MELISSA: Hello, everyone. This is Melissa McCarthy from … · · 2017-04-262016-06-08 11.45 HOPE Elizabeth Rosenzweig 2 Page 5 However, we know that this comparison is based on

2016-06-08 11.45 HOPE Elizabeth Rosenzweig 2 Page 1

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MELISSA: Hello, everyone. This is Melissa McCarthy from the RIDBC

Renwick Centre, and we are just going to get started with our presentation

today.

I would like to welcome you all to today's Hope seminar on oral bilingualism

presented by Elizabeth Rosenzweig. Elizabeth is an LSLS certified auditory

verbal therapist who provides auditory verbal therapy, oral rehabilitation and

educational advocacy services to families.

She also mentors aspiring listening and spoken language specialists and has

authored two children's books featuring characters with Cochlear implants.

On behalf of RIDBC Renwick Centre and Cochlear Ltd, please join me in

welcoming Elizabeth. I need to find your microphone here, hold on one

second.

ELIZABETH: Thank you so much, Melissa. Welcome, everyone. Let's get

started.

So here is what we are going to cover today. When we speak about children

who are learning more than one oral language, children who have hearing loss,

first we want to talk about the statistics and demographics. What is this

population that we are looking at? Then we will discuss some principles of oral

bilingualism. What are the basic concepts of bilingualism and what are some

myths and facts? And then what does the research say about how we apply

these principles of bilingualism to children with hearing loss, what is the same

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as general bilingual and what is different? And then, knowing that, how do we

adjust our therapy styles to support children learning more than one oral

language? How can we partner with their families, especially if you are a

monolingual therapist, or you’re a therapist who speaks more than one

language but none of them are languages spoken by the family?

Then I will share some case studies from my practice to help tie it all together.

At the end we will have some time for questions and answers. I would love to

hear from you tips and tricks that you have found successful or problematic

cases that you would like to share that we can discuss together.

So, first, statistics and demographics. We know that multilinguals outnumber

monolinguals worldwide. Basically, I am probably preaching to the choir about

all of this, if you are already taking this webinar. But bilingualism is here and it’s

growing. If these children are not already on your case load, they will be, and

we need to know how to serve them best.

Here where I live in Toronto 31 per cent of the population speak something

other than English or French, which are the two languages of Canada, at

home. In the US, 21 per cent of children, over a fifth of the children, in the

school system speak a language other than English at home. Worldwide it is

about equal; there are approximately as many bilingual as there are

multilingual children.

I have a particular interest in this population, because my practice is done

solely through teletherapy. From my office here in Toronto, I work with families

all over the world. I either work directly with families or mentor professionals

on every inhabited continent in the world. I have also been involved in

professional training trips to physically go to places in Latin America like Costa

Rica and the Dominican Republic and build their in-country resources by

providing training to professionals on the ground.


In my practice the families speak English. We have many different US regional

dialects as well as British English, English from Northern Ireland and Ireland,

German, Gaelic, Italian, Bemba, which is a tribal language in Zambia, Hebrew,

Yiddish, Swahili, which is a tribal language that is spoken in Kenya,

Cantonese, a version of Chinese, Catalan, which is closely related to Spanish,

Norwegian, Arabic, Tagalog, which you might also know as Filipino, Mandarin,

another variant of Chinese, Malaysian and Spanish.

So, really what we are going to talk about today is our privilege and our

responsibility as auditory verbal therapists to honour and enhance family

language and culture and to enable parents to speak to their children who are

deaf or hard of hearing in what I will call the language of their heart. You will

hear that throughout this presentation.

I really want families to feel valued and to feel empowered to use the language

of their hearts, the most fluent language in which the parents can express and

be their truest selves.

When we think about principles of oral bilingualism, the questions we need to

ask before we consider anything else are: does this child have access to fluent

language models, a quality of language for sufficient amounts of time each

week. That is quantity of language. They need consistent interaction with

people who are modelling fluent language. That is not a few hours a week with

grandma who is fluent and then we are expecting you to learn a whole

language from that. And that is not all day long with a parent speaking to you in

maybe one to two-word phrases. Neither of those are providing the quality or

quantity of language interaction that is needed.

But even if you have quality and quantity for children with hearing loss the

second principle we need to keep in mind is: does this child with his or her

hearing technology have excellent aided threshold and speech perception

scores that demonstrate perceptual access to this quantity and quality of


language coming in?

Another thing we need to keep in mind is, if all variables are constant, you can

learn two or more languages as well as you can learn any single language.

Constant variables mean they are getting equal exposure to both languages,

they have equal perceptual access to both languages, and so that is going

well. That means essentially if a child has language issues in their L1, their

primary language, they most likely will in their L2 as well, their second

language they are learning. Really these language disorders or these

language delays and issues are not attributable to there being two languages.

It is an issue of organic language disorder.

We will discuss a case study like this at the end, but essentially the old

received wisdom was: well, if a child is having trouble and they speak two

languages it is probably because they are getting mixed up and confused. We

know a child's ability to learn one language and a child’s ability to learn more

than one language are equal. It is based on that child's intrinsic factors, their

internal language learning abilities.

Of course, the qualifier is that if all the variables are constants, if we are

achieving that quantity, quality and perceptual access that we discussed on the

previous slide.

What are some myths about bilingualism? Bilingual research is a really hot

topic right now and we see many benefits of bilingualism—in terms of

processing, vocabulary growth, cognitive skills, things like that, in hearing oral

bilinguals. Many people who advocate for sign language as a receptive

expressive mode of communication and then some supplementary English

literacy--some may call this a bimodal bilingualism or bilingual biculturalism--

often tend to hitch their cause to this wagon of research on hearing oral

bilingual, so to speak, and it is very tempting to try to attach their cause to that

research because the research on hearing oral bilinguals is very positive.


However, we know that this comparison is based on faulty logic. If we are

talking about sign and English bilingualism, we know that children with hearing

loss are not often in environments with fluent sign language models.

Over 95 per cent of children with hearing loss are born to hearing parents with

no prior experience with deafness. If that family decides that they are going to

attempt to learn a sign language system from day one that their child’s hearing

loss is detected, they are behind the curve. Because we know that a child's

brain is a sponge for language. It is excellent. That child is starving for

language.

