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Speech and Language Therapy Services for Multilingual Children with Migration Background: A Cross-Sectional Survey in Germany

  • Hochschule Bremen - City University of Applied Sciences

Abstract and Figures

Speech, language, and communication needs are particularly common among multilingual and migrant children. More than every third child in Germany has a migrant background. In the city of Bremen, this figure is even higher, including refugee children. The availability of comprehensive data on the provision and uptake of speech and language therapy (SLT) services is still inadequate, especially for multilingual children. However, health-monitoring programs report that migrants differ in many health-related areas from the majority population, mainly in barriers in health care. This study examines the current provision of SLT services for multilingual children following a medical prescription for the specific case of suspected language disorder. Information was obtained from speech-language pathologists (SLPs) representing 28 practices in different districts across one of the moderately largest cities affected by sociospatial polarization. The SLT practices were clustered according to the proportion of minor migrants and minor welfare recipients in the district. The survey included the number and proportion of multilingual children on the SLT caseloads, as well as the age of children by time of referral, physician and SLP diagnoses, application and type of assessment materials, intervention goals, and sociodemographic data of practicing SLPs. Questionnaire responses were analyzed using descriptive statistics and an explanatory interpretive approach. Findings suggest that multilingual children experience later referral compared to monolingual German-speaking children, with approximately half of the multilingual children demonstrating a developmental language disorder (DLD). The SLP’s level of experience determines the accuracy of differential diagnosis between communication disorders and typical linguistic variations. Consequently, participation in continuing education focusing on service provision of the multilingual and multicultural clientele is essential. This study highlights the obstacles and the needs for increased multiprofessional awareness and an enhanced professional knowledge to provide effective and swift diagnosis earlier to allow multilingual children with a DLD to access relevant services on equal terms with native resident children.
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Research Article
Folia Phoniatr Logop 2019;71:116–126
Speech and Language Therapy Services for
Multilingual Children with Migration Background:
A Cross-Sectional Survey in Germany
Wiebke Scharff Rethfeldt
Hochschule Bremen, City University of Applied Sciences Bremen, Bremen, Germany
Received: March 7, 2018
Accepted: November 18, 2018
Published online: May 14, 2019
Prof. Dr. Wiebke Scharff Rethfeldt
Head of Applied Therapeutic Sciences, Speech and Language Therapy, Faculty 3
Social Sciences, Hochschule Bremen, City University of Applied Sciences Bremen
Neustadtswall 30, DE–28199 Bremen (Germany)
E-Mail w.scharff.rethfeldt @
© 2019 S. Karger AG, Basel
DOI: 10.1159/000495565
Speech and language therapy service provision ·
Multilingual children · Misdiagnosis · Diversity ·
Socioeconomic status · Developmental language disorders
Speech, language, and communication needs are particu-
larly common among multilingual and migrant children.
More than every third child in Germany has a migrant back-
ground. In the city of Bremen, this figure is even higher, in-
cluding refugee children. The availability of comprehensive
data on the provision and uptake of speech and language
therapy (SLT) services is still inadequate, especially for mul-
tilingual children. However, health-monitoring programs re-
port that migrants differ in many health-related areas from
the majority population, mainly in barriers in health care.
This study examines the current provision of SLT services for
multilingual children following a medical prescription for
the specific case of suspected language disorder. Informa-
tion was obtained from speech-language pathologists (SLPs)
representing 28 practices in different districts across one of
the moderately largest cities affected by sociospatial polar-
ization. The SLT practices were clustered according to the
proportion of minor migrants and minor welfare recipients
in the district. The survey included the number and propor-
tion of multilingual children on the SLT caseloads, as well as
the age of children by time of referral, physician and SLP di-
agnoses, application and type of assessment materials, inter-
vention goals, and sociodemographic data of practicing
SLPs. Questionnaire responses were analyzed using descrip-
tive statistics and an explanatory interpretive approach.
Findings suggest that multilingual children experience later
referral compared to monolingual German-speaking chil-
dren, with approximately half of the multilingual children
demonstrating a developmental language disorder (DLD).
The SLP’s level of experience determines the accuracy of dif-
ferential diagnosis between communication disorders and
typical linguistic variations. Consequently, participation in
continuing education focusing on service provision of the
multilingual and multicultural clientele is essential. This
study highlights the obstacles and the needs for increased
multiprofessional awareness and an enhanced professional
knowledge to provide effective and swift diagnosis earlier to
allow multilingual children with a DLD to access relevant ser-
vices on equal terms with native resident children.
© 2019 S. Karger AG, Basel
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SLT Services for Multilingual Children
with Migration Background
Folia Phoniatr Logop 2019;71:116–126
DOI: 10.1159/000495565
The Changing Demography of Migrant Populations
A changing demography and structural changes con-
tinue to provide the framework for the working field of
speech and language therapists (SLTs) in Germany,
where migration has a major impact on assessment and
intervention. Germany has experienced large-scale im-
migration since World War II. In 2016, Germany’s total
population was estimated to stand at 82.5 million, with
a growth of 1.14 million people or +1.2% within 1 year
due to immigration from diverse countries. The migrant
proportion of the population reached 22.5% [1]. The
proportion of children aged under 10 years with a mi-
gration background has grown to more than one third
of the overall population, and in some urban areas the
figure is more than 50% [1]. The term “migration back-
ground” officially does not only focus on immigrants as
such but includes certain descendants who were born in
Germany as well. It is important to differentiate between
citizenship and migration background, as only about
half of these people possess foreign citizenship. Al-
though Europe continues to be the most important re-
gion of origin, other continents, especially Africa, have
become more important with regard to immigration
over recent years.
Migration has led to a high variety of cultural and lin-
guistic diversity. Migrant and refugee children grow up
with multiple and opaque experiences concerning the
patterns of exposure, attrition, or change of languages in
their environment. This variability is due to linguistic di-
versity among caregivers, change of caregivers, change of
habitat, and the quantity and quality of exposure over
time. Consequently, using the standard terminology of
simultaneous and sequential bilingualism to refer to the
age of exposure is considered inappropriate as this may
lead to incorrect assumptions and interpretations [2].
Not claiming to explore the myriad of terminological is-
sues of bilingualism and multilingualism, bilingual (in-
cluding multilingual) children may be broadly defined
following the Royal College of Speech and Language
Therapists’ (RCSLT) definition as “individuals or groups
of people who acquire communicative skills in more than
one language … with varying degrees of proficiency, in
oral and/or written forms, in order to interact with speak-
ers of one or more languages at home and in society …
regardless of the relative proficiency of the languages un-
derstood or used” [3, p. 268]. With regard to this study,
the terms bilingualism and multilingualism are being
used interchangeably.
Although people with a migration background, in-
cluding second or third generation migrants, may differ
culturally and linguistically, most share a common char-
acteristic of continued disadvantages compared to those
without a migrant background in terms of education,
participation, and income [1]. The language use of people
with a migration background varies. Even many adults
lack standard or even minimally proficient German,
which is argued to be one of the major obstacles to their
integration. Thus, second or third generation migrant
children are exposed to German less frequently and they
often lack proficiency when they enter school [4, p. 17].
The high and growing number of persons with a migrant
background among the younger populations entails new
challenges for health care service institutions as well as
preschool and school education settings in large cities.
The needs of health care will increase according to the
significant growth of the population in Germany. This
will result in higher numbers and demands associated
with a greater number of multilingual children in SLT
caseloads [5, 6].
The Challenge of Differential Diagnosis
The cultural and linguistic diversity of the current
population living in Germany presents clinicians with
new issues [7]. Multilingual, especially migrant, children
with speech and language difficulties are presented in var-
ious areas of the health, social, and educational systems.
