Cultural Competency and Evaluation of Children from Diverse Backgrounds


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  • factors can profoundly influence the interactions between clinicians and their clients and, therefore, can significantly affect the practice of speech-language pathology (Tomoeda & Bayles, 2002).
  • Interdependence is highly valued in some cultures and the well-being of the group is more important than that of the individual.What implications do individualism and collectivism have on assessment?-Families may be hesitant to agree to an assessment for children that exhibit disorders, believing that the child will develop speech and language in his or her own time.-It may be important to involve extended family members in the assessment process, when asking about the child’s communication interactions, and when sharing the results of the evaluation. -In a collectivistic culture, family members may provide assistance in ways that may be considered “cheating” so that the individual is performing more like the group.Do you feel that your family more greatly values a. independence or b. care and concern for others?If your son were receiving a speech evaluation, would you be more offended if you were told that he should interact more with other children or that he is too “clingy” with the family? If you were to be inadvertently insulted by someone based on your own cultural beliefs, what would it sound like?
  • This parameter refers to how strictly a culture adheres to a schedule. Some cultures emphasize punctuality, while others are more event-oriented. For the latter group, beginning a new event is determined by the completion of the previous event, rather than by a schedule. This parameter also refers to personal space and how much distance between conversational partners is required for individuals to feel comfortable (Tomoeda & Bayles, 2002).Americans are not typically event-oriented but are concerned with time. Being late can be considered rude or disrespectful. Whereas, other cultures can perceive tardiness as giving priority to a more urgent situation. Some cultures require less personal space to feel comfortable. A European American may require two to three feet of personal space. This could be considered as cold, unfriendly, or as a method to demonstrate superiority.What implications do time and space have on assessment?-This parameter influences clients’ timely arrival for scheduled appointments, their comfort with pre-specified duration of sessions, and their expectation to be accommodated if they miss or cancel a session. Clinicians should be aware that event-oriented cultures will not view arriving late to be rude or disrespectful. Therefore, tardiness should not be taken as a personal offense nor should it be interpreted as a lack of interest in the assessment.-Consider the affect that the client’s mode of transportation may have on arrival time. -Clinicians that value punctuality working with event-oriented cultures can try scheduling sessions 15 minutes earlier.-It’s also important to keep in mind the possibility of reduced personal space with some cultures. Family members may position themselves closer to each other or to the clinician than he or she is accustomed. When meeting a family for the first time, start with a handshake and be aware that with increased familiarity this greeting may change.Do you consider yourself punctual? Is this at odds with your family’s habits? (Are you always late/early for Thanksgiving dinner?)Does punctuality or the lack of it in your family/coworkers/yourself bother you? How do you successfully deal with this difference?
  • An example of one dynamic is: male supremacy (machismo) with maternal submissiveness (marianismo). In these roles, the male is the head of the household and the figure that makes the final family decisions. The female may put family needs ahead of her own personal desires and often has exclusive domain over child rearing.Higher education and increased immigration are affecting these roles.What implications do male/female roles have on assessment? -As clinicians, we most often interact with a mother when meeting to discuss a child’s evaluation. -However, in meetings where a decision needs to be made that will affect a course of treatment, it is suggested that both parents be encouraged to attend.-Also, keep in mind that while interacting with both parents, it may be important to address questions and information to the father. -As a female clinician, interactions with males in some cultures may be different. For example, an Arabic male may not feel comfortable shaking hands with a female. Did your parents/grandparents have definite roles at home?  Do you believe in these roles or reject them? Would/do/did these roles influence your impression of people when working together or dating? How would you respond to a parent who compliments your evaluation because they didn’t “know a man/woman could do this job?”
