Providing Therapy for Patients 
from Second Language Backgrounds
Ellen Kester, Ph.D., CCC-SLP Scott Prath, M.A., CCC-SLP K...
Objectives
 Increase clinical judgment with regard to working 
with bilinguals
 Understand typical development for bilin...
ASHA Definition:
Bilingual SLP
One who can:
• speak their L1 and at least one other language with 
native or near native ...
ASHA Definition:
Bilingual SLP
One who can:
• administer and interpret formal and informal 
assessment procedures to dist...
You?
How many of you meet ASHA’s definition of a 
bilingual SLP?
How many of you have a need to work with 
patients from...
Do you need Continuing Education or want 
to listen to this course live?
Click here to visit 
the online courses.
How do we qualify and work 
with a bilingual population when:
• The tests we used are not normed on this population.
• My ...
• + =    Positive transfer
• + =    Negative transfer
Difference vs. Disorder
NORMAL
ERRORS
SECOND-
LANGUAGE
INFLUENCE
ATYPICAL
ERRORS
All of the documents and charts in this presentation 
can be downloaded from our Free Resource Library.
Click here to visi...
Speech
Differences Similarities
 0‐1 month – crying and vegetative sounds
 1‐6 months – cooing, laughter, squealing, 
growling
 4‐6 months – marginal b...
For parents:    (Lynch, Brookshire & Fox, 1980)
• 18 months ‐ ~25% intelligible
• 2 year olds  ‐ 50‐75% intelligible
• 3 ...
/ɲ/
/‫ש‬/
/r/
/‫/ /׹‬ਫ/
/ᾩ/  /dЋ/
/h/  /ŋ/ /θ/
/Ѣ/  /ʃ/
/v/  /w/
/z/ /Ћ/
SPANISH ENGLISH
/b/ /d/ /ɡ/
/p/ /t/ /k/
/m/ /n/
/...
Spanish Dialects
 Spanish has many dialects
 Most common in U.S. are: Southwestern (Mexican‐
American) and Caribbean (Cu...
13‐14 vowel sounds in English (depending on 
dialect and detail)
5 vowels in Spanish (a e i o u)
/æ//ѐ//Ѩ/
/u//ѩ//ϯ/
/‫گ‬//i/
/a/
/e/
/i/
/o/
/u/
SPANISH ENGLISH
Vowel Chart
English and Spanish
Spanish                                                English
CV Dominated
Few words ending in C
Few allowable phonemes
a...
Phonological Processes
Based on motor constraints  not necessarily 
language‐specific
We see certain processes in Spani...
Cluster reduction
Stopping
Fronting
Assimilation
Gliding
Final consonant deletion
Deaffrication
Liquid Simplification
Weak...
Phonological Processes – English:
From: Bowen, C. (1998). Typical speech development: the gradual acquisition of the speec...
From: Contextual Probes of Articulation Competence – Spanish
Super Duper Publications 2006
Phonological Processes – Spanish:
From: Contextual Probes of Articulation Competence – Spanish
Super Duper Publications 20...
Speech Activity 1
Consonant Differences 
BATH BAT
Speech Activity 1
Consonant Differences 
THREE TREE
Speech Activity 1
Consonant Differences 
SHOE CHEW
Speech Activity 1
Consonant Differences 
VASE BASE
Speech Activity 2
Vowel Differences 
HAT HOT
Speech Activity 2
Vowel Differences 
GET GATE
Speech Activity 2
Vowel Differences 
HIT HEAT
Speech Activity 2
Vowel Differences 
FUN PHONE
Speech Activity 2
Vowel Differences 
LOOK LUKE
Speech Activity 3
Clinical Judgment with 
the Goldman Fristoe
Other Common Languages
Vietnamese
Romanian
Hindi
Urdu
Arabic
Other Common Languages
Vietnamese
• 10 Vowels
• 28 Consonants
• 30 Diphthong and 
Triphthong Variations
• 6 tones
• GREAT...
Other Common Languages
Arabic
• 3 Vowels 
 2 long
 2 short
 2 diphthongs
• 28 Consonants
Other Common Languages
Romanian
• 7 Vowels 
 30 diphthong and 
triphthong combinations
• 20 Consonants
• A Latin languag...
Other Common Languages
Hindi
• 11 Vowels 
• 23 Consonants
• 40% of India
Urdu
• 10Vowels
• 28 Consonants
While you could...
Speech Summary
So what do we know:
• Building blocks are the same for both monolinguals and 
bilinguals, and across langu...