However, these systems differ in their organizational
structures and in understanding and list of measures con-
cerning children with speech, language, and communica-
tion needs (SLCN). Health and education systems in Ger-
many are structurally separated, making communication
and collaboration more difficult. Speech-language pa-
thologists (SLPs) working in outpatient practice require
a prescription for assessment and intervention from a
medical doctor. Consequently, this requires the coopera-
tion of medical individuals. Clinical assessment and in-
tervention is not offered in daycare centers and schools.
Thus, these children may not receive adequate support
for their needs.
The distinction between differentiating typical from
atypical language development may not occur reliably, as
there may be multilingual children who have SLCN, a
term that is largely associated with insufficient experience
with a new language [8]. In contrast, some children may
present with a developmental language disorder (DLD) or
language disorder associated with a known biomedical
etiology. These children are likely to experience lifelong
difficulties with their communication skills if not receiv-
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Folia Phoniatr Logop 2019;71:116–126
DOI: 10.1159/000495565
ing therapeutic intervention. Learning a new language
generally does not cause language problems. Thus, multi-
lingual children should not be more or less likely to have
a DLD in comparison to the monolingual population [9].
So far, data on the incidence and prevalence of language
disorders in the German population are missing. Interna-
tional epidemiological surveys converge in estimating the
total population prevalence of language disorders at 9.92%
[10] and the prevalence of DLD to be around 7% [11, 12].
However, as current prevalence estimates are based upon
the general population in the UK and the USA, these find-
ings must be regarded with caution, given the lack of reli-
able data on incidence and prevalence of language disor-
ders in the culturally diverse population in Germany.
The identification of a DLD is particularly challenging
in multilinguals [11], as educational and clinical profes-
sionals are not fully familiar with multilingual children
with language disorders. This places multilingual children
at risk for misdiagnosis and interventions, such as early
intervention focusing on educational achievement instead
of individual therapy. There is still an insufficient number
of qualified multilingual clinicians, and a lack of system-
atic diagnostic tools, as standardized tests are generally
biased in favor of individuals from the majority culture.
This especially accounts for multilingual children with
suspected DLD as language difficulties are not associated
with a known biomedical condition [13]. Since there is no
robust normative data for the tremendously diverse popu-
lation of multilingual children, there is a higher risk that
language assessments may overidentify, but also underi-
dentify, or misidentify multilingual children [14].
Current literature recommends that clinical approach-
es and assessment in multilingual children should be
based on data collected from a variety of sources [15].
These include results from application of criterion-refer-
enced measures [16], language-processing measures [17,
18], dynamic assessment [19] integrated within sociocul-
tural approaches [20], as well as detailed ethnographic
information. Moreover, applied clinical reasoning strate-
gies for choice of methods and interpretation of results
need the clinician to possess intercultural competencies
[21]. Although assessment procedures with multilingual
children have been well described, the realities of practice
are still very different from the suggested evidence-based
Decrease in Medical Prescriptions for SLT
The proportion of young people with a migration
background has dramatically increased since 2014. None-
theless, the rate of children and adolescents who receive
SLT has slightly decreased [22]. There are marked region-
al differences in prescription rates and therefore in utili-
zation of SLT services. While the national average pro-
portion for children aged less than 14 years was 12%, only
10% of the insured children in the state of Bremen have
seen an SLT, with DLD being the most frequent diagnosis
[22, p. 33]. It is also noteworthy that, compared to chil-
dren without a migration background, migrant children
consult a pediatrician significantly less often [23].
Statement of Problem
Numerous studies have shown that the population
with a migrant background has a higher risk of poverty
compared to native Germans, even if holding citizenship
[24]. The link between financial poverty and health status
and well-being has also been demonstrated in several
studies [6]. In addition, research on access to health care
services and preventive behaviors suggests that inade-
quate language skills in children may aggravate existing
health problems at the age of 6 years and lead to cumula-
tive health and social disadvantage [7]. Understanding
how multilingualism and socioeconomic status (SES) in-
teract in immigrant societies with diverse competencies
in health care and education systems, and how this may
enhance the risk of misdiagnoses, remains a major chal-
Study Objectives
With reference to the repeatedly discussed migrant-
specific issue of access to health care services in relation
to SES, the MeKi-SES project (Mehrsprachige Kinder mit
Sprachentwicklungsstörung; “Multilingual Children with
Developmental Language Disorder”) was initiated. Since
access to SLT in Germany requires a medical prescrip-
tion, the main objective of the study was to determine
which factors place multilingual children at a higher risk
of a lack of access to SLT provision. This study examines
the current provision of SLT services for multilingual
children following a medical prescription for the specific
case of suspected language disorder. To identify those
multilingual migrants at risk of developing a language
disorder and to assist with the assessment and treatment
of multilingual children in general, the present study fo-
cused on multilingual children undergoing SLT. Conse-
quently, specific aims of the study were to (a) to collect
sociodemographic data on SLPs offering services to mul-
tilingual children including sociospatial information, (b)
to establish data on the referral of multilingual children
to SLT services in outpatient caseloads, (c) to determine
which measures are used when assessing multilingual
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SLT Services for Multilingual Children
with Migration Background
Folia Phoniatr Logop 2019;71:116–126
DOI: 10.1159/000495565
children with suspected language disorder, and (d) to
gauge SLTs’ opinions and estimates regarding their
framework conditions relevant for multilingual and mi-
grant children.
Research Design
A cross-sectional survey was conducted in the German city of
Bremen, where the proportion of people with a migrant back-
ground was 29.4% [25]. This urban setting is characterized by so-
ciospatial segregation, resulting in a division into identifiable areas
distinguished by poverty rates (including child poverty in house-
holds defined by welfare recipient status) and by the proportion of
the population that are migrants.
Between May and July 2016 all listed SLT practices across the
city of Bremen were contacted using the telephone directory and
online practice portal. Approximately half of the advertised prac-
tices were no longer offering SLT services. The recruitment crite-
rion was that the practice had to include at least one SLP, speech
therapist, clinical linguist, or a state-certified breath, speech and
voice teacher – all professions that fulfill the approval require-
ments of the national health insurance agency to offer SLT ser-
vices to the general public. Provision of specialized services to mul-
tilingual patients was not required. In sum, data of 30 SLT prac-
tices were collected. Two SLT practices reported that they are
specialized in working with an elderly population exclusively, so
they were excluded from this study. Since this study focuses on
services for children, further findings are based on data from the
remaining 28 SLT practices.
Questionnaire Development
The data were collected by means of questionnaires. The con-
tent of the survey was developed through focus groups with seven
SLPs from diverse SLT practices across the city to determine their
practice settings, who were recruited following their participation
at a regional association meeting. Questions to be included were
devised on the basis of a literature review [3, 7, 20, 23] and in-depth
interviews. This produced a pilot version of the instrument which
was tested by an additional five SLPs in diverse SLT practices out-
side Bremen, and then revised by a group of six SLPs who work
part-time and continue their studies at the City University of Ap-
plied Sciences Bremen. Analysis of the responses and feedback re-
garding clarity and ambiguity of the questions resulted in a final
refinement, and the survey required approximately 45 min to com-
plete. Financial compensation was offered, equivalent to the stan-
dard fee for one therapy unit per practice.
Data Collection Procedures
The final version of the questionnaire was fully completed on-
line or by mail after individual consultation with regard to the pre-
ferred version. The questionnaire was available for a 10-week pe-
riod. The final sample for analysis of SLT provision for multilin-
gual children was analyzed using descriptive statistics (SPSS v24).
