SeeHearSpeak Podcast

0:00:12 Tiffany Hogan: Welcome to See Hear Speak Podcast Episode 30. In this Episode I speak with Karla N. Washington about distinguishing difference from disorder in childhood speech and language disorders in multilingual children.

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0:00:57 Tiffany: Welcome to Episode 30 of See Hear Speak podcast. Today I have guest Karla Washington, and I will have her start by introducing herself.

0:01:06 Karla Washington: Well, hello, Tiffany. Thank you so much for having me here today. I'm very excited to be here. My name is Karla Washington, and I'm an Associate Professor at the University of Cincinnati in Ohio, USA. I'm also Director of the Pediatric Language Literacy and Speech Outcomes Lab. It's a mouthful, PedLLS for short, where we focus on outcomes across a linguistic spectrum from monolingual to multilingual development and our primary foci include distinguishing difference from disorder, documenting treatment outcomes and building capacity and SLPs by providing them with new knowledge and skill sets for working with children and families who do not speak the same language as they do. So that's me and we have an Instagram page at @pedlls. So, it's @p-e-d-l-l-s_lab_, that's our Instagram. And then for Twitter, it's @lls_ped. The other handle was already taken by the time we set up our Twitter.

0:02:02 KW: Happy to be here. [chuckle]

0:02:03 Tiffany: Oh, that's great, cause we have a lot of followers who are on Twitter and Instagram, so that's fantastic.

0:02:08 KW: Excellent.

0:02:09 Tiffany: To get that plug out there. That's great. So, I'll just jump right in with the first question. So, we know it's common for children of the world to speak more than one language, and I would argue it's very useful to speak more than one language, that should be continuing to be what we strive for. And it's estimated that up to half of the world population is bilingual. But the difficulty comes in deciding what bilingualism is and gathering reliable statistics around multilingualism, so not just two languages but more than one language. So, with this reality in mind, what are some of the main issues you see around diagnosing and treating speech and language disorders in multilingual or bilingual children within the context of your work? Cause I know that's a big focus of your work.

0:02:47 KW: Right. Yes, yes. Great question. And whenever I hear this topic addressed, the first thing I sort of pigeon-hole to is the category of children. And because it's true that it's common for children of the world to speak more than one language, but it is in fact true that the majority of children in the world speak more than one language. So, it's not just that it's common, numerically speaking it's a large proportion of the children that do. And so I think one of the first things that I would think about is having a consistent and agreed upon definition of what is bilingualism and what is multiculturalism, and what is it. If we can all come from the same starting point, then data that follow can then be compared across studies so that we can understand outcomes and treat difference versus... I'm sorry, treat disorders and know what is considered to be different. So, one of the groups that I have been a part of is the International Expert Panel on Multilingual Children's Speech. It is chaired by Professor Sharynne McLeod and a Dr. Sarah Verdon in Australia, at Charles Sturt University.

0:03:52 KW: And this group of experts, sort of a consortium of researchers across the world was established in 2012, and Professor McLeod invited me to join this group knowing of my work interested in multilingualism. So, as I use that word and I talk about this group, this group is comprised of more than 40 international researchers who work with multilingual children around the world. So, they would treat in the native language and maybe in the more matrix or the ambient language as it's referred to in the literature. And so what we did as a group, is that we developed a position statement on working with children who are multilingual, and the first thing we did was to have a definition. What are we going to define this group as? And so as a group, we expanded on a definition by Greg and McLeod from 2012 to say that people who are multilingual, including children, are acquiring more than one language, are able to comprehend and or produce two or more languages in oral, manual or written form with at least a basic level of functional proficiency or use, regardless of the age at which the languages were learned.

0:05:03 KW: So, this is part of our international expert panel statement, position statement, that's available online through Charles Sturt University, and it's also available as part of publications we produced in Journal of Communication Disorders and the American Journal of Speech Language Pathology. So, we... Using that definition, it's helped us to have... Also apply a broader conceptualization about bilingualism to understand language pairings that might be different. So, for example, if we have a language pairing like Spanish and English. One is Germanic, one is a Romance language. And we know that how that pairing comes together, the type of logical properties associated might then be different from say a language that I study, which would be Jamaican Creole and English or what is considered to be a parent language, or a historical contributor to the other.

0:05:58 KW: So, English is the lexifier language of Jamaican Creole, because Jamaican Creole is an English-based Creole. And that's sort of the history of most Creole languages, they have a parent language. Now, is that linguistic typology different from the one that's more traditionally studied? It's very possible. So, while we have a definition that informs our practice, how those language pairings come together is another consideration. So, broadening our understanding of multilingualism beyond the well-studied typologies is also what's needed, and we do study those well-studied pairings simply because of the numbers. There are more people in the world that might speak those pairings than say people who speak Jamaican Creole and English. So, there's a practical consideration.

