Speech-language pathologists as determiners of the human right to diversity in communication for school children in the US

Abstract

Article 19 of the Universal Declaration of Human Rights states that everyone has the right to freedom of opinion and expression – the right to communication. Communication is at the core of the speech-language pathology (SLP) profession. Yet, while we celebrate the 70th anniversary of the Universal Declaration of Human Rights some of our most vulnerable youth are being placed in special education at disproportional rates. School-based SLPs in the United States may be unwittingly contributing to this phenomenon, obstructing the human right to communication because of biased assessment procedures. However, increasing cultural competence, diversifying the profession, and utilising additional assessment measures are actions that can be taken to promote equity in assessment for all children.

Keywords:

• Article 19
• Universal Declaration of Human Rights
• United Nations
• medical-model
• overrepresentation
• cultural and linguistic diversity

Introduction

Article 19 of the Universal Declaration of Human Rights states that everyone has the right to freedom of opinion and expression – the right to communication (United Nations, 1948). Communication is at the core of the speech-language pathology profession. Yet, while we celebrate the 70th anniversary of the Universal Declaration of Human Rights some of our most vulnerable youth are being placed in special education at disproportional rates. School-based speech-language pathologists (SLPs) in the United States may be unwittingly contributing to this phenomenon, obstructing the human right to communication because of biased assessment procedures. However, increasing cultural competence, diversifying the profession, and utilising additional assessment measures are actions that can be taken to promote equity in assessment for all children.

Overrepresentation in special education

The overrepresentation of students of colour in special education in the United States has been under scrutiny for nearly 50 years (Dunn, 1968). Most recently, the Office of Special Education and Rehabilitative Services (2015) reported that in 2013, Native American and African American children between the ages of 6 and 21 were 1.5 and 1.4 times, respectively, more likely to be certified as special education students than students in all other racial groups combined. The risk ratio for Native American students ages 6–21 was larger than the risk ratio for students in all other racial groups combined for all disability categories except autism and orthopaedic impairments. African American students accounted for the highest percentage of students identified in the emotional disturbances and intellectual disabilities certifications. African American students were 2.1 times more likely to be identified as a student with an emotional impairment and 2.2 times more likely to be identified as a student with an intellectual disability than all other racial groups combined. However, the issue of overrepresentation in special education is not unique to the United States. For example, researchers in Europe, Australia, and Canada have documented that minority groups experience increased placement in special education which leads to stigmatisation and marginalisation in education systems (Berhanu & Dyson, 2012; Greflund, McIntosh, Mercer, & May, 2014; Sweller, Graham, & Van Bergen, 2012).

Communication judgment

Overrepresentation of speech and language impairments in children from culturally and linguistically diverse (CLD) backgrounds may be the result of issues in the assessment process. In the United States, the special education category speech and language impaired has been referred to as a “judgment category” because the diagnosis is thought to be subjective and based more heavily on clinical judgment than on hard, biomedical data (Harry & Klingner, 2014). The reference point for identifying an impairment is therefore arbitrary (Laing & Kamhi, 2003). This means that each professional has to decide what constitutes an impairment and where on the communication continuum differences are accepted as a freedom of expression outlined in the Universal Declaration of Human Rights (United Nations, 1948). This can put children from CLD backgrounds, whose communication patterns often do not fit the mainstream of public schools in the United States, at greater risk for identification as a special education student (Samson & Lesaux, 2009).

Standardised tests are often required and relied on when assessing a student for special education but alone are not sufficient for determining the presence of a communication impairment (ASHA, n.d.-d; Dollaghan, Horner, & Oetting, 2011). The primary purpose of administering a standardised test is to determine if a child is significantly different from her peers (Paul & Norbury, 2012). However, content bias, linguistic bias, and disproportionate representation in sampling in standardised tests have been well documented (Arias & Friberg, 2017; Caesar & Kohler, 2007; Laing & Kamhi, 2003). In determining the presence of a disability, it is imperative that SLPs understand that children from CLD backgrounds are often unaccustomed to the culture of standardised testing which fails to take into account bilingual language development and relies on mainstream cultural knowledge (Munoz, White, & Horton-Ikard, 2014). This can negatively impact standardised testing scores, increasing the risk for the misdiagnosis of a communication impairment (Arias & Friberg, 2017; Kapantzoglou, Restrepo, & Thompson, 2012).

Transformations

With known issues in standardised assessment for CLD students in the United States, it is essential that SLPs examine their practice in order to ensure that the human right to communication (United Nations, 1948) is honoured for all. Increasing cultural competence, diversifying the profession, and utilising additional assessment measures represent opportunities to diminish bias in assessment.