All practices were clustered according to their location, taking into
account the mean sociospatial values of the proportion of welfare
recipient households with children and the proportion of minors
with migrant background in their area. Quantiles were used as cut
points, dividing the city-wide probability distribution into four
equal-sized groups and creating the termed quarters A–D, in order
to apply the aforementioned proxy indicators of migration and
Sociodemographic Data of Clinicians
Data from submitted questionnaires of 30 SLT prac-
tices represented 72 clinicians with a mean age of 47 years
(SD = 7.7), while most (74%) of the surveyed clinicians
were 51 years of age or older. They had a mean of 17 years
of professional experience (SD = 7.3). In one third of the
practices surveyed, service is offered by one clinician
only. All surveyed practices have been established for at
least 3 years, while the majority (52%) of the practices
have been offering services for more than 15 years. Two
practices reported that they are specialized in working
with an elderly population exclusively, so they were ex-
cluded from the study. Since this study focuses on ser-
vices for children, further findings are based on data from
the remaining 28 SLT practices.
Nearly half of the surveyed SLT practices (47%) re-
ported that they use German exclusively to make contact
for intervention including consultations, informed con-
sent discussions, and education talks with caregivers. An-
other 44% of the clinicians said that they use English
when assessment and intervention is not possible in Ger-
man. In 3 of the practices, one of the clinicians also speaks
Russian, Turkish, or Polish with their patient and/or care-
givers. More than half of the respondents (57%) said that
they had received additional education or attended a
training course in the field of childhood multilingualism.
Sociospatial Location
SLT practices from all sociospatial areas were includ-
ed in this study (Fig.1, 2). With the city-wide proportion
of the migrant population in the under 18 age group
standing at 53.3% [25], the average number of children
with migrant background in the surveyed practices is
49% and is therefore similar. Also, the practices can be
assigned to areas in which the proportion of welfare re-
cipient households with children under 15 years is on
average 24%, only a bit less than the city-wide share of
29% [25].
Taking into account the sociospatial polarization of
the city by the variables (1) proportion of the migrant
population aged under 18 (MPOPu18) and (2) propor-
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Folia Phoniatr Logop 2019;71:116–126
DOI: 10.1159/000495565
tion of welfare recipient households with children aged
under 15 (WRHCu15), the participating SLT practices
were clustered into four district groups (Table 1). This
allocation was made in accordance with the city-wide
average [25]. In examining Table 1, it can be seen that,
for example, district A is characterized by a higher rate
of migrant children and a higher rate of welfare recipi-
ent households with children compared to the city aver-
Patient Cohort
The proportion of multilingual children with migrant
background in SLT practices (n = 635) corresponds, with
minor exceptions, to the proportion of minor migrants of
the SLT practice’s district. Based on the group of patients
by district, a slight to moderate correlation was revealed
(Cramer’s V = 0.37). Thus, the proportion of multilingual
children in such practices that are assigned to district
group A is significantly higher than those of district group
B. Overall, SLT practices have on their caseloads from
26% up to 86% multilingual children, depending on the
demographic composition of their neighborhood. There
was a moderate relationship (Cramer’s V = 0.25) between
the number of multilingual children at the time of the
survey present in SLT practices and the proportion of the
migrant population aged under 18 (districts A and C).
Out of all 28 SLT practices assessed, referrals for mul-
tilingual children to SLT are received from various medi-
cal doctors. All (100%) receive referrals from a pediatri-
cian, while many practices receive referrals from an ear-
nose-throat specialist (79%), an orthodontist (79%), a
phoniatrician (60%), a dentist (50%), and others such as
general practitioners (25%). The respondents indicated
that the mean age on referral was 4.3 years for monolin-
gual children, whereas the referral of multilingual chil-
dren was made 3 months later (mean age 4.6 years). Sig-
nificant gender differences were identified (p = 0.018).
Thus, the proportion of multilingual boys was almost
SLT practice
No data
Fig. 1. The sociospatial distribution of surveyed SLT practices across the city according to the proportion of the
migrant population aged under 18 (city average: 53.5%).
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SLT Services for Multilingual Children
with Migration Background
Folia Phoniatr Logop 2019;71:116–126
DOI: 10.1159/000495565
twice as high, with an average number of 12 male versus
7 female multilingual children per SLT practice.
Among the surveyed SLT practices, 93% reported that
multilingual children were referred with a report of “lan-
guage disorder before completion of language develop-
ment” (SP 1). Half of the practices reported to receive
referrals of multilingual children for a (co-occurring)
“speech sound disorder” (SP 2). In addition, 40% of the
SLT practices’ caseloads of separate referrals for multilin-
gual children were for “fluency disorders” (RE 1).
SLT practice
No data
Fig. 2. The sociospatial distribution of the surveyed SLT practices across the city according to the proportion of
welfare recipient households with children aged under 15 (city average: 29%).
Table 1. Clustering of the surveyed SLT practices into four district groups according to their location with regard
to the sociospatial variables of the proportion of the migrant children population and the proportion of welfare
recipient households with children
District group
Criteria according to city-wide average >MPOPu18
SLT practices, n9 16 3 2
MPOPu18, proportion of the migrant population aged under 18; WRHCu15, proportion of welfare recipient
households with children aged under 15.
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Folia Phoniatr Logop 2019;71:116–126
DOI: 10.1159/000495565
Assessment and Intervention
Upon referral of multilingual children with a suspected
DLD, clinicians reported on a multiple response question
that they used a broad range of assessment procedures.
Almost all of the surveyed clinicians (96.4%) reported
their primary assessments included observation and lan-
guage sampling from different settings such as spontane-
ous conversation or play. Most SLPs (92.8%) used pre-
assessment information by interviews on sociocultural
factors and language use and took case history informa-
tion in free conversation with accompanying caregivers.
More than a third (35.7%) of the clinicians used support
from interpreters or language mediators, while 19% of
them used questionnaires in diverse languages. When as-
sessing a multilingual child, 35.7% of the clinicians used
informal measures and 28.6% used German monolingual
norm-referenced standardized measures only; 35.7% of
the surveyed clinicians reported using a combination of
diverse approaches. Half of the SLPs (50%) used case his-
tory information compiled by a third party (e.g., kinder-
garten teacher following guardian’s consent), and 28.6%
used multi-professional reports in order to derive an SLT
diagnosis upon assessment of multilingual children.
It was reported that medical and SLT diagnoses were
not always congruent. In the case of the multilingual chil-
dren who were referred with the physician’s diagnosis of
a DLD, 57% were not treated for this after the SLP identi-
fied that they did not present with a language disorder.
Instead, the clinicians reported that they judged a need
for language support mostly due to a lack of knowledge
of German. In those cases where intervention with mul-
tilingual children had targets that differed from the med-
ical referral reason, 61% of the SLPs diagnosed other fun-
damental or more relevant disorders. As another reason
for their different treatment focus, 29% of the clinicians
explained that they found parental training was the prior-
ity need. Only 7% of the SLPs stated that they would al-
ways treat according to the medical indication. There was
a weak relationship between the number of clinicians
working in a practice and the critical examination of
medical indication (Cramer’s V = 0.20), that is, clinicians
in practices allowing team meetings to reflect upon clini-
cal decision making compared to one-person SLT prac-
tices. In particular, the establishment of a requirement for
language support contrary to a medical indication of a
DLD was disproportionately reported by the 2 SLT prac-
tices established in district D, that is, in an environment
containing a population with a migrant background be-
low the city-wide average but above average in terms of
the proportion receiving welfare.
SLP Assessment of the Child’s Needs
About half of the SLP respondents (53%) agreed, some
even strongly agreed (13%), while some disagreed (20%)
that the number of therapy sessions prescribed by the re-
ferral agent was sufficient for the multilingual children
with migrant background and DLD. Only a few clinicians
(13%) were undecided. Many clinicians also rated the
particular risk of an educational disadvantage for these
children as very high (60%) or high (23%), while others
rated the risk as either average (10%) or low (7%). The
majority of clinicians considered the prediction that mul-
tilingual children with migrant background and DLD
face social problems and are at a high risk of stigmatiza-
tion as high (30%) or very high (47%), while others rated
the risk as either average (17%) or low (7%). Overall, 40%
of respondents assessed access to treatment options for
multilingual children with a DLD as currently being un-
satisfactory, while 33% considered options as satisfactory,
and 13% rated the available options as very satisfactory;
another 13% were undecided. Overall, most of the re-
spondents rated the availability of consultation and edu-
cation information for caregivers of multilingual children
with migrant background and DLD to support SLT ser-
vices as being low (38%) or moderate (45%), while few
clinicians considered the availability of patient informa-
tion as either high (8%) or not at all (8%).
