Multilingual Contexts: Screening, Assessment and Intervention Activities for Children with Speech Difficulties

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By Daniel Bérubé, Speech-Language Pathologist and Associate Professor, Speech-Language Pathology Program, University of Ottawa

The identification of children with speech sound disorders (SSDs), which are defined as neurobiological disorders that affect speech development, is necessary in order to provide a good education for all children. The major sign of SSDs is poor speech intelligibility. SSDs are part of broader language disorders, in which one or more components of receptive and expressive language can be affected, such as phonology, sentence structure and vocabulary (ASHA, 2023).

Special attention must be given to identifying SSDs in multilingual contexts. In this article, multilingual contexts are characterized by situations in which the educator and the child do not speak the same language, or in which the children speak two or more languages. The guidelines indicate that educators, including teachers, speech-language pathologists and early childhood educators, should consider the language skills of the child in all of the languages spoken by the latter to properly identify SSDs (SAC, 2021).

In the past 30 years, the number of children living in multilingual contexts in Canada has doubled. It is thus important to provide services in all of the languages spoken, including Canada’s official languages, English and French, and non-official languages, defined as any language other than English and French (Statistics Canada, 2022).

Approximately 10% of children under 18 years of age have SSDs (Rajan et al., 2017). Speech-language pathologists who specialize in helping children with a communication disorder should identify any SSDs as soon as possible since the affected children are prone to encounter difficulties with phonological awareness, that is, awareness of sound units and reading. There is good news, on the one hand, in that early identification of and treatment for speech sound disorders, based on a scientific rationale, reduces the risk of literacy disorders. On the other hand, a lack of or delay in identification poses a significant risk to children’s school success, socialization and self-esteem (Felsenfeld et al., 1994; McCormack et al., 2009; Pennington and Bishop, 2009).

In Canada, most of the educational resources for helping children who have SSDs are in English and French. In our multilingual society, educators need to serve children who speak other languages (SAC, 2021). A common set of problems arise when educators need to provide services, but do not speak the same language as the child. Few tools are available in non-official languages, and many educators do not feel comfortable providing support in a language that they do not master. What’s more, many educators feel ill-equipped to provide services in multilingual contexts (Nelson et al., 2020). In order to meet this need, this article will explore resources in English, French and several other languages. In addition, suggestions for providing an education that meets the needs of children in multilingual contexts will be presented.

Resources presented are based on the Response to Intervention (RTI) model. This educational framework proposes approaches validated by research and comprises three tiers designed to improve the success of all students (Catts et al., 2015). The framework of the response to intervention is represented by a traffic light in which each colour is associated with an intervention based on a child’s risk factors of SSDs.

Green light: Screening for all children

The most important risk factor for detecting SSDs is poor speech intelligibility (ASHA, 2023). Intelligibility is connected with speech clarity and consists of understanding what the child is saying. In other words, when a child is not understood because their speech is not clear, adults and educators should see this as a risk factor. Early speech screening will make it possible to identify children at risk of difficulties in phonological awareness, reading, and speech intelligibility. What should be done, then, when parents and educators do not understand clearly what the child says?

According to the Response to Intervention (RTI) model, universal early screening makes it possible to quickly observe the child’s speech in all languages spoken by the child. To do so, parents and educators are called upon to pay attention to the intelligibility of the child’s speech. Screening should be done in each of the languages spoken by the child (SAC, 2021). For example, if a child speaks Mandarin at home with their parents and French at the daycare centre with the early childhood educator, the parents and educators can assess the intelligibility of the child’s speech in each of the languages spoken (Bernhardt et al., 2023).

There are a few tools and approaches to speech screening in multilingual contexts. The Intelligibility in Context Scale (ICS), a questionnaire dealing with the intelligibility of children’s speech, is particularly sought after. The ICS fits in organically with the concept of intelligibility, as it leaves it up to the parents to assess their child’s intelligibility. Parents answer seven questions, indicating how often different people understand the child in various environments, according to a scale from 1 to 5 (1 = never; 5 = always).

Click here to view the English version of the Intelligibility in Context Scale. 

The ICS has been adapted and validated in 66 languages, including several non-official languages in Canada (McLeod, 2020). The validation process of the Francophone ICS in multilingual contexts is currently underway, and the validation should be completed in 2023. Readers can find the ICS in several languages at the following link:

http://www.csu.edu.au/research/multilingual-speech/icshttps://www.csu.edu.au/research/multilingual-speech/ics 

The Canadian Association of Speech-Language Pathologists and Audiologists recommends speech screening for all children, including those in multilingual contexts, in each of the languages that they speak, from three years of age. In some cases, screening will be done in the daycare centre; for other children, it will take place when they start a new school year. The ICS requires less than three (3) minutes to complete and makes it possible to determine very quickly if a child’s speech requires a more in-depth assessment or if it falls within a normal variation.