  • What determines an individual’s societal position and place of respect varies across cultures. Wealth often plays a large part in the determination of class in many cultures. Socioeconomic class may result in even greater group dissimilarities than country of origin. For example, a person from Mexico of low socioeconomic status could share more in common with a poor Peruvian farmer than a member from the Mexican middle class. Formal education and higher education degrees are also sources of respect in the Latino community (Robayo, 2003).If a culture is class conscious, members of different social classes may not socialize together. Because of this concern with class and status, individuals may be particularly attentive to good hygiene and physical appearance. Many cultures are concerned with maintaining, and ultimately improving their social class status. (i.e., immigration) (Robayo, 2003).In Japanese culture, class and status plays an important role in language and how you address one another. Therefore, when meeting a new person business cards are exchanged to establish societal position prior to greeting one another. What implications do class and status have on assessment? -It is important for clinicians to consider the sensitivity that many people of that culture have toward social class and status and their concern with maintaining and/or improving their status.-The Latino culture is typically more formal than that of mainstream American culture.-In some Asian cultures, formal third-party introductions that include names, titles, professional roles, and clinical responsibilities are important for establishing status.-In non-western cultures conversation may flow from the person of higher prestige to lower prestige, rather than having equal back and forth conversation. This may result in the clinician posing a series of questions rather than holding a conversation with the family.What value do you give to education?What value do you give to wealth? Are these two concepts connected for you?Do these ideas influence your thoughts of another person?How do you think a therapist’s beliefs about class and status could affect the degree to which they feel that a child is impaired?
  • An example of values in the Latino culture may include: (1) “familismo,” or the ultimate importance of the family relationship(2) “respeto,” treating authority figures such as parents, elders, and priests with respect(3) “personalismo,” a personal (vs. impersonal) interest in a relationship (Tomoeda & Bayles, 2002).What implications do values have on assessment?-In some cultures, one way that children are expected to exhibit respect is by generally remaining quiet in the presence of adults.-Sensitivity regarding a cultural group’s values is important for all stages of the evaluation process, but especially in sharing evaluation results. For example, for speakers of Arabic eloquent and creative use of language is highly valued. A language disorder can therefore mean social penalty. Clinicians should be particularly sensitive about how the results of the evaluation are presented to these families.-By including parents’ values in the assessment planning process, clinicians can build collaborative relationships with the parents that are positive and effective. In one word, what would your mother and/or father put the most value on (e.g., respect)?How would you react during an evaluation if your client told you that this value (e.g., respecting adults) was “the dumbest thing she ever heard of?”
  • Is the American English-speaking culture high-context or low-context?The American English-speaking culture is a low-context culture, while the Latino Spanish-speaking culture is a high-context culture (Tomoeda & Bayles, 2002).For example, a study of Latino children found that, compared to other ethnic groups, these children had a higher sensitivity to nonverbal communication and indicators of feelings.In high-context cultures, communication is focused more on the relationship and interaction, rather than being task-oriented.High vs. low context cultures usually work on a continuum. For example, a Texan and New Yorker may both be low-context cultures, but the New Yorker may use less pauses and be more explicit and to the point than a Texan. Some examples of low-context cultures include: Northern American, Australian, English, Irish, and German. Examples of high-context cultures include: Arab, Chinese, French Canadian, Greek, Indian, Thai, Italian, and Russian.What implications do language have on assessment?-Clinicians should consider that with high-context culture information is frequently conveyed through setting or context in addition to or even in place of verbal communication.Is it appropriate to say hello to a stranger? Do your family members talk with their hands? Are you more clear or less clear in an email rather than in person? With a low-verbal client, do you focus on increasing his words more, increasing his gestures more, or relying on both equally?Have you ever thought during an evaluation that a child may be more communicative because she is using one strategy over another?
  • Some examples of common celebrations and holidays in other cultures include:Kwanzaa- an African American celebration that takes place from December 26th to January 1st. The purpose of this holiday is to celebrate the strength of family and unity. Lunar New Year- an important holiday for many Asians. In China, the Lunar New Year is usually celebrated in February. Cambodians and Laotians celebrate in the fifth month of the lunar calendar, which usually occurs in April.Ramadan- a Muslim month-long observation in which family members (including children to some extent) are expected to fast as a demonstration of dedication and self-control. What implications can rituals or ceremonies have on assessment?-Clinicians should consider holidays and celebrations or daily rituals (important meals or prayers) when scheduling assessments to avoid conflicts. -Care should be taken when selecting assessment pictures and activities so as not to include items that are culture dependent. -Festivities can also be included in the language sample elicitation to make the activity more meaningful and motivational for the child. What traditional holidays did you grow up celebrating (e.g., Easter, Ramadan, Yom Kippur)?What would your family’s reaction have been if one of your parents’ bosses demanded that they work that day?Example: Assuming you had an Islamic client, what may be the repercussions of scheduling evening therapy or a food activity during Ramadan?
