Using AAC with Dual Language Learners Patricia D. Quattlebaum, M.S.P.,CCC-SLP SC Assistive Technology Expo March 18, 2010

Objectives Terminology, demographics and cultural sensitivity Normal patterns of development Atypical patterns of development Implications for AAC users Resources

Terminology Bilingualism Simultaneous bilingualism Sequential bilingualism

Dual Language Learners Term used to describe both simultaneous bilingualism and sequential bilingualism/second language learners

Other Terminology L1 (first language) L2 (second language) LEP (Limited English Proficiency) ELL (English Language Learners) ESOL (English for Speakers of Other Languages)

Terminology Related to Support for L1 and L2 Additive Bilingualism: Achieving high levels of proficiency in both languages is encouraged Subtractive Bilingualism: Child’s first language is replaced by the second language

Terminology Related to Cultural Acceptance Majority ethnolinguistic community: the language has high status and is widely used. Minority ethnolinguistic community: the language is less widely spoken, is valued less and may not be supported by institutions such as schools.

Codeswitching Alternating between two languages in a single interaction

Demographics 2000 Census: 4 million residents in SC 2.4 % Hispanic and Latino (96,000).9% Asian (36,000) In some states, minorities already make up half the population (ex: CA)

US Census indicated that 20% of the school age population spoke a language other than English in the home and 5% of children spoke English with difficulty (US Dept of Education)

% of American children 0-19 years of age will belong to a racial or ethnic minority (American Acad. Pediatrics, 2004)

2050 Hispanic population will constitute almost 25% of the US population and Asian population will double These and other minorities will comprise half of the population Must also consider other special populations with unique life/cultural experiences: homeless children and those in foster care (AAP, 2004)

Implications for Today’s Majority Ethnolinguistic Community With shift in population, many more individuals around us will be speaking Spanish (and other languages) as well as English

Implications for Health Care Issues related to access to health care Issues related to acceptance of interventions by caregivers

Cultural Disparities Persist Saltapida and Ponsford (2007) studied 2 groups of patients with TBI in Australia and found CALD participants had poorer outcomes including employment, cognitive independence, mobility, social integration and greater anxiety De la Plata, et.al (2007) found higher rates of severe disability among Hispanics and Spanish speakers following TBI Alamsaputra, et.al. (2006) found a disproportionate disadvantage for non-native English speakers when listening to synthesized speech

Is Bilingualism Harmful or Beneficial to Children ? Old research indicated bilingualism had negative effects Newer studies show benefits

How Many Students are Dual Language Learners? In 2004: 7 % of public school students were second language learners— Approximately 3 million children

How Many Dual Language Learners Will Have Communication Disorders? Studies show that 10% of young children have some type of communication impairment. Incidence could be higher when poverty or limited access to health care are factors.

Determining if Dual Language Learner is Developing Normally A true language impairment will be evident in both languages. Weakness in one is likely a feature of incomplete mastery of that language. (Barlow and Enriquez, 2007) Best match for assessment will be educators and health care providers who speak the same language as the child.

Strategies for Assessment of Dual Language Learner by Monolingual SLP Seek information about child’s culture and language experience Use interpreter/translator

Child’s Language Experience Age at which exposure to L2 began Amount of exposure to L2 Progress relative to siblings Parents’ impressions

Simultaneous Bilingualism Child should have minimal interference between the languages

Simultaneous Development of L1 and L2 Simultaneous Bilingualism occurs in three different ways: Parents’ L1 and community language L2 One parent L1 and the other L2 Home L1 and daycare L2

Features of Development At 18 months, a typically developing child easily determines what language is needed Vocabulary Efficiency of access to language Codeswitching

Red Flags for Language Disorder in Simultaneous Language Learners Child is: Unaware of the language he/she speaks Does not respond in the language of the interaction Seems less competent than other children in the family or community

Sequential Biligualism L2: “second language learners” Child learns first language in infancy Learns the second language later in childhood (3 years old or older)

Features of Development Diverse group of learners Consider: Age Exposure to L1 and L2

Age Age: ability to acquire second language may decline as children approach adolescence But…. If the second language is introduced while the first language is still developing, progress in first language may stop or there may be regression in that language

Home Family members’ language use Interaction with peers

School Age at school entry—likely a critical variable Ability of school staff to support development in each language

Age Related School Performance Number of years to reach 50 th %ile in academics 5-7 year olds needed 3-8 years 8-11 year olds needed 2-5 years year olds needed 6-8 years

