Saturday 9 February 2013

Speech-language clinics: cultural meeting places?

When our children are referred to speech-language services, the least of our concerns is probably to muse on whether the clinic is a suitable venue for cultural happenings. We go there to seek expert assistance, that’s all. Expertise, however, isn’t absolute, because experts aren’t abstract beings. Like the rest of us, they’re shaped by cultural backgrounds and professional training which are bound to specific places and specific times.

Clinical observations leading to diagnoses start at the clinic’s door: Does the child greet new people, and show appropriate curiosity about new surroundings? Does the child say please or thank you, which speakers of languages with words for please and thank you take as a sure sign of basic politeness? Is there telltale body language? How about body contact? If the child shuns an open, extended, unfamiliar hand, or recoils at that hand patting cheeks or ruffling hair, is this culturally odd? What if the same hand insists on heaping dolls, teddy bears and other lifeless representations of living beings near a child who’s scared witless of these things because they’re associated with taboo meanings?

We may all know, in theory, that the same behaviour can be interpreted in widely different ways, but we may not realise that “invisible” cultural considerations, those that we take for granted because they shape our routines, impact clinical observation and assessment: is avoidance of eye contact, for example, a sign of social impairment or of deference? What about silence? The verdict rests with the clinician. The excellent news about this is the growing awareness, among speech-language clinicians, of cultural considerations concerning their little multilingual clients.

Many speech-language clinicians are trained to use a single language of intervention, and receive no training in matters of multilingualism and multiculturalism. There may be no shared language between clinician and client, for example, or no shared ways of using it. One common practice is to ask the parents to interpret, or hire an ad hoc interpreter. A previous post explains why the former solution cannot work, and other research explains what is involved in proper training of clinical interpreters, who aren’t simple, “neutral” vehicles of messages in different languages. See, for example, Claudia V. Angelelli’s book Medical Interpreting and Cross-cultural Communication.

There may also be a shared language, though no normed assessment instruments for other languages used by child clients. Translation comes to mind, here, too: speech-language clinicians do report that they themselves translate and/or adapt instruments which were normed for other languages. But doing so in fact invalidates the standardisation of these tests, making them unusable. Rhea Paul and Courtenay Norbury’s book, Language Disorders from Infancy through Adolescence provides a thorough review of these issues. Elizabeth D. Peña, in an article titled ‘Lost in translation: methodological considerations in cross-cultural research’, raises an additional issue. Neither the instruments were devised to be translated, nor what is in question is the accuracy of a translation: translated tests yield “different patterns of response” in different languages, which “may be due to differences in cultural interpretation” (p. 1257).

We can’t translate languages without translating cultural practices, in other words, because languages are there to serve them. Margaret Friend and Melanie Keplinger, in a study on ‘Reliability and validity of the Computerized Comprehension Task (CCT)’, discuss their adaptation of a vocabulary test from (American) English to (Mexican) Spanish, which they used to assess Mexican infants. The task required the children to grasp an object, when prompted with the word for that object. All children failed this task, arousing suspicion of language delay, compared to their American peers. The cause of the failure, as it turned out, was not language, but culture. When questioned about possible reasons for their children’s results, the Mexican parents clarified that they forbid their children to touch things that do not belong to them.

Other recent research reports on growing awareness of cultural issues arising in speech-language clinics. From Australia, in ‘Speech-language pathologists’ assessment and intervention practices with multilingual children’, Cori Williams and Sharynne McLeod found that clinicians actively sought information about their clients’ languages and cultural backgrounds, faced with a lack of culturally appropriate tools which would do justice to them. Lack of culturally appropriate resources for assessment and intervention is also the case in the US, as Mark Guiberson and Jenny Atkins discuss in ‘Speech-language pathologists’ preparation, practices, and perspectives on serving culturally and linguistically diverse children’. Finally, in a review of clinical practices in multilingual settings worldwide, ‘Towards evidence-based practice in language intervention for bilingual children’, Elin Thordardottir observes that “Existing clinical methods have largely been developed within Western middle-class cultures” (p. 532). In multilingual settings, clinicians are not only being required to interpret what they’re unfamiliar with but, perhaps as crucially, they’re realising that they must stop mistaking what they’re familiar with for “norms”.

Several of my own contributions to this issue focus on monocultural and monolingual features of clinical approaches to speech and language. One book chapter titled ‘Sociolinguistic and cultural considerations when working with multilingual children’ discusses clinical practices which take culturally-bound ‘mono’ tenets as default behaviour. Another chapter, ‘Assessing multilingual children in multilingual clinics’, in my book Multilingual Norms, reports on the consequences of monolingual training on the practices of multilingual clinicians.

The next post will have some more to say about small children and their well-being, namely, what does it mean to “teach” children?

Friend, M., & Keplinger, M. (2008). Reliability and validity of the Computerized Comprehension Task (CCT): data from American English and Mexican Spanish infants. Journal of Child Language, 35 (01). DOI: 10.1017/S0305000907008264

Guiberson, M., & Atkins, J. (2010). Speech-Language Pathologists’ Preparation, Practices, and Perspectives on Serving Culturally and Linguistically Diverse Children. Communication Disorders Quarterly, 33 (3), 169-180. DOI: 10.1177/1525740110384132

Peña, E. (2007). Lost in Translation: Methodological Considerations in Cross-Cultural Research. Child Development, 78 (4), 1255-1264. DOI: 10.1111/j.1467-8624.2007.01064.x

Thordardottir, E. (2010). Towards evidence-based practice in language intervention for bilingual children. Journal of Communication Disorders, 43 (6), 523-537. DOI: 10.1016/j.jcomdis.2010.06.001

Williams, C., & McLeod, S. (2012). Speech-language pathologists’ assessment and intervention practices with multilingual children. International Journal of Speech-Language Pathology, 14 (3), 292-305. DOI: 10.3109/17549507.2011.636071

© MCF 2013

Next post: “Teaching” children. Saturday 23rd February 2013.


  1. Very interesting your comment about the practitioner's background, culture and perception. I once met another fellow Cuban who was told not to speak in Spanish to her son because he might develop dyslexia. I know, I know, laugh all you want but she felt frightened. The doctor was an ignoramus, of course, but he was not the exception.

    Another great post. Thanks.

    Greetings from London.

  2. You’re dead on, Cubano! I had similar “advice” heaped on me from educational and medical “experts”: we would be causing our children irreparable cognitive and developmental damage if we “insisted” on speaking “so many languages” at home.

    I did laugh then, quite a lot, but this was before I came to realise the appalling extent and influence of this kind of expert ignorance. Most parents do get frightened, as you report, and force themselves to change what comes most naturally to all of us: raising our children in our languages. That, to my mind, *is* irreparable damage, to the children and their families.

    Thank you for being there!



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