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.

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. 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. 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. 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. 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?

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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. • + = Positive transfer
• + = Negative transfer

9. Difference vs. Disorder
NORMAL
ERRORS
SECOND-
LANGUAGE
INFLUENCE
ATYPICAL
ERRORS

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. Speech

12. Differences Similarities

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. 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. /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. 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. 13‐14 vowel sounds in English (depending on
dialect and detail)
5 vowels in Spanish (a e i o u)

18. /æ//ѐ//Ѩ/
/u//ѩ//ϯ/
/‫گ‬//i/
/a/
/e/
/i/
/o/
/u/
SPANISH ENGLISH

19. Vowel Chart
English and Spanish

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. 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. Cluster reduction
Stopping
Fronting
Assimilation
Gliding
Final consonant deletion
Deaffrication
Liquid Simplification
Weak Syllable Deletion
Tap/Trill
Deviation Vocalization
SPANISH ENGLISH

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. From: Contextual Probes of Articulation Competence – Spanish
Super Duper Publications 2006

25. Phonological Processes – Spanish:
From: Contextual Probes of Articulation Competence – Spanish
Super Duper Publications 2006

26. Speech Activity 1
Consonant Differences
BATH BAT

27. Speech Activity 1
Consonant Differences
THREE TREE

28. Speech Activity 1
Consonant Differences
SHOE CHEW

29. Speech Activity 1
Consonant Differences
VASE BASE

30. Speech Activity 2
Vowel Differences
HAT HOT

31. Speech Activity 2
Vowel Differences
GET GATE

32. Speech Activity 2
Vowel Differences
HIT HEAT

33. Speech Activity 2
Vowel Differences
FUN PHONE

34. Speech Activity 2
Vowel Differences
LOOK LUKE

35. Speech Activity 3
Clinical Judgment with
the Goldman Fristoe

36. Other Common Languages
Vietnamese
Romanian
Hindi
Urdu
Arabic

37. Other Common Languages
Vietnamese
• 10 Vowels
• 28 Consonants
• 30 Diphthong and
Triphthong Variations
• 6 tones
• GREAT regional
variation

38. Other Common Languages
Arabic
• 3 Vowels
 2 long
 2 short
 2 diphthongs
• 28 Consonants

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. 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. 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. Language

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. • 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.  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.  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.  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. 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.  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. 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

52. 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?

53. 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

54. Treatment
Language of intervention
Let’s discuss…
• When do you recommend that a family choose
one language or a primary language for
intervention?

55. 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”!

56. 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

57. Using an Interpreter in
Assessment and Treatment