K. Kohnert/[email protected]

ArSHA. 4/12/2013

M-O-M

Treating Bilingual Children with Primary Language Impairment: Evidence & Opportunities

e a n s

p p o r t u n i t i e s

o t i v a t i o n

LANGUAGE ABILITY

Kathryn Kohnert, PhD., CCC-SLP

Professor Emirtus, University of Minnesota (Kohnert, 2008; 2009, Kohnert & Pham, 2010)

Bilinguals- Typical • • • • • •

Experience with & social need for two languages. Quantity, quality & timing of experiences linked to ability. Shifting levels of L1-L2 skills. Uneven ability or distributed skills within and across languages. Links between languages and cognition Individual variation even in response to similar circumstances.

M-O-M

LANGUAGE ABILITY

M-O-M

LANGUAGE ABILITY

Primary Language Impairment (PLI): • Aka SLI, LD, LLD, LD-NOS, Late Talkers, SNAP etc.

• Persistent, unexplained significant delays in language. • Inefficiencies in cognitive processing system. • Degree of heritability-positive family hx of CDis. • Heterogeneity within diagnostic category.

BILINGUAL TYPICAL Skills in at least one language WNL.

BILINGUAL PLI Delay/disorder in two languages.

( e.g., Kohnert, 2010; Leonard, 1998; Schwartz, 2009)

LANGUAGE ABILITY

(Kohnert, 2010, 2013; Pham & Kohnert, 2013)

M-O-M

MONOLINGUAL PLI Delay/ disorder in one language.

Experience with & need for two languages.

Inefficiency in “doing” language. (Mom)

Degree of proficiency in eachlanguage may vary. (mOM)

Range of severity

Subtle weakness in general cognitive processing skills.

Bilingual Children with PLI • Similar to typical bilingual learners, with some key differences. • Similar to monolingual children with PLI, with some key differences. Kohnert, 2013, Figure 1.1

Phoenix, AZ

1

K. Kohnert/[email protected]

ArSHA. 4/12/2013

Plan How can we facilitate optimal communication outcomes in bilingual children with primary language impairment (PLI)?

I. Treatment Premises for Bi-PLI

When bilingualism is inherent in a child’s life circumstances, clinical actions which support gains in both languages are optimal.

I. Treatment Premises for BI-PLI II. Evidence: Treatment (Tx) Studies III. Contextual Model & Common Factors IV. Options for Multi-Pronged Action Plans

Effective treatment viewed as essential for improving language and, by extension, academic, social, emotional and vocational outcomes.

5 Reasons for treatments that support both languages in bilingual learners with PLI 1. Children with PLI can learn two languages. 2. Bilingualism is a cognitive, linguistic, social and vocational resource. 3. Successful treatment is determined by environmental demands; different environments may require different languages. 4. Language is linked to culture; strong cultural connections are linked to social-emotional well-being and academic success. 5. Building on an existing language foundation takes advantage of previous experiences: starting over can exacerbate a skill gap. (e.g., Kohnert, 2010; 2013; Kohnert & Derr, 2012; Kohnert & Medina, 2009; Peña & Bedore, 2009; Pham, 2011)

Phoenix, AZ

2

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ArSHA. 4/12/2013

4 Challenges to promoting bilingualism in children with PLI

Shift from which to how?

(1) (2) (3) (4)

Institutional & individual opposition. L1 plateau or erosion. Mismatch in client & clinician languages. Limited evidence investigating different Txs

(e.g., Ebert et al., 2013; Kohnert, 2010; 2013; Restrepo & Kruth, 2000; Restrepo et al., 2013)

(2) L1 Plateau or Erosion (alongside slow gains in L2)

(1) Institutional and Individual Opposition

Parents/Family

Expressive One Word Vocabulary Test: Raw

80

70

60

50

English (L2)

40

30

Spanish (L1)

20

Linear (English (L2))

10

0

6 yrs

7 yrs

8 yrs

9 yrs

10 yrs

11 yrs

Linear (Spanish (L1))

Kohnert, 2013, Figure 6-1

(3) Mismatch in client & clinician languages.