The parents’ brain, let’s say at 30 years old, is far past the optimal point of

language acquisition, and resources for learning a new language, getting that

quantity and quality input if you are busy parent with a new infant and a job and

other responsibilities are very hard to come by.

Parents who choose a sign language system are often almost always not able

to provide the fluent language models that their children need and certainly not

able to provide those from the beginning. So, to compare the research on

children who sign and are learning English as their second language, to

hearing oral bilinguals is not an accurate comparison. These children are not

in an environment that have fluent sign language models. They are not getting

the quality. And even if they are, and let’s say perhaps they are not getting it at

home but they are at school, that is not hitting the quantity criterion, meaning

they are not getting those fluent language models for significant hours per

week.

We also know that this research is not comparing apples to oranges. Unlike

hearing oral bilinguals children with hearing loss do not have equal perceptual

access to both languages, especially if they are in an environment that

devalues hearing.


If you're prioritising a visual language like sign as your receptive expressive

mode of communication, generally those are not children who are using

hearing technology all waking hours, whose hearing technology is being

programmed by an audiologist who is aggressive because their understanding-

-for example, if the child is in an AV program, we must program their

technology aggressively because that listening is going to be their key to

language. If looking is a child’s key to language, there is certainly a different

priority in terms of programming their technology.

So, in this presentation we are discussing children with hearing loss who are in

listening and spoken language environments, whose families have made the

choice to give their children listening and spoken language, who are learning

more than one oral language. But because this bilingualism issue is often

completed, I do think it is important to know how to pick apart the research and

understand that this is not an accurate comparison.

What are some more myths? It used to be that we thought children with

hearing loss could not become fluent in more than one oral language. It is

what myths from what Carol Flexer, who is an amazing audiologist—if you

have not heard her speak—likes to call the “good old bad old days”. We now

know that these are not only not true, but they actually in many cases undercut

that wonderful rich fluent language model that the parents are able to provide,

even if that language model is not in English. It is much more important for the

child to have a strong base in any language than to receive fragmented English

from a parent who is not fluent because they have been told by us that is what

is best. It is much more important for families to teach--we used to think it is

more important for families to teach the language of school, right; you have got

to be prepared for school so teach the majority language in culture than your

home language. We now know that is incorrect. I would rather have mum

speaking fluent Mandarin than trying to piece together a preschool-level

sentence in English for her fourth grade child.


We also used to tell parents that you must choose one person, one language.

Have mum only speak Greek, have dad only speak English. Really, what we

need now to think about is more balanced exposure. So, choosing one person,

one language may work if the child is with both parents equally. But if the child

is with mum all day long, and mum’s language is Tagalog, and dad is the

English parent but he is at work all day, one person, one language is not a

great model for this family because the child is not getting balanced exposure.

Other things that we need to consider when helping a child with hearing loss

become an oral bilingual is: how can we structure this child's environment to

provide the quantity and quality exposure to both languages. We need to think

what people will be speaking each language. Again, it is not necessary to

divide one parent, one language. There is nothing inherently magical about

the set-up, but if that set-up is what helps the family balance languages then it

may be a good strategy for them. It really just depends what amount of time is

each person spending with the child and what kind of quality input is that

parent going to be able to give in that language.

When we think about people spending time with the child, we tend to zoom in

and think about just the parents, but there are many other people in that child's

world--caregivers, people at school, extended family and friends in the

neighbourhood. Their language input should also be considered when we are

thinking about quality and quantity of language exposure.

We also want to help families think about language use that is tied to place.

Does the family use one language during cultural events, at their place of

worship or one language at grandma's house and another language at the

park? What places does the child use each language and is he or she in those

places enough to gain that quantity and quality of exposure?

We also need to think from an intervention perspective: what kind of

vocabulary is rooted in those places. I don’t know about your grandmother, but


I would assume that this child perhaps is not often discussing geometry with

grandma. So, he may be missing that vocab in whatever language he is using

with the grandmother.

Another consideration is time. Are there different times of day that the child

uses different languages? For the sake of providing exposure, might it be wise

for the family to choose at dinnertime we’re speaking X, or on weekends we

will speak Y, if that’s what works for them to get them to this quantity and

quality benchmark.

As children enter formal schooling now they may be spending more significant

hours per week learning at school in the majority language. Families at that

point do need to make a conscious effort to keep up exposure to L2 at home

so the child's vocabulary doesn't get stuck at a preschool level. This often

happens. Because remember that a four or five-year-old before entering formal

schooling is a really communicative and conversational person. So, it’s

tempting to think that if a child stops getting significant exposure to the family's

language at that age and then their focus is more on the majority language at

school--a five-year-old can really hold a great conversation, but a five-year-old

doesn't have the vocabulary of a 17-year-old in that language. We need to

continue to support and grow the home language even as the child is spending

more and more time operating in the majority language at school.

So, when a child is exposed to two languages we often see the following

progression. At first there is a silent period. The child is really taking in both

languages. When we are intervening with a child with hearing loss, silence can

be tricky and scary because we wonder are they understanding us, is the

hearing technology functioning, is there some other underlying language

delay? Why aren't we starting to see output.

During the silent period it is important to focus on growing the child's auditory

skills, on giving lots of rich exposure and on very closely monitoring their


receptive language development.

If we see over a period of time that receptive language development in both or

either language is not growing, if the child isn't starting to make some attempts

to imitate just familiar phrases or single words in either language, that is a red

flag for us that there may be some kind of other underlying language disorder

or that we are not hitting the quantity and quality we need on one or both

languages.

After that silent period, children tend to go through a period of language mixing.

They may use one word for “dog” at home and then use that same word for

“dog” at school but the rest of the sentence is in the majority language. They

may only know the word for “telephone” at home and so they are using it in the

home language everywhere. They may do sentences half in Spanish and half

in English. They may read a story in Japanese but discuss their

comprehension of it with you in English. They are mixing it up. And that is very

normal.

