SLP 460 Exam #2

Exam #2- Please note that there is going to be a lot of repetition. That means that you will see flashcards that show all bullet points from the slides, as well as fill in the blanks for some of the slides. This is to help us… hopefully.

Evidence-based Practice

Evidence-based Practice

“EBP in speech-language pathology is an approach to clinical decision making in which different sources of information are integrated into an action plan that best serves the long-term interests of individuals with communication disorders" (Kohnert, Ebert, & Pham, 2021)”

EBP applies to

All clinical activities, including assessment process, treatment, as well as family education and counseling

The 4 basic steps to implement EBP

a) frame the clinical question

b) find relevant evidence

c) assess the quality of this evidence

d) make clinical decisions about how to apply the evidence

What is PICO?

A format to use to initial clinical questions and start the EBP process.

What does each letter mean (PICO)?

Prefers to the particular problem or patient population of interest

Is the intervention of interest

the Comparison or alternative to the intervention of interest

the Outcome of the evidence

Examples of PICO questions (adults)

• For bilingual adults with:

  • A primary acquired aphasia [p] (problem)

  • does lexical semantic treatment in one [i] (intervention)

  • or two languages [C] (comparison)

  • result in the greatest functional outcomes [O]? (outcome)

Examples of PICO questions (preschool-age children):

• developmental langauge disorder who use Spanish at home and English at school [P] (problem)

• Show greater vocabulary improvement in English [O] (outcome)

• following bilingual or English-only [c] training ? (Comparison)

• Result in the greatest functional outcomes [O]? (Outcomes)

Three sources of information serve as the basis for decision making within the EBP framework: (three-legged stool)

1. external empirical evidence (clinical decisions MUST be based on the highest quality of external evidence available)

2. internal evidence developed by the clinician

3. client characteristics

EBP: External Evidence

• Strongest: systematic reviews/ Meta-analysis of RCTs

• RCT Studies (gold standard)

• Single-subject or single-subject experimental designs

• Case studies, correlational studies, and quasi-experimental studies

• Weakest = expert opinion

Two general types of internal evidence:

Objective and subjective measures

Define Objective

It measures of progress include clinician observations of various communication skills such as the length or grammatical accuracy of sentences, the number of words produced or understood, or the types and frequency of communicative attempts

Objective measures of progress include clinician ____ of various communication skills such as the ____ or ______ accuracy of sentences, the number of words produced or _____, or the types and ______ of communicative attempts

Observation; length; grammatical; understood; frequency

Define Subjective

Measures consist of evidence from the client’s perspective (e.g., patient-reported outcomes)

Subjective measures consists of evidence from the _____

Client’s perspective

Principles and components of evidence-based practice (EBP), discussed within the _____ __ _____ and _____ ______

Context of cultural ; linguistic diversity

Introduction to ______ _______, drawing on literature from counseling psychology. The contextual model emphasizes the role of ______ or _____ ______ in treatment outcomes. The relevance of both ____ and the contextual model transcends actions with a particular disorder or type of client.

Contextual model; general; common factors; EBP

The application of principles of the contextual model to SLPs and advocate for a practical and inclusive approach to clinical decision making. This approach integrates ___ with the _____ ____ and common factors to best serve bilingual individuals with language disorders.

EBP; contextual model

Client Characteristics

• Client and family characteristics, beliefs, and informed preferences are the third essential source of information in EBP

• Client characteristics include the different languages or dialects needed to succeed across various settings as well as the cultural contexts in which communication is embedded (Kohnert, 2007)

• Consistent with principles of EBP and professional cultural competency client preferences must be informed by the best available external and internal evidence and delivered in a way that can best be received by those affected by language disorders.(Kohnert, Ebert, & Pham, 2021)

  • This requires superb cultural and interpersonal communication by the SLP, sometimes in collaboration with interpreters.

  • It also requires that the SLP be familiar with the relevant external evidence on bilingualism in typical and atypical learners

  • Information on these characteristics can be gathered through ethnographic interviews, skillful dialogue, observations, etc.

Client and family characteristics, beliefs, and informed preferences are the ___ essential source of information in EBP.

Third

Client characteristics include the different ______ or _____ needed to succeed across various settings as well as the cultural contexts in which communication is embedded.