(4) Limited evidence investigating different Txs

US Census Bureau Highlights and Trends: 2012 Statistical Abstract. ASHA Counts for Year End 2010. http://www.asha.org/uploadedFiles/2010Member-Counts.pdf#search=%22ASHA%22

Client/ Family Factors

External Research Evidence

Clinician/ Agency Factors

• • • • •

285,797,349 US population > 5 yrs ~20 % of US population [57 million] speaks LOTE 35,000,000 Spanish-speakers 126,219 ASHA Certified SLPs 4.9% of US SLPs [5,962] bilingual; 2.1% [2,613] in Spanish & English

Phoenix, AZ

Evidence-based Practice (cf ASHA, 2005; Gillam & Gillam, 2006; Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000)

3

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ArSHA. 4/12/2013

External research evidence on Tx in Bi-PLI (Ebert, Kohnert, & Disher, 2012; Perozzi, 1986; Perozzi & Sanchez, 1992; Pham, Kohnert, & Mann, 2011; Restrepo et al., 2013; Thordardottir et al., 1997)

II. Evidence: Treatment Studies (from our lab)

Funded by US National Institute of Deafness and other Communication Disorders (R21DC010868) and National Institute of Child Health and Human Development (F31HD055113).

Effective Treatment Results in

 Learning Improvement on trained tasks, items

 Generalization Benefits beyond trained items, tasks or settings.

Using computer interface, bilingual stimuli and an English-only speaking classroom aide consulting with a bilingual SLP.

L1

L2

Cognitive Processing

Phoenix, AZ

L1

Giang Pham

L2

Cognitive Processing

4

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ArSHA. 4/12/2013

Study 1

Preschooler with PLI: Vietnamese (L1), English (L2) • 10 min/session, 2 sessions/day, 2 days/wk • In classroom by Englishonly teacher • Used computer interface & pre-recorded audio files in (a) English-only & (b) Bilingual (Viet-Eng). • DV = % of items correctly identified in each lang.

Research Questions Study 1: Does bilingual presentation facilitate or interfere with new word learning in English? Study 2: Can an EO interventionist promote new learning in Vietnamese and English? Study 3: Can this method be used to promote generalization from recently learned concepts to other picture exemplars?

(Pham, Kohnert, & Mann, 2011, LSHSS)

Study 1:

Study 2

(Pham et al., 2011)

Study 1:

Does bilingual presentation facilitate or interfere with new word learning in English?

Does bilingual presentation facilitate or interfere with new word learning in English?

Study 2:

→ Facilitates attention to task.

Study 2:

Can an EO interventionist promote new learning in Vietnamese and English?

Can an EO interventionist promote new learning in Vietnamese and English?

Study 3:

→ Yes. Receptive vocabulary gains in L1 & L2.

Study 3: Can this method be used to promote generalization from recently learned concepts to other picture exemplars?

Can this method be used to promote generalization from recently learned concepts to other picture exemplars?

→ Yes. At least in the case of receptive vocabulary.

(Pham et al., 2011)

General Language Counts

Conclusion:

Prior to Tx (age 3:11) Vietnamese:

• Feasible, in some cases, for a monolingual clinician to promote gains in the L1 as well as the L2 in preschool children with PLI through creative collaborations with bilingual colleagues and the use of technology.

– 60 expressive vocab – 1-2 word sentences

English: – 10 expressive vocab – Rote phrases

Following Tx (age 4:5) Vietnamese: – 200+ expressive vocab – 4-6 word sentences

English: – 100+ expressive vocab – 2-4 word sentences

(Pham et al., 2011)

Phoenix, AZ

(Pham et al., 2011)

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ArSHA. 4/12/2013

2 SSED Studies with School-age Children DV: Repeated Measures & Standardized Tests Tx: Nonlinguistic Cognitive Processing

L1

L2

Nonlinguistic Cognitive Processing (NCP) Tx Activities (Based on Ebert & Kohnert, 2009; Ebert, Kohnert, Disher, 2012) Speed & Attention

Kerry Ebert

Cognitive Processing

Reasoning: IF cognitive deficits contribute causally to PLI and these skills are modifiable, then treatment of cognitive processing skills should generalize to improved language outcomes.

SSED Study 1: • Subtle nonlinguistic cognitive processing (NCP) weaknesses in children with PLI (see

Two Monolingual Participants P1=8;0 & P2=7;1 Pre- & Post-Tx Standardized Test Results

Kohnert, Windsor, & Ebert, 2009; Ullman & Pierpont, 2005 for reviews).