0:06:41 KW: I also consider defining within multiculturalism or multilingualism is what is cultural competence, what is culture responsivity, and what's cultural humility. Now, the latter mentioned, humility, is much more recent, I think, within the literature. It's not recent in terms of its existence, and when we think about cultural competence or culture, it's that congruent set of attitudes, behaviors and policies that come together in a system and agency, or among professionals that enable the system, the agency or the professional to work effectively across different cultural situations. And then, that would also embody ethical considerations, respecting the background of the person, the choices of the individuals, and also, things that might be related to more justice, like social justice issues. And so, that's... We build the competence by equipping, in our case, I think about professionals that are speech and language pathologists, with the knowledge and skills that they need to perform equitably across varieties of linguistic variation and also cultural variation.

0:07:47 KW: But you don't want to just equip them with the skills, you want them to be able to actually act on those skills, to be able to be responsive to the clients that come to their clinic, or when they go to school settings or homes or whatever setting it might be. Also, I consider the humility, so while you might have all the cultural competence, and you're being responsive, you might encounter someone who, if you look solely at their name, you might make an assumption that this person's from a particular culture, might speak a particular language, when that is not the case. For example, not all speakers from Mexico speak Spanish, they might speak a native tongue, a native tongue that is not Spanish per se. But it might be more indigenous, of an indigenous language, and so then, we have to consider, okay, as much as we might be cognizant, and have some experiences about Spanish-English bilinguals who are of Mexican ancestry, it doesn't mean that all are. How can I be responsive to those who are different from my standard profile?

0:08:49 KW: So, there's the humility in accepting the truth that you don't know everything about all cultures. You know something about a subset of one culture that can then, maybe springboard to inform the other culture that you're going to be interacting with. Third, I also think about the linguistic homogeneity of the profession. So, there's this famous quote, Caesar & Kohler said in 2007, which was that, "We need to close the gap between the linguistic homogeneity of the profession and the linguistic diversity of the clientele," so the majority of children, and I always say children, cause this is my area of focus, on the case load of the speech and language pathologist, is going to be at least half that do not speak the same language as the SLP. And so, where does that put the speech-language pathologist? We don't expect... There are over 8000 languages in the world, we do not expect the speech-language pathologist to be able to speak all of the languages spoken by their clients. But we want them to have cultural humility, responsivity and competence, to know what they could do to bridge the gap.

0:09:55 KW: Are there interpreters? Now, online, there's Google, and I'm telling you, Google has a lot of information that is actually quite well vetted and made available. The international expert panel has a website through the... It's called... Oh my goodness, I'm drawing a blank, it's through Charles Sturt University, and online, there are a number of resources available, a speech-language pathologist can have access to, and it's freely available to them. What I also consider my fourth topic here, is distinguishing difference from disorder.

0:10:28 Tiffany: Yes.

0:10:29 KW: So, it looks... It might look the same, and you assume that what in fact, might be a disorder in one language is actually a well-formed feature of another language. So how are you going to know this distinction? So, if we go back to just understanding what is a difference, it's usually a rule-governed system that deviates somewhat from the mainstream, but the point being, it's rule-governed. With the disorder being where the individual has difficulties learning all properties of all languages and not just the languages which they're faced with. So, it's a key distinction, and with experience, it's going to get better, especially with newer speech and language pathologists. You have those speech pathologists who are working in the area of bilingualism, but in fact, it's only about 4% to 5% of ASHA-registered SLPs, that are...

0:11:22 Tiffany: Really?

0:11:23 KW: Yes, it's a very, very...

0:11:24 Tiffany: Talk about a mismatch.

0:11:26 KW: I know, I know. It is a mismatch, and I want to make sure I double check my numbers, cause I did look that up. 8.2% of the SLP profession are from a racial minority. There was a 2019 year-end report, and only 4%... 5% are listed as having the bilingual skills sufficient for clinical work with the population.

0:11:53 Tiffany: What a mismatch.

0:11:54 KW: It's quite the mismatch.

0:11:56 Tiffany: Oh, we have to do so much better. And a big part of all these issues that you talked about, is the research you're doing, you're tackling so many of these issues. So, how are you tackling some of these issues?

0:12:06 KW: Yes, thank you. A nice transition into what I wanted to talk about next. [chuckle] So to try and guide my practice as an educator, a researcher, and a clinician, I apply the International Classification of Functioning, Disability and Health framework for children and youth, and it's offered by the World Health Organization. So, it provides a comprehensive way of conceptualizing and defining and establishing children's functionality, when disability might be present. So, we think about it, it has two parts. Part one considers body functions and structures and activities and participation. So, if we think about structurally, what are some of the things that we as speech pathologists focus on, it's usually head and neck. When we think about activities, what's an activity we might work on, it might be speaking or it might be writing, and then, we think about participation, it's ability to apply that skill set. So, speaking to produce a speech sound, the skill set of being understood by others is a participation. So, how intelligible are you to people in your environment? And then, we think about those contextual factors that impact on-body function and structures.

