The Identification Conundrum How do we keep bilingual children from being over- or under-identified with speech-language impairments? There’s no failsafe method. But we minimize the risk of misdiagnosis when our assessments are rich, deep and drawn from multiple unbiased sources. Features
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Features  |   November 2014
The Identification Conundrum
Author Notes
  • Maria L. Muñoz, PhD, CCC-SLP, is associate professor in the Department of Communication Sciences and Disorders and coordinator of the Emphasis in Bilingual Speech-Language Pathology at Texas Christian University. She is an affiliate of ASHA Special Interest Group 2, Neurophysiology and Neurogenic Speech and Language Disorders, and serves on the coordinating committee of SIG 14, Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations. m.munoz@tcu.edu
    Maria L. Muñoz, PhD, CCC-SLP, is associate professor in the Department of Communication Sciences and Disorders and coordinator of the Emphasis in Bilingual Speech-Language Pathology at Texas Christian University. She is an affiliate of ASHA Special Interest Group 2, Neurophysiology and Neurogenic Speech and Language Disorders, and serves on the coordinating committee of SIG 14, Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations. m.munoz@tcu.edu×
  • Melissa White, MA, CCC-SLP, is co-director of clinical services for Bilingual Therapies, Inc., where she works with culturally and linguistically diverse children. She serves on the SIG 14 coordinating committee. melissa.white@bilingualtherapies.com
    Melissa White, MA, CCC-SLP, is co-director of clinical services for Bilingual Therapies, Inc., where she works with culturally and linguistically diverse children. She serves on the SIG 14 coordinating committee. melissa.white@bilingualtherapies.com×
  • RaMonda Horton-Ikard, PhD, CCC-SLP, associate professor in the School of Communication Science and Disorders at Florida State University, specializes in communication development and disorders in children from culturally and linguistically diverse ackgrounds. rhorton2@fsu.edu
    RaMonda Horton-Ikard, PhD, CCC-SLP, associate professor in the School of Communication Science and Disorders at Florida State University, specializes in communication development and disorders in children from culturally and linguistically diverse ackgrounds. rhorton2@fsu.edu×
  • © 2014 American Speech-Language-Hearing Association
Article Information
Speech, Voice & Prosodic Disorders / Cultural & Linguistic Diversity / Language Disorders / Features
Features   |   November 2014
The Identification Conundrum
The ASHA Leader, November 2014, Vol. 19, 48-53. doi:10.1044/leader.FTR3.19112014.48
The ASHA Leader, November 2014, Vol. 19, 48-53. doi:10.1044/leader.FTR3.19112014.48
In a perfect world, you assess a bilingual child when you suspect a speech-language problem, and you get a clear and accurate answer: The child has a disorder or the child is developing normally. But ours is not a perfect world. Neither is it simple.
And that means a traditional speech-language assessment will likely not render a reliable result from bilingual children. Most standardized tests fail to account for bilingual language development, normal language variability among bilingual children or differences in cultural experiences.
So what happens when standard, narrow testing is used with these children, and clinicians don’t account for typical bilingual language development over time? Children who are developing just fine may be classified as speech-language impaired (causing overidentification of disabilities). And the reverse problem can happen, too: Clinicians may postpone assessing bilingual children because they don’t feel properly qualified to do so—and bilingual children with genuine language impairments may be considered typically developing (causing under-identification of disabilities).
The combination of these two problems is known as “disproportionality”—defined by the U.S. Department of Education as overrepresentation and underrepresentation of minority students in special education and related services. Disproportionality is at odds with the Individuals With Disabilities Education Act, which mandates nondiscriminatory assessment, identification and placement of K–12 students. And the problem is all too real (see sources). For example, reading-development researchers Jennifer Samson and Nonie LaSeaux reported in 2009 that Latino students are underrepresented in special education during kindergarten and first grade, but overrepresented by third grade (bit.ly/over-ident).
So how do SLPs help prevent disproportionality when assessing English-language learners? While there’s no failsafe method, conducting a rich, multifaceted speech-language assessment that draws from multiple unbiased sources is key to avoiding over- and under-identification. Let’s take a closer look.
Frame it
If there’s one tool you need to make a nonbiased assessment, it should be a diagnostic framework, without a doubt. This framework is what guides you through data collection and interpretation.
Speech-language researchers recommend incorporating a pre-evaluation when assessing English-language learners (see sources). Their advice: Carefully consider the nature of the referral, language history and use patterns, and educational history. This information allows you to generate hypotheses about difference versus disorder. Next, interview parents and teachers to help you gauge how the child’s development compares with that of peers and siblings.
One framework that can be used to guide assessment data collection was developed by speech-language pathology academics Ronald Gillam and LaVae Hoffman, who suggest incorporating at least four sources of information: academic activities, contextual tests that reflect communication abilities, speech-language probes, and decontextualized tests. Drawing from these various areas ensures balance, note Gillam and Hoffman.
Best practice, according to research, is using the pre-referral process to determine the language(s) to assess. Federal guidelines mandate assessing a child’s native language, but often assessing both languages is best, given how knowledge is distributed across languages. For some children, you may need to use interpreters and translated tests for portions of the assessment. However, translated tests may miss aspects of language impairment unique to the language. When measures aren’t available in the native language, it is preferable to use nonstandardized assessment procedures and consider what a child is expected do in the native language. Formal tests, administered in English and/or the native language, may be used descriptively and should be balanced with nonstandardized measures, such as language and narrative sampling and dynamic assessments. Considered together—and interpreted with an understanding of bilingual language development and the child’s bilingual experience—these data will help you determine whether you’re looking at an actual disorder or just a difference.
A case in point
Let’s look at how one SLP we know used a non-biased framework to evaluate “José,” a 6-year-old Spanish-speaking boy who moved to the United States at age 3 and is assigned to an English-only kindergarten classroom. After a referral team requested a speech evaluation because of his articulation errors, the SLP initiated a five-stage assessment. She:
  • Identified the referral concern. José’s teacher initiated the referral based on a concern that he is “hard to understand.”