• NCP weaknesses may underlie language deficits in PLI (e.g., Leonard et al., 2007). • 3 main areas of NCP deficit: – Speed of processing (e.g., Kohnert & Windsor, 2004; Miller et al., 2001).

– Sustained and selective attention (Ebert & Kohnert, 2011).

– Working memory (e.g., Danahy et al., 2007; Hoffman & Gillam, 2004).

• Speed of processing and attention “modifiable” in other populations (e.g., Ball, Edwards, & Ross, 2007; Cosper et al., 2010; Dye & Bavelier, 2010; Dye et al., 2009; Kerns et al., 2009; Stevens et al., 2008; Yildirim et al., 2010).

Concepts & Following Directions

Word Structure

Recalling Formulated CELFSentences Sentences 4, Core

ROWPVT

EOWPVT

P1 Pre

3

2

1

1

46

86

69

P1 Post

3

5*

1

5*

60**

92

84**

P2 Pre

3

3

1

1

48

89

73

P2 Post

4

3

3*

4*

60**

89

87**

*Change in score is outside one-tailed 95% CI ** Change in score is outside two-tailed 95% CI

(Ebert & Kohnert, 2009)

SSED Study 2:

Two Spanish-English Bilinguals: P1= 8:4 yrs & P2= 7;5 yrs

Bilingual SSED:

Repeated Measures Effect Sizes 1, 2 Task

P1

P2

Choice Visual Detection

1.67 or 0.01

1.81 or 3.46

Rapid Automatic Naming

2.30 or 3.4

0.88 or 0.90

Sentence Repetition

2.03 or 1.8

1.80 or 1.20

Nonword Repetition, English

2.06 or 1.69

1.27 or 5.5

Nonword Repetition, Spanish

2.01 or 2.3

1.12 or 3.18

1Effect

5 repeated measures tasks: Sent Rep-E; NWR-E, NWR-S, CVD-RT, RAN-RT

(Ebert, Disher, & Kohnert, 2012)

Phoenix, AZ

sizes calculated by subtracting the mean of the first three data points from the mean of the last three data points and dividing by the pooled standard deviation across all data points for each individual based on Gillam et al., 2001. 2 Effect sizes calculated using all data points after initiation of treatment, using the variance of the baseline, based on Olive & Smith, 2005. (Ebert, Disher, & Kohnert, 2012)

6

K. Kohnert/[email protected]

ArSHA. 4/12/2013

Group Study: RCT*

Kerry Ebert, PhD., CCC Rush University

L1

L2

Jill Rentmeester-Disher, MA, CCC PhD Student, UMN

Giang Pham, PhD, CCC U Mass, Amherst Bita Payesteh, MA, CCC PhD Student, UMN

Cognitive Processing

Treatment Study Collaborators!

Funded by grant to K. Kohnert from the National Institute of Deafness and other Communication Disorders (R21DC010868)

Project Coordinators • Jill Rentmeester Disher, M.A., CCC-SLP • Kerry Danahy Ebert, PhD., CCC-SLP • Bita Payesteh, M.A., CCC-SLP • Giang Pham, PhD., CCC-SLP

Research Assistants

• • • • • • Community Collaborators • • • Daniel Jakab, M.A.-SLP • • Nicole Root, M.A., CCC-SLP • • Frank Cirrin, Ph.D, CCC • Staff and speech-language pathologists at • • the following MPS elementary schools: • – Andersen • – Armatage • – Green Central • – Jefferson • • – Nellie Stone • – Ramsey

Participants

Maura Arnoldy Shana Banas, Sheila Cina Bao Dang Mary DesChamps Jasmine Egli Laura Grueber Christina Heinzen Megan Jirschle Phyllip Johnson Jennifer Johnston Malka Key Laura Kawatski Angie Luther Olivia Matthys Amelia Medina Andrea Morales Emily Rodgers Bethany St. Martin Meg Introwitz Williams

• • • • •

N= 59 Age- 5;6 to 11;2 Clinical dx c/w PLI L1= Spanish; L2=English Passed hearing screening • Scored >80 on TONI • Scored ≥ 2 standard deviations below mean on Spanish AND English CELF, EOW, ROW tests.

