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Getting Started: Non-English EI Referrals

12 Oct

Hey ya’ll.

If you were an early intervention speech therapist, and you got a referral for a child who does not speak a language that you speak – what would you do?

@liselschwartz and I discussed the other day and I wanted to share some of our ideas. I see a lot of Spanish-speaking children, but I don’t get too many referrals for other languages. Even though I speak some Spanish, my sessions can be a little disjointed. Early intervention is about coaching and guiding parents so they can provide therapy services all week long when you aren’t there. If you can’t talk to them during your sessions how can you make this happen? Here are some ideas!

Figure out how to get an interpreter in there. Our child-find program typically schedules an interpreter for at the least the first session, and then once a month following for non-English speaking families. If you don’t get an interpreter scheduled off the bat, ask your supervisor about what the protocol is for requesting one. When/if you get someone who can interpret for you, try to get some basic vocab words  in THEIR language written down for your knowledge and use. For early intervention my top ten in no particular order are usually:

1. More (some therapists aren’t into this being a first word but it’s quick and easy so I’m sticking with it)
2. Give me/my turn
3. All done
4. Open
5. Help
6. Eat
7. Drink
8. Cookie – or cracker, or apple, or whatever the child eats a lot of
9. Milk – or water, or juice, or whatever the child drinks a lot of
10. Play

– If you can’t get a list from someone who can interpret, trying Googling the words you want – if it’s the wrong word the family will likely know what you MEANT and will tell you the correct word (for example, I didn’t know the Spanish word for “marble” so I just called it “pelota” until a Mom told me “canica.”) If you put into Google “German for ball” it will give you several options, so I just pick the one that sounds closest and the families correct me if I picked the wrong concept. I also LOVE for colloquial definitions.

Put those words to signs for the family. In our center we even make a little sign language book with a picture of the sign and the word below. I know each language has its own corresponding sign language – but this is hard enough without adding extra sign languages to the picture so I just stick with ASL.


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And so on and so forth.

– Do what you can to provide services in their native language. This can hard for a number of reasons (the main being that YOU do not speak Twi or Cantonese or Hmong or whatever). But also sometimes families know that the child is going to be exposed to English in the school system, and so they just want you to speak English to the child. But the two year old should really keep being exposed to their native language so they can communicate with their family members when you aren’t there. This is why it’s vital to get the family playing and doing the therapy, while you coach.

– If caregiver knows someone who can read English, who isn’t there at the time of your sessions, see if you can write down ideas to have translated later. Sometimes Dad or cousin or sister reads English, and so I’ll write down my “ideas” for the week, and then they’ll have that person read later. If you can find something like “Handy Handouts” from SuperDuper (which is in both English and Spanish) that’s ever better – you want to provide resources as much in the native language as you can. As the languages get more “obscure,” the harder this becomes.

– Sometimes families will have a little English in the home, or siblings will speak English, so families will ask, “If the English word is easier to say, can I just model the English word?” (think “ball” instead of “pelota” or “shoe” instead of “zapato.”) I usually try to steer clear of this unless that really is their preferred word that they’d typically use (I see a lot of Spanglish so some families really do just say “apple” instead of “manzana.”) I typically recommend in this circumstance to model approximations of the native language word, rather than modeling the English.

– If there are older siblings in the home who speak English try getting them involved, they can be a huge help for you, and they always love teaching the “teacher” their language and words. 🙂


Any other ideas out there? What do you do with kiddos and parents who don’t share your language? What if you can’t get an interpreter, or the family resists an interpreter? Please share!

NP: Florence + the Machine – Blinding


Measuring vocabulary development in bilingual children

10 Feb

The topic of my first Research Tuesday Blog is (drumroll please): “Total and Conceptual Vocabulary in Spanish–English Bilinguals From 22 to 30 Months: Implications for Assessment.”

This is all there is to see folks

This is all there is to see, folks

To understand the purpose and findings of this article it is beneficial to know the difference between total and conceptual vocabulary.

Total vocabulary is the sum of the words a child knows across two languages.

