CPLOL Congress, Berlin 2006
Eva-Kristina Salameh, Speech
and Language Pathologist, Ph D (Medical Faculty),
Linguistic and cultural factors affecting assessement and intervention for bilingual children with language impairment
Irrespective
of whether a child with suspected language impairment (LI) is mono- or
bilingual, the same clinical problems have to be addressed:
In order to
address these problems, the Speech and Language Clinician, SLC, must have
knowledge of language impairment in bilingual children. In order to investigate
whether bilingual children differ from monolingual children, a project called
Language impairment in Swedish bilingual children at
Epidemiological data from 192 bilingual and 246 monolingual children were used for comparison on a number of variables, concerning referral, assessment and intervention (Salameh, Nettelbladt, Håkansson & Gullberg 2002). Bilingual children ran a significantly higher risk to be referred after the age of 5 years, and also for parental refusal of initial assessment. When assessed, prevalence was lower in bilingual children, but they ran a significantly higher risk of being diagnosed as having a severe LI, compared to monolinguals. The risk for bilingual children of being discharged owing to non-attendance was also significantly higher, and the risk increased with severity of LI. As a result a joint project with the Swedish Child Health Clinics (CHC) has been started to minimize the high risk of parental refusal of initial assessment., A SLC is now present at the referral of children with suspected LI in ethnically diverse areas, and can inform parents why the child is referred and what will happen at the clinic. Figures of refusal have dropped considerably, and the project is now permanent.
In another epidemiological study, a multiple regression based on data from 252 bilingual and 446 monolingual children, identified risk factors for increasing severity of LI in bilingual children compared to monolingual children (Salameh, Nettelbladt & Gullberg 2002). Most risk factors for LI relative to degree of severity seemed to apply to both groups, as parental distress and short attention span, but gender and hereditary factors seemed to need to interact with environmental factors to appear as risk factors in bilingual children. Some risk factors were specific for the bilingual group, such as parental need of interpreter after more than 5 years of residence in Sweden.
In the linguistic part of the project mentioned above, the definition of LI stated that the child must exhibit impairment in both languages, in order to distinguish impairment from insufficient exposure to the second language. As a consequence a satisfying development in the mother tongue rules out a LI. This means that it is necessary for the SLC to have information regarding language development and present status in both languages. It is always possible to make an informal assessment of the mother tongue with help of the parents, but to get comparable results on the grammatical development, a theoretical base is needed. A very useful theory is Processability Theory by Manfred Pienemann (Pienemann & Håkansson 1999). The predictions of this theory are non-language specific, which allows for a comparison of grammatical development in two typologically different languages.
Since Swedish-Arabic children is by far the largest language group among the bilingual children at the Speech and Language Clinic at University Hospital MAS in Malmö, experimental tests based on Processability Theory were constructed in Swedish and Arabic. This made it possible to identify Swedish-Arabic bilingual children with severe LI. The results showed that pre-school children with severe LI developed their grammar in both languages in the same implicational order as children without LI, although at a considerably slower pace.They also seemed more vulnerable to a limited exposure of both Swedish and Arabic. Children without LI scored from the beginning at high grammatical levels in Arabic. After of exposure of two years to Swedish in preschool, the children without LI scored at high grammatical levels also in Swedish. This was not the case with most of the children with severe LI. A time limit of two years has thus the potential of becoming clinically significant when assessing the second language in bilingual children with suspected LI (Håkansson, Salameh & Nettelbladt 2003; Salameh, Håkansson & Nettelbladt 2004). Further use of the tests has shown promising results.
The phonological development of both languages
was also tested, and showed that all children tended to develop Arabic and
Swedish phonology in the same way as monolingual children in each language.
Both groups used syntagmatic phonological processes in the earlier stages of
Swedish, i.e. simplifying pronunciation by changing the phonotactic structure
of the word (Nettelbladt 1983). The children with severe LI produced several
syntagmatic processes in Arabic as well as in Swedish after more than two years
of exposure, while this was not the case with the children without LI (Salameh,
Nettelbladt & Norlin 2003). The presence of numerous syntagmatic processes
in the mother tongue and in the second language after more than two years
exposure might also have the potential of becoming clinically significant.
An important question to be raised is of course
whether it is possible to test bilingual children entirely within a monolingual
frame-work, since the bilingual language ability is different from the
monolingual. Code-switching between two languages while talking to another
bilingual, is an ability in bilinguals which also has the potential to become
clinically interesting. Several studies have shown that bilingual individuals
who code-switch frequently, also have a high command of both languages
(Håkansson 2003). Children with LI usually do not code-switch when they are
unable of finding a word in one language. They become quiet, while bilingual
children without LI do code-switch.
When it comes to intervention, it is of utmost
importance to involve the parents. In order to address the problem of
non-attendance, it is necessary to investigate the role of linguistic and
cultural factors. Swedish-Arabic parents who either completed intervention or interrupted
it, are currently interviewed regarding their views on language socialization
and language impairment, and also their idea of an optimal intervention for
their child. For a comparison monolingual Swedish and Arabic parents are also
being interviewed, the latter in co-operation with the Aamal institute in
To further engage Swedish-Arabic parents a
network in Malmö has been founded in cooperation with the national society for
parents with children with LI. The goal is to provide information in Arabic and
offer a possibility for meeting other parents. Meetings have been well
attended, and many of the parents have made useful comments on how to provide a
culture-specific intervention.
References
Håkansson,
G (2003) Tvåspråkighet hos barn i Sverige. [Bilingualism in children in
Håkansson, G, Salameh, E-K &
Nettelbladt, U (2003) Measuring language proficiency in bilingual children.
Swedish-Arabic bilingual children with and without language impairment. Linguistics 41 (2), 255-288
Nettelbladt, U (1983) Developmental
studies of dysphonology in children. Doctoral diss.
Salameh, E-K, Nettelbladt, U,
Håkansson, G & Gullberg, B (2002) Language impairment in Swedish bilingual children. A comparison between
bilingual and monolingual children in Malmö. Acta Paediatrica 91, 229-234
Salameh, E-K, Nettelbladt, U &
Gullberg, B (2002) Risk factors for language impairment in Swedish bilingual
and monolingual children relative to severity. Acta Paediatrica 91, 1379-1384
Salameh, E-K, Nettelbladt, U &
Norlin, K (2003) Assessing phonologies
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Language Teaching and Therapy, 19(3), 338-365
Salameh, E-K, Håkansson, G & Nettelbladt, U (2004) Developmental perspectives on bilingual Swedish-
Arabic children with and without language impairment: a
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