Other Variables That May Affect Sequential Bilingual Language Development Poverty Community attitudes: Idea of additive bilingualism vs. subtractive bilingualism Personality: self-concept, shy vs. extroverted Anxiety Motivation to fit in with peers

Normal Features Associated with Second Language Learning in Sequential Language Learners Silent period Therefore, silence may not equal disorder

Normal Features Associated with Second Language Learning (cont.) Language Loss Therefore, can be difficult to discern if this child has a specific language impairment

Normal Features Associated with Second Language Learning (cont.) Language Transfer: Cross-linguistic influence that languages may have on each other.

Optimal Assessment Performance in one language probably not the best indicator of ability Assess in both languages whenever possible

Two Special Situations International Adoptions Children with Known Developmental Delays

International Adoptions This event induces subtractive bilingualism most of the time: The adoptive parents do not usually speak the language of the child they have adopted

International Adoptions and Language Learning Rate at which English is learned seems to vary with age at adoption: < 2 years old at adoption >2 years old at adoption

International Adoptions (cont.) Environmental deprivation Influence of L1 on L2 Language loss Performance in L1 as adults Academic performance

Assessment of Internationally Adopted Children Tests of gesture comprehension and use The “catch up” period of several years that older L2 learners need does not apply Testing in English appropriate much earlier

Dual Language Learners with Developmental Delays Assess in both languages Determine the language of intervention Proficiency in L1 and L2 Avoid language loss

Cultural Competence An essential quality for effective engagement A step toward decreasing health care disparities

Culturally Effective Pediatric Health Care AAP: Culture includes the full spectrum of values, behaviors, customs, language, ethnicity, gender, sexual orientation, religious beliefs, socioeconomic status and other distinct attributes of population groups.

Influence of Cultural Awareness on Service Provision Expect variations in Expectations for adult-child interactions Beliefs about the cause of disabilities/health problems

ASHA Guidelines Beliefs and values unique to that individual clinician-client encounter must be understood, protected, and respected. Care must be taken not to make assumptions about individuals based upon their particular culture, ethnicity, language, or life experiences that could lead to misdiagnosis or improper treatment of the client/patient. Providers must enter into the relationship with awareness, knowledge, and skills about their own culture and cultural biases. Providers should be prepared to be open and flexible in the selection, administration, and interpretation of diagnostic and/or treatment regimens. When cultural or linguistic differences may negatively influence outcomes, referral to, or collaboration with, others with the needed knowledge, skill, and/or experience is indicated.

Increasing Cultural Sensitivity Consider your own values and expectations Read/research the family’s culture Connect with members of the local cultural community Consider family’s value system when setting goals

VISION Model VValues and beliefs of family and professional IInterpretation of experiences of family with clinical process SStructuring the relationship between the professional and the family IInteraction style /verbal & nonverbal communication of professional and family OOperational strategies for accomplishing goals NNeeds perceived by family and professional

When Should AAC Be Introduced ? The guidelines are the same as for monolingual children: Whenever there are concerns about developmental delays/slow progress When there are obvious indicators that child is at risk for speech delays: e.g., limited vocalizations, identification of genetic syndrome with associated speech problems, motor disorder such as cerebral palsy

What Should the Language of Intervention Be? MUST support both home language and English Parents need to teach their children in the language they know best Provide parents with ideas to support language development in infants and toddlers

Low/No Cost Strategies for Infant Language Stimulation Read simple books (point out pictures) Talk to baby face-to-face Label common objects Introduce music and singing

Low/No Cost Strategies for Infant Language Stimulation (cont.) Encourage baby to look in mirror Point out body parts Point out objects, people, etc. seen in the house and outside Use short utterances with lots of inflection Play peek-a-boo and pattycake Imitate the sounds baby makes

Help Parents Stay Focused on One Goal Preschoolers should be learning the language of home, and this goal should be emphasized whenever possible in the school environment. (Nelson, 2010)

AAC Devices & Strategies for Dual Language Learners Emphasize the importance of early literacy experiences (Harrison-Harris, 2002) Consider changing language on BoardMaker or using both Consider Speaking Dynamically Pro and devices that support other languages— carefully assess how well this works for each child

Changing Language in Boardmaker 1. Open or create display 2. Go to Symbol Finder 3. Select Language 4. Return to board and proceed as usual If you need help, in HELP, put in “changing language”