All children, particularly those who encounter difficulties with speech sound production affecting intelligibility, will benefit from interactive communicative approaches. For parents at home and educators in daycare centres or the classroom, the Canadian Association of Speech-Language Pathologists and Audiologists (2021) recommends a number of activities/games and modes of communication that foster the intelligibility of a child’s speech:

• Communicate in all of the child’s languages, if good language modelling is possible
  • Choose the appropriate times to communicate in each of the child’s languages. For example, a parent may speak with their child in a non-official language at home, whereas educators will use one of the official languages in daycare centres or at school.
• Use an interactive style rather than a directive style
  • Increase communication according to the child’s interests. For example, the teacher can make comments and observations when playing with toy cars or when painting or dancing. The adult can ask open-ended questions, which allows the child to describe an action, make a request and clarify their communication failure.
  • Add information when the child comments. For example, when a child says, “The car is driving,” the parent can add, “Yes, the little car is driving fast!”
• Model a positive interaction focused on enjoyment
  • Have fun! Communication is enhanced when children take pleasure in communicating. Parents can interact with their child by suggesting enjoyable activities, for example, playing ball, tag, or hide-and-seek. Activities that mesh with the child’s interests, in all of the languages that they speak and are in line with the family’s cultural routines, are favoured.
• Use exaggerated suprasegmental indicators
  • Exaggerate your intonation in communicating with the child, either during play or sleep routines, or when reading—for example, by placing stress on an emotional word in the story, or when asking the child a question.
  • Slowing down the rate of speech will enable the child to pay better attention to the relevant phonological features of speech. For example, the teacher can occasionally exaggerate the production of sounds that seem to be more difficult for the child.
  • Exaggerate the stress placed on certain words or sentences in activities that are motivating for the child. For example, the teacher can separate and emphasize the production of each syllable in a word.
• Attract the visual and auditory attention of the child before providing them with a verbal model
  • Attract the child’s attention. Before commenting, asking questions or giving instructions, the teacher can attract the child’s attention and ask the child to look at their face in order to hear and see better. Auditory and visual information will help the child to better conceptualize speech sounds. Modelling by adults supports speech development.

Yellow light: Additional interventions in small groups of children

For some children, speech intelligibility is greatly affected. In some cases, parents and educators will not understand much of what the child says. Based on the Response to Intervention approach, children whose speech is not very intelligible will benefit from an additional intervention. At the same time, children are typically referred for speech therapy services, even though specialized services are not necessary for all of the children identified at the Yellow tier (Swaminathan and Farquharson, 2018). In several school boards, wait lists for specialized services are common and can persist for several months. It is better to intervene early in the classroom to help children in need.

At Tier 2, i.e., the Yellow tier, children receive more targeted interventions in small groups, guided by the educator. In addition, all of the activities and games proposed at the Green tier should continue. A few suggestions are proposed for improving the speech intelligibility of children in daycare centres and in the classroom. It should be recalled that the activities will take place in small groups.

At school, Yellow-tier activities are guided by educators who are the best-placed people to provide a quality intervention. The groups can vary from three to five children (St-Pierre et al., 2010). Just as for the activities proposed at the Green tier, communication between the educators and the child should take place in the child’s everyday language, with an interactive style and using fun activities. In multilingual contexts, the teacher should provide interventions using the best language model possible, which will correspond to the shared language between the child and the teacher. In cases where the teacher, e.g., a Francophone, does not speak the child’s dominant language, e.g., in the case of an Arabic-speaking child, it is recommended that activities be carried out in the language of instruction when the child is developing an academic language, e.g., French. Activities can be carried out in Arabic at school if an educator also speaks Arabic. As much as possible, parents can read with their child in the dominant language that is shared at home, e.g., Arabic. An intervention in the child’s dominant language is the best choice (McLeod et al., 2017).

Only speech-language pathologists are trained to work specifically on speech production. Other Yellow-tier activities undertaken by the teacher are based on reading, phonological awareness and print awareness (St-Pierre et al., 2010). Such activities will help with the production of speech sounds. A few activities are proposed for the classroom:

• Dialogic reading
  • Story reading is shared between the teacher and the group of children. The child takes an active role in reading. For example, before reading, the teacher encourages the child to reflect and to predict what the story is about based on the title of the book and the pictures. During and after reading, the teacher asks open-ended questions about the main characters and the outcome of the story. In addition, the child is invited to give an overview of the relevant events. Teachers can summarize the child’s response and provide corrective feedback on how the child produced the sounds of a word, or they can add to the content of the child’s response. For example, once the child has finished reading a sentence, the teacher can point out any reading errors to the child and can model the correct reading. Next, the child can repeat reading the word in the sentence following the modelling by the adult.
  • Repetitive reading of the same book will enable the child to better predict the story elements and to become a more active reader.
• Phonological awareness
  • The development of phonological awareness has a positive effect on the production of speech sounds and reading. When children encounter difficulties regarding speech intelligibility, teachers are encouraged to work with students on phonological awareness, regularly, for example, every day or three/four times a week, for short cycles of 15–20 minutes. This work should be done as early as possible, soon after the students start a new school year.
  • The targeted activities can include the segmentation, fusion, addition, omission and localization OR detection of syllables of phonemes. See the table with examples of varied targets in this article.
  • Phonological awareness activities are carried out using real words, for example, words taken from books in the classroom, and non-words. It is more beneficial to use real words since this will help to increase the child’s vocabulary. The use of non-words develops speech sound memory, which is a critical skill to build for reading.
• Print awareness
  • The development of print awareness is an essential prerequisite to reading. Children acquire print awareness when they learn about the functions, conventions and forms of writing. Helping children to gain print awareness requires diligent, strategic and ongoing work.
  • Children whose speech is unintelligible are at risk of having SSDs and reading disorders. It is therefore important to explicitly teach children print awareness practices, to leverage the optimal conditions for reading early on.
  • Several activities are prioritized continuously, and students are encouraged to spend 10 to 15 minutes a day working on them. The prioritized activities include those that focus on the importance of a book’s cover page, for example by demonstrating a book’s orientation, by explaining where the title is and what it is used for, and by teaching the names of letters and the written letter/sound correspondence. Thus, when students begin to read a text, the teacher needs to provide a model to show where to start reading, how to distinguish between the text and the images, and to demonstrate the direction of reading, that is, from left to right and from the top to the bottom. Before, during and after reading, the teacher explains the concepts of letters, words, sentences and paragraphs. Strategic teaching of the concepts of uppercase and lowercase letters can also help the child to become aware of the code for written words.

 Examples of phonological awareness activities: 

Red light: Individual, intensive interventions

Around 10% of children will present with SSDs (Rajan et al., 2017). These children are often highly unintelligible, that is, they are very difficult to understand and should be given an in-depth assessment by a speech-language pathologist who specializes in communication disorders. Based on the Response to Intervention approach, highly unintelligible children would have already received additional support in a small group at the Yellow tier. Only speech-language pathologists are qualified to assess speech sounds and to provide a specialized intervention. In a multilingual context, it is recommended to inform the speech-language pathologist about all of the languages spoken by the child so that the assessment will be accurate and informed. A few resources are proposed for the assessment and individual intervention:

• Proportion of whole-word matches
  • Take, for example, a situation in which a Francophone speech-language pathologist does not speak the same language as the Arabic-speaking child. In this context, a holistic approach that analyzes the proportion of “whole-word matches” is suggested (Bernhardt et al., 2020). In the example involving Arabic and French, the assessment of speech sounds in these two languages can be carried out based on a list of a few words in each language. The Francophone speech-language pathologist listens to the child produce words in Arabic and French, and determines whether the production of each word fully matches the adult target. The adult target productions in Arabic are pre-recorded, and the speech-language pathologist compares the child’s production to that of the adult target. When there is a lower proportion [of whole-word matches] in each of the languages, [the child’s] speech is likely more indicative of SSDs. A proportion of less than 40% in both languages indicates that a more in-depth assessment is necessary and that the child is at risk of SSDs. More information about the “Whole Word Match” assessment method in several languages can be found in the work of Bernhardt et al. (2020).
• Nonlinear analysis
  • Highly unintelligible children often have several speech sounds that do not match the adult target. An assessment of the phonological system should focus on the child’s strengths as well as their needs. Nonlinear analysis allows the speech-language pathologist to verify large phonological units (e.g., words and syllables) and small phonological units (e.g., consonants, vowels and diacritical marks).
  • Phonological tools based on nonlinear analysis exist in many languages, including English, French and several non-official languages. Please consult the website: http://phonodevelopment.sites.olt.ubc.ca. On this website, you can find shared word lists, audio files for sound elicitation, analysis grids and intervention targets, tutorials for using the grids, as well as exemplars of intervention activities in several languages.
• Personalized multilingual interventions
  • In multilingual contexts, speech-language pathologists are encouraged to provide an intervention in all of the languages spoken by the child. Several multilingual intervention approaches exist. We suggest that readers consult the complete work of William et al. (2021), who present more than 20 phonological approaches.

All educators play an important role in identifying the speech intelligibility of children. In multilingual contexts, screening should be done in each of the languages spoken by the child. The Response to Intervention (RTI) model is an intervention guide: i.e., Green = screening of all children; Yellow = targeted interventions in small groups; and Red = intensive personalized interventions. Tips, activities and resources are proposed to improve speech comprehension for all children.