Technical Support

– Whittier – Windom

•

Edward Carney, PhD

Participant flow Recruitment via school SLPs.

Follow-up assessment.

Post-Tx Assessment. Repeat pre-tx battery.

Cognitive

Phone screen to determine eligibility/interest.

NCP Tx Group

English Tx Group

Bilingual Tx Group

(~18 sessions; 6 weeks)

(~18 sessions; 6 weeks)

(~18 sessions 6 weeks)

Verify eligibility with nonverbal IQ test & hearing screen.

Tx Groups quasirandomly assigned.

Pre-Tx Assessment: English, Spanish, and cognitive processing skills.

Delayed Tx group

~45 contact hours per child completing treatment.

Phoenix, AZ

Assessment Battery

3 Month Post-Tx

English

Spanish

CVD

CELF-4 (Core Subtests + RAN)

CELF-4 (Core Subtests +RAN)

(Kohnert & Windsor, 2004)

(Semel et al., 2003)

(Wiig et al., 2006)

[CFD, CRS, CFS]

[CFD, CRS, CFS]

ASM

ROW

ROW

(Windsor & Kohnert, 2009)

(Brownell, 2000b)

(Brownell, 2001b)

SSA**

EOW

EOW

(Ebert & Kohnert, 2011)

(Brownell, 2000a)

(Brownell, 2001a)

Post-test only: Parent satisfaction survey Child satisfaction survey

NWR

NWR

(Dollaghan & Campbell, 1998)

(Ebert, et al., 2008)

Narrative (story tell) (MLU, #utts, NDW, mazes etc)(Mayer, 1969; SALT)

Narrative Retell (story tell) (Mayer, 1969; SALT)

13 measures yielding > 70 potential DVs

7

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3 Treatment conditions

– – – – – – –

NCP

English

Bilingual

(n=16)

(n=17)

(n=15)

Administered by nationally certified SLP (1:2; 1:3) After school /summer school programs 75 minutes of treatment activities/session (+ break) 4 sessions/week x 5-6 weeks scheduled 3 computer activities + 3 interactive activities (5/session) Videotaped sessions to establish treatment fidelity Planned Analyses: Learning & Generalization; Absolute & Relative Group 11 in control or deferred group

NCP Tx Activities Name

Format

Description

Change1

Computer

React to appearance of target (vs. non-target) stimulus as quickly as possible. Target stimulus changes.

Scanning1

Computer

Locate targets (e.g., colors, shapes, letters) in complex arrays.

Dominoes1

Computer

Match tile symbols, rotate and align tiles within time limit.

Blink2

Interactive

Play cards that match in number, color, or shape of symbols pictured.

Bop-It2

Interactive

Complete command given via musical noise within a short time limit.

Simon Trickster2

Interactive

Replicate tone/light sequences of increasing length.

1Loutour

Multimedia/Learning Fundamentals; 2Commercially available

English Tx Activities

Bilingual Tx Activities

Name

Format

Description

Name

Format

Description

Adjectives & Opposites1

Computer

Identify new vocabulary items by name and attributes; Identify opposite attributes.

Early Classifying Games1 OR My Home, My Town2 (Sp until >80%)

Computer

Identify new vocabulary items by name and attributes; Identify opposite attributes.

Prepositions1

Computer

Identify pictures that depict prepositional phrases.

Rosetta Stone-Spanish

Computer

Firefighter Fly2

Computer

Follow directions of increasing length and complexity.

Identify pictures that depict prepositional phrases; Follow directions of increasing length and complexity.

Category Card Games3

Interactive

Categorize vocabulary items in multiple game formats.

Gram’s Cracker3

Interactive

Complete grammatical tasks including sentence completion and identification.

Plunk’s Pond3

Interactive

Name items based on description. 1Laureate, 2Earobics, 3Linguisystems

Methodological

Obstacles

Firefighter Fly (English)3 Computer

Follow directions of increasing length and complexity.

Category Card Games4,5 Interactive (Spanish-English)

Categorize vocabulary items in multiple game formats.

Gram’s Cracker4,5

Interactive

Complete grammatical tasks including sentence completion and identification.

Interactive

Name items based on description.