  • Americans are largely defined by their work, but people in many other cultures are defined by the groups they are members of and their role in the community. In some families, there is an expectation that children will take up work roles within the family, such as childcare, helping with chores, or actually working with other family members. These responsibilities may stem from economic necessity.What implications do work roles have on assessment?-Children from other cultures are sometimes expected to work within or outside of the home.-This requirement may involve these children in activities and settings that clinicians do not usually associate with their young clients.-It is important for clinicians to inquire about and be aware of their young clients’ activities in order toappropriately assess that client’s communicative needs.When you meet someone new, what do you ask them?  If you are talking with someone new about their job, would you ask how much money they make?If someone were to ask you to describe yourself, would you include what you do for a living?If you asked someone to describe himself and he did not mention a job, would you question whether there are difficulties or if he was unemployed?
  • In some cultures, a close relationship between religion and illness can be common. A disability may be seen as related to God’s will and might affect a family’s motivation to address change.However, many of the studies on health beliefs have centered on rural and/or low socio-economic status. Thus, it is possible that the religion/illness relationship is more related to socioeconomic factors, rather than culture.What are the implications of beliefs about health on assessment?-Parents’ beliefs about the cause(s) of speech and language disorders can determine whether or not they will seek out assistance.-A culture that views disability in a different way may not have the appropriate vocabulary in their language for describing disabilities. For example, in some Native American languages, the word for “disability” does not exist. Instead, they may use words like “incomplete” or “slow.”How closely have you followed suggestions from your doctor, physical therapist, dentist, etc?Should every disease have an explanation, even if not yet known, or are there some things we just can’t understand?Do you routinely believe medical professionals or do you seek second opinions?How could you get a family that has never been compliant to follow through with take-home therapy? Are you offended if a family does not follow through with your suggestions?
  • Your family has relocated from the U.S. to France for work-related reasons. You plan on living in France for 3-5 years. Your child is four years old at the time of the move. You enroll your child in a preschool, and over the next year, he acquires conversational fluency in French. By the end of first grade, his teacher expresses concern with your child’s lack of attention, trouble following directions, and poor academic performance. He is referred to the special education team and diagnosed as having an expressive and receptive language delay that is affecting his academic performance. He is put into another classroom deemed more appropriate for meeting his language needs. The teacher recommends that your family consistently use French in the household rather than English to foster his academic success.
  • *Barring cognitive issues.Top 2 that are normal on this model—one is typical (i.e., big E or big S)Small SE from bottom of previous model represents the bottom line on this model
  • These are the types of behaviors that authors of tests are often trying to get information about.
  • This is a process, happens in phases/stages (e.g., certain info is gathered before assessment to guide the rest of the process)Use open-ended questions rather than dichotomous questions that trigger a yes or no responseRestate what the client says by repeating the client's exact words; do not paraphrase or interpretSummarize the client or parent's statements and give them the opportunity to correct you if you have misinterpreted something they have saidAvoid asking multiple questions back-to-back and/or multipart questionsAvoid leading questions that tend to orient the person to a particular responseAvoid using "why" questions because such questions tend to sound judgmental and may increase the client's defensiveness
  • This is a process, happens in phases/stages (e.g., certain info is gathered before assessment to guide the rest of the process)SEE FEB COMMUNICOLOGIST ARTICLE
  • Consistency of clinical data
  • Identify an area of weaknessChoose an approach:Test-Teach-RetestTask/stimulus variability: modification of the context or the way the stimulus is presented, presented in a more naturalistic wayGraduated prompting (stimulability/trial therapy)From: Laing & Kamhi, 2003
  • If child has limited book/picture experience, allow the child to name real objectsObserve memory, sequencing, (attention span); often with disordersOn receptive vocabulary tests, have the child name the picture and point to the picture to determine appropriateness of test labelOmit items you expect the child to miss due to language or culture
  • SPLIT into 2 slides?