References

American Speech-Language-Hearing Association (2023). Making effective communication a human right for all: Speech sound disorders and phonology. https://www.asha.org/practice-portal/clinical-topics/articulation-and-phonology/

Bernhardt, B. M., Bérubé, D., Ciocca, V., Stemberger, J., Ayyad, H., Sygal, N., Belzile-Lapalme, C., & Ardillez, J. (2023, accepted). Approaching phonological assessment in multilingual contexts: Speech-language pathologist’s judgements of whole word match across languages. Proceedings from the APSSLH Symposium, Journal of Speech-Language and Hearing.

Bernhardt, B. M., Stemberger, J. P., Bérubé, D., Ciocca, V., Freitas, M. J., Ignatova, D […] and Ramalho, M. A. (2020). Identification of protracted development across languages: The whole word match and basic mismatch measures. In E. Babatsouli & M. Ball (Eds.), An Anthology of Bilingual Child Language (pp. 275-308). Bristol, UK: Multilingual Matters.

Catts, W., Nielsen, D. C., Bridges, M. S., Liu, Y. S., & Bontempo, D. E. (2015). Early identification of reading disabilities within an RTI framework. Journal of Learning Disabilities, 48(3), 281-297.https://doi.org/10.1177/0022219413498115

Felsenfeld, S., Broen, P. A., & McGrue, M. (1994). A 28-year follow-up of adults with a history of moderate phonological disorder. Journal of Speech & Hearing Research, 37(6), 1341-1353. https://doi.org/10.1044/jshr.3706.1341

McCormack, J., McLeod, S., McAllister, L., & Harrison, L. J. (2009). A systematic review of the association between childhood speech impairment and participation across the lifespan. International Journal of Speech-Language Pathology, 11(2), 155-170. https://doi.org/10.1080/17549500802676859

McLeod, S. (2020). Intelligibility in Context Scale: Cross-linguistic use, validity, and reliability. Speech, Language and Hearing, 23(1), 9-16. https://doi.org/10.1080/2050571X.2020.1718837

McLeod, S., Verdon, S., Bérubé, D., MacLeod, A. A. N., and International Expert Panel on

Multilingual Children’s Speech. (2017). Speech assessment for multilingual children who do not speak the same language(s) as the speech-language pathologist. American Journal of Speech Language Pathology, 26, 691-708. https://doi.org/10.1044/2017_AJSLP-15-0161

Nelson, T. L., Mok, Z., & Eecen, K. (2020). Use of transcription when assessing children’s speech: Australian speech language pathologists’ practices, challenges, and facilitators. Folia Phoniatricia Logopaedica, 72(2), 131–142. https://doi.org/10.1159/000503131

Pennington, B., & Bishop, D. (2009). Relations among speech, language, and reading disorders. Annual Review of Psychology, 60, 283-306. https://doi.org/10.1146/annurev.psych.60.110707.163548

Rajan, A. S., Parish, S. L., Akobirshoev, I., Son, E., & Rosenthal, E. (2017). Population estimates, health care characteristics, and material hardship experiences of U.S. children with parent-reported speech-language difficulties: Evidence from three nationally representative surveys. Language, Speech, and Hearing Sciences in Schools, 48, 286-293. https://doi.org/10.1044/2017_LSHSS-16-0072

Speech-Language & Audiology Canada (2021). SAC position paper: Speech-language pathology and audiology in multicultural, multilingual context. https://www.sac-oac.ca/resource/position-paper-on-speech-language-pathology-and-audiology-in-the-multicultural-multilingual-context/

St-Pierre, M.-C., Dalpé, V., Lefebvre, P. & Giroux, C. (2010). Difficultés de lecture et d’écriture. Prévention et évaluation orthophonique. Québec : QC, Presses de l’Université du Québec.

Swaminathan, D., & Farquharson, K. (2018). Using response to intervention for speech sounds disorders: Exploring practice characteristics and geographical differences. Perspective, 3(16), 53-66. https://doi.org/10.1044/persp3.SIG16.53

Williams, A. L., McLeod, S., & McCauley, R. J. (2021). Interventions for Speech Sound Disorders in Children (2^nd edition). Baltimore, MD: Brookes Publishing.

Daniel Bérubé has been an Associate Professor in the Audiology and Speech-Language Pathology Program at the University of Ottawa since 2017 and a speech-language pathologist since 2005. His teaching and research program focus on the language acquisition and literacy of children living in multilingual contexts. Professor Bérubé collaborates on numerous projects funded by the Social Sciences and Humanities Research Council, the Consortium national de formation en santé (CNFS) and Health Canada, exploring the language skills of children. He derives his greatest joy at work from collaborating with students and making discoveries together.