In the present study, the provision and uptake of SLT
services for multilingual children with migration back-
ground in a setting characterized by sociospatial segrega-
tion were analyzed for the first time, thus providing pre-
liminary insights into SLP caseloads. This helps us to
identify whether multilingual children are put at a higher
risk of not receiving appropriate SLT assessments and in-
terventions. The survey was developed to collect sociode-
mographic data on clinicians offering services to multi-
lingual children and to establish data on this patient pop-
ulation in SLT outpatient practices. In addition, the study
aimed to determine SLP practices with multilingual chil-
dren, to identify their typical assessment approaches, and
to understand the reasons for the occurrence of misdiag-
nosis and/or inappropriate case management. Finally, it
aimed to gauge the opinions of SLPs and estimates in re-
lation to their working situation.
Due to the lack of findings from comparative surveys
as well as documentation in published databases, the re-
sults presented here still need to be replicated in further
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SLT Services for Multilingual Children
with Migration Background
Folia Phoniatr Logop 2019;71:116–126
DOI: 10.1159/000495565
research. Since the city of Bremen has such a high level of
children with a migrant background (53.3%) [25], and
since the sample in this case study represents at least half
of all outpatient SLT practices established across the city
of Bremen, the reported results can be considered to be
broadly reflective of the national situation of urban mi-
gration in Germany.
The sociodemographic data of the clinicians in this
study show that the majority of the SLPs currently serving
the pediatric population are likely to retire from the work-
force before 2025. This finding is similar to estimates
based on surveys of the total workforce, in particular sec-
ondary services, which revealed similar demographic
trends leading to imminent shortages of skilled profes-
sionals in the health care sector [26]. Possible explana-
tions for the low number of younger SLT employees in-
clude less attractive working conditions, such as low wag-
es, and the high proportion of women experiencing
incompatibility between family and work. In contrast to
other member states of the European Union, SLT in Ger-
many is not yet a fully academically qualified occupation.
Consequently, as the data show a clear tendency towards
a decreasing SLT provision in general, this will addition-
ally impact on the multilingual and migrant population.
It can be seen that the surveyed SLT practices map the
sociospatial area well, since half of the practices are lo-
cated in districts where both the proportion of welfare
recipient households with children and the proportion of
the child migrant population are above average. This
sociospatial polarization based on the factors of poverty
and migration background is considered an appropriate
proxy indicator for variability in the uptake of SLT ser-
vices. The gender composition of multilingual children
with a language disorder present in the surveyed prac-
tices is in line with international prevalence estimates
[11]. The current findings confirm the moderate support
for a greater rate of language disorders among males than
females, although it is important to bear in mind the pos-
sible bias as samples do not represent incidence but prev-
alence on SLT caseloads. Overall, a high proportion of
multilingual children with migrant background on SLT
caseloads were revealed. The referred proportion seems
to be appropriate in relation to their representation in the
local population. However, in comparison to their mono-
lingual peers, multilingual children experience later re-
ferral of 3 months, a noteworthy delay in this preschool
age group. The later referral may be attributable to diverse
reasons. As previous studies identified an interaction be-
tween SES, migrant background, language differences,
and access-resource barriers [7, 23], it is likely to result
from language barriers and a disparity of access to medi-
cal care and subsequently prescribed SLT assessment and
intervention. As another possible reason, it cannot be
ruled out that a later referral due to belated appearance is
an expression of a previously recognized underdiagnosis
by the physician or related to a type of compensation. A
closer examination of disparities, including collecting,
analyzing, and monitoring ethnic and also language data
on all compulsorily national health care-insured chil-
dren, is needed to disentangle these compounding fac-
tors. This also accounts for the diverse medical profes-
sions that prescribe SLT, which need to be taken into ac-
count in order to enhance multiprofessional collaboration.
The necessity for a close collaboration between medical
doctors and SLPs aiming at providing better care be-
comes evident in incongruent diagnoses of physicians
and SLPs. Hence, only a very small portion of clinicians
treat multilingual children irrespective of their own diag-
nostic findings, and more than half of the surveyed clini-
cians, in defiance of the previous medical diagnosis of a
language disorder, found lack of language skills following
a comprehensive SLT assessment instead. On the one
hand, this may indicate a medical overdiagnosis and/or
on the other hand, an expression of confidence in SLT
differential diagnosis competences and assessment pro-
cedures in order to confirm, specify, or reject the medical
diagnosis of prescription as to an early time as possible.
The current findings rather confirm the latter, thus indi-
cating the notion of a collaborative model, as exchange
and transfer of knowledge between those who require this
information seems to occur. However, it remains unclear
whether this collaboration is incidental or intentional.
In agreement with the best practice recommendations
of the literature [15, 19, 27], most surveyed clinicians con-
firmed to use a variety and combination of diverse assess-
ment methods to obtain the most complete assessment
information, such as spontaneous speech samples in all of
the languages with diverse interlocutors, language-pro-
cessing measures, criterion-referenced measures, dy-
namic assessment procedures, and a full profile of the
child’s case history including an individual multilingual
profile. However, as the latter information is usually
sourced in interviews with parents and/or caregivers, cul-
tural and linguistic mismatches may challenge many cli-
nicians. The current results demonstrate and confirm the
challenges associated with serving a linguistically and cul-
turally heterogeneous population that requires a corre-
spondingly comprehensive expertise for a valid assess-
ment and consultative intervention. The common mis-
match between patient and clinician languages is evident
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DOI: 10.1159/000495565
as they do not reflect the variety of numerous migrant
languages, and SLT service offered in a migrant language
such as Turkish or Russian is extremely rare. Moreover,
they do not comply with the many diverse languages and
varieties spoken by immigrants and refugees from Syria,
Bulgaria, Romania, or the Maghreb countries that have
largely immigrated to Germany in the past years. As lan-
guage barriers impede assessment and intervention for
language competence is conducted via language itself, bi-
ased assessment and as a consequence inadequate inter-
vention are evident risk factors [28]. In addition, it is evi-
dent that applying comprehensive assessment measures,
which is in accordance with best practice [14, 19, 27],
takes more time compared to using procedures devel-
oped with monolingual children. On the basis of the ele-
ments provided, this requires a corresponding minimum
amount of time, estimated by the methods given as three
to five units (regularly 45 min per unit). In addition, the
clinician’s use of diverse assessment methods in combi-
nation applies fully with the recommended best practice.
Many respondents reported that they had received addi-
tional training in multilingualism, which underscores the
need to provide education courses already within initial
The increased use of standardized assessments and
thus the use of material developed with a monolingual
mindset and/or applying normative data that has been
developed with monolingual German children is serious-
ly questionable, as this will increase construct, method,
and item bias and subsequently the risk of misdiagnoses
[21, 3]. An alternative interpretation of the use of stan-
dardized assessments by more than every second clini-
cian may be that it is done to complement the abovemen-
tioned measures following the identification of a lack of
language skills after a language disorder has already been
ruled out by the SLP’s thorough assessment. At the inter-
section of the health and educational systems, the SLP’s
objective then has changed from a clinical one to provid-
ing an estimate on successful school attendance in orien-
tation to the monolingual norm and placement into regu-
lar classroom instruction, even if SLPs in Germany for-
mally do not have authority to do so.