  • Developed hypotheses. The SLP set out to test two hypotheses: (1) José presents with a speech disorder in his native language and in his second language; (2) José presents with typical first- and second-language speech development, and errors in English are normal.

  • Reviewed and collected information from various sources. José’s teacher reports that he struggles to produce the English consonants /th/, /r/, /v/, /z/, /sh/, /j/, /ng/ and /er/. He gets along well with peers and participates in small and large groups. He speaks mostly Spanish with Spanish-speaking peers on the playground, but speaks English with them in the classroom. He uses gestures when speaking English with adults and peers. José participates in a response-to-intervention group for phonemic awareness. His parents report that his only articulation difficulties in Spanish are trilled /r/ errors. He speaks mostly Spanish at home and some English with siblings and cousins. He was enrolled for two years at Head Start, where his bilingual teacher had no concerns about his articulation. Language-proficiency testing classifies him as “Limited English Speaking/Early Advanced” and “Fluency Spanish Speaking/Advanced.”

  • Created a balanced assessment. Classroom observation indicates that RTI is improving José’s phonological awareness. The Developmental Reading Assessment places him at beginning kindergarten level. Speech-language pathology probes—a phonetic inventory, consonant probes, a speech sample and dynamic assessment—indicate that, in Spanish, José is 100 percent intelligible and produces errors only on /r/ sounds. In English, José scored 82 percent on consonant correctness and was 92 percent intelligible. Dynamic assessment targeting /sh/ indicated that José easily modified his production given structured feedback. No norm-referenced articulation test standardized on bilinguals was available in English, so none was given. José scored a standard score of 110 on the Contextual Probes of Articulation Competence in Spanish, which is within the average range.

  • Tested hypotheses to make diagnostic decisions. According to the assessment data, José presents with typically developing speech in his native language. Not only is his English articulation typical of second-language learning, but his developmental errors are typical for English-speaking children as well. The only error reported by his mother is developmental in Spanish. José communicates appropriately with peers in Spanish, and peers and adults generally understand his English. Both norm-referenced and non-standardized assessments indicate typical performance in Spanish. Dynamic assessment indicates that his sound production is emerging normally. The data support the hypothesis that José’s speech development is typical for a Spanish-speaker learning English as a second language.

Keep it non-biased
In José’s case, the SLP’s deep and careful assessment dispelled fears of a speech-language disability and revealed that he is developmentally on target. Here are some strategies SLPs can use to similarly hone diagnostic accuracy:
  1. Use the pre-referral process. Determine whether concerns may stem from typical bilingual development. RTI frameworks require school districts to document and rule out language and cultural factors as causes of learning issues. Monolingual and bilingual clinicians who familiarize themselves with dual-language learners’ development will interpret observations more effectively. An effective pre-referral process may have determined that the “errors” seen by José’s teacher were typical for Spanish-speaking second-language learners.

  2. View speech-language development as a complex and dynamic process. To avoid bias, assessment should incorporate insight into language-learning potential. Strategies such as fast mapping and dynamic assessment examine a child’s language-learning potential rather than language knowledge, which depends heavily on cultural experience.

  3. Understand the social-cultural factors that may influence a child’s development. Culture shapes speech-language learning. Although clinicians may see linguistic skills as universal, the reality is that language activities like storytelling and picture-naming vary greatly across cultures.

  4. Know the federal and state mandates regarding assessment. State standards for special education often specify that norms and standardized tests should not be used when such tests do not adequately represent the child’s population. Federal law does not indicate that a standard score needs to be used to determine eligibility and requires the use of multiple and appropriate data sources (2006 IDEA Part B, sec. 614).

  5. Identify and remediate sources of assessment bias. Clinicians need to identify and modify any assessment procedures that penalize children based on factors unrelated to the purpose of the testing. Overidentification as speech-language impaired can result when a child is unfairly penalized for any of the following: lack of knowledge of the pragmatics expectations associated with testing (situational bias), unfamiliarity with subtest instructions and format (format bias), dialectal or second-language differences (linguistic bias), or providing an answer other than that identified by the test due to differences in cultural rules or experiences (value bias).

  6. Understand models of second-language instruction and their effects on language development. Districts generally offer one or more educational options for bilingual children that may or may not facilitate maintenance of the first language. Additionally, it typically takes children five to seven years to develop the second-language proficiency needed for academic success.

SLPs assess a child at a specific moment in time, capturing experiences that have supported, or potentially inhibited, the development of one or both languages. Assessment results must be understood in the context of the child’s multiple language-learning experiences and their impact on language development. In the case of a child like José, a thorough, multidimensional assessment by an SLP will show that child’s speech development is typical for an English-language learner.
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November 2014
Volume 19, Issue 11