When you hear that in therapy session, if the child says, “Tanoon, cat.” Or, “I

have a cat”--half in Spanish and half in English--we might think, “Oh my

goodness. What’s wrong here? Why isn't this child sorting out languages?” If

that is happening early on in a child's language development and early on in

the child’s bilingualism, that is very normal.

But eventually we do want to see with maturation and experience some

differentiation and code switching; an awareness of the child of this

metalinguistic concept that different people speak different languages, I know

what these languages are called, I know who speaks which language and I can

switch appropriately based on my conversation partner or based on the setting.

What does the research tell us about oral bilingualism for children with hearing

loss? We know that children with hearing loss can develop proficiency in two


or more oral languages and these languages must correlate with the amount

and intensity of the exposure the child has to the second language and the

implant experience.

We know that all of the children in the study, the first study, the McConkey

Robbins study that I am discussing, they all received their Cis before two

years, which now we think that sounds ancient. In 2004 in the States that was

pretty good. You all are better at that in Australia and I’m envious. But it’s early

implantation relative, right? Now we wouldn't consider that earlier but at the

time of the study we did.

And all of these children were enrolled in listening and spoken language

therapy. When we consider these results, those factors are also important,

right? These children have great perceptual access and they are getting it

early. We are hitting them at the point where it is developmentally appropriate;

instead of having to do remedial work, they can learn language from a

developmental standpoint, and these children are in programs that focus on

the primacy of audition, focus on coaching parents, focus on supporting home

language. These children are really focusing on their oral language

development.

It makes sense that if we are giving them the amount and intensity of exposure

and they have got a long length of hearing experience, and that would

correlate with overall language growth, they would be able to grow skills in two

or more oral languages.

We also know that better performance outcomes for children with hearing loss

who are oral bilinguals are associated with earlier age of hearing loss

diagnosis, earlier intervention, amplification and less severe hearing loss,

which is similar to findings of English studies--of English speaking children.

Children who are monolingual. So, what does that tell us?


Basically, what we are hearing here in the second study is that children who do

well learning two or more languages have similar characteristics to children

who do well learning one language. That tells us, reinforcing what we

discussed earlier, you can learn a second language as well as you can learn

any language. It is more about child characteristics rather than the

characteristics of the languages or the bilingualism itself.

Given that very positive research, would we ever not recommend bilingualism

for a child with hearing loss? What if a child has minimal exposure to fluent

language models? Absolutely. At that point we have to think: what is the

goal? If I am only hearing Chinese when I go to China once a year to visit my

family really at home my parents are very Americanised, we only speak

English, I don't do any Chinese cultural activities. This is like a once a year,

one week trip.

I wouldn't discourage the family from helping that child learn some familiar

phrases and some vocabulary, but they are certainly not hitting the exposure

criterion that we need for that child to achieve fluency.

What if this is a child who has a language disorder that we have identified that,

outside of the hearing loss, the child has a language disorder? What if this is a

child with hearing loss who is severely delayed? Let’s say they weren't

identified until age 3. So, we really have a lot of ground to catch up? But the

family still only speaks Arabic at home and the majority language of the country

is English. Should we tell the family we have lost so much time; we just need to

focus on English? Or what if this is a child with hearing loss for whom hearing

loss is the least of their issues? Perhaps they also have motor issues and

cognitive delays. What should we say to those final three--the language

disorder, the severely delayed or the child with multiple disabilities? Should we

recommend that they focus only on the majority language? Does that disqualify

them from becoming an oral bilingual?


My answer to you is, not really. This child might never achieve the excellent

language skills we’d hope for in both languages. Perhaps. This child might not.

But that is probably true if we just chose one language as well. Right? If we just

chose one language for a child who has an independent language disorder or

who was identified years and years after that optimal window or who has

multiple disabilities. We know from the research that the language outcomes

for those children, even for a monolingual child with hearing loss with those

characteristics, may not be as high as a child who is monolingual but does not

have those characteristics.

I would rather err on the side of helping that child connect to the social unit of

his family, and to be able to bond with the parents in the language of their heart

than focus just on English when the research really doesn't bear out that that

would even be beneficial above and beyond using two languages for that child.

What about language classes in school? So far we have spoken primarily

about children with hearing loss who are growing up in environments where

multiple languages are used; that they are getting this exposure from the

beginning. But for children with hearing loss who begin auditory verbal therapy

when they are young, they often do very well and are off our caseloads far

before they begin formal schooling. Once they are in formal schooling, even

our children from monolingual families may have opportunities just like their

hearing peers to take second language classes in schools.

We have to really consider what is the goal. Do we really expect children with

or without hearing loss to become fluent in a language when they are starting

at an older age in a non-immersive language situation? Let's say they have

Spanish class for 45 minutes once a week or in high school they are taking

French for one hour a day four or five days a week. That will not get them

fluent. That is not the goal of these language classes in school, so I don't think

that not achieving fluency has anything to do with the characteristics of the

child having hearing loss; it is more about inherent problems with the way we


structure second language learning in our formal academic system.

We have to think: what is the frequency and quality of exposure this child will

get in school? What are the child's auditory and imitation skills? We really have

to go back. Maybe this child hasn't had AVT since they were three and now

they are 13. We have to dig out of our toolbox that old auditory feedback loop,

helping that child listen to the productions of this new language around them

and match their output to the model so they can achieve the accent, the right

prosity, all of those things.

The child can learn vocabulary. He may or may not achieve pronunciation and

accent like a native speaker, and the hearing children in that class may not,

either. But to be able to have a working vocabulary and knowledge of grammar

and be able to get around in a second language is always a positive. We also

need to think what if the parents cannot pre-teach or post teach at home? For

our children with hearing loss pre and post teaching in the general academic

classroom is generally kind of a commonplace modification we put in or

something we coach parents to do. But if the child is taking a class in a

language the family does not speak, we may need to consider bringing in an

outside tutor or relying more heavily on some extra prep work from the teacher

of that class at school.

When you are working with a family that speaks more than one language at

home the first thing to think is: what and who are my resources? If I don't

speak this language are there resource centres in the community for this ethnic

group? For example, in the States in the southwestern US where there are

many immigrants from Mexico and Latin American there are often cultural

groups like the Hispanic Chamber of Commerce, or are there cultural

organisations. For example, an immigrant group from China. If they have

started a Chinese dance group in your town, can you go to them to get some

information to find out about the language, to find out about the heritage and

how you might best work with this family.