Languages; dialects

EBP: Client Characteristics

• One example of the distinction between uninformed and informed client preferences, consider Diego, a 3-year-old boy recently diagnosed with a severe language disorder in the face of otherwise normal development. (Kohnert, Ebert, & Pham, 2021)

• Diego lives with his parents, older sister, and grandmother. The primary home language is Spanish, although Diego’s father and sister are also proficient in English.

• The SLP and other members of the early childhood assessment team meet with Diego’s parents to present them with treatment options.

Practical Perspectives on Clinical Actions

• Interacting factors such as the clinician, the client, the relationship between them, the structure of treatment (I.e., dosage, physical setting, group versus individual, home practice), the clinician's belief in the approach they are using, the client's expectations, etc. impact clinical actions and outcomes

• A clinical goal is to identify these potential influential and interacting factors and exploit them to the greatest extent possible to ensure optimal outcomes— the ultimate goal of EBP.

• Important to consider a variety of sources of evidence when working with bilingual individuals -- especially considering the literature on language treatment in general and with bilingual individuals is emerging

• Clinical actions are informed by internal and external evidence but embedded in a context of interacting human and structural factors; --> deliberate and ongoing attention to the multiple contextual factors that may affect the clinical process

______ _____ such as the clinician, the client, the relationship between them, the structure of treatment (I.e., dosage, physical setting, group versus individual, home practice), the clinician's belief in the approach they are using, the client's expectations, etc. impact clinical actions and outcomes

Interacting factors

A clinical goal is to identify these _____ ______ and ______ ______ and exploit them to the greatest extent possible to ensure optimal outcomes— the ultimate goal of EBP.

Potential influential; interacting factors

Important to consider a _____ _ ____ of evidence when working with bilingual individuals -- especially considering the literature on language treatment in general and with bilingual individuals is emerging

Variety of sources

_____ ______ are informed by internal and external evidence but embedded in a context of interacting human and structural factors; --> deliberate and ongoing attention to the multiple contextual factors that may affect the clinical process

Clinical actions

Single-Language Learners: First Language Milestones

• Language development begins at/before birth and continues throughout adulthood

• Language milestones are simply predictable benchmarks along the developmental pathway

Language development begins ___ / __ birth and continues throughout adulthood.

At / before

Prelinguistic period of infancy:

Marked by intentionality of interactions

interactions in infancy (includes):

• requests

• References to items or actions

• Turn taking expressed with either gestures or vocalizations

Communication Milestones - 2 months

• coos and gurgling sounds

• Turning head to sounds

Communication Milestones - 4 months

• Lexical-semantic knowledge, grammatical complexity, and conversational skills continue to develop and expand throughout the preschool years.

• Use increasingly sophisticated grammatical skills and narrative abilities as they engage in frequent imaginative play.

• Speech is understood most of the time by familiar listeners

  • Some children experience normal disfluencies or interruptions to the forward flow of speech production as their expressive language skills further accelerate

Communication milestones: preschool years (5 years old) (pt. 1)

• Easily understood by most listeners as they speak in long, complex, largely grammatically correct sentences

• Nearly mastered the sounds and sound patterns of their language

  • with the exception of some of the most motorically complex or acoustically less salient sounds (e.g., the English r, th, or v or the combination of phonemes in words such as cinnamon, aluminum, or squirrel)

• Able to understand and use language for a wide range of social or pragmatic functions

• Vocabularies consist of several thousand words— between 6,000 and 14,000

Communication Milestones: preschool years (5 years old) (PT. 2)

• Word learning remains robust throughout childhood and beyond, with approximately 300 additional words added to children’s lexicons during each year they attend school

• Developing figurative language

• Refining and expanding their understanding and use of sounds, grammar, word meaning, and use.

• Increasing emphasis on academic language, including decontextualized language and metalinguistic skills— using language to think, learn, and talk about language

Cognitive Considerations

• Knowing sounds, words, meaning, grammatical devices, and the range of ways to combine these linguistic pieces into syntactically and pragmatically appropriate constructions is necessary and important

• But proficiency in a language also requires the ability to use this knowledge during the dynamic, fast-paced communicative interactions that characterize real-time language use

• Processing efficiency is essential for language functioning (I.e., cognitive skills and considerations)

• general cognitive processes involved in efficient language learning/use include perception, attention, processing speed, and working memory

• To process linguistic information in real-time, speakers need to do so automatically, resisting interference from either internal or external distractions.

• Ability to quickly learn, recall, access, and deploy known linguistic forms continues to develop throughout adolescence

Income and Input-Related Considerations

• Input, as used here, refers to a child’s cumulative experience with spoken language.