(Spanish) Pond4,5

Plunk’s (cognates)

1Super

Duper, 2Laureate, 3Earobics, 4Linguisystems, 5Adapted into Spanish

Methodological Obstacles:

A few examples . . . Site/ Personnel Logistics • • • •

Reconciling intense Experimental Tx with educational times. School space Interruptions- Codes (blue, yellow, red); Conferences, ETC SLPs to deliver Tx

Child attendance • Illness, vacations, competing demands • Snow days, transportation • Family stability, neighborhood crime

Measuring change • Development

• Variability in relative L1-L2 levels • Heterogeneity of bilinguals & PLI • Valid and sensitive measures/DV

Phoenix, AZ

8

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Ebert, Kohnert, Pham, Rentmeester-Disher, Payesteh, 2013

Learning Results:

e.g., Relative L1-L2 Skills by Measure & Child *youngest to oldest… 1

2

3

4

5

6

7

8

9

10 11 12 13 14 15 16 17 18

Examples only of Improvement on Trained tasks and stimuli

• Nonlinguistic Cognitive Processing Group (n=16) – Faster & more accurate in locating target responses in increasingly complex arrays – Increased length of sequences recalled (e.g., from 1-6)

CELF -SS C & FD-R SentRep-R FS-R EOWPVT-SS

*

 English-Only Language Group (n=17)

*

– Increased number of vocabulary words, prepositional phrases, grammatical morphemes identified &/or named in English. – Followed increasingly complex directions in English.

EOWPVT-R ROWPVT-SS ROWPVT-R Tot. Utts

.

MLU-W

.

 Bilingual Group (n=15)

NWR RAN

*

*

= better score in Spanish = better score in English

*

Comparable performance in Spanish & English (≤ 10% difference)

Generalization Results:

– Increased number of vocabulary words, prepositional phrases, grammatical morphemes identified &/or named in Spanish (and English). – Followed increasingly complex directions in Spanish (and English).

English (L2): Percent Change Raw Score

 Nonlinguistic Cognitive Processing Group (n=16)  Gains on 6/6 English language measures.  Gains on 4/6 Spanish language measures.  Gains on 3/3 nonlinguistic processing measures.

* *

BI *

*

 English-Only Language Group (n=17)

NWR-E CFS-E

 Gains on 6/6 English language measures.  Gains on 5/6 Spanish language measures.  Gains on 3/3 nonlinguistic processing measures.

EO *

CFD-E EOW-E

 Bilingual Group (n=15)

ROW-E

*

NCP

 Gains on 6/6 English language measures.  Gains on 4/6 Spanish language measures.  Gains on 2/3 nonlinguistic processing measures.

* 0

10

20

Spanish=L1; English= L2

Spanish (L1): Percent Change Raw Score BI

CRS-E

*

30

40

50

(Ebert, Kohnert, Pham, Rentmeester-Disher, Payesteh, 2013)

Cognitive Processing: Percent Change Scores

BI

* NWR-S

*

*

CFS-S EO

CRS-S

*

EO

CFD-S

SSA ASM

*

CVD-RT

EOW-S

*

ROW-S

NCP

NCP *

-10

0

10

20

30

40

50

(Ebert, Kohnert, Pham, Rentmeester-Disher, Payesteh, 2013)

Phoenix, AZ

-10

0

10

20

30

40

50

(Ebert, Kohnert, Pham, Rentmeester-Disher, Payesteh, 2013)

9

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Ebert et al., 2013

Clinical Extensions of RCT (actions we could not take

Results Summary:

in a controlled experimental design, but would do in “real life” SLP work)

• Absolute Change: – Learning: participants improved on trained tasks/stimuli/activities in each of the 3 conditions. – Generalization: improvement within & across languages & domains for each Tx condition on some measures. – Cross-domain & cross-language generalization bidirectional.

• Relative Change: – – – –

ArSHA. 4/12/2013

English (L2) Tx : > English & NCP change Bilingual Tx: > Spanish change Spanish gains were smaller than English gains in all 3 conditions Few between-condition comparisons reached statistical significance

1. Combine approaches 2. Individual adaptations 3. Link Tx targets to academic lessons 4. Develop home program 5. Enlist partners/tools for “other” language 6. Additional information for parents, teachers 7. SLP mediated discussion groups &“metalanguage” use

NOTE: Analyses still in progress for narratives, 3 mo f/u, PLI severity/L1-L2 proficiency influences, effect of differences in age or sessions attended (13-24) etc.