Language
 Fact or Myth?
• Children code switch between languages because they don’t know 
either language well.
• Raising children...
• 0-1 month – crying and vegetative sounds
• 2-3 months eye gaze
• 6-9 months-- joint attention
• 9-12 months -- using ges...
 Bilingual children develop early vocabulary 
at the same rate as monolingual children 
(Pearson, 1993).
 Early language...
 Vocabulary:
• 12 months – first words (usually labeling familiar objects, actions, and 
properties in child’s environmen...
 English‐speaking parents use more nouns
• First words of English speakers typically nouns (Gentner, 1982; Nelson, 
1973)...
What do children talk about with their 
families at home?
What do children talk about with their 
peers and teachers at ...
 High correlation between language exposure and 
vocabulary production1 
 For bilingual toddlers 30% of vocabulary are 
...
The effects of Spanish on English can result in 
errors in:
• Verb errors (especially unmarked present for past 
tense)
•...
Treatment
Treatment of underlying cognitive linguistic 
skills = transfer
 Evidence from literature on bilingual reading...
Treatment
Language of intervention:
• With bilinguals, treatment is inevitably 
bilingual
• Transfer of skills from one l...
Treatment
Language of intervention
Let’s discuss…
• When do you recommend that a family choose 
one language or a primar...
Treatment
Targets:
• Phonological patterns approach
• Shared vs. unshared
• Nondevelopmental approach (e.g. –
maximal opp...
Intervention Is:
Focused on Language
 Select based on what is appropriate in each language and 
what is appropriate for c...
Using an Interpreter in 
Assessment and Treatment
Providing Therapy for Children from Second Language Backgrounds: Identifying treatment methods that work across languages ...
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Providing Therapy for Children from Second Language Backgrounds: Identifying treatment methods that work across languages and cultures

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This presentation identifies speech and language therapy techniques that can be used across languages and cultures. It reviews cultural competence and therapy targets for speech and language. You will learn how to appropriately select the language of intervention, work with interpreters, and create appropriate intervention goals. Culturally appropriate intervention materials will also be discussed.

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Providing Therapy for Children from Second Language Backgrounds: Identifying treatment methods that work across languages and cultures

  1. 1. Providing Therapy for Patients  from Second Language Backgrounds Ellen Kester, Ph.D., CCC-SLP Scott Prath, M.A., CCC-SLP Keith Lebel, M.A., CCC-SLP Marie Wirka, M.A., CCC-SLP Seton Rehabilitation Continuing Education Series September 14, 2010 Austin, Texas
  2. 2. Objectives  Increase clinical judgment with regard to working  with bilinguals  Understand typical development for bilinguals  Identify typical errors of bilinguals  Apply clinical judgment to assessment tools  Develop therapy goals for bilinguals  Understand potential of interpreter bias   List ASHA requirements for a bilingual SLP
  3. 3. ASHA Definition: Bilingual SLP One who can: • speak their L1 and at least one other language with  native or near native proficiency in lexicon, semantics,  phonology, morphology, syntax and pragmatics. • describe the process of normal acquisition for both  languages in monolingual and bilingual individuals.
  4. 4. ASHA Definition: Bilingual SLP One who can: • administer and interpret formal and informal  assessment procedures to distinguish between  communication differences and disorders. • apply intervention strategies for treatment of  communication disorders in the client’s language. • recognize cultural factors which affect the delivery of  services to the client’s language community.
  5. 5. You? How many of you meet ASHA’s definition of a  bilingual SLP? How many of you have a need to work with  patients from other language backgrounds? How many of you feel well‐equipped to do so?
  6. 6. Do you need Continuing Education or want  to listen to this course live? Click here to visit  the online courses.
  7. 7. How do we qualify and work  with a bilingual population when: • The tests we used are not normed on this population. • My gut feeling doesn’t match the test results. • I don’t know what goals are appropriate.
  8. 8. • + =    Positive transfer • + =    Negative transfer
  9. 9. Difference vs. Disorder NORMAL ERRORS SECOND- LANGUAGE INFLUENCE ATYPICAL ERRORS
  10. 10. All of the documents and charts in this presentation  can be downloaded from our Free Resource Library. Click here to visit the Resource Library
  11. 11. Speech
  12. 12. Differences Similarities
  13. 13.  0‐1 month – crying and vegetative sounds  1‐6 months – cooing, laughter, squealing,  growling  4‐6 months – marginal babbling  6‐8 months – reduplicated babbling  8‐10 months – variegated babbling  8‐12 months – echolalia  9‐12 months – phonetically                consistent forms  9‐12 months – jargon Click here to download this chart as a pdf.
