French from babysitter who watches child Sunday mornings

– What situations• Spanish and English at home (75:25%)

– Spanish spoken actively with family – English hear passively via television

• English/Spanish at Daycare five days a week (80:20% respectively)• Resources

– Hammer et al. (2012) article “Predicting Spanish-English Bilingual Children’s Language Abilities” in JLSHR– Li et al. (2006) Language history questionnaire: A Web-based interface for bilingual research in Behavioral

Language History Interview

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VERY FEW appropriately standardized tests exist

Translated tests used for INFORMAL PROBING ONLY

Translated Tests | Fraught with Problems•Different developmental milestone sequences•Different linguistic structures across translations•Different cultural experiences

There are NO NORMATIVE DATA from which to calculate scoresAny scores generated from the test’s norms are MEANINGLESS

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Assessment Tool Limitations

!!Do not report scores from translated tests!!

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• Dynamic Assessment

• Portfolio Assessment

• Narrative Assessments

• Structured Observation

• Academic and social language sampling

• Interview assessment tools

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Assessment Paradigms

Better alternatives to standard approaches

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Good Option for Multilingual and Multicultural children

- Want of appropriate formal tests

- Formal tests may misdiagnose/misinform- Want of experience- Cultural/Linguistic differences

- Typically developing children tend to improve

- Genuinely impaired children tend not to and/or struggle to improve

- More accurate language impairment identification in ML/MC children (Peña et al. 2006)

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Dynamic Assessment

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Assessment Approaches- TRADITIONAL:

Compare child to peers. Static

- DYNAMIC: Compare child to his/herself. Natural-like setting

Vygotsky’s Model of Cognitive Development- Zone of Proximal Development

- Knowledge develops in social interactions and when culturally relevant

- Support decreases for new information as skill internalizes

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DA: Background and Theoretical Bases

Photo Credit: http://en.wikipedia.org/wiki/Lev_Vygotsky

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Work in Zone of Proximal

Development

Assess the following:NATURE of change

DEGREE of change

SIZE

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DA: Background and Theoretical Bases

ZPD

Independent Skill Set

Beyond Skill Set

Vygotsky – Diagnostic Assessment Connection

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•TESTING-THE-LIMITS•See J. Carlson and K. Wiedl

•GRADUATED PROMPTING•See B. Bain and L. Olswang

•TEST-TEACH-RETEST•See C.S. Lidz & E. Peña

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Overviews of Dynamic Assessment Methods

Dynamic Assessment of Diverse Children: A TutorialV.F. Gutierrez-Clellen and E. Peña

Lang Speech Hear Serv Scho, 2001, 32http://lshss.pubs.asha.org/article.aspx?articleid=1780262

Alternative Assessment of Language and Literacy in Culturally and Linguistically Diverse Populations

S.P. Laing & A. KamhiLang Speech Hear Serv Scho, 2003, 34

http://lshss.pubs.asha.org/article.aspx?articleid=1780297

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• Modify traditional testing procedures

• Simple Feedback: indicate correctness to child

• Elaborated feedback: give reason why a response is incorrect and explain task’s underlying principals

• Verbalization: children describe test question and how they came to their conclusion

• Ascertain progress readiness (relative to communication disorder)

• Be weary of validity and reliability issues when deviating from standard delivery

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DA Method: TESTING-THE-LIMITS

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• Sample Cases of Task/Stimulus Variability (Laing & Kamhi, 2003)• Lower SES African American children performed worse

relative to Caucasian peers with traditional (picture stimuli) relative to manipulatives.

• Performance on par when executed within thematic tasks. (Fagundes et al., 1998)

• Laing & Kamhi Suggestions• Replace black and white picture stimuli with three

dimensional shapes in the context of a Simon Says tasks to provide context for lower SES African American Children

• Have children pretend to be robots when recalling sentences

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DA Method: TESTING-THE-LIMITS

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• Present hierarchy of pre-determined prompts to establish ZPD

• Readiness for greater task difficulty informed by responses to different degrees of prompting

• Measure learning aptitude by degree of skill transfer to other contexts

• Advantage over [Test-re-test] (Patterson et al., 2013)• Shorter time, over brief single session • Less examiner training w highly [structured?] prompts• Potentially good screening option

• Evidence of predicting language and literacy performance (Bridges and Catts, 2011)

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DA Method: GRADUATED PROMPTING

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MULTI-STEP. ACTIVE. INTERACTIVE- 1. Test → 2. Teach → 3. Re-Test- Focus = Learning process in the ZPD

AIMS- Identify skills- Ascertain learning potential- Help determine difference from disorder