• Although children from families with diverse incomes begin to talk at similar ages, there is strong evidence that family income level (presumably correlated with educational and literacy levels) is linked to the amount of input a child receives. --> This input, in turn, exerts a significant effect on language development

• Evidence suggesting the presence of a word gap – differences in vocabulary directed towards (and this learned) by children from low socioeconomic status families and high socioeconomic families

  (Kohnert, Ebert, & Pham, 2021)

• Researchers and educators widely agree that language input is influenced by the both the quantity and quality of interactions.

• The quality of language directed at children has two key ingredients: lexical diversity and reciprocity

• Enhancing the quality and quantity of environmental language input (or the O in MOM) makes a positive difference in children’s language abilities (e.g., using more complex sentences and increasing adult-child discourse)

Developing Bilinguals

• Traditionally: the term bilingual has been used to refer to individuals who demonstrate some level of proficiency/ability in more than one language

• A functional/Needs-Based Definition of Bilingual: Individuals who have a past, present, o future need for two or more languages are considered bilingual

  • Broad and inclusive definition

  • Emphasizing the language environment in which individuals live

  • Encompasses varying levels of proficiency in two or more languages

  As with monolingual children, the majority of children learning two languages are typically developing, with intact social-emotional, cognitive, neurological, motor, and sensory systems. Typically developing children are well equipped for the task of acquiring two (or more) languages .

• Developing bilinguals are children who receive regular input in two or more languages during the most dynamic period of communication development— somewhere between birth and adolescence.

• Globally, developing bilinguals are the rule rather than the exception.

• In the United States it is estimated that at least 1 in 5 children speaks a language other than English at home (National Center for Education Statistics, 2009).

• As of 2016, 22% of the Canadian population speaks a mother tongue other than English or French

As with monolingual children, the majority of children learning two languages are _____ ______, with intact social-emotional, cognitive, neurological, motor, and sensory systems. Typically developing children are well equipped for the task of acquiring two (or more) languages .

Typically developing

Factors that affect the process and product of langauge proficiency in developing bilinguals:

A) the age at which consistent input in the two languages begins (such as Spanish and English beginning at birth or Spanish from birth and English beginning when the child is 3, 5, or 9 years old)

B) the environments in which this language experience occurs (e.g., home, school, television, parents, teachers, peers)

C) the relative social prestige and broader community support associated with each language (e.g., compare broad support for both French and English with limited support for Vietnamese or Indonesian languages in Canada)

D) the purposes for which these languages are needed (e.g., interpersonal communications, literacy, community interactions)

Developing bilingualism is variable in the time frames and patterns of language acquisition, as well as the child’s resulting proficiency in each language.

• Sources of normal variability include those that affect monolingual children, such as socioeconomic circumstances, parent education, and home literacy (Bohman, Bedore, Peña, Mendez-Perez, & Gillam, 2010; Portes & Rumbaut, 2001).

• In addition, individual differences in styles, preferences, and cognitive abilities or aptitude affect language learning

Children learning two languages do so…

• at various ages

• Under diverse conditions

• In varying degrees of relative skill in each language

Bilingual development is ____ and highly ____!

Dynamic; variable

3 conventional ways to quantify or qualify language ability, or proficiency in developing bilinguals:

1) Consider the bilingual child’s abilities in each of his or her languages as compared to those of monolingual same-age peers in each language (i.e., monolingual to bilingual comparisons)

2) Consider the degree or level of language attainment in developing bilinguals by comparing performance to that of age and experience-matched bilingual peers (i.e., bilingual to bilingual comparisons)

3) Describe bilingual language abilities by using within-speaker comparisons –> In within-speaker comparisons, a child’s ability in one language is compared to his or her ability in the other known language

The timing of experience with two different languages can be used to classify children into two major categories:

1) simultaneous bilinguals

2) sequential (or successive) bilinguals

Simultaneous bilinguals (defined)

a child’s concurrent experience with two different languages beginning at about the same time in his or her life, typically during infancy.