  14. 14. For parents:    (Lynch, Brookshire & Fox, 1980) • 18 months ‐ ~25% intelligible • 2 year olds  ‐ 50‐75% intelligible • 3 year olds  ‐ 75%‐100% intelligible For unfamiliar:     (Flipsen, 2006) • 18 months ‐ ~25% intelligible • 2 year olds ‐ ~50% intelligible • 3 year olds ‐ ~75% intelligible • 4 year olds ‐ 100% intelligible Click here to download this chart as a pdf.
  15. 15. /ɲ/ /‫ש‬/ /r/ /‫/ /׹‬ਫ/ /ᾩ/  /dЋ/ /h/  /ŋ/ /θ/ /Ѣ/  /ʃ/ /v/  /w/ /z/ /Ћ/ SPANISH ENGLISH /b/ /d/ /ɡ/ /p/ /t/ /k/ /m/ /n/ /s/ /tʃ/ /j/ /l/ /f/
  16. 16. Spanish Dialects  Spanish has many dialects  Most common in U.S. are: Southwestern (Mexican‐ American) and Caribbean (Cuban, Puerto‐Rican).  Phone Mexican  Cuban Puerto Rican Context /b/ v ‐‐ ‐‐ Free variation /s/ Ø or h Ø or h Ø or h Final position /r/ R (rare) R or x Initial position From: Contextual Probes of Articulation Competence – Spanish Super Duper Publications 2006
  17. 17. 13‐14 vowel sounds in English (depending on  dialect and detail) 5 vowels in Spanish (a e i o u)
  18. 18. /æ//ѐ//Ѩ/ /u//ѩ//ϯ/ /‫گ‬//i/ /a/ /e/ /i/ /o/ /u/ SPANISH ENGLISH
  19. 19. Vowel Chart English and Spanish
  20. 20. Spanish                                                English CV Dominated Few words ending in C Few allowable phonemes as final Cs (only l, n, d, s, r) More clusters Many words ending in C Many allowable phonemes final Cs
  21. 21. Phonological Processes Based on motor constraints  not necessarily  language‐specific We see certain processes in Spanish and  English as part of normal development • Examples: consonant cluster reduction, final  consonant deletion
  22. 22. Cluster reduction Stopping Fronting Assimilation Gliding Final consonant deletion Deaffrication Liquid Simplification Weak Syllable Deletion Tap/Trill Deviation Vocalization SPANISH ENGLISH
  23. 23. Phonological Processes – English: From: Bowen, C. (1998). Typical speech development: the gradual acquisition of the speech sound system. Retrieved from http://www.speech-language-therapy.com/acquisition.html on 06/21/2010.
  24. 24. From: Contextual Probes of Articulation Competence – Spanish Super Duper Publications 2006
  25. 25. Phonological Processes – Spanish: From: Contextual Probes of Articulation Competence – Spanish Super Duper Publications 2006
  26. 26. Speech Activity 1 Consonant Differences  BATH BAT
  27. 27. Speech Activity 1 Consonant Differences  THREE TREE
  28. 28. Speech Activity 1 Consonant Differences  SHOE CHEW
  29. 29. Speech Activity 1 Consonant Differences  VASE BASE
  30. 30. Speech Activity 2 Vowel Differences  HAT HOT
  31. 31. Speech Activity 2 Vowel Differences  GET GATE
  32. 32. Speech Activity 2 Vowel Differences  HIT HEAT
  33. 33. Speech Activity 2 Vowel Differences  FUN PHONE
  34. 34. Speech Activity 2 Vowel Differences  LOOK LUKE
  35. 35. Speech Activity 3 Clinical Judgment with  the Goldman Fristoe
  36. 36. Other Common Languages Vietnamese Romanian Hindi Urdu Arabic
  37. 37. Other Common Languages Vietnamese • 10 Vowels • 28 Consonants • 30 Diphthong and  Triphthong Variations • 6 tones • GREAT regional  variation
  38. 38. Other Common Languages Arabic • 3 Vowels   2 long  2 short  2 diphthongs • 28 Consonants
  39. 39. Other Common Languages Romanian • 7 Vowels   30 diphthong and  triphthong combinations • 20 Consonants • A Latin language with  influence from:  Turkish  Greek  German  Slavic Languages
  40. 40. Other Common Languages Hindi • 11 Vowels  • 23 Consonants • 40% of India Urdu • 10Vowels • 28 Consonants While you could generally assume that a Pakistani family speaks Urdu, there are 22 languages in India and a 1961 census recognized 1652 “mother tongues.”