Are there language clubs of people who are learning to speak this language in

your city? Could those people help you with some vocabulary and some

translation?

Are there language students at a high school or university level who are in

need of volunteer hours who could assist you in your therapy? Do you have

access to certified interpreters or do you have colleagues who may be from

this cultural or linguistic background? Maybe not even colleagues who work

with you in your physical space but colleagues through professional

organisations like AG Bell or other list serves or Facebook groups that you

could reach out to to get some information.

It’s a great way to learn about how therapy is done in different countries and

different cultures. It is incredibly enriching and it will help you, that

collaboration, you can take back what you have learned from that to serve the

families in your therapy room.

I am also going to share with you two websites here and we will show you the

resources from them later--bilinguistics.com and childrenslibarary.org, and I will

show you what those websites look like later, but those are two terrific

resources.

You may also, if the family is from a country that has a speech language

association, for example, you know the British Association of Teachers of the

Deaf or the Irish Speech Language Association. I know Spain has an

association. You can go and get some resources from that association’s web

page, either parent friendly resources to share or resources for yourself as a

professional to help you learn. Go back to what are your resources, what

information can you gather from these various places to better serve this

family?


I will say before we go on that it is a pitfall—and it’s easy and tempting to fall

into—using family members as interpreters or using family members as your

source of information. But I feel that that is first of all a real blurring of

boundaries. If I am a nine-year-old big brother, it is not really my job to

translate this emotionally loaded and really important information to my parents

as they make decisions for my baby sister's hearing health. I think that is really

tempting to fall into, because that is sometimes all you have got, but I would

discourage against it. I think that it usurps the parents' position of power and I

think you fall into some really tricky ethical dilemmas. I would use these

resources. Big people handle big problems. Little people, even if they speak

the same language as you, should handle little problems, not the big problems

for their parents.

Another therapy consideration is: what are the AV golden rules? When we

think about auditory verbal we also have to examine what we may consider to

be absolutes or golden rules of how children learn language. We need to

remember that these beliefs are culturally situated and we accept them

because they were part of our enculturation or socialisation into the

professional culture.

This doesn't mean throw them out. But we need to combine them with

knowledge of the family. What does this family think about child-directed

speech? How are their pragmatic norms different from ours? What vocabulary

might be worth emphasising for them versus what is not?

If I’m working with a family from Costa Rica and snow is not a part of their

winter experience, a lesson planned around a snowman will not be very

effective.

Same thing with the Ling six sound check and learning to listen sounds; they

are not universal but the concept is. We think about these as split part of the

AV canon, as it were, but we need to consider what is the point of these


sounds. The sounds themselves are just a means to an end. The Link six

sound check is a check that gives us a rough estimate of the child's access to

speech. The sounds themselves fall out at important places along the

frequency spectrum. For example, I have one family for whom using a snake

for Sss is not culturally appropriate. Kids don't play with snakes in their world,

even toy ones. We use instead a spray bottle that makes a sound like Sss,

sss. sss. So those sound object associations are not set in stone. We are

getting the same information.

Or we may need to change the sound. In Vietnam and other Asian countries

where children used to learn the toilet much earlier than Western children,

sometimes that sss, sss sound is used as an elimination cue. Understandably,

parents don’t want to use that in therapy or we might end up with a mess. We

might substitute fff, like an F phoneme, to check the high frequency audibility.

The same thing with learning to listen sounds. We need to not be so tied into

the sounds themselves but think: what is the point? The point is we want to

give a basic library of sound object associations to build that child's idea that

sounds equal meaning for things, and to use that library for auditory

discrimination, to give that child practice articulating all of the sounds of the

language in a way that is fun and play based versus drill and kill, and to do all

of this in a way that is developmentally appropriate and something that the

child’s hearing peers would be doing or playing with anyway.

What you use for each animal sound is not as important as getting at those

objectives. If the family is Spanish speaking and they use nya, nya, nya, like

that nyay sound for a pig that may be different than the oink, oink that you use,

but it’s great because that is helping the child learn a phoneme that is not

present in English.

Books--using books in therapy is one of the most important things that we do.

How can we provide literacy experiences to our multilingual families?


The first thing to ascertain is whether or not the parents read in their native or

languages. If a parent doesn't read, that doesn't mean we throw out books

altogether. It doesn't mean we can't share books in therapy.

In another Hope course about Bringing Books to Life, which was also

generously sponsored by Cochlear and RICBC, I discussed some strategies

for getting around this. You can find a recording of it on my website if you

would like to go back and learn more.

Basically, we need to change the conversation from reading a book means

reading from page 1 to page ‘the end’ and reading each word to sharing a

literacy experience. Can you find some bilingual books or can you create them

either by writing in a direct translation, if you are able, or glossing with some

key words and phrases, and I will show an example of that next.

And I will show you a resource for multilingual ebooks. But I share this with

extreme caution. We know that children do not learn as well from ebooks as

print books. I want to use this as a very last resort and use those that are not

enhanced, meaning there’s nothing to click, it doesn't make sounds, it doesn’t

move; I was as boring a possible PDF that looks like I am just reading the

book. Children use far too much technology, and technology—time spent with

technology is at the expense of communicative interactions with people. Even

if the parent and therapists are interacting with the book and the child, we know

that the quality of this is not as high when technology is in the mix. So share

as a last resort.

Here is an example of glossing. Maybe your Spanish isn't good enough to

translate all of these verbs, see versus looking at me. That is tricky. But if you

can gloss with a simple phrase like (speaks Spanish) the white dog says bow

wow, then you can still share this in Spanish with the family and perhaps you

read in English and mum reads that in Spanish, or maybe mum is saavy

enough that she can translate, “White dog, white dog, what do you see? I see


a black sheep looking at me” into Spanish and then you, the multilingual

therapist learning Spanish, can chime in talking about what the dog says.

