Saturday, 5 March 2016

Being multilingual in clinic

When we feel that we’re not feeling quite like ourselves, we may choose to consult a specialist in (un)well-being to find out what might be going on. Our decision will draw on what feeling well has felt like to us, which is our baseline for comparison. In order to decide that we’re unwell, in other words, we compare ourselves to ourselves.

Children can’t make decisions of this kind on their own, so we adults will have to step in on their behalf. But who are ‘we’? We parents may resort to the same kind of baseline that we use for ourselves and compare the child to itself, because no one knows our children better than we do. This is true of suspected language disorders, too: if a child who is less lively than usual may be running a fever, so a child who is using, say, fewer words than usual may be having language problems. We teachers, in contrast, are of necessity less likely to get to know the children in our care in as much detail. This is why teachers are also more likely to compare individual children to generally accepted norms which, also of necessity, were standardised through other children. Because such norms are standardised, that is, statistically validated, they claim an impartiality which cannot always be ascribed to parental norms.

Most referrals of multilingual children to special/remedial services come from school, typically following subpar ranking in language aptitude screening procedures in the school’s mainstream language. Tests in other languages that the children may use, where available, will show similar results, raising suspicion that the children lack a complete language or, as described in Jeff MacSwan’s report The “non-non” crisis and academic bias in native language assessment of linguistic minorities, that they are non-nons: nonverbal in all of their languages. Failure to perform up to test standards is in all good faith feared to reflect a linguistic disorder.

Enter the clinician who, to a significantly higher degree than a teacher, will also be a stranger to the child. Like the child’s teachers, the clinician will typically be unfamiliar with multilingual linguistic behaviour, a finding that my study Assessing multilingual children in multilingual clinics. Insights from Singapore was the first to report for clinicians who are themselves multilingual. Like the tell-tale school tests, the assessment instruments available to the clinician will as typically be monolingual, normed for (mainstream) monolinguals, and thereby likely to confirm a diagnosis of disorder. The child now has a clinical record, having been duly sanctioned as special by a specialist.

But there is a snag. Several, actually, which can be summarised like this: the languages of a multilingual cannot be monolingually ‘complete’, because multilinguals aren’t monolinguals. It is the persuasion that they should be that leads to mistaking their full linguistic repertoire for a null linguistic repertoire. The assumption that testing one of the languages of a multilingual – *any* of the languages of a multilingual – yields reliable insight about multilingual linguistic ability draws on three misconceptions. First, the belief that multilingualism is the addition of monolingualisms that I’ve termed multi-monolingualism. It’s not: if multilinguals could use all of their languages in the same way that monolinguals use their single one, they wouldn’t need all of their languages.

Second, the persistent confusion between the two meanings of the word ‘language’. Language disorders affect all the languages of a multilingual, and cannot therefore be diagnosed from proficiency, or test scores, in one particular language.

And third, the myth that monolingualism equals unquestionable linguistic health, whereby we misrepresent deviations from single-language tests as linguistic impairment. Since the tests are monolingual but the child is multilingual, multilingualism must be the cause of deviation, if not the deviation itself, and must therefore be eradicated. Treating the child for multilingualism will, no less, fail to identify and remedy disordered multilingualism, which research such as Kathryn Kohnert’s, and Elizabeth Peña’s and colleagues has shown must take into account the child’s full linguistic repertoire. Why? Simple fairness: that’s what we do for monolingual children.

Encouragingly, there is growing awareness among professionals that monolingual assessment tools should be used with great caution for multilingual populations. Brian A. Goldstein alerted to this in a guest post to this blog, Providing clinical services to bilingual children: Stop Doing That!, and so did I, in a book chapter titled Sociolinguistic and cultural considerations when working with multilingual children

The question then arises of how to assess the language ability of children who use languages for which there are no norm-referenced tests, or who don’t share a language with the clinician. The tempting answer is that this is virtually impossible, because of the ‘complexity’ of multilingualism: there are just too many multilingualisms, given the number and type of languages involved in each individual’s case. But if this is true, then it is also true that there are too many monolingualisms as well: if multilinguals in languages A, B and C are fundamentally different from multilinguals in languages Y and Z, then monolinguals in C are as fundamentally different from monolinguals in Y – which is an additional reason why multilinguals shouldn’t be assessed by monolingual standards: monolingualism, like multilingualism, matters locally, so which monolingualism do we choose?

The factual answer is that dynamic assessment provides methods of evaluating language ability regardless of ability in specific languages, and that clinicians can avail themselves of practical assessment guidance where no shared language of intervention exists. This is the topic of an article currently in press, authored by the International Expert Panel on Multilingual Children’s Speech of which I am a member, and titled Tutorial: Speech assessment for multilingual children who do not speak the same language(s) as the speech-language pathologist.

Multilingual children must be assessed as multilinguals, so we can tell whether their language development raises cause for concern. The reason why multilinguals outnumber monolinguals in special/remedial care is that we go on blaming multilingualism for deviations to our assessment standards, instead of querying the appropriateness of those standards. Multilinguals are special only in the special attention we keep paying to them, to which I turn next.


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Cruz-Ferreira, M. (2012). Sociolinguistic and cultural considerations when working with multilingual children. In S. McLeod & B. A. Goldstein (Eds.), Multilingual Aspects of Speech Sound Disorders in Children (pp. 13-23). Bristol: Multilingual Matters.

Cruz-Ferreira, M. & Ng, B.C. (2010). Assessing multilingual children in multilingual clinics. Insights from Singapore. In M. Cruz-Ferreira (ed.). Multilingual Norms (pp. 343-396). Frankfurt: Peter Lang.

Kohnert, K. (2007). Supporting two languages in bilingual children with primary developmental language disorders. In Kohnert, K. Language Disorders in Bilingual Children and Adults. San Diego, CA: Plural.

MacSwan, J. (2005). The “Non-Non” crisis and academic bias in native language assessment of language minorities. In J. Cohen, K. McAlister, K. Rolstad, & J. MacSwan (Eds.), ISB4: Proceedings of the 4th International Symposium on Bilingualism (pp. 1415-1422). Somerville, MA: Cascadilla Press. 

McLeod, S., Verdon, S., & International Expert Panel on Multilingual Children’s Speech (2017). Tutorial: Speech Assessment for Multilingual Children Who Do Not Speak the Same Language(s) as the Speech-Language Pathologist. American Journal of Speech-Language Pathology. DOI: 10.1044/2017_AJSLP-15-0161

Peña, E., Bedore, L., & Kester, E. (2016). Assessment of language impairment in bilingual children using semantic tasks: two languages classify better than one. International Journal of Language & Communication Disorders, 51 (2), 192-202. DOI: 10.1111/1460-6984.12199


© MCF 2016

Next post: Attitudes to multilingualism – or to multilinguals? Saturday 2nd April 2016.

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