TWO PRINCIPAL OUTCOMES- Determination of language difference or disorder- Intervention targets (Need be…)

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DA Method: TEST-TEACH-RETEST

ASHA Practice Portal | Dynamic Assessment Multi Media Guidehttp://www.asha.org/practice/multicultural/issues/Dynamic-Assessment.htm

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• TEST– Assess present performance

• TEACH– Mediated Learning Experience (MLE)– Facilitate strategy development– Observe how child changes and learns

• RE-TEST– Re-test child– Compare pretest and post test

performance– Assess strategy transfer or lack thereof

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Test-Teach-Re-Test Framework

Signorelli (2016)

• Goal of the MLE– is to empower a child to be an independent

and self-directed learner

• The MLE affords the clinician– Time to observe how child learns

– Opportunities to train and foster learning strategies

• Components of the MLE– Intentionality

– Meaning

– Transcendence

– Competence65

Mediated Learning Experience (MLE)

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Components of the MLE

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Component Techniques Rationale

Intentionality

- Share the intention to change the child’s learning skills

- Tell the child your target- Give the rationale for the MLE

Create Awareness

Meaning

- Direct focus to what is important

- Point out important aspects or features of the activity

- Ignore what is irrelevant or unimportant

Helps child understand

what is important and why

Adapted from ASHA Practice Portal Chart | Link cited above Signorelli (2016)

Components of the MLE

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Component Techniques Rationale

Transcendence

- Bridge ideas & events beyond the immediate task

- Introduce of abstract concepts- Use questions such as, “Where

else have you…? “What would happen if…?, and “Did you ever…?"

Helps Child Think Critically

and Hypothetically

Competence

- Review strategies and develop a plan

- Cue child to think about how they will employ strategies or skills

- Discuss appropriate times to use various skills

Fosters Active Learning, Self-Monitoring

and Self-Regulation

Adapted from ASHA Practice Portal Chart | Link cited above Signorelli (2016) 68

Sample MLE

Component Sample Script

Intentionality Hi Michael. Today we are going to work on saying a special phrase, “does not.”

Meaning

The phrase “does not” is important because, in English, it’s the way speakers let others know if something has happened, it helps us form questions, and it helps emphasize important things.


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Sample MLE

Component Sample Scrip

Transcendence

Can you think of things you mom does not like? Imagine how you would tell someone. Do you hear your teacher use the word “does” when she tell you what is not happening?

Competence

It’s important to show what someone does not like or when something does not work. How can you make sure you use the phrase, “does not” so people understand well. You can stop and think before talking or think about how you said something after.


Determining language difference from disorder

can be based on

MODIFIABILITYHow does child respond to

information and the process?

How well are skills transferred?

How much and what type of clinician effort and prompting is

needed?70

Mediated Learning Experience (MLE)

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Measurement Behaviors

Responsivity

- General response to intervention- Attention to task, to verbal information- Ease correct response vs. repeatedly giving the wrong

answer

Transfer

- Does child transfer skills learned in mediation to other tasks?

- What is the speed and quality of generalization?- Does transfer persist or do skills need to be re-taught

a few days later?

Examiner Effort

- How taxing is mediation for the clinician during and following interaction

- Does the clinician have a sense of fatigue?71

Determining Outcomes of the MLE

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Judging Modifiability

• Learning Strategies Checklist (Lidz, 1991; Pena, 1993)

– 3-point scale– 13 items

• Attention, discrimination, planning, self-regulation/awareness, application, motivation

• Modifiability Scale (Lidz, 1991)

– 3 & 4-point scales– 3 items: Examiner effort, responsiveness to intervention,

transfer

Kapantzoglou et al. (2012) had success with…

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Judging ModifiabilityPeña’s (2000) Modifiability Scale and Learning Strategies Checklist

Modifiability Scale

EXAMINER

EFFORT

“0” Extreme

“1”High-

Moderate

“2”Moderate

“3”Slight

CHILD

RESPONSIVITY

“0”None at

all

“1”Slight

“2”Moderate

“3”High

TRANSFER“0”Low

“1”Medium

“2”High

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• Attention/Discrimination– Initiated focus w minimal cues– Maintained focus w minimal cues– Respond to relevant cues/ignore irrelevant cues

• Comparative Behavior– Comments on features of the task– Uses comparative behavior to select items– Able to talk about same/different

• Planning– Talks about overall goal– Talks about plan

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Judging ModifiabilityLearning Strategies Checklist Components (Peña 2000)

Point Values

“0” None of the

time

“1” Some of the

time

“2” Most of the

timeSignorelli (2016)