Here is that other website I mentioned. Childrenslibrary.org. This has an

amazing library. You can see here an amazing list of languages. Pretty much

anything that walks through your clinic door you should be able to find here.

So there is an amazing library of books in all different languages, and the great

thing—they are very boring. They are just PDFs, nothing fancy, nothing moving

that detracts from the learning. Even better than having multiple languages is

that some books themselves are available in multiple languages.

If I can read this book Round and Round through in English and then share it

with a family who speaks Marati, which is an Indian dialect, then we can both

be reading it together, and I actually know what is going on.

We also need to think when we are planning therapy what sounds overlap

between languages and what sounds don't exist and therefore aren't heard or

discriminated in each language. How does the order of phoneme acquisition

vary?

Here are resources from the Bilinguistics, the website I told you about earlier.

Here is a vowel inventory between English and Spanish. English--we use

many, many more vowels than they do in Spanish.

Here is an overlap between consonant phonemes in English and Arabic. If I am

modelling a word with “G”, like go versus tow, and the child isn’t discriminating

and the parent also isn’t discriminating, perhaps that is because the G

phoneme just doesn't exist for them in Arabic.

We also need to think that phonemes not only do some exist and not exist and

so aren't discriminated in different languages; they are also acquired in


different order. When we are thinking about assessing whether or not a

bilingual child has an articulation delay, it is important to keep these things in

mind.

Another therapy consideration is to exploit those cognates. You get double

bang for your buck in terms of vocabulary growth and so these are great words

to target. If I can teach elephant in English that is going to really quickly

translate to elephante in Spanish, so I am teaching two words. I am

emphasising and supporting both languages. You can get a lot done there.

You get the most bang for your buck when you are choosing vocabulary

targets by teaching cognates first.

Another thing we need to think about when talking about vocabulary for these

children is making sure we don't leave things behind. What kind of vocabulary

do we use at home and what kind of vocabulary do we use in more academic

settings?

A child may know “glue” from school, but they might not know in Spanish that

mummy calls it pegamento at home. You often see children who appear to be

doing quite well and testing quite well in both languages, but they have these

holes based on the experiences that are different at school and at home.

Especially like we discussed before as a child who speaks multiple languages

approaches formal schooling, they will be learning very rapidly lots of new

vocabulary for school supplies, school subjects, technical terms, the names for

people like principal, custodian, lunch lady, all the people who work in the

school. Those aren't necessarily be learned yet in their home language,

because I don't come across a custodian at my home. There is no principal in

my family. We need to make sure that we are supporting and continuing to

grow both languages together.

The same thing for home vocabulary. Hopefully if you are an auditory verbal

therapist you are using and supporting these natural routines that are


happening at home. If the family is already doing chores, I want the child to

know those in the home language but then also let's play in the therapy room,

let’s replicate experiences that are happening at home so the child can then

add the terms for that in their second language.

Another thing when we talk about a vocabulary gap is this BICS-CALP gap.

The gap between basic interpersonal communication skills. “Hi, how are you?

What’s the weather? What are you wearing? Where are you going?” And this

cognitive academic language proficiency. You know, find the sum of these two

angles. Very, very different kinds of communication, and we usually are only

assessing and making recommendations for bilingual children based on BICS

and not scratching deeper below the surface and looking at CALP. So, there is

really two different levels to what we consider fluency.

At the core of the AVT method is our belief that families serve as their

children's first and best teachers. Just because a family comes from a different

culture or speaks a different language does not change that. It can be

especially tempting, even if you are the majority language expert or even the

only majority language speaker in this session, to take over and deliver a much

more clinician directed style of therapy. We know this is not as effective in the

long run for the child. What can you do?

It used to be that we’d talk about this concept of cultural competence; you

know, what level do I have to reach to be considered a culturally competent

individual? So, what I propose, based on the work of Turbelon and Murray

Garcia(?)—it is an excellent article. I really strongly suggest that you read it. It

is a relatively quick read for research, and full of great information—is that we

move from this idea of cultural competence to an idea of cultural humility.

Because you can never really prepare for every culture, language or family

situation that walks through your door. And memorising a few characteristics

of each culture is not enough. For example, here in Canada we call our native

population First Nation. If I learn, okay, here is my fact sheet that I read off


some handout, First Nations children are expected to listen, not talk. And then

I just go into work with every First Nations family assuming that is true. But

then what if I meet a family that is from First Nations ancestry and they don't

operate that way? Learning these kind of, okay, here are five facts about each

culture really often leads to stereotyping and we are not really meeting the

family as they actually are; we are meeting them with our predetermined or

assumption that this is what the textbook says happens in this culture.

Instead of aiming for cultural competence, because what are the criteria for

that anyway, instead we should aim for humility. We need to be humble and

open-minded learners letting the families teach us about them and flexible, not

holding any firm opinions or judgments so we can be more adaptable to

whoever walks in our door.

Some other things to consider is: what is your status compared to the family?

If I am a native resident of this country, I am educated—right? If I got to the

point of being a therapist; I have been through a whole lot of school, I speak

the language fluently. I can navigate through society very easily. This family,

perhaps if they are an immigrant family, are feeling at a lot lower status. So

that is their status in this country, but what if back home that family actually

held a quite prominent position and you as a young female would have a much

lower status than them?

Families are often experiencing quite a bit of role loss. For example, if I am a

parent and in my home country I spoke the language, I had a good job and I

was really great, you know, I knew how to raise my kids. Now I move to a new

country, I don't speak the language, so everyone assumes I am dumb, and I

don’t have a job yet, and now I have a child with hearing loss. I thought I knew

how to parent, but I don't know anything anymore. I really have lost all of my

roles and it’s a profoundly discomforting kind of experience, and we need to be

sensitive to that.


Names are also really important. How you pronounce them; taking the time to

say it correctly shows respect. We also need to know what is a respectful way

to address parents and elder family members in this culture. I want to model

that and I want to help the child learn to do that as well.

Also consider that holidays and celebrations--I generally suggest not doing

these in therapy. Even if you celebrate the same holidays as the family, who is

to say that you celebrate them in the same way. And what you do in therapy is

often taken as the gold standard; this is the way it should be. I never want my

idea of how to celebrate a holiday to become the standard for that family or for

them to think that theirs is any less than.