  • In depth language history over the phoneResearched Farsi sound system & language characteristics- compare & contrast with Englishan interpreter was arrangedAssess in BOTH, child is bilingual, has had exposure to both languages and we need a complete picture
  • Could the scores be reported from the English portion of testing on the OWLS?
  • Could the scores be reported from the English portion of testing on the OWLS?
  • Errors not expected for her age & language background. No considered age appropriate or cross-linguistic influence. Although we don’t have norms for Farsi, we make an assumption that a 7 year old speaker of Farsi should understand verb tenses. Also, anecdotal information from parent and interpreter support this assumption.
  • Difficulty with velars (Farsi & English)= ATYPICAL for age & language background (UNEXPECTED ERRORS)Difficulty with: R, TH, NG (English) = Accounted for by language background & age (EXPECTED ERRORS)
  • Cultural Competency and Evaluation of Children from Diverse Backgrounds

    1. 1. Learner Objectives • Describe formal and informal measures for testing culturally and linguistically diverse children • Describe the concept of difference versus disorder • Discuss the use of standardized tests when a student is not represented in the normative sample • Identify red flags for speech and language impairment in culturally and linguistically diverse children
    2. 2. Texas Public School Demographics: 48% 34% 14%4% 2009 Snapshot • Vietnamese • Chinese (Mandarin) • Arabic • Urdu
    3. 3. Why study culture? • Between 1990 and 2000 the Latino population increased by 57.9 percent. (Salas-Provance, Erickson, and Reed, 2002). • Clients from culturally and linguistically diverse backgrounds comprise almost 35% of speech-language pathologists’ caseloads across employment settings (ASHA survey, 2000). • Unfamiliarity of culture can lead to under- referral, over-referral, inappropriate diagnosis and service delivery
    4. 4. The Nine Parameters of Cultural Consideration
    5. 5. Nine Cultural Parameters 1. Individualism versus collectivism 2. Views of time and space 3. Roles of men and women 4. Concepts of class and status 5. Values 6. Language 7. Rituals 8. Significance of work 9. Beliefs about health From: Tomoeda & Bayles, 2002
    6. 6. Individualism vs. Collectivism • A culture is termed individualistic when great value is placed on individuals and their rights and decisions. • Members of individualistic societies may tend to have more casual relationships. • A culture is collectivistic when great value is placed on the group and membership in the group. • These societies form close ties between individuals and reinforce extended families. 1.
    7. 7. View of Time and Space • Time • How strictly a culture adheres to a schedule • Emphasis on punctuality • Event oriented • Space • Personal space and how much distance between conversational partners is required for individuals to feel comfortable. 2.
    8. 8. Roles of Men and Women • Gender roles vary across cultures and influence many areas, including: • Education • Ownership • Choice of profession • Decision-making authority in the family. (Tomoeda & Bayles, 2002) 3.
    9. 9. Concepts on Class and Status • What determines an individual’s societal position and place of respect varies across cultures (Tomoeda & Bayles, 2002). • Wealth often plays a large part in the determination of class. • Socioeconomic class may result in even greater group dissimilarities than country of origin. 4.
    10. 10. Values • A cultural group’s values are manifested in it’s view of the relationship of man to nature and of human beings to other human beings, the importance of ancestors and of the environment, and the degree of materialism (Tomoeda & Bayles, 2002). 5.
    11. 11. Do you need Continuing Education or want  to listen to this course live? Click here to visit  the online courses.
    12. 12. Language • The influence that the pragmatics of a language has on interpersonal communication. • The amount of information conveyed through setting or context differs among cultures, ranging from high to low context. • High-context cultures • context is crucial to communicate meaning • a culturally competent provider would be especially aware of nonverbal aspects of communication, such as eye contact, gestures, space, use of silence, and touch. • Low-context cultures • Meaning is conveyed primarily through words 6.
    13. 13. Rituals • Rituals or ceremonies are conventional ways of commemorating significant historical events or life changes and renewing commitment to shared values. • Weddings • Births • Deaths • Religious worship • Daily rituals including meals and daily routines (Tomoeda & Bayles, 2002) 7.
    14. 14. Significance of Work • This parameter refers to the importance of work in a culture and how it is defined by the members of the culture (Lynch & Hanson, 2004). 8.
