Family and community beliefs about language use can also vary as a function of wider community and social attitudes in the mainstream as well as their own home community. As a result, when probing about language use patterns, clinicians need to ensure that they convey a sense of sincere interest in understanding how all languages are used as well as an open supportive attitude toward multiple language use.
If families and individuals feel that information about their language used will be accepted openly, they will be more willing to disclose. It is still the case that some professionals continue to counsel families against using more than one language even when research such as that cited in Kohnert clearly shows that learning more than one language does not confuse children and that children with language delays are just as capable as their monolingual peers of learning more than one language.
In recent years, there have been changes in the types of family structures and networks around the world. The traditional family unit in the United States has typically been the nuclear family, consisting of a married man and woman with one or more unmarried children. This traditional family unit, however, is changing in the United States. Census Bureau , Families are becoming more varied, including married and unmarried couples, both men and women living alone or living together with or without children; single parents with children; and blended families consisting of two parents who have remarried or who are not married to each other, with children from their previous marriages or relationships, and male and female same-sex parents.
Along with these changes has been an increased acceptance of divorce, non-marital cohabitation, unmarried parenthood, permanent non-marriage and voluntary childlessness. In extended family households, it is very common for family members across two or three generations to live within the same household or within close proximity of each other. According to the U. Census Bureau , in the United States 3. In some cultural communities, the extended family unit also included nonbiologic kin. The inclusion of nonbiologic kin within the family unit is also common in same-sex partnerships.
These families consist of fictive kin that provide family, cultural, and social support networks for gay, lesbian, bisexual, and transgender individuals.
During the past couple of decades, there has been a significant shift in perspectives on gender equity and equality in some countries such as the United States. As a result, males and females are more likely to have equal status in the child-rearing or elder care. Despite these changes, there are still many parts of the world where the male continues to serve as the primary family representative for any matters concerning the family. For example, in Iran, where the traditional culture is still patriarchal and hierarchical, the father has the greatest authority for all family decisions.
In the absence of the father, the oldest son has the primary authority. In other cultures, it will be the female. In still others, the decision will be shared equally between the males and females. In some communities, it is the grandparents rather than the parents who have this primary responsibility. In Haitian communities, when an individual has a disability, decisions regarding the most appropriate type of intervention or rehabilitation plan are made by the entire family, with each member of the extended family being consulted before a final decision is reached Jacobson , The individual who represents the family publicly in certain settings may not be the one who is charged with the primary responsibility of decision making in private.
Because of their complexity and variety, the roles of each member of the family may be less clear to clinicians. Clinicians may need to determine the most appropriate decision maker by addressing questions to all involved and watching for the individual who appears to take the lead most often. Questions and concerns may be addressed primarily to the individual who holds the legal or guardianship responsibility while still considering the comments and concerns of other family member participants.
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There are a number of clinical implications for clinicians conducting the assessment with clients from different cultural backgrounds given some of the issues addressed in this chapter. One of the best strategies for addressing some of these differences is being prepared for the case history interview by researching in advance some of the possible communication and other cultural issues that may potentially affect the process using some of the resources provided at the end of this chapter.
Professionals can also work closely with interpreters, translators, and other professionals who can serve as cultural brokers that are familiar with the communication norms of the community of the families served. A summary of other suggestions for communicating effectively with families from diverse cultural backgrounds around the world are presented in Box A key component of the case history interview with CLD clients involves the types of questions that are used and the ways questions are worded.
The types of questions used with clients who speak more than one language are also key to determining important issues, such as the primary languages for assessment and intervention. Obtaining input from significant others also helps clinicians determine how well a client is able to communicate according to the standards of his or her community. The purpose of this section is to provide an overview of key considerations to be taken into account when interviewing bilingual clients. There are a number of key topics and questions that should be addressed when interviewing caregivers of bilingual child clients.
The following section contains a summary of key topic and question considerations for the case history interview with caregivers. A list of possible questions can also found in Appendix This information is useful for determining the language for assessment and intervention. However, it is also useful to conduct at least some part of the assessment e. As previously mentioned in the section on language attitudes, clinicians need to be mindful of the potential sensitivity of probing for information about language s used in the home, especially when the languages used differ from the majority language of a county or region.
Even in those cases in which a child is primarily exposed to English, it is helpful to know something about other languages used in the home because they can still affect the vocabulary used by the child. It is common for bilingual and multilingual child speakers to have their early vocabulary and concepts coded in one language but not the other receptively, expressively, or both. It is also important to know something about the primary languages of instruction that have been used for educating the child as well as during any previous speech and language intervention services.
Another topic that should be addressed during the interview is the perceived levels of relative language proficiency across and within all languages spoken and understood. In addition, when identifying the language the child speaks most often, clinicians should determine which language the child speaks best.