For example, this general middle American commercialised Christmas is very

different than the way a Mexican family might celebrate Christmas, because

Mexican Christmas has its own traditions and it’s certainly a much more

religious holiday for the vast majority of celebrants.

If I am giving the family great AV tools and techniques each week, I trust that

they can use those tools to convey information about whatever holidays and

celebrations and traditions are important in their culture. Because it’s not for

us to present the way that a holiday should be celebrated or assume that if we

don't teach it in therapy the family is never going to get it.

If that is our assumption, that is horrible. We are not doing our job as coaches

and guides. I want to give the tools so that the family can convey whatever is

important to them.

Also, we should not assume anything. Let the families teach you. Just

because you have worked with one family from this culture doesn't mean you

know what all families or even just the next family from that culture will do or

want.


Most importantly, have a sense of humour. These cultural interactions can

sometimes be fraught with a lot of anxiety. “I don't want to make the wrong

move. I don’t want to offend. I don’t want to say something inappropriate.” Most

I think sense sincerity, and if you’re coming to this with humility and a sense of

humour families are going to be responsive back. You will make mistakes. You

will pronounce something wrong. You will say something silly, but that is good

for families to see, that you are also human, right? We’re not perfect. Your

willingness to make a mistake and laugh at yourself frees up the family to

make mistakes as they try new AV skills and models great persistence. For the

child, having a great attitude about their own abilities.

When we partner with families we need to validate. They have often absorbed

some negative messages about their home language and culture from the

prevailing medical and educational establishment. We need to let them know

that their language, spoken fluently and with love, is the best gift they can give

their child. Help them realise their power. And in therapy, look for ways to

validate the scripts, routines, patterns and interactions that are already

happening in their home.

Ask the family maybe to walk you through their day and then point out amazing

things that are already happening. Sometimes you are really going to have to

get creative and dig, but find something that they are doing that is helping to

build that child's brain, and let the family know.

When you are doing X, that is helping your child Y. And then shape that

behaviour and add new techniques. Don't go in and think you are starting from

scratch and building this family from the ground up. You have AV knowledge

and the family have lived experience, and together that is a really powerful

combination.

We also need to equalise our roles. Most families are very used to thinking

that the professional is the one who will lecture and direct and take over. “I am


going to take you to this therapist, they will fix it.” That is not so in AV.

We need to let them know our role is to guide and coach. Parent participation

is not enough. If a parent is participating that still means that I am running the

show. You know, “Here. I’ll set up a game and you take a turn. Check. The

parent participated.” That is not what is going to get this family to success.

I don't want a participant, I want a partner. I want that parent to be a partner.

That means that I value their feedback. I solicit their feedback. I want them to

take the reins equally in leading the session.

In terms of specific partners—that information is kind of general for all auditory

verbal therapy. In terms of building specific partnerships with bilingual families,

I want to ask them about their language goals. Do they want dual fluency? Is a

particular language important for the family's religious services? What is their

motivation for learning these language? And how do they use the language in

their home? I have linked here to the BiFi, the bilingual family interview. It’s a

great way to get past assuming that you know the patterns of language used in

the home and to ask the family. So it goes through each member of the family,

what languages do they use, do they write them, read them, speak them, how

well? t is an excellent tool to give you a map of the language landscape of the

family.

Working with bilingual families who may not be literate in English requires

creativity. It is a good thing that AVTs are great at this.

So perhaps instead of sending home the family with written notes and goals

you can work together to create a pictorial representation, like a revis(?) or a

cartoon with speech bubbles that shows what to work on that week. Or can

you record on the parent's phone and take a video of an activity or take

pictures of what you did to jog their memory?


And AV techniques are great at helping children to understand, but they are

also an amazing way to learn the second as an adult. I feel like I have learned

so much Arabic from my Arabic-speaking family, just from listening to them use

scripts and routines and repetitive language and acoustic highlighting with their

children. So, use those same kind of techniques to build a bridge between a

parent and a therapist who may also speak different languages. It has actually

been a really great experience for me, because I feel like I get a tiny window of

insight into what language learning must be like for the children I serve as I am

trying to learn a language from an adult parent who speaks a different

language than me but is using these AV techniques.

When you are working on an activity, go through an 'I do, we do, you do'

progression. Meaning the therapist models, and then we will do it jointly and

then the parent will do it, perhaps each in our own languages.

So here are some case studies. Mariam was a little girl who was born with

genetic bilateral profound sensorineural hearing loss. She received bilateral

CIs at 12 months. Her older sister was seven and who was born in their home

country profoundly deaf, so she did not get a CI and she was a sign

communicator. The parents only spoke Arabic. The older brother spoke

English and Arabic. So Mariam really was growing up in a home that had

English, Arabic and sign. Primarily though Arabic.

What we did, because I was learning Arabic from the parents, I would

sometimes use the words that I knew but mainly mum also was not literate in

any language, so we would draw out our session notes and send them home

with a cartoon every week that had some basic words, 'in', 'out', and then a

drawing of it, or just an overall picture drawing of the technique that we use,

and that would be how mum would remember what to work on that week.

Also, when we were working on new techniques, I would model a technique in

English and then translate key words in the Arabic I knew and then mum would


implement it in Arabic with Mariam.

Heddy is a little girl that I work with whose parents are both native German

speakers. But she uses English at home and at school and her parents are

fluent in both English and German. But she speaks German with her nanny,

who spends time with her each day, who is also a fluent native German

speaker, and her grandparents with whom she takes frequent extended trips.

So really for Heddy the issue was not quality of exposure. She is surrounded

by fluent speakers. But quantity. We really had to increase the amount of

German time by reminding her nanny to use German with her throughout the

day.

Isa was little girl whose parents spoke Norwegian and English, but she spoke

only Norwegian. And this is a real testament to parent coaching in AVT. She

didn’t speak English and her parents weren't focussed on her learning it at the

time. I should mention this was by teletherapy. She lived in Norway. So it is

not unusual for her not to know English or for that not to be a priority. I was

really forced to coach the parents only and then they would translate and

implement into their language. We really had to be partners, because I needed

their feedback about phonemic qualities of words in a language that I did not

speak. And only because I was able to use all of my coaching skills were they

able to implement and be really successful at helping her learn language.