Conceptual vocabulary gives the child credit for knowing concepts rather than words, and concepts that are represented in both languages are counted only once.

So basically, when looking at a bilingual child’s total vocabulary you would count both the word perro and the word dog. If you were looking at conceptual vocabulary you would only give the child credit for knowing one concept: the furry, four-legged creature in my house which barks and eats kibble is a dog/perro.

The bottom line about this article? The researchers found that when assessing bilingual children, it is most appropriate and beneficial to look at total vocabulary (total vocab FTW!) A clinician is able to look at total vocabulary in a bilingual child by providing the MacArthur Bates Communicative Development Inventory (CDI; Fenson et al.,1993) in English as well as in the family’s home language.

What happened in this research project? Cynthia Core, Erika Hoff, Rosario Rumiche, and Melissa Señor provided families of 47 bilingual families with the CDI and the Inventario del Desarrollo de Habilidades Comunicativas (IDHC; Jackson-Maldonado et al., 2003.) This was a longitudinal study; the children were assessed at 22, 25, and 30 months-of-age.  The children were age and socioeconomically matched with 56 monolingual (English-speaking) children who were assessed with only the CDI.

At the initial 22 month trial, all parents completed the Ages and Stages Questionaire (Squires et al., 1999). The parents of monolingual children completed the CDI, and the parents of bilingual children completed both the CDI and IDHC, at the 22, 25, and 30 month session. The CDI and IDHC provide parents with a checklist of words they have heard their child produce and yields raw vocabulary scores based on this checklist. Both tests provide a percentile based on monolingual norms.

Then the researchers ran all sorts of crazy ANOVAs and t-tests and z-ratios which were totally over my head so I skipped ahead to the conclusion.

Researchers found:

The Spanish-English bilingual children showed a mean conceptual vocabulary which was significantly lower than their total vocabulary.

Total vocabulary in the bilingual children was not different from the monolingual children at any of the three sessions.

Conceptual vocabulary in the bilingWual children was considerably lower than the monolingual children at the 30 month visit.

Total vocabulary assessment did not identify any more/less at-risk bilingual children than bilingual children. Conceptual vocabulary assessment identified a higher number of bilingual children who appeared to have vocab development in the low-average range.

When one compares a bilingual child’s vocabulary to monolingual norms it underestimates the child’s expressive language and over-identifies at-risk children.

Using the CDI (and the home-language counterpart) clinicians can get a clear picture of a bilingual child’s total vocabulary without being responsible for considering the child’s language experiences, and language dominance, and language overlap, and the “balance” in their bilingualism. Clinicians are able to see clear change using these protocols (which we all love).

The authors caution us to remember to take socioeconomic status and receptive language into account. They also suggest that monolingual testing may be appropriate in the event that a clinician wants to know about English proficiency (or the proficiency of the home language.) They also pointed out that similar studies have been done previously with mixed results. ALSO the researchers did a really nice literature review to give you more background on bilingualism, total and conceptual vocab etc., so please read that if you desire.

Direct Link (you will need your ASHA login):


Cynthia Core, Erika Hoff, Rosario Rumiche, Melissa Señor; Total and Conceptual Vocabulary in Spanish–English Bilinguals From 22 to 30 Months: Implications for Assessment. J Speech Lang Hear Res 2013;56(5):1637-1649. doi: 10.1044/1092-4388(2013/11-0044).

Fenson, L., Dale, P. S., Reznick, J. S., Thal, D., Bates, E., Hartung, J. P., … Reilly, J. S. (1993). The MacArthur Communicative Development Inventories: User’s guide and technical manual. San Diego, CA: Singular.

Jackson-Maldonado, D., Thal, D. J., Fenson, L., Marchman, V., Newton, T., Conboy, B. (2003). El Inventario del Desarrollo de Habilidades Comunicativas: User’s guide and technical manual. Baltimore, MD: Brookes.

Squires, J., Potter, L., Bricker, D. (1999). Ages and Stages Questionnaire: Parent-Completed Child Monitoring System (2nd ed.). Baltimore, MD: Brookes.