    15. 15. Beliefs about Health • Illness and disabilities are viewed differently across cultures. • In many cultures, someone with a disability may be seen as special or holy, or they may be seen as bewitched. • Illness may be thought to occur when an individual is out of harmony with nature or the universe, and a spiritualist, folk healer, herbalist, or witch doctor may be chosen over Western medical professionals to provide health care. 9.
    16. 16. All of the documents and charts in this presentation  can be downloaded from our Free Resource Library. Click here to visit the Resource Library
    17. 17. Language Assessment of Children from Diverse Language Backgrounds
    18. 18. Difference vs. Disorder • Language Difference: deviation from the mainstream language that can be accounted for by a person’s cultural and/or linguistic experiences • Language Disorder: difficulty with the underlying ability to learn and process language adequately. Therefore, it is observed in both or all languages spoken
    19. 19. Spanish English ED BE BS SD ED = English Dominant BE = Bilingual English BS = Bilingual Spanish SD = Spanish Dominant
    20. 20. Determining Speech-Language Impairment in Bilinguals Low English Low English Spanish OK Spanish OK NormalNormal English OK English OK Low Spanish Low Spanish NormalNormal Low English Low English Low Spanish Low Spanish Impaired Or Language Loss Impaired Or Language Loss
    22. 22. The Assessment Process
    23. 23. • Medical records • School referral documents (e.g., RTI data, parent & teacher information, language survey) • Academic records • Parent/Caregiver Interview
    24. 24. • This information source is essential • According to Westby, Burda, and Mehta (2003), the SLP should use ethnographic interviewing (vs. traditional interviewing). This includes: • Focus on use vs. meaning • Use of open-ended questions • Restate vs. interpret • Summarize & clarify • Avoid the use of multiple questions, leading questions, and ‘why’ questions
    25. 25. • Determine language(s) of assessment • Determine whether interpreter is to be used- make arrangements • Research the characteristics of the language(s) • Research the cultural background- but do not assume, generate more questions than answers • Assessment tools
    26. 26. • Detailed language history is crucial • Crucial components:  Time- past & present  Who  Where/contexts  Input & output  Dialect  Subjective information • Home Language Surveys
    27. 27. Understand all stages of the process: • Selecting interpreter • Preparing for the assessment • Use of interpreter during the evaluation • After the session See:
    28. 28. • Wikipedia • Google search • Textbooks • Bilingual Language Development and Disorders in Spanish–English Speakers (Goldstein, 2011) • The International Guide to Speech Acquisition (McLeod, 2007) • Knowledgeable people- speakers of the language • ASHA Multicultural Affairs- Phonemic Inventories • The Speech Accent Archive: • resources •
    29. 29. Assessment Tools: Issues • Bilinguals: • perform better on different test items than monolinguals (Peña & Bedore, 2000) • have unique organizational, structural & processing capacities (Bialystok, 1987) • are artificially disadvantaged when compared to monolingual standards (Grosjean, 1989) • “Bilingualism is like random chaos for psychometrics” -- Richard Figueroa
    30. 30. Assessment Tools: Important Information • Clearly defined standardization sample (size, SES, etc.) • Is the test valid and reliable for the population? • Test-Retest reliability • Inter-examiner reliability • Item analysis during test construction • Concurrent validity with other valid methods • Predictive validity
    31. 31. Assessment Tools: Additional Considerations • Does the examinee come from a background similar to participants in the test standardization sample? • Direct Translation? • Does the sampling method assess the student’s language skills effectively? Description versus Test Scores. • Assessment in a contextually embedded or contextually reduced situation? • Does the scoring system effectively capture the student’s abilities? Analysis of answers may provide more useful information than “correct” or “incorrect.