Last is a study about Jose. He was born with moderate bilateral sensorineural

hearing loss and received hearing aids at eight months old. The family spoke

English and Spanish and he got English exposure at school.

Jose was exhibiting really odd errors, like difficulty with article noun gender

agreement, like el daka(?) in Spanish instead of lavaka(?). And it’s not seen in

typical Spanish language development. That is a sign of a language disorder

for a monolingual Spanish speaker as well.


He also really had difficulty with attention, working memory, auditory memory

and retention of what we have learned. When we gave him the TONI, which is

the test of non-verbal intelligence, so it kind of gets at what is this child’s

cognitive ability independent of any language disorder—he was scoring in the

high 70s, low 80s. We also saw these same kinds of processing difficulties and

errors that were not attributable to his hearing loss when he was speaking

English as well.

Convention wisdom may say, ‘Don’t have this child learn Spanish. He should

really only focus on English', but that would have cut him off from his large

extended family, which was one of his greatest sources of support. Instead of

blaming these language problems that we saw on bilingualism, we may just

have to realise that some children have language disorders above and beyond

their hearing loss and they would have had them even if they were hearing or

even if they were monolingual. We can still help those children succeed and

thrive in both of their languages and their cultures. That is all I have for you

today. What do you have to say? We have some time for questions and

answers, so I think you will be able to chat those to Melissa and we can

discuss them.

MELISSA: That is exactly right, Elizabeth. If you do have questions please

use the chat feature to type them to me and I will speak them out to you, and

we will see what Elizabeth can share with us. Any questions from the

audience? We have quite a few people here today. Nobody wants to be the

brave first person to ask a question.

ELIZABETH: I don't blame you; I don't like to be first, either.

MELISSA: Okay. So, Mia wants to know: is there a time when it is too late for a

child to start to be bilingual?


ELIZABETH: I think that in general when we look at language learning we

know that really before three is ideal and before 12 is best.

Our ability to be flexible cognitively and learn new languages, even for a

hearing person, diminishes greatly after puberty. But if the language is of

value to the family, meaning it is culturally relevant and it’s really important to

give that child access to communication with people in the family, it is never

too late to start learning even though the level of fluency achieved may not be

as great as if we had started it earlier with the child. It is about those two Qs,

the quality and quantity.

It is possible even as an adult to become fluent in language, but you will need

a huge quantity of input and a huge quality of input. Just think about the two

Qs and then kind of think about what is your goal here.

If the goal is just to learn a new language for the sake of learning a new

language, maybe it would be wiser to focus attention elsewhere. Right? If I am

just randomly choosing to Mandarin. But if learning this language is helping the

child academically and giving the child access to cultural events or things that

are important for the family's heritage, and they think it is of value because it is

connecting the child to people and events in their lives.

MELISSA: I have another question here. Christine wants to know whether

you think a child can pick up English only at childcare. She has a family who

want their child to speak English but only want to speak Hindi at home.

She also says thank you for your comments about being able to validate

families on humility and humour.

ELIZABETH: Thank you, I love that Turbelon(?) and Murray Garcia article.

You should read it. It is really fabulous. I think it is a great new mindset shift

from competence to humility.


If we think about those two cues again, yes, that child—depending obviously if

they are only spending five hours in daycare a week then, no, that level of

English exposure isn’t going to do it. But I do think that a child would be able

to pick up both, especially because if they are getting fluent Hindi models at

home, and that’s their language base, even if that child may hit full-day

kindergarten, let’s say, at age five, if you are in the States, with a slight

language delay in English, meaning that their Hindi maybe let’s say at age

appropriate and our English is a bit behind, if that child has great perceptual

access, if that child is getting quantity and quality of models at school and from

friends and other people in the neighbourhood, and the family have great AV

skills, they are able to teach language and become their child's first and best

teachers, I think that should be fine.

Obviously with languages there are a lot of variables, but based on what you

have said, I think that child should easily be able to become fluent in both.

MELISSA: Mary Jones would like to know how do you make use of

interpreters in your session when you are lucky enough to have one?

ELISABETH: Yes, exactly. I think obviously basic interpreter etiquette applies.

You are talking to the family, not to the interpreter. Sometimes though the

interpreter can serve more as a cultural broker or a language detective, I

suppose. If I am communicating with the family and we are having difficulty

with a term or a concept, then it may be appropriate to turn to that interpreter

and use them to help me understand, “Does this sound exist in your language

or not?” Obviously I would first direct the question to the parents. If they are

unable to answer, often the parents will turn to the interpreter as the person

who is kind of the language professional in that language, and we can all

discuss it together. Generally what I will do is I will speak and give over the

coaching to the parent, just as I would if the parent spoke English, have the

interpreter interpret that into the family's language, and then I will do what I do,


doing the 'I do' part, and then together we will do 'we do', and then the

interpreter will interpret my directions to the family and let me know what the

family is saying, and then turn it over to the family. If they speak their native

language, that interpreter can give me the back-end quiet translation of what is

happening.

I do think when we have a child, especially a child who is a new listener, we

need to be cognitive about when is that interpreter talking and making sure that

interpreter is not talking over the parents. Even though that helps me to have a

realtime translation, it might interfere with the child’s ability to process

language or follow those auditory-only directions.

MELISSA: Thanks for that. Alicia Davis would like to know: how would you

recommend assessing a child in both L1 and L2?

MELISSA: So if you are fortunate enough to have language assessments in

languages other than English, and there are some good ones out there but for

primarily things like Spanish, especially in the States, right, if that is kind of the

mostly widely spoken L2, you are more likely to get an assessment in Spanish

than you are in let’s say Marati, with a much smaller language base, that Indian

dialect.

Ideally we would assess with norm reference testing in both languages.

Sometimes that seems just like a dream; you can't really get that level. There

we really have to look at criterion reference assessment, and a lot of parent

reports. This is a great way to make parents partners, not just participants, in

your session.