However, given that levels of language proficiency can vary within the same language across different domains of language, it is important to ask for separate ratings of abilities in different communication modalities within all languages spoken e. The developmental progress of each language spoken should also be included.
This can be obtained by identifying the age at which first words were spoken in each language, the age at which sentences were produced in each language, and the current average length of sentences in each language. Identifying the average number of words used by a child in sentences in each language can also help clinicians determine the strongest language. A key focus of any case history interview is the types of communication difficulties observed and experienced.
The same information should be obtained for bilingual children. The difference from monolingual language speakers is that whatever is asked about one language should be asked about any others spoken. Identifying areas of difficulty in more than one language helps to support a diagnosis of true impairment. There is an interdependent relationship or common underlying proficiency between the L1 and L2 in bilingual speakers Roseberry-McKibbin , As a result, difficulties in one language are likely show to be similar in the second. This suggests that true disorders are likely to be evident in all languages spoken.
Although there can be differences in the way in which an underlying disorder is expressed owing to language-specific characteristics of each language, the underlying nature of the difficulties is likely to be the same. As a result, the bilingual Spanish-English speaking child who uses velar fronting in English e. The types of questions that should be asked of bilingual and multilingual adult clients with suspected communication disorders are similar to those that should be asked when evaluating child clients with a few exceptions and additions.
See Appendix for sample bilingual adult topics and questions. In addition to those questions recommended in Appendix , clinicians may also review questions that are included in the Language Experience and Proficiency Questionnaire LEAP-Q for assessing the language proficiency, profiles, and background of adult multilingual speakers Marian et al.
Similar to child clients, interviews with adult bilingual and multilingual speakers should include questions about the languages that they currently use in the home and other relevant communication environments. With adults, these environments include work, school, and social community. The types of communication partners should include the spouse, partners, children, grandchildren, family caregivers, extended family, caregivers, and others residing in the home.
With individuals using alternative augmentative communication AAC devices and other nonvocal forms of communication, gathering information during the case history interview on current language use will also help determine not only the decisions of what languages to include in the assessment but also decisions about possible languages to be used when selecting the type of vocabulary and symbols to be used on the AAC device.
With AAC devices that have voice output, identifying languages that might be used over the phone when communicating with family and friends in a home country can be useful in determining the most appropriate languages for assessment and intervention.
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Questions should focus not only on exposure languages but also on when, how, and where the exposure occurred. It is important to determine family and community perceptions of past and current communication ability. The same type of question can be asked about current skills. In addition to determining which languages are used, it is also useful to obtain some information on the extent to which the different languages are spoken within each environment and the percentage of time each language is used in various environments.
This helps to determine not only the most appropriate languages for testing but also the functional advantages and significance of providing intervention in more than one language. For adults who plan to return to employment after a stroke, it is important to identify the language that they will need to use in the workplace. Determining the extent to which languages are used for social activities is also relevant. Practicing words, phrases, and functional sentences that are used within that context using the language used most in that setting is a good strategy for promoting functional and relevant communication skills.
With adult clients, it is useful to obtain self-ratings of their perceived levels of language proficiency across all domains of communication e. When assessing the language abilities of clients whose communication skills have changed over time as the result of some type of neurological injury e. With adult clients, it is important to obtain descriptions of communication difficulties in each of the key languages spoken, including related issues, such as when the problem was first noticed in each language. Descriptions of the types of difficulties experienced in both languages should also be provided.
Adults who are literate in one language may not be so in another. Therefore, it may not always be possible to test written language abilities in all languages spoken. It is useful to obtain information about the languages used in their education. A number of different factors have influenced current perspectives and clinical practice as they relate to assessment of CLD clients in the United States and worldwide.
The following is a brief summary of the regulatory, professional association standards, and research-based influences that have the greatest impact on shaping best practice perspectives and paradigms in populations primarily in the United States but increasingly for other parts of the world as well. A number of models, assessment frameworks, and principles have been proposed for assessing child CLD clients.
A brief overview of some of the most recent can be found in Box Asian and Pacific American cultures. Battle Ed.
Boston: Butterworth-Heinemann. Multicultural students with special language needs: Practical strategies for assessment and intervention 3rd ed.
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Although each of the frameworks presented in Table varies slightly in terms of specific recommended considerations, each framework emphasizes the importance of a comprehensive assessment that generates a variety data, uses a variety of procedures and measures, is conducted in each of the languages spoken or understood by the client, and includes the case history interview, review of written documentation, observation, and both formal and informal measures. They all emphasize a move away from sole reliance on standardized tools for determining the presence of disorder and a growing reliance on dynamic, process-based procedures.
Topics in Language Disorders Issue Editors: L. Language disorders in young children pp. Johnson Eds. Evanston, IL: TherapyEd. Comprehension of language pp. Shulman Eds. Communication in a multicultural society. Schwartz Ed. Boston: Pearson. Involving parents in teaching social communication skills to young children.