• Self Regulation/Awareness– Waits for instructions– Seeks help when has difficulty– Self corrects– Self rewards

• Transfer– Applies strategies within a task– Applies strategies across tasks

• Motivation– Perseveres even when frustrated– Shows enthusiasm

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Judging ModifiabilityPeña’s (2000) Modifiability Scale and Learning Strategies Checklist

Learning Strategies Checklist Components

Point Values

“0” None of the

time

“1” Some of the

time

“2” Most of the

time

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Test-Teach-Retest: Word Learning, Single Session

• Task: Novel word-learning– Mitigates experiential bias– Children w language impairment difficulty learning new

words

• Participants:– 4 to 5 y/o Predominantly Spanish Bilinguals with typical

and disordered language

76Kapantzoglou et al., 2012

Kapantzoglou et al., 2012

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• Intervention – Materials

• 3 novel objects from different semantic categories given CVCV nonword labels (Undeterminable animal, seeds, bubble level)

• familiar objects (flower, pizza, sunglasses)

– Methods• One, 30 to 40 minute Test – Teach – Retest Session• Pretest = Named all six items• MLE: Taught nonwords in scripted structured play (Lidz, 1991). • Script was for consistency, but allowed feedback based on child’s

responses (Pena et al. 2001)• Modifiability gauged via Learning Strategies Checklist & Modifiability

Scale

77Kapantzoglou et al., 2012Signorelli (2016)


• Results– Typical and children w language impairment discriminated

successfully, albeit not perfectly (78%)

– Typical language children faster than disordered language children making phonological and semantic associations.

78Kapantzoglou et al., 2012 Signorelli (2016)

Test-Teach-Retest: Narratives

• Background– Two experiments

– First determined equality of pre/post-test stories

– Authors wanted to assess viability of DA as a classification protocol

– Establish presence, or not, of potential bias of pretest measures

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Peña et al. (2006)

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• Methods (Experiment 2)– 1st and 2nd graders with and without a language impairment– Three groups:

• Children w language impairment• Typical language who participated in an MLE• Control group of typical language children NO MLE

– Pre/Post test: • Child thought of story while looking at wordless picture book• Child then told story looking at pictures

– MLE: Two, 30 minute narrative skill and strategy sessions to increase length and complexity of narratives

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• Results– LI group significantly less pre- to posttest change

– TLC more modifiable, related better stories

– Classification via Pretest Measure: • Acceptable only for some. Case x Case: African Am./Latino misclassified

– Classification via Posttest: • Fair. Higher sensitivity to pretest

– Classification via MLE: • Most accurate of the three

– Overall accuracy best combining MLE and Posttest measures 81Peña et al. (2006) Signorelli (2016)

DAPPLE

• Assessment protocol in development– < Sixty minute administration estimate

• Test-Teach-Test– Learn vocabulary, Sentence Structure, Phonology

• Preliminary results promising to help differentiate typical from language disordered bilingual children

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Dynamic Assessment of Preschoolers’ Proficiency in Learning English

Discriminating Disorder from Difference Using Dynamic Assessment in Bilingual Children. N. Hasson, B. Camilleri, B. Jones, C. Smith, B. Dodd

Child Language and Therapy, 2013, 29

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• Reports should ALWAYS include…– Information about the child’s linguistic and cultural

environment/s

– Statements regarding how diagnosis and decisions were made via clinical/professional judgment

• There are ethical concerns in reporting scores from psychometrically flawed assessment tools like translated or inadequately designed/normed tests

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CASES STUDIES:IDEA and/or Best Practices

Not Followed

HIPAA/FERPA Warning:Identifying Information has been modified to

secure patient/student privacy

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• Kindergarten Age - International Adoptee– Background not fully clear due to adoption circumstances

• English suspected to be third language

• Found abandoned in home at age ≈ 1.5 years of age– No food, water, electricity– Possible Turkish speaking home– Brought to Russian Orphanage. First exposure to Russian

• Adopted at ≈ 3.5 years of age – Adoptive family arranged for local tutor to speak English w child a few weeks

before moving to US

• Arrived in US in June of year X

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International Adoptee

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• Bilingual (Russian/English) Speech-Language and Psychological Evaluations

• General cognitive functioning was within normal limits

• Delayed speech & language skills

• Appropriate protocols followed

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International Adoptee Testing: Arrival in JUNE

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• English-only SLP & Psych Reassessment• Only six months regular exposure to English• No caveats

– about English only testing– multilingual/cultural background– traumatic childhood