  41. 41. Speech Summary So what do we know: • Building blocks are the same for both monolinguals and  bilinguals, and across languages • General guidelines for intelligibility are the same  • Expect some cross‐linguistic influence in speech  production where the two languages differ • Use therapy materials that provide speech sounds that are  appropriate for the child’s age and language
  42. 42. Language
  43. 43.  Fact or Myth? • Children code switch between languages because they don’t know  either language well. • Raising children with two languages will confuse them. • Parents should not use more than one language with their child. • Comparisons to siblings and peers is not appropriate. • Children with language impairment should not learn more than  one language at a time.  See www.nethelp.no/cindy/myth.html and  www.spanglishbaby.com for responses to many myths  about bilingualism.
  44. 44. • 0-1 month – crying and vegetative sounds • 2-3 months eye gaze • 6-9 months-- joint attention • 9-12 months -- using gestures • 12-15 months--following simple commands • 18 months – symbolic play, pretend play • 24 months – sequencing of activities • 36 months – episodic play
  45. 45.  Bilingual children develop early vocabulary  at the same rate as monolingual children  (Pearson, 1993).  Early language milestones are similar  (single words, lexical spurt, 2‐word phrases)  (Pearson and Fernandez, 2001).  Conceptual scores are similar (Pearson, 1998).
  46. 46.  Vocabulary: • 12 months – first words (usually labeling familiar objects, actions, and  properties in child’s environment) • 15 months ‐ 4‐6‐word vocabulary • 18 months – 20‐50‐word vocabulary • 24 months – 200‐300 word vocabulary • 36 months ‐ roughly 1000 words  Overextensions • “dog” for all four‐legged animals • “it’s out of ink” to describe anything that doesn’t work  Underextensions • “blankee” is only one particular blanket • “Crayon” only refers to red crayons, the rest are colors
  47. 47.  English‐speaking parents use more nouns • First words of English speakers typically nouns (Gentner, 1982; Nelson,  1973)  Mandarin Chinese‐speaking parents use more verbs • First words of their children are nouns and verbs (Tardif, 1995)  Korean‐speaking parents talk about activities more • First words of their children are nouns and verbs (Choi, 2001)
  48. 48. What do children talk about with their  families at home? What do children talk about with their  peers and teachers at school? If they use different languages in these two  settings, what should we expect? 
  49. 49.  High correlation between language exposure and  vocabulary production1   For bilingual toddlers 30% of vocabulary are  translation equivalents2  Young school‐age bilinguals produce same # of  category items in Spanish and English BUT 70% are  unique to one language3  1 Pearson, Fernandez, Lewedeg, & Oller, 1997   2 Pearson, Fernandez & Oller, 1995  3 Pena, Bedore & Zlatic, 2002
  50. 50. The effects of Spanish on English can result in  errors in: • Verb errors (especially unmarked present for past  tense) • Content word errors (more than general words) • Prepositions • Pronouns • Word order
  51. 51. Treatment Treatment of underlying cognitive linguistic  skills = transfer  Evidence from literature on bilingual readings skills  Theoretical models regarding language independence of  some cognitive‐linguistic processing skills  Social‐cognitive skills  “Peripheral”  or “supporting” skills that are acquired in  therapy‐ following structure & routine  Exceptions? 
  52. 52. Treatment Language of intervention: • With bilinguals, treatment is inevitably  bilingual • Transfer of skills from one language to the  other? • Cross‐linguistic effects and dialect features  should not be targeted
  53. 53. Treatment Language of intervention Let’s discuss… • When do you recommend that a family choose  one language or a primary language for  intervention?
  54. 54. Treatment Targets: • Phonological patterns approach • Shared vs. unshared • Nondevelopmental approach (e.g. – maximal opposition) • Consider types & rates of errors  Get more  “BANG for your buck”!
  55. 55. Intervention Is: Focused on Language  Select based on what is appropriate in each language and  what is appropriate for child’s and family’s situation.  e.g.‐ Spanish •Gender •Verbs •Article+nouns •Household items •Food •Clothing Both •People •Functions •Categorization •Part-Whole English •Pronouns •Prepositions •Nouns •Colors •Numbers •Shapes Peña & Kester, 2004
  56. 56. Using an Interpreter in  Assessment and Treatment

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