The current results show that indeed many of the sur-
veyed clinicians identify a lack of language skills instead of
an indication for therapy. It is noteworthy that this is more
often the case in districts with high child poverty. This
finding is concordant with those previous studies linking
SES to language development [29, 30]. Although a low SES
background does not necessarily lead to a language disor-
der, low SES children are more likely to demonstrate com-
prehension deficits leading to SLCN [31]. As SES impacts
well-being and subsequently health at multiple levels, SLT
practices seem to unofficially function as a support system
to family and neighborhood. As a result, in many cases the
respondents carry out parent training or counseling in-
stead of therapy and despite their command may even
keep multilingual children without language disorder on
their caseload. Possible motivation on the part of the clini-
cians to take measures of support irrespective of therapy
indication can also be deduced from the current findings.
Thus, a large proportion of respondents see a high risk of
discrimination and stigmatization of multilingual chil-
dren with migrant background. This is a legitimate con-
cern as it is in line with studies clearly demonstrating that
multilingual children with migrant background are more
likely to experience severe disadvantages at German
schools, for the education system in Germany is consid-
ered “deeply unequal, hierarchical and exclusive” [32, p.
93]. As the German education system, including kinder-
garten, has been claimed to fail to provide adequate lan-
guage training for children who speak native languages
other than German, the competencies of SLPs could play
a key role in early identification and planning of appropri-
ate actions for their improvement. SLPs are competent to
serve in both systems, health and education. Strategic col-
laboration with education providers as done in other
countries could contribute to solving this issue. However,
this requires a greater flexibility of the system and the legal
allowance to autonomously see children and derive diag-
noses independent of a medical doctor.
This study provides data on provision of SLT services
to multilingual children with a migration background in
Germany. Although the results of the study are based on
a regional survey of a limited number of clinicians and
hence cannot be generalized, they do suggest that there
are considerable differences between the referral reasons
and the SLPs’ diagnoses of these children’s difficulties.
The results highlight the need for collaborative models of
multiprofessional exchange and a concrete solution-fo-
cused approach to a population that requires support
from both health care and education. One approach may
be a change of legal allowance for SLPs to not only serve
in the health care but also in the educational system. In
this way they could make a contribution to support the
children. The demand for these qualified professionals is
high. Further, there is a considerable need to make the
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SLT Services for Multilingual Children
with Migration Background
Folia Phoniatr Logop 2019;71:116–126
DOI: 10.1159/000495565
profession more attractive for recruitment and retention
of future SLP professionals in Germany. Moreover, the
results highlight that multilingual children with and with-
out migrant background are put at a higher risk from a
lack of access to SLT provision and emphasize the risk of
a future lack of clinicians. The current findings point out
the need for a timely referral by medical doctors and – in
terms of content and time – a comprehensive differential
SLT diagnosis to avoid the risk of misdiagnoses in cultur-
ally and linguistically diverse children. These aims can be
most strongly advocated when SLT qualification pro-
grams account for competencies in this area and adapt
their curricula and practical training by including knowl-
edge and different strategies for action in culturally and
linguistically diverse settings. Future research on lan-
guage disorders in multilingual children needs to account
for the relationship between migration and SES.
The work was supported by the Hochschule Bremen Fund for
Research and Development. The author would like to thank all
clinicians who took part in this study.
Statement of Ethics
The study was approved on February 16, 2016 by the review
board of ethics of the Hochschule Bremen. Informed consent was
Disclosure Statement
The research was funded by a grant of the Hochschule Bremen
Fund for Research and Development. There are no other declara-
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... Lack of resources (34,39,40,45,46,49) 11. Feelings of distrust toward language discordant healthcare providers (36,57,59) 12. Feelings of stigma (48,56) emerged: (1) disconnect between the needs of users and services offered, (2) treatment quality, (3) lack or training for healthcare professionals, (4) challenges with interpretive services, and (5) lack of quality information in the minority language. ...
... What is striking is that the need for services in minority languages may not be recognized by those who work within the healthcare system. For example, in a study of SLPs in Germany, only 40% of practitioners considered that service options for minority-language speakers were inadequate (48), which seem to conflict with the challenges in finding services in the minority-language that parents experience. Sadly, challenges in finding services in the minority language have led some caregivers to make the difficult choice to only speak the majority language with their child with an NDD, believing that their child would otherwise "lose out" on receiving intervention (20). ...
... Even when minority-language speakers with NDDs are able to access healthcare services (be it in the majority or the minority language), they often experience barriers with regards to the quality of the treatment that they receive (13 studies). Indeed, children from minority-language households are less likely than their majority-language peers to receive a developmental screener (41,49,58), or a referral for a language or developmental assessment from their pediatrician (46,48,49,53). Consequently, children from minority-language households tend to receive an NDD diagnosis later than their majoritylanguage peers [(48), although see (47) for contradicting findings]. ...
Full-text available
Introduction Minority-language speakers in the general population face barriers to accessing healthcare services. This scoping review aims to examine the barriers to healthcare access for minority-language speakers who have a neurodevelopmental disorder. Our goal is to inform healthcare practitioners and policy makers thus improving healthcare services for this population. Inclusion criteria Information was collected from studies whose participants include individuals with a neurodevelopmental disorder (NDD) who are minority-language speakers, their family members, and healthcare professionals who work with them. We examined access to healthcare services across both medical and para-medical services. Method Searches were completed using several databases. We included all types of experimental, quasi-experimental, observational and descriptive studies, as well as studies using qualitative methodologies. Evidence selection and data extraction was completed by two independent reviewers and compared. Data extraction focused on the barriers to accessing and to utilizing healthcare for minority-language speakers with NDDs. The search process and ensuing results were fully reported using a diagram from the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review . Results Following the database search, a total of 28 articles met our final selection criteria and two articles were hand-picked based on our knowledge of the literature, for a total of 30 articles. These studies revealed that minority-language speakers with NDDs and their families experience several barriers to accessing and utilizing healthcare services. These barriers, identified at the Systems, Provider and Family Experience levels, have important consequences on children's outcomes and families' well-being. Discussion While our review outlined several barriers to access and utilization of healthcare services for minority-language speakers with NDDs and their families, our findings give rise to concrete solutions. These solutions have the potential to mitigate the identified barriers, including development and implementation of policies and guidelines that support minority-language speakers, practitioner training, availability of referral pathways to appropriate services, access to tools and other resources such as interpretation services, and partnership with caregivers. Further research needs to shift from describing barriers to examining the efficacy of the proposed solutions in mitigating and eliminating identified barriers, and ensuring equity in healthcare for minority-language speakers with NDDs.
... Humanitarian migrants are a heterogeneous group that create new and different challenges to the health system of most countries. For example, a number of studies have shown that hospital and health care service utilization among humanitarian migrant populations is lower than the general population (Correa-Velez, Sundararajan, Brown, & Gifford, 2007;Hasanović, Šmigalović, & Fazlović, 2020;Murray & Skull, 2005;Scharff Rethfeldt, 2019). This may be due to various reasons including: not being aware of the availability and purpose of health services; access and affordability issues; the lack of knowledge of health care rights and health systems; poor knowledge of the language; different belief systems around disease and cultural expectations of health care; general lack of trust in experts and governments; as well as shame and guilt around sickness and/or disability (Davidson et al., 2004;Finney Lamb & Smith, 2002;Stow & Dodd, 2003). ...
Full-text available
The Chapter is part of the IALP book publication "The Unserved – Addressing the needs of those with communication disorders", authored by members of the 14 Committees of the IALP, presents ideas to assist all those who work with children and adults who have difficulty in communicating or swallowing in order to improve services for unserved and underserved communities. It offers strategies to address disorders and conditions that affect many areas of everyday life and which are exacerbated by lack of adequate health, education and social services. Please visit the website to read all chapters
... It has been suggested that in addition to direct measures of word knowledge, other language measures should be considered that provide a more comprehensive evaluation of language proficiency (Peña et al., 2018;Golinkoff et al., 2017). The use of standardised language tests that have been devised for monolinguals, to assess the language abilities of bilinguals is highly questionable (Rethfeldt, 2019). Indeed, bilingual children are particularly vulnerable to being misdiagnosed. ...