Increasing confidence and competence

As the demographics of public schools in the United States change, SLPs must increase their level of cultural competency. Only 8% of school-based SLPs in the United States felt very qualified in addressing cultural and linguistic influences in service delivery and outcomes (ASHA, 2016b). In graduate school in the United States, SLP students are exposed to multicultural coursework and taught about difference versus disorder in some way (ASHA, n.d.-c), yet they may not have had the opportunity to directly connect that information to the local communities in which they may be employed (Farrugia-Bernard, 2016). It is important to note that cultural competence is a “dynamic and complex process requiring ongoing self-assessment and continuous expansion of one's cultural knowledge. It evolves over time…” (ASHA, n.d.-a, para 4). Thus, we cannot expect that information presented in graduate school will be enough to have SLPs possess cultural competence and feel confident serving CLD students. Once in the field, researchers have found that the combination of professional development and diverse cultural experiences appear to increase the confidence and competence of SLPs servicing individuals from CLD backgrounds (Kritikos, 2003; Roseberry-McKibbin, Brice, & O’Hanlon, 2005; Verdon, Wong, & McLeod, 2016). Dixon (2014) described seven strategies for the development and application of cultural competence for SLPs: know your cultural identities and beliefs, get to know the community where you work, get to know your students’ families, set the stage for information exchange, gather other professionals into a professional learning community, know your students, and use ASHA resources.

Diversification of the field of speech-language pathology

In the United States, the field of SLP severely lacks diversity, yet SLPs serve an increasingly diverse population in schools. In 2015, only 7.7% of SLPs affiliates across the U.S. self-identified as a person of colour (ASHA, 2016a). This can be compared to 50% of students enrolled in public schools in the U.S. that have been identified as a person of colour (NCES, 2017). ASHA (n.d.-b) has expressed concerns that the lack of diversity in the field will limit the ability to properly serve the increasingly diverse population.

Drawing from the field of education because of the lack of research on this topic in the field of SLP in the United States, Achinstein and Ogawa (2011) outlined demographic and democratic imperatives for diversifying professions in education. The demographic imperative highlights the issue that public school students in the United States primarily experience White education professionals who are more likely to uphold and reinforce dominant culture practices (Villegas & Irvine, 2010). The democratic imperative focuses on the challenges of schools in the United States to meet the complex educational needs of students of colour (Harry & Klingner, 2014). Diversification of professionals in education has been shown to increase the success of students of colour in terms of academic performance, absenteeism, high school dropout rates, and higher education enrolment (Klopfenstein, 2005). It should be noted that the imperatives to diversify the field do not dismiss the effectiveness of White education professionals working with students of colour nor does it assume that all professionals of colour will be successful with students of colour. Rather, by addressing the demographic discrepancy, all students are exposed to a variety of different individuals and pedagogical practices and thus have an increased chance of success (ASHA, n.d.-b).

Additional assessment measures

While standardised assessments can be used by SLPs to gain quantitative knowledge of a CLD child’s speech and language skills, SLPs should also seek qualitative data to be used in speech and language impairment diagnosis. Language sampling, dynamic assessment, and adaption are useful qualitative tools that can be used in assessment.

Language sampling

Speech-language pathologists can obtain information about a child’s overall communication abilities and specific language skills through collection and analysis of a language sample. Due to the fact language sampling is an informal, criterion-referenced measure, SLPs can use materials that are familiar to the child, which can reduce bias (De Lamo White & Jin, 2011). Language sampling is already a common practice of school-based SLPs in the United States (Arias & Friberg, 2017; Caesar & Kohler, 2009). However, it should be noted that language sampling can be biased if the SLP lacks knowledge about the culture of the child (De Lamo White & Jin, 2011). As a result, language sampling should be combined with ethnographic interviewing (Westby, Burda, & Mehta, 2003) in order to gain a firsthand, detailed account of life experiences from the child and caregivers. In this way the SLP can view the results of the language sample from an appropriate cultural lens (Paradis, 2005).

Dynamic assessment

Dynamic assessment represents an alternative to standardised testing. The goal of dynamic assessment is to identify the speech and language skills the child currently possesses as well as potential for learning (Peña, Gillam, & Bedore, 2014). Through the highly interactive test–teach–retest method of dynamic assessment, cultural bias can be minimised due to a focus on learning instead of static knowledge, which is often replete of cultural and linguistic bias (Hasson & Joffe, 2007). In addition, dynamic assessment can yield important information about appropriate intervention strategies and targets (Hasson, Camilleri, Jones, Smith, & Dodd, 2013).

Adaption

Standardised assessments can also be adapted in order to minimise bias. Carter et al. (2005) outlined several guidelines that could be followed when adapting standardised instruments: include native speakers of the home language/dialect in the development of the instrument; pilot-test the assessment on a representative sample of typically developing children from the home community; pilot-test any pictures by asking typically developing children from the community to identify them; pilot-test instructions to identify deficits in the home language/dialect; if whenever possible, have the assessment administered by native speakers; use material familiar to children from the community; and for children who are unfamiliar with the testing situation, consider giving extra practice items. Making modifications to a standardised test invalidates the standardisation and thus, an SLP would not be able to use the test to see if the child was significantly different than her peers. However, it does give valuable information about the speech and language of the child that can be used as a criterion-referenced measure (Paul & Norbury, 2012).

By increasing cultural competence, diversifying the field, and using additional assessment measures, SLPs in the United States will be in a position to better serve CLD students in public schools. With every assessment, each SLP has the power to uphold the human right to expression and communication (United Nations, 1948) and to shape their practice, and thus the field of SLP, in meaningful ways for all students.

Declaration of interest

No potential conflict of interest was reported by the author.