Example of simultaneous bilinguals

• Use language for the same communicative purposes, with the same degree of clarity, as single-language learners

• Similar age of onset and rate of progression of critical early language skills as single-language learners

• Breadth of words known for simultaneous bilingual children from middle-income families is consistent with the number of words known by their middle-income monolingual counterparts, *(when both languages are considered)*

  • e.g., child might know agua in Spanish for water and doggies in English – part of the single linguistic repertoire of bilinguals

• Simultaneous bilingualism DOES NOT cause delays in attainment of early language milestones

• Mastery of the phonological system, syntactic prowess, and narrative abilities, is also similar to that of

  monolingual peers

• By 3 to 5 years of age, typically developing simultaneous bilingual children child will speak at least one language at a proficiency level comparable to monolingual norms.

• Development of two or more languages relies on, at least in part, on opportunities to use these different linguistic systems (Kohnert, Ebert, & Pham, 2021)

  • However, simultaneous bilinguals may use their two languages for different purposes, with different interlocutors, in different communicative contexts (MOM framework) - impacts language acquisition

  • These differences in language use may lead to a relative strength in one of the languages for certain purposes

Overall, typically developing ______ bilingual children meet the same linguistic _____ (similar age of onset and rate of progression of critical early language skills) as _____-language learners.

simultaneous; milestones; single

Early sequential bilinguals (Define)

children who acquire a single first language (L1) beginning at birth and begin to acquire a second language (L2) at some point during childhood

Early sequential bilinguals (information)

• In some cases, the L1 is the majority language of the community (e.g., English in the U.S) and children learn the L2 in formal immersion educational programs designed to promote foreign language proficiency or proficiency in a second national language (e.g., attending an immersion educational program in which French, German, Spanish, Hebrew, Arabic, or Chinese is the language of instruction)

• In other cases, the language of the home (L1) is a minority language in the community and L2 is the majority language of both the educational system and broader community (Kohnert, Ebert, & Pham, 2021)

  • This is the case for children living in the United States whose parents speak Spanish, Vietnamese, Cantonese, Hmong, Somali, Tagalog, Urdu, among other languages

  • This group represent large sections of the general population in almost every nation of the world, including Western countries such as the United States

  • Under the MOM framework, the minority language has reduced O (Opportunities: fewer partners, contexts, and purposes) and reduced M (Motive: less social value) compared to the language used by the majority community

Dynamic interactive processing perspective (defined)

Language is a dynamic system that emerges within a social context through interactions of cognitive, neurobiological and environmental systems and subsystems across nested timescales.

In the United States, children whose primary home language differs from that of the broader community are currently classified in the educational system as _____ _____ _____ (ELL) or ____ ______ (EL) .

English Language Learners; English learners

In the United States, children whose primary home language differs from that of the broader community are currently classified in the educational system as English language learners (ELL) or English learners (EL) .

• The term EL directs attention to the L2, the primary language of the educational system.

• Children’s developing proficiency in the L2— English, in the United States— is typically the main concern of the educational system.

True or False: Bilinguals are two monolinguals in one

False

Dual monolingualism is not possible

We cannot expect equal proficiency in each of the child’s languages

True or false: Bilinguals are not monolinguals

True

Code switching

A term commonly used for bilinguals who “mix” linguistically during conversation.

Translanguaging

Posits that bilinguals have one linguistic repertoire from which they deliberately select features to communicate effectively

Why do bilinguals translanguage?

1. Some concepts are better expressed in one language over another.

2. To satisfy a “linguistic need” with a word or expression in a particular domain.

3. To reiterate or report something that was said in a particular language.

4. Communicative or social strategy to demonstrate group involvement.

Translanguaging is not

• an indicator of “semilingualism” or an incomplete acquisition of a languages (Grosjean, 2010; MacSwan, 2020)

• an indicator of a language disorder among bilingual children (Chirchi, Downing, & Mullen, 2011; Kohnert, 2008)

Translanguaging is “a verbal skill requiring a large degree of linguistic competence in more than one language, rather than a defect arising from ______ knowledge of one or the other” (Poplack, 1980, p. 615)

Insufficient

Formal and informal language assessments (e.g., BESA; Dynamic Assessment) account for ______ in some procedures in order to gain a better understanding of children’s linguistic abilities (Gutiérrez-Clellen & Peña, 2001; Peña, et al., 2018; Prymus & Alvarado, 2019).

Translanguaging

Translanguaging is not an indicator of “semilingualism” or an _____ _____ of a languages (Grosjean, 2010; MacSwan, 2020)

Incomplete acquisition

Translanguaging is not an indicator of a _____ _____ among bilingual children (Chirchi, Downing, & Mullen, 2011; Kohnert, 2008)

Language disorder