    32. 32. Pros and Cons of Formal and Informal Tests Pros Cons Formal Efficient Provide scores Insufficient Can lead to misdiagnosis if used alone Informal More naturalistic Less biased Little normative data SOLUTION: Use various assessment methods, recognizing differences in cultural appropriateness
    33. 33. Informal Assessment • Conversational language sample • Narrative language sample • Dynamic Assessment
    34. 34. Language Sample • Conversation, narrative language • Allows for observation of naturalistic, functional, and culturally-appropriate language • Provides more data to compare to formal testing information
    35. 35. Dynamic Assessment • Emphasizes the learning process rather than experience • Interactive and process-oriented • Process gives the child learning experiences, strategies, opportunities to show their learning ability • Observe how the child learns, what the child needs to learn, how much investment is necessary to produce change • Transfer of learning/generalization may be predictive of ability • Relates directly to intervention • Children with true language disorders have poor language learning ability (Pena & Quinn, 1992)
    36. 36. Test Modifications • More practice examples • Experience relevant to content of the question • Reword or expand instructions • Additional time to respond • Test beyond the ceiling • Record any relevant information during testing • Take note of dialect/language differences-do not score as incorrect • Allow student to explain answers (Kayser, 1995)
    37. 37. Analysis of Results Case History Formal Data Informal Data
    38. 38. Analysis of Results  Can you report the test scores?  How do you interpret errors? TYPICAL ERRORS SECOND- LANGUAGE INFLUENCE ATYPICAL ERRORS
    39. 39. • Phonemic inventory, accuracy, and patterns • Functional intelligibility- we have expectations for this • Word-level skills, connected speech, and stimulability • “Universals”- common sounds throughout languages of the world, complexity • Error analysis is essential • Vacuum produced as “tatuum” vs. “bacuum” TYPICAL ERRORS SECOND- LANGUAGE INFLUENCE ATYPICAL ERRORS
    40. 40. /ɲ/ /ɾ/ /r/ /ɣ/ /β/ /ð/ /ʤ/ /h/ /ŋ/ /θ/ /ɹ/ /ʃ/ /v/ /w/ /z/ /ʒ/ SPANISH ENGLISH /b/ /d/ /ɡ/ /p/ /t/ /k/ /m/ /n/ /s/ /tʃ/ /j/ /l/ /f/ Click to visit
    41. 41. Spanish CV Dominated Few words ending in Cs Few allowable phonemes as final Cs (only l, n, d, s, r) English More clusters Many words ending in Cs Many allowable phonemes final Cs For more Information like this, get Difference or Disorder.
    42. 42. Articulation Errors • 3-year-old who is 75% intelligible • A 6-year-old who has not mastered “B” in both of the languages she speaks and it is a high frequency sound • A 5-year-old speaker of another language substitutes “SH” for “CH” when speaking English and his native language does not have this sound TYPICAL ERRORS ATYPICAL ERRORS SECOND- LANGUAGE INFLUENCE
    43. 43. Language Errors • Overgeneralization of past tense rule • Daddy goed to the store • Pronoun error, copula omission • Her said, “Clifford nice” • Third person present tense for past tense • E.g., Yesterday he jump. TYPICAL ERRORS ATYPICAL ERRORS SECOND- LANGUAGE INFLUENCE
    44. 44. • Difficulty learning both languages, even • with adult assistance • Family history of language/learning disabilities • Slower development than siblings • Idiosyncratic error patterns • Language performance unlike others with similar cultural/linguistic experiences • Difficulty interacting with peers • Difficulty with language in many routines ATYPICAL ERRORS Click to visit
    45. 45. Possible Sources of Misdiagnosis • Insufficient data • Consideration of academic instruction vs. learning problem • Assumptions of proficiency in L1 • Child may choose not to communicate with you in L1 • Taking results at face value, score comparison in L1 and L2 • Assumption that giving directions in L1 will help a child who has received academic instruction in English • Asking a child to speak about experiences from L1 context in L2 • Expecting vocabulary to be equivalent in L1 and L2 (Adapted from Langdon, 2008)
    46. 46. Reporting Procedures • Detailed case history and sources of information • Detailed language background • Report adaptations and modifications • Language of testing/use of interpreter • Report norms when appropriate; Do not report if not valid: ▫ Normed on speakers outside U.S. or speakers of a different language group ▫ Test was translated or adapted • Discussion of findings in terms of difference vs. disorder
    47. 47. Click to visit
    48. 48. Difference or Disorder?  Understanding Speech and Language  Patterns in Culturally and Linguistically  Diverse Students Rapidly identify speech‐language  patterns related to second language  acquisition to  distinguish difference from disorder.
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