Full-text available
Diagnosing language disorders in bilingual children represents a clinical challenge because of similarities in the language profi ciency profi le between typically developing bilingual children and monolingual children with a language disorder. Measures of working memory are less dependent on accumulated knowledge than traditional language tests and might help to differentiate a language disorder from a language difference related to experiences with a language.
... Die Sprachstanderfassung wird aber auf Länderebene unterschiedlich gehandhabt [10], ist in der Regel nicht verpflichtend und wird auch nicht, obwohl avisiert, flächendeckend umgesetzt [26]. Einzelne Sprachstanderfassungsverfahren unterscheiden sich dabei nicht nur in den Alters-, sondern auch in den Zielgruppen ( [16]. Mit der sprachtherapeutischen Unterversorgung von KMM stellt Deutschland (in diesem Fall Hessen) keine Ausnahme unter europäischen Ländern dar [21]. ...
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Zusammenfassung Hintergrund Eine verspätete Erkennung bzw. versäumte Intervention bei Sprachentwicklungsstörungen beeinträchtigen den schulischen und beruflichen Werdegang. Aufgrund ungünstiger soziodemografischer Bedingungen (mangelhafte Deutschkenntnisse der Eltern, niedriges familiäres Einkommen etc.) sowie medizinischer Auffälligkeiten sind zunehmend viele Kinder in ihrer Sprachentwicklung gefährdet. Ziel der Arbeit Im Rahmen einer hessischen Sprachstanderfassungsstudie wurde geprüft, inwiefern 4‑jährige Kinder mit (KMM) und ohne Migrationshintergrund (KOM) sprachtherapeutisch versorgt wurden, und wie diese Therapien motiviert waren. Material und Methoden Vierjährige Kindergartenkinder ( n = 1384) wurden mit dem Sprachtest KiSS.2 untersucht. Beide Untergruppen (KMM und KOM) wurden hinsichtlich sprachbezogener Störungsbilder und sprachtherapeutischer Versorgung verglichen. Ergebnisse Insgesamt nahmen 8 % aller Kinder an Sprachtherapien teil. KMM waren fast doppelt so häufig klinisch abklärungsbedürftig wie KOM (21 % vs. 11 %). Bei KOM wurden dagegen mehr sprachbezogene Störungsbilder (z. B. häufige Mittelohrentzündungen) bereits vor der Studienteilnahme diagnostiziert. Klinisch abklärungsbedürftige KOM befanden sich daher häufiger in einer Sprachtherapie als KMM (37 % vs. 23 %). Diskussion Es fanden sich Hinweise für Diskrepanzen zwischen Sprachtherapiebedarf und sprachtherapeutischer Versorgung von bestimmten Untergruppen der 4‑jährigen Kinder. Evidenzbasierte, flächendeckende Sprachstanderfassungsprogramme können dazu beitragen, dass bei der Einteilung der Kinder in sprachförder- und sprachtherapiebedürftige weniger falsch-positive bzw. -negative Ergebnisse erzielt werden.
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Due to the difficulties in differentiating bilingual children with Developmental Language Disorder (DLD) from bilingual children with temporary language difficulties that may be caused by heterogeneous language input, language assessments of bilingual children are challenging for clinicians. Research demonstrates that assessments of bilingual children should be in all the languages a bilingual child speaks. This can be arduous for clinicians, but computerised screening approaches provide potential solutions. MuLiMi is a new web-based platform designed to automatise screening procedures for bilingual children at risk of DLD. To validate this procedure and investigate its reliability, 36 Spanish-speaking children, aged 4–6 years old, living in Italy, were tested remotely using the Italian–Spanish MuLiMi DLD screening. Sixteen of the participants were previously diagnosed with DLD. L2 (second or societal language) as well as L1 (first or family language) language abilities in static (nonword repetition, grammaticality judgement, and verb comprehension) as well as dynamic tasks (dynamic novel word learning) were assessed. Speed and accuracy of the children’s responses were automatically recorded (except nonword repetition). Significant associations emerged between the results obtained in the screening tasks when comparing them to parental questionnaires and standardised tests. An exploratory analysis of the diagnostic accuracy indicates that the single screening scores as well as the overall total score significantly contribute to DLD (risk) identification.
Full-text available
Zusammenfassung Hintergrund Der Sprachstand 5‑jähriger Kinder wird in Hessen nicht systematisch erfasst. Daher liegen keine Angaben zum Anteil sprachauffälliger Kinder in dieser wichtigen Altersgruppe kurz vor der Einschulung vor. Fragestellung Die Studie hatte zum Ziel, den Sprachstand 5‑jähriger Kinder zu beschreiben und soziodemografische Faktoren zu untersuchen, die mit sprachpädagogischem Förder- bzw. klinischem Abklärungsbedarf zusammenhängen. Matherial und Methoden Es wurden 263 monolingual deutschsprachige (MON) und 645 multilinguale Kitakinder (MULT) im Alter von 5;0–5;11 Jahren bezüglich ihrer Deutschkenntnisse mit dem Kurztest „Kindersprachscreening“ (KiSS.2) untersucht. KiSS.2-Normwerte für Fünfjährige wurden durch das Studienteam entwickelt. Soziodemografische Merkmale der Kinder und ihrer Familien wurden mit KiSS.2-basierten erweiterten Fragebogen für Eltern und KitaerzieherInnen erfasst. Ergebnisse Ein Fünftel der MON und über zwei Drittel der MULT zeigten sich in KiSS.2 als sprachlich auffällig, d. h., ihre Ergebnisse lagen unterhalb der Normwerte. Die große Mehrheit der MULT erwies sich als sprachpädagogisch förderbedürftig. Die Anteile klinisch Abklärungsbedürftiger waren bei MON und MULT vergleichbar. Sprachpädagogischer Förderbedarf war mit eingeschränktem Deutsch-Input außerhalb der Kita assoziiert. Unter den Sprachkontaktvariablen waren es ausbleibende sprachliche Äußerungen beim Spielen, an denen sich klinischer Abklärungsbedarf am besten erkennen ließ. Die meisten Sprachauffälligen, v. a. MULT, wurden weder sprachpädagogisch noch -therapeutisch versorgt. Diskussion Da MULT mehr als die Hälfte aller hessischen Vorschulkinder ausmachen, kann davon ausgegangen werden, dass kurz vor der Einschulung die meisten hessischen Kinder sprachauffällig bleiben (in der aktuellen Studie 57 %). Es liegen Hinweise auf eine sprachpädagogische und -therapeutische Unterversorgung von 5‑jährigen Kindern, in erster Linie MULT, vor.