III. Contextual Model and Common Factors

The Great Psychotherapy Debate (Wampold, 2001) or

Why does treatment work? Treatment A

Treatment B

SPECIFIC INGREDIENTS Medical Model

COMMON FACTORS Clinician, Client, Relationships, Beliefs, Structure Contextual Model (see Imel & Wampold, 2008; Wampold, 2001)

Percent of improvement in psychotherapy patients as a function of therapeutic factors Extratherapeutic Change Techniques

Common Factors Expectancy

15% 40%

Gillam et al., 2008, JSLHR Efficacy of FFW-L Intervention in School-Age Children with LI: A RCT

• RCT, N= 216; 6-9 y.o. • Summer camp 5- 3.5 hour sessions/week x 6 wks • Data collection: pre-tx, post-tx, 3 mo post, 6 mo post (CASL, Token, backward masking, word blending) • Four Therapy conditions plus supervised snack, board games, art, outdoor activities with similar-ability peers.

15%

30% FFW-L

CALI

ILI

Control AE

Recreated from “Psychotherapy Outcome Research: Implications for Integrative and Eclectic Therapies,” by M.J. Lambert, 1992 in Norcross & Goldfried (Eds.), Handbook of Psychotherapy Integration (p.97). Reproduced in Wampold, 2001.

Phoenix, AZ

10

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Condition

Time

SS

CALI

Pretest

79.0

*64.8%

Posttest

83.4

**54%

3 months

84.9

6 months

86.3

FFW-L

Pretest

78.0

*59.3%

Posttest

83.0

**59%

3 months

83.8

6 months

85.2

ILI

Pretest

80.8

*75.9%

Posttest

85.7

**69%

3 months

87.8

6 months

89.9

AE

Pretest

78.2

*70.4%

Posttest

82.1

**54%

3 months

83.8

6 months

86.2

Indirect evidence #1: Clinician Factor in SLP Tx • Rvachew & Nowak (2001) compared phonological tx outcomes & reported results for individual SLPs. • Reanalysis of reported data showed differences by SLP as well as Tx (Ebert & Kohnert, 2010).

Perspective:

Clinician Factor • In psychotherapy, some clinicians are consistently more effective than others in producing positive outcomes, all else being equal, accounting for ~6 to 9 % of variance (Wampold, 2001). • If this is also the case in SLP, understanding SLP “success factors” could help improve outcomes for all. • Another factor to think about and exploit in Tx. • SLP effectiveness not yet directly investigated . . . . . .

(Ebert & Kohnert, 2010)

Indirect Evidence #2: Survey Top 10 Clinician Factors Selected as Positively Influencing SLP Treatment Outcomes Clinician Factors

1 2

Clinician’s rapport with client. How well clinician places therapy in a functional context.

3 4

Communication between clinician and client. Clinician’s willingness to change intervention goals and activities.

5

Clinician’s theoretical framework for understanding the disorder.

6

Extent of communication betweentoclinician and & client’s family.relationships. 1. Ability establish maintain

8

2. Ability treatment meaningful. Degree to which clinician followsto themake principles of evidence-based 3. Use of frameworks for problem-solving. practice. 4.reconsiders Interest &the flexibility demonstrated in tx process. How often the clinician client’s progress.

9

Amount of motivation clinician has for treating this particular client.

10

Clinician’s creativity.

7

Note. Survey respondents were 158 speech-language pathologists (SLPs) presented with a list of 25 clinician factors (generated by another group of SLPs) who were instructed to “choose three that you think have the greatest power to positively influence therapy outcomes” (Ebert & Kohnert, p.146). Survey source: K.D. Ebert and K. Kohnert (2010), Common factors in speech-language treatment: An exploratory study of effective clinicians in Journal of Communication Disorders, 43, 133-147.

Common factors in Bilingual 3 Tx Study

Embrace BOTH common factors and theoretically-motivated specific techniques in treatment plans to optimize positive outcomes. 1. Systematic: structured, scripted 2. Small group (2-3): camaraderie & competition 3. Clinicians: Knowledgeable, skilled, caring professionals 4. Client/Family “buy in” (See Wampold, 2001 for “Common Factors” discussion in Psychotherapy; see Kohnert, 2013 and Ebert & Kohnert, 2010 for applications to SLP)

Phoenix, AZ

11

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Essential Components of Effective Intervention Plans Common Factors Theoreticallymotivated & empirically validated procedures.