• Erroneously diagnosed with delays/disorder• INAPPROPRIATE PROTOCOLS FOLLOWED

• Psychologist’s Especially Inappropriate Actions– Diagnosing out of purview: speech & language disorder including

DSM code– Erroneously stated should have better English language skills with

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International Adoptee Testing: Six Mos. Later in January

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• Placed in classroom with severely impaired children with autism– Child having intact cognitive and linguistics skills

could not function well– Family pulled child from setting and home schooled child

• Received speech-language therapy with monolingual clinicians in English until September– while not harmful, not considered appropriate

• Meant for habilitation of clinical needs, not to teach English

– ESL and language enrichment activities would have been more appropriate

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International Adoptee Clinical & Educational History

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• In September began speech-language therapy with bilingual-trained clinician– Diagnostic therapy to differentially diagnose true

language disorder from second-language learning

– Learned skills at good rate

– Determined to have normal language functioning and to have been misdiagnosed by untrained professionals following inappropriate protocols

– Discharged from therapy at end of fall semester

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• Bilingual SLP encouraged family to engage child in language rich activities– social activities to practice English skills with peers– reading

• New assessment: Qualified for “Gifted and Talented” program

• Family, nonetheless, had to fight to remove misdiagnosis

• Failure to follow best practices resulted in– Time lost toward appropriate habilitation and socialization – Additional financial burden to family

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• 3 y/o Bilingual | Developmental Delay

• Background History & Timeline– Bilingual, Spanish-dominant home

– Spanish at home from birth until age 2.5• Parents, grandparents, babysitter

– Formal introduction to English in daycare at age 2.5 (January) • Some English used at home - approximately 15% of the time

– Formal Evaluations at age 3 years (June)

– Entered preschool (September)

– Contacted Bilingual SLP with concerns of improper assessments and placements (October)

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Child Developmental Delay, Early English Learner

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• Reports/Evaluations- Initial SLP Eval

- Educational Eval

- Secondary SLP Eval

- Social History

- Developmental Pediatric Eval

- Individual Education Plan92


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• All assessments, with the exception of one SLP evaluation were performed in English

• The reports, rightly indicated child came from a Spanish dominant or speaking home

• Reports often mentioned:– Child produced Spanish output– Child could not be tested second to non-compliance

• Not uncommon for a child in a testing situation, interacting with an unfamiliar adult in unfamiliar setting, speaking a less familiar language. Though, not noted by professionals

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• Spanish background and output completely ignored by the professionals making decisions and diagnoses about the cognitive-linguistic development and functioning.

• No caveats to interpret the findings with caution as the children were not assessed in their dominant language.

• Outcomes of English-based reports revealed a fraction of the child’s cognitive-linguistic capabilities

• The evaluations were largely invalid according to IDEA and best practices

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• The educational and remedial provisions did not appropriately consider the child’s bilingual status and fell short of needs – Recommendations were for English-based interventions and

settings – Of particular concern was the wholly INAPPROPRIATE

recommendation for the family not to use Spanish• Potentially detrimental cognitively and social-emotionally

• Failure to follow best practices resulted in– Time lost toward appropriate habilitation – Additional financial burden to family– Potential uneasy relationship with family and school district

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Test Your Knowledge

What’s your multicultural IQ?• http://leader.pubs.asha.org/article.aspx?artic

leid=2293384

Cultural Competence Checklist: Personal reflection

• http://www.asha.org/uploadedFiles/Cultural-Competence-Checklist-Personal-Reflection.pdf#search=%22Cultural%22

Cultural Competence Checklist: Policies and Procedures

• http://www.asha.org/uploadedFiles/Cultural-Competence-Checklist-Policies-Procedures.pdf#search=%22Cultural%22

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Sources for Foundational Content• ASHA

• State Regulation Boards

• Departments of Education– Local– State– Federal

• Professional Organization and Associations – Center for Applied Linguistics– National Association for Bilingual

Education– National Center for Bilingual Research– National Clearinghouse for Bilingual

Education

• Related Research Journals– International Journal of Bilingualism– ERIC – Educational Resources

Information Center– Brain and Language– The Modern Language Journal– Review of Educational Research

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In Sum…

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PLEASE Introduce Yourself If You Want to Link-In:http://www.linkedin.com/in/teresasignorelli

• Build knowledge and skills

• Bilingualism– can mimic language impairment– children need home language to learn a second

language

• Pit falls of standardized testing– Dynamic Assessment Great Option

• Great Resources

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Thank You

What are your questions?

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PLEASE Introduce Yourself If You Want to Link-In:http://www.linkedin.com/in/teresasignorelli

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multilingual matters disclosure statements for clinicians

Documents