Purpose: This study aimed to gather the views and experiences of clinicians and managers on early intervention audiology and speech-language pathology services for culturally and linguistically diverse (CALD) families of children with hearing loss. Method: This qualitative descriptive study involved 27 semistructured interviews with audiologists, speech-language pathologists, and managers working with CALD families of young children with hearing loss. Purposeful sampling was used to recruit participants from three hearing centers working with these families. Interviews were analyzed using thematic analysis. Results: Analysis of the data resulted in five themes: (a) There were perceived added complexities for CALD families in accessing and being involved in services and receiving information; (b) there were perceived family-provider relationship complexities, cultural differences, and service delivery challenges in working with CALD families; (c) clinicians and managers used various strategies for service provision of CALD families; (d) involving interpreters benefited service provision but was challenging at times; and (e) looking to the future and recommendations for clinical practice. Conclusions: Current practices reflect some principles of family-centered care for CALD families of young children with hearing loss. Families and services may benefit from more support regarding family-provider partnerships, information materials and child assessments, working with interpreters, and center support for time and resources. Supplemental material:
Background: Teachers and clinicians may struggle to provide early identification to support multilingual children's language development. Dynamic assessments are a promising approach to identify and support children's language development. Aims: We developed and studied a novel word learning task that is dynamic and language neutral. It makes use of multilingual children's abilities to apply language transfer, fast mapping and socially embedded language to the learning of new words. Methods & procedures: A total of 26 children attending kindergarten in French participated in this study. Within this group, 13 different home languages were spoken. Children took part in a dynamic assessment task of their word learning that consisted of a test-teach-retest task. Children's scores on this task were compared with their language abilities reported by their parents, amount of language exposure and scores on standardized tests of vocabulary. All tasks were delivered in French. Outcomes & results: Children had higher accuracy for known words as compared with new words in the task, which may suggest transfer of knowledge from their first language. They also showed increased accuracy in identifying and naming the new words across the three trials, suggesting fast mapping of these new vocabulary items. Finally, the scores on the dynamic task correlated to children's vocabulary scores on the standardized tests, but not parent report of language development, or the amount of exposure to the language of school. Conclusions & implications: This novel dynamic assessment task taps into the process of vocabulary learning, but is less influenced by prior language knowledge. Together, these findings provide insight into early word learning by young multilingual children and proposes a conceptual model for identifying strategies to support second language acquisition. What this paper adds: What is already known on the subject Many barriers exist with regards to assessing the language abilities of multilingual children when a clinician aims to assess their language abilities in both languages. An alternative approach is to measure children's language processing abilities. What this paper adds to existing knowledge A novel dynamic and multilingual task was developed and implemented in this study. This task builds on children's word learning abilities that include cross-language transfer, fast-mapping, and socially imbedded learning. This multilingual task was found to tap into vocabulary learning but was not influenced by prior language knowledge. What are the potential or actual clinical implications of this work? Applying a task that focuses on language processing abilities is a promising strategy to capture language abilities in multilingual children. In addition, the dynamic nature of this tasks allows a clinician to identify scaffolding strategies that best support children's word learning.
Diversität in der Gesundheits- und Pflegeversorgung ist kein neues Phänomen, dennoch wird es im Kontext kommunikativen Handelns und kultureller Zugehörigkeit mit Herausforderungen konnotiert. Insbesondere sprachlich-kulturelle Missverständnisse können als Hindernis für Patientenorientierung betrachtet werden und zuweilen die Patientensicherheit gefährden. Die beruflichen Anforderungen einer Migrationsgesellschaft setzen somit Bildungs- und Lernprozesse voraus, die interkulturelle Aspekte inkludieren. Im Beitrag wird sowohl die Nomenklatur Migrationsprozesse – Kultur – Inter- und Transkulturalität als auch die bildungswissenschaftliche Perspektive auf den interkulturellen Lernprozess in der Gesundheits- und Pflegebildung expliziert. An einem didaktischen Konzept werden der Erwerb (reflexiver) interkultureller Kompetenz exemplarisch erläutert und Potenziale für Lehr- und Lernarrangements aufgezeigt. Theoretische Hinführung sowie pädagogisch-didaktische Implikationen bilden den Rahmen des Beitrags.
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Speech-language pathologists all over the United States are experiencing the challenge of providing clinical services to an increasingly diverse population of students. In most states, there are growing numbers of English Language Learners (ELL) in the public schools. Since the 1990-1991 school year, the ELL population has grown 105%, whereas the general school population has grown only 12% (Kindler, 2002). Many experts in the field of speech-language pathology have emphasized the importance of improved service delivery to ELL students with communication disorders. There has especially been an emphasis on the need for more valid, reliable methods and materials for less biased assessment of ELL students. In 1990, a survey was sent out to public school SLPs all over the United States to determine current conditions regarding service delivery to ELLs as well as respondents' needs and interests for more information in this area (Roseberry-McKibbin & Eicholtz, 1994). In 2001, because the survey had become dated and was no longer representative of the current state of the art, we sent public school SLPs a similar survey with mostly identical questions and a few new questions. We analyzed a total of 1,736 returned surveys and compared the results to those of the 1990 respondents (Roseberry-McKibbin, Brice, & O'Hanlon, in press).
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Background: The language profiles of children with language impairment (LI) and bilingual children can show partial, and possibly temporary, overlap. The current study examined the persistence of this overlap over time. Furthermore, we aimed to better understand why the language profiles of these two groups show resemblance, testing the hypothesis that the language difficulties of children with LI reflect a weakened ability to maintain attention to the stream of linguistic information. Consequent incomplete processing of language input may lead to delays that are similar to those originating from reductions in input frequency. Methods: Monolingual and bilingual children with and without LI (N = 128), aged 5–8 years old, participated in this study. Dutch receptive vocabulary and grammatical morphology were assessed at three waves. In addition, auditory and visual sustained attention were tested at wave 1. Mediation analyses were performed to examine relationships between LI, sustained attention, and language skills. Results: Children with LI and bilingual children were outperformed by their typically developing (TD) and monolingual peers, respectively, on vocabulary and morphology at all three waves. The vocabulary difference between monolinguals and bilinguals decreased over time. In addition, children with LI had weaker auditory and visual sustained attention skills relative to TD children, while no differences between monolinguals and bilinguals emerged. Auditory sustained attention mediated the effect of LI on vocabulary and morphology in both the monolingual and bilingual groups of children. Visual sustained attention only acted as a mediator in the bilingual group. Conclusion: The findings from the present study indicate that the overlap between the language profiles of children with LI and bilingual children is particularly large for vocabulary in early (pre)school years and reduces over time. Results furthermore suggest that the overlap may be explained by the weakened ability of children with LI to sustain their attention to auditory stimuli, interfering with how well incoming language is processed.
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Background: Lack of agreement about criteria and terminology for children's language problems affects access to services as well as hindering research and practice. We report the second phase of a study using an online Delphi method to address these issues. In the first phase, we focused on criteria for language disorder. Here we consider terminology. Methods: The Delphi method is an iterative process in which an initial set of statements is rated by a panel of experts, who then have the opportunity to view anonymised ratings from other panel members. On this basis they can either revise their views or make a case for their position. The statements are then revised based on panel feedback, and again rated by and commented on by the panel. In this study, feedback from a second round was used to prepare a final set of statements in narrative form. The panel included 57 individuals representing a range of professions and nationalities. Results: We achieved at least 78% agreement for 19 of 21 statements within two rounds of ratings. These were collapsed into 12 statements for the final consensus reported here. The term 'Language Disorder' is recommended to refer to a profile of difficulties that causes functional impairment in everyday life and is associated with poor prognosis. The term, 'Developmental Language Disorder' (DLD) was endorsed for use when the language disorder was not associated with a known biomedical aetiology. It was also agreed that (a) presence of risk factors (neurobiological or environmental) does not preclude a diagnosis of DLD, (b) DLD can co-occur with other neurodevelopmental disorders (e.g. ADHD) and (c) DLD does not require a mismatch between verbal and nonverbal ability. Conclusions: This Delphi exercise highlights reasons for disagreements about terminology for language disorders and proposes standard definitions and nomenclature.