IV. Options for multi-pronged action plans

Tools & Activities

Structuring Treatment to promote learning & generalization in bilingual PLI

Figure 7.1 Bilingual Treatment

E n v i r o n m e n t

Meta-systems & Overlapping structures & functions

L1 Structures & Functions

L2 Structures & Functions

Underlying Cognitive Systems & Functions

www.latinamericalinks.com/Spanish_cognates.htm • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

SPANISH COGNATES LETTER- A RETURN TO COGNATESSPANISHWORDOFTHEDAY.COMabandon - abandonarabdicate - abdicar abnormal - abnormal abolish - abolir abolition abolición abominable - abominable abolish - abolir abound - abundar abrupt - abrupto absolute - absoluto abolutely -absolutamente absorb - absorber abstain - abstener se abstraction - abstracción absurd - absurdo abundance- abundancia abundant - abundante abunantly - abundantemente abuse(n) abuso abuse(v) abusar abyss - abismo academy-academia accelerate-acelerar accent- acento accentuate-acentuar accept-aceptar acceptance - aceptación access - acceso accessory-accesorio accident -accidente accord(n)-acuerdo accuse-acusar acquire - adquirir act -acto active - activo actor- actor actress - actriz actuary - actuario adapt- adaptar adhere-adherir

Washington Learning Systems

Talking and Books and Talking and Play. Available in English, Spanish, Korean, Vietnamese, Mandarin, Filipino. Each version features parents and children who are native speakers of each language. All versions of Language the Key programs are available in (see Kelley &isKohnert, 2012, LSHSS) DVD and VHS format. www.walearning.com/

Phoenix, AZ

Meta-systems & overlapping E structures (e.g., compare & n contrast features, translation v tasks, organization & discourse; i communication strategies; r L1 L2 cognates) o Language-specific features Language-specific features n (e.g., at sound, word, syntax, discourse m levels directly or collaborating with e partners using software etc) n t (e.g., Family education Cognitive Processing Mechanisms or training, listening (e.g., Attention to auditory & visual details; timed enhancements (noise tasks & memory activities e.g., Learning reduction),favorable Fundamentals & Earobics software, Blink; Eye Spy; seating or placement, Uno; Simon Trickster, Luminosity) Professional devel. etc)

SLPs: Agents of Change

“Do it” or “cause it” to be done Indirect as well as direct approaches to facilitating language, in general, & “a language” in particular may be used.

12

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ArSHA. 4/12/2013

Figure 6.1 Direct and Indirect Actions to Improve Communication Outcomes Professional Actions

Partners

Focused on

Advocate

Client with PLI

English/School language

Educate, inform

Class, Group

Other Language

Facilitate change

Peers, siblings

Intersection of L1/L2

Mediate interactions

Software, Internet

Environment

Plan, organize, select, supervise

Colleagues, teachers, allied professionals, administration

Academic, Social, Vocational, Personal

Teach, train, mentor, monitor Parents, care providers, family & community Identify, recommend members, assistants resources

Cognitive underpinnings

And for language-matched bilingual SLPs: • Expanded role – Consultants and mentors to SLP colleagues, – Develop/disseminate materials in other languages – implement parent/family education programs – Monitor outcomes in the “other language” of programs implemented by monolingual colleagues – Provide exquisite direct services in other language. – Engage in professional development (Restrepo & Gray, 2012)

Summary

5 General ways to support the other language in cases of client-clinician language mismatch: 1. Communicate the “Why Bi?” 2. Exploit common factors 3. Expand opportunities for other language with indirect methods. 4. Provide direct training in areas of potential generalization. 5. Use theoretical frameworks, service delivery models & empirical evidence to support diverse actions in a multi-pronged plan.

How We can facilitate optimal communication outcomes in bilingual children with primary language impairment (PLI). . . even when we do not speak both of the child’s languages. SLP support may be direct or indirect but must be systematic and explicit.

Thank you!

Note on references Summary information from Kohnert, K. (2013). Language Disorders in Bilingual Children and Adults (2nd edition). San Diego, CA: Plural. Citations for primary sources and noted separately throughout presentation.

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