If you are fortunate enough maybe not to have an assessment but to have a

language milestones chart in that language or to be able to speak to a

colleague either at your centre or maybe internationally, go to those speech

language hearing associations in different countries and different languages,


see if they have at least a basic developmental milestone chart they can give

you to go through with the parent and see if they you are witnessing that.

Last resort would be to use a criterion reference assessment in English and

then translate or ask the parent, let's say, at 18 months for a child in the States

we would expect them to have approximately 30-50 expressive words. The

mean age for 50 expressive words is 19.25 months in the States. Then if I am

speaking to a family that speaks Tagalog can I just ask for your 18 month old,

how many words does he say in Tagalog? Is it valid? No, not necessarily, but

sometimes that is all we have.

MELISSA: An interesting one about school language, Elizabeth—in Australia,

school is often seen as the highest priority for immigrant families particularly

who may not have a lot of English. Can you talk a little more about the issue of

parental belief that the child needs to learn that language of school even in

those very early years, 0-3 or 0-5?

ELIZABETH: Yes, absolutely. I think it is pervasive. I have seen it in the State.

I have seen it here in Canada, where I live now. And I think even in

monolingual speakers we see this kind of trickle down of, “Okay. I need my

three-year-old to know all their shapes and colours. I need my five-year-old to

be doing their vocabulary flashcards and their reading flashcards.

So I think it is unfortunately kind of a really pervasive disease regardless of

where the family lives or what language or languages they speak. I think that

by helping parents understand whether it is sharing research or sharing stories,

whatever level is comprehensible to them, it is much more important to have a

language base in any language that will enable them to learn that language

later than to get a piece-wise model. One way might be to show the family a

written paragraph and then to cut out 50 per cent of the words and say

essentially if you are trying to talk to your child in a language that you don't

know all of you’re giving them half the picture. Do you think that they will learn


what this paragraph is talking about or what it means by only seeing half of it?

Of it a family doesn't read, show them half a picture? And say, you know, when

–I can even tell them, 'When I am trying to speak Arabic to your child, I know a

handful of words, so I am showing let’s say maybe in an activity with a baby, a

very simple activity, I can give 20 per cent of the picture.’ Showing 20% of a

picture, you are not going to be able to guess what the picture is if you see

20%. I'd rather you see 100% of a different but related picture and later you

are going to be much more able to transfer that information. I think it is really

helping the parent dismantle some of those beliefs. It is very hard. If you

sacrificed everything to emigrate, and you know that school is the key to

success for your child, then you want them to be successful in school.

As therapists we have to say, okay, to be successful in school, to achieve this

goal here is how you go about it. And it’s not perhaps maybe the way you

think.

MELISSA: On a related note, how do you bring the home language up to the

school language level without confusing the child in learning the concepts?

ELIZABETH: I think that this issue of confusion is one we often see. It is often

a misplaced fear. If the child has developed these differentiation skills and if

they have the metalinguistic terms to understand English is a language and

here’s how you say ‘cat’ in English; French is a language and here is how you

say ‘cat’ in French. If they have got this metalinguistic code-switching

differentiation ability, then it’s not—I wouldn’t worry about confusing them. I

don't think it’s more confusing to learn two words if one is in English and one is

in French than just to learn two words period. So any confusion we are seeing

is probably to do with learning, not necessarily the languages being learned.

So, often a way that we can input some of that school vocabulary is if in

therapy we are doing a craft, you know, if we are gluing, cutting, colouring,

some families will do crafts at home. For other families, sitting down to do a

craft is not really a thing.


For example, pegamento for ‘glue’, the example that I was giving earlier, that

was a vocabulary word that came up. We were gluing something in therapy at

their home, this family. Crafts were not an activity they enjoyed doing together.

The little girl knew 'glue' and 'tape' but didn't know pegamento and cinta(?),

which are the words in Spanish. Any time you can do an activity and have the

parent be paralleling you doing that activity in our home language within the

therapy session then the child is learning vocabulary for both.

I think it is also just something to raise the parents’ consciousness of. Saying

that, 'As she is starting grade 3 she is going to be learning a lot of new words.

I don't want her to fall behind in Polish.’ When she brings home a vocabulary

list, if there are words on there that you can translate it would be important to

help her learn that as well.

MELISSA: We are running over of time. We just have one more case

study-type question. Sarah has a family who has one child with implants and

one hearing aid. He is two years old and has just started wearing his speech

processor. Mum speaks Greek. Dad speaks Spanish. They want him to learn

Greek and Spanish and English. He is severely behind at the moment

because of his age. What would your recommendation be for working with this

family?

ELIZABETH: I think that it is possible, he could do it, it's going to be hard and

a lot of work. If we can coach the family to have appropriate expectations and

buy-in and a real understanding of that quality-quantity criteria and just help

them understand it is going to take both quality and quantity in all three

languages to get him where he needs to be. For me, I don’t think this is an

impossible situation. I think it is a real coaching challenge. If the family gets it,

if they’re on board and if you can get them very quickly up to speed with all of

those AV techniques, I can teach them the AV techniques in English and they

establish for themselves a language plan for their family of when each of these


languages will be taking place, when we are getting our cue and cue for each

language, then they can translate those techniques into all of them—I think

they are providing the input that is necessary and priming that input with the

AV techniques, providing it in a way that it is much easier to catch the

language. I think it is tough, but possible. That is a real conversation you need

to have with the family to make sure that they understand all that you

understand about what it is going to take to get their child there.

MELISSA: Thank you very much, Elizabeth. There was certainly a lot of

useful information and ideas in your presentation today. Quick reminder for

participants that today's event has been accredited by AG Bell and you will

receive a link to the presentation in approximately two weeks' time. If you do

need anything else from the RIDBC Renwick Centre regarding the webinar,

just send us an email. Thank you again, Elizabeth, and we look forward to

seeing you next time.

ELIZABETH: Thank you for attending and thank you for organising it, Melissa.

MELISSA: No problem. Have a good day, everyone.

Documents

MELISSA: Hello, everyone. This is Melissa McCarthy from … · · 2017-04-262016-06-08 11.45 HOPE Elizabeth Rosenzweig 2 Page 5 However, we know that this comparison is based on