TO CHANGE TO A DIFFERENT LANGUAGE ON SD PRO OR BOARDMAKER PLUS!, FOLLOW THESE STEPS: SELECT FILE. SELECT APPLICATION LANGUAGE. CHOOSE THE DESIRED LANGUAGE FROM THE 'CLICK HERE TO SELECT THE NEW LANGUAGE' PULL-DOWN MENU. SELECT ACCEPT LANGUAGE CHANGE. SELECT YES WHEN PROMPTED, “ARE YOU SURE THAT YOU WANT TO DO THIS". SELECT OK WHEN ALERTED, “THE NEW LANGUAGE WILL BECOME ACTIVE THE NEXT TIME YOU START THE PROGRAM”. SELECT FILE. SELECT EXIT. START THE SOFTWARE AGAIN & NEW LANGUAGE SHOULD BE IN USE. NOTE: THE ADDITIONAL LANGUAGE OPTIONS OF GERMAN, SPANISH, FRENCH OR FRENCH CANADIAN HAVE TO BE PURCHASED FOR USE WITH BOARDMAKER PLUS! OR BOARDMAKER WITH SD PRO. PLEASE CONTACT MAYER-JOHNSON CUSTOMER SERVICE AT FOR ADDITIONAL INFORMATION. SD Pro or Boardmaker + : How do I change to a different language?

References Alamsaputra, D., Kohnert, K, Munson, B. & Reichle, J. (2006). Synthesized speech intelligibility among native and non-native speakers of English. Augmentative and Alternative Communication, 22,4, Barlow, J.A., & Enriques, M (July, 2007). Theoretical perspectives on speech sound disorders in bilingual children. Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations. American Speech-Language Hearing Association. Bellon-Harn, M. & Garrett, M. (2008). A model of cultural responsiveness for speech-language pathologists working in family partnerships. Communication Disorders Quarterly, 29, 3, Committee on Pediatric Workforce. Ensuring culturally effective pediatric care: Implications for education and health policy. American Academy of Pediatrics (2004). de la Plata, C., Hewlitt, M., de Oliveira, A., Hudak, A., Harper, C, Shafi, S, Diaz,-Arrastia, R. (2007). Ethnic differences in rehabilitation placment and outcome after TBI. Journal of Head Trauma Rehabilitation, 22, 2, Genesee, F, Paradis, J. & Crago, M. (2004). Dual language development and disorders: A handbook on bilingualism and second language learning. Baltimore, MD: Paul H. Brookes. Goldstein, B. & Gildersleeve-Neumann, C. (July 2007) Typical phonological development in children. Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations. American Speech- Language-Hearing Association. Glennen, S. (2008, December 16) Speech and language mythbusters for internationally adopted children. The ASHA Leader. Harrison-Harris, O. (2002, November 05). AAC, Literacy and Bilingualism. The ASHA Leader. Hour, M.B., Parrette, H.P., & Saenz, T.I. (2001) Conversations with Mexican Americans regarding children with disabilities and augmentative and alternative communication. Communication Disorders Quarterly 22 (4)

Justice, L. (2010). Communication sciences and disorders: A contemporary perspective. Boston, MA: Allyn & Bacon. Kohnert, K. (July 2007). Evidence-based practice and treatment of speech sound disorders in bilingual children. Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations. American Speech- Language-Hearing Association. Langdon, H. (2008). Assessment and intervention for communication disorders in culturally and linguistically diverse populations. Clifton Park, NY: Thomson Delmar Learning. Marian, V., Faroqi-Shah, Y., Kaushanskaya, M., Blumenfeld, H. & Sheng, L. (2009, October 13). Bilingualism: Consequences for language, cognition, development and the brain. The ASHA Leader. McCord, S. & Soto, G. (May 2000). Working with low-income Latino families: Issues and strategies. Augmentative and Alternative Communication. American Speech-Language-Hearing Association. Nelson, N.W. (2010). Language and literacy disorders: Infancy through adolescence. Boston, MA: Allyn& Bacon. Roseberry-McKibbin, R.(2007). Language disorders in children: A multicultural and case perspective. Boston, MA: Allyn & Bacon. Saltapidas, H. & Ponsford, J. (2007). The influence of cultural background on motivation for and participation in rehabilitation and outcome following traumatic brain injury. Journal of Head Trauma Rehabilitation, 22, 2, References (cont.)