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Title: A paradigm crisis in culturally sensitive SLT service provision – The underestimated role of social evidence. Critical re ections on evidence-based approaches to multilingual children with language impairment. Abstract: Providing appropriate assessment and intervention services to individuals from culturally and linguistically di- verse populations (CLD) according to evidence-based principles is challenging, especially when clinicians rely on Western standardized assessments. Currently there may be a disproportionate consideration of the social component. Problems and alternative solutions to the use of norm-referenced measures that may reduce the risk for misdiagnoses of multilingual children and biases inherent in standardized tests will be discussed. Then a culturally sensitive decision-making framework will be proposed. Next to a critical re ection of the use of monolingual standards and measures, it will be inevitable to consider and self-assess the impact on SLT’s personal and professional attitudes towards CLD. Kurzfassung: Das Ziel einer optimalen Versorgung von kulturell und linguistisch diversen Patienten (KLD) im Sinne einer evidenzbasierten Praxis stellt viele LogopädInnen vor eine Herausforde- rung, da ihre theoretischen Grundlagen und Denkmodelle an westlichen und einsprachigen Standards orientiert sind. Es zeigt sich ein Ungleichgewicht der drei EBP-Wissensquellen, insofern tendenziell die soziale Evidenz vernachlässigt wird. So werden z.B. für einsprachige und westliche Zielgruppen konzi- pierte Verfahren für die KLD angewendet, was als möglicher Bias wirken kann. Dabei könnte die umfas- sende Einbeziehung der sozialen Evidenz eine strukturelle Inäquivalenz, d.h. die Messung unterschied- licher Konstrukte, und damit Fehldiagnosen verhindern. Neben der kritisch-re ektierten Rezeption von einsprachigen Standards geprägten etablierten Instrumenten und der Berücksichtigung der Belange der Patienten ist daher eine wechselseitige Auseinandersetzung mit dem eigenen kulturellen, linguistischen und professionellen Hintergrund erforderlich.
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Ein Drittel aller Kinder im Vorschulalter haben einen Migrationshintergrund, viele wachsen mit zwei oder mehr Sprachen auf. Häufig weicht die Sprachentwicklung bei diesen Kindern von der einsprachig deutsch aufwachsender Kinder ab. Das stellt Therapeuten vor Probleme. Sind die sprachlichen Auffälligkeiten des Kindes noch Teil einer regelrechten Sprachentwicklung oder liegt hier eine Störung vor? Was sind die Besonderheiten der mehrsprachigen Entwicklung? Welches differenzialdiagnostische Vorgehen ist geeignet, welcher Therapieansatz ist für mehrsprachige Kinder mit einer Sprachentwicklungsstörung adäquat? Welche Rolle spielen kulturelle Unterschiede und wie geht man mit diesen um? Auf diese Fragen gibt Wiebke Scharff Rethfeldt eine Antwort. Sie schildert: • Mehrsprachigkeit erstmals aus sprachtherapeutischer Sicht • Diagnostik von SES bei Mehrsprachigkeit: - klinische Relevanz von Symptomen einer SES bei Mehrsprachigkeit - Anamnese im interkulturellen Kontext - Sprachentwicklungsbezogenes Vorgehen unter Einsatz von Verfahren • Therapie bei mehrsprachigen Kindern: - Abgrenzung zwischen Förderung und Therapie - Therapieindikatoren - verschiedene Therapieansätze, u.a. der Induktive Ansatz, der auch von monolingual deutschsprachigen Therapeuten durchgeführt werden kann • Ansätze und sämtliche Aspekte werden sprachenunabhängig formuliert und sind auf alle mehrsprachigen Gruppen anwendbar Praxismaterialien zu einer Multilingual und Interkulturell orientierten Anamnese, zur Erstellung eines Bilingualen Patientenprofils und zur Elternkooperation sind als kostenloser Download im Netz abrufbar
Background: Diagnosis of 'specific' language impairment traditionally required nonverbal IQ to be within normal limits, often resulting in restricted access to clinical services for children with lower NVIQ. Changes to DSM-5 criteria for language disorder removed this NVIQ requirement. This study sought to delineate the impact of varying NVIQ criteria on prevalence, clinical presentation and functional impact of language disorder in the first UK population study of language impairment at school entry. Methods: A population-based survey design with sample weighting procedures was used to estimate population prevalence. We surveyed state-maintained reception classrooms (n = 161 or 61% of eligible schools) in Surrey, England. From a total population of 12,398 children (ages 4-5 years), 7,267 (59%) were screened. A stratified subsample (n = 529) received comprehensive assessment of language, NVIQ, social, emotional and behavioural problems, and academic attainment. Results: The total population prevalence estimate of language disorder was 9.92% (95% CI 7.38, 13.20). The prevalence of language disorder of unknown origin was estimated to be 7.58% (95% CI 5.33, 10.66), while the prevalence of language impairment associated with intellectual disability and/or existing medical diagnosis was 2.34% (95% CI 1.40, 3.91). Children with language disorder displayed elevated symptoms of social, emotional and behavioural problems relative to peers, F(1, 466) = 7.88, p = .05, and 88% did not make expected academic progress. There were no differences between those with average and low-average NVIQ scores in severity of language deficit, social, emotional and behavioural problems, or educational attainment. In contrast, children with language impairments associated with known medical diagnosis and/or intellectual disability displayed more severe deficits on multiple measures. Conclusions: At school entry, approximately two children in every class of 30 pupils will experience language disorder severe enough to hinder academic progress. Access to specialist clinical services should not depend on NVIQ.
The paper examines the educational experiences of Turkish youth in Germany with special references to the statistical data of Educational Report, PISA surveys. The results of the educational statistics of Germany show that more than group characteristics like social and cultural capital, structural and institutional factors (multi-track system with its selective mechanism, education policy, context of negative reception of Germany, institutional discrimination, and lack of intercultural curriculum) could have a decisive role in hampering the educational and labor market integration and social mobility of Turkish youth. This can be explained by a mix of factors: the education system which does not foster the educational progress of children from disadvantaged families; the high importance of school degrees for accessing to the vocational training system and the labor market; and direct and indirect institutional discrimination in educational area in Germany. Thus, this work suggests that the nature of the education system in Germany remains deeply "unequal," "hierarchical" and "exclusive." This study also demonstrates maintaining the marginalized position of Turkish children in Germany means that the country of origin or the immigrants' background is still a barrier to having access to education and the labor market of Germany.
Speech-language pathologists (SLPs) are obligated to judiciously select and administer appropriate assessments without inherent cultural or linguistic bias (Individuals with Disabilities Education Act [IDEA], 2004). Nevertheless, clinicians continue to struggle with appropriate assessment practices for bilingual children, and diagnostic decisions are too often based on standardized tests that were normed predominately on monolingual English speakers (Caesar & Kohler, 2007). Dynamic assessment is intended to be a valid and unbiased approach for ascertaining what a child knows and can do, yet many speech-language pathologists (SLPs) struggle in knowing what and how to assess within this paradigm. Therefore, the aim of this paper is to present a clinical scenario and summarize extant research on effective dynamic language assessment practices, with a focus on specific language tasks and procedures, in order to foster SLPs' confidence in their use of dynamic assessment with bilingual children.
Purpose: To provide an overview of typical and atypical English L2 (ELL) development and to present strategies for clinical assessment with ELLs. Method: A review of studies examining the lexical, morphological, narrative and verbal memory abilities of ELLs is organized around three topics: Timeframe and characteristics of typical English L2 development, comparing the English L2 development of children with and without specific language impairment (SLI), and strategies for more effective assessment with ELLs. Results: ELLs take longer than 3 years to converge on monolingual norms, and approach monolingual norms asynchronously across linguistic sub-domains. Individual variation is predicted by age, first language, language learning aptitude, length of exposure to English in school, maternal education and richness of the English environment outside school. ELLs with SLI acquire English more slowly than ELLs with typical development; their morphological and non-word repetition abilities differentiate them the most. Use of strategies such as parent questionnaires on first language development and ELL norm-referencing can result in accurate discrimination of ELLs with SLI. Conclusion: Variability in the language abilities of ELLs presents challenges for clinical practice. Increased knowledge of ELL development with and without SLI together with evidence-based alternative assessment strategies can assist in overcoming these challenges.