0:13:15 KW: Well, we think about things like the language spoken, socio-economic status, the access to services that might be needed, the relationship between the client and the clinician. In fact, the speech-language pathologist is listed in this framework, and the relationship between the speech pathologist and the child is a factor that could impact an outcome. So, if there's this mismatch, this linguistic and cultural mismatch between client and SLP, could that impact outcome? It could, in the fact that maybe a child is misdiagnosed, and misdiagnosis informs both over and under-diagnosis, because disorders do occur in the multilingual context, but sometimes the monolingual SLP might misinterpret what is actually disordered and attribute it to being a difference because they're less aware of the features of the language.

0:14:05 KW: So in our educational context, and part of the ICF framework when we think about those contextual factors, is in the school educational setting for SLPs, who are learning, we need to improve upon how much they learn about what is disordered and what is different to increase their multicultural competence, once again, and their responsivity and also humility.

0:14:27 Tiffany: Humility for sure.

0:14:28 KW: Yes. And then I also use methodological approaches, such as I use descriptive studies. One thing we have looked at, this was informed by Professor Sharynne McLeod, is to use drawings to understand young children's talking experiences, where we use visual analog scales and we examine, "Okay, tell us about the talking partners that you have. How do you feel about the way you talk? Tell us about the people who you talk with." And they use a visual scale and they color and let us know. We analyze the drawings using descriptive techniques. And in 2018, we submitted an abstract to ASHA, and our student won the award for highest-rated abstract in her category, which was in the global category. And so we... This is important for speech pathologists because if we can find creative ways of overcoming a linguistic barrier, then we can find more ways of being informed by the children, and this is actually responsive to Article 12 of the United Nations Conventions on the Rights of the Child, so the rights of the child to be heard in ways that the child can communicate and the rights of the child to be included in matters that pertain to them.

0:15:41 KW: And so, how are we gonna include kids? Especially the group that I'm looking at, these young kids, they can't all read and write, but they do draw, and so we just use the drawings and provide interpretations about those drawings. I also use computerized techniques to understand speech profiles, language profiles, but primarily speech, because we wanna increase more objectivity into the decision-making process. So, okay, to know that this is a P, for example, as in Peter, the initial position, what does that look like acoustically? Or when we want to increase accuracy in transcriptions, we look at the Phon program. It's a software developed by Yvan Rose from Newfoundland, I like to give a plug to Canadians whenever I can, and my colleague Tara McAllister at NYU, she actually helped to improve the clinical applications of Phon.

0:16:42 KW: And we are using Phon right now. Within Phon, what you can do, you include, you insert audio recordings of the participant then you can transcribe based on what you're hearing, and there's an IPA map in Phon, a computerized software, which then will link... You'll get a transcription of a word, and then that can be linked to a spectrogram from Praat. And so you tie the transcription to the spectrogram, and then you can build acoustic models from there, or you can look at enhancing the, or streamlining reliability analyses and just being able to calculate things like PCC, PVC, PPC. And I should say that for the audience, that's percentage of consonants correct, percentage of vowels correct, percentage of phonemes correct, which are transcription-based methods for measuring intelligibility.

0:17:347 KW: But you can also use acoustic-based measures of looking at intelligibility as well. And so with Phon, it helps us to increase the efficiency in those processes. I also use qualitative and quantitative approaches. One of my doctoral students used qualitative approaches to inform linguistic features in child productions based on adult models from the same linguistic community. It's been recommended by the international expert panel and also practice recommendations within our field to use those local models to inform accuracy versus difference, so accuracy and difference versus error. But we don't do that enough. And so using an adult model and analyzing, okay, what kind of linguistic patterns are we seeing here? Oh, do they tend to use something called linguistic variation, for example, where instead of using the term "binoculars," in the Jamaican context, a lot of adults say "spying glass" or "looking glass."

0:18:35 KW: Children do the same thing, but if they did that on a test, someone might say, "Well, that's an error." If we see an adult doing it, then we know that's not necessary developmental, but it's actually a feature of the community. And then we look at generating psychometric properties for tools that are available, such as discriminant analysis, and my student Michelle Leon just had her paper accepted in Clinical Linguistics and Phonetics detailing the sensitivity and specificity of the Intelligibility in Context Scale and also the Jamaican Creole translation of that tool.

0:19:08 KW: So, the sensitivity and the specificity allow us to examine true positives and true negatives. So, is it people who are disordered are in fact categorized as disordered based on scores, and people who are typical are categorized as being typical based on scores? And we found that both the ICS, Intelligibility in Context Scale, and the translated version in Jamaican Creole have good sensitivity and specificity. So, I use these quantitative and qualitative methods, and so in that same umbrella, I disseminate research in milieus where scientists, students, clinicians naturally congregate, such as a conference or in a well-read journal, so depending on the topic area, who do I want to capture. So, I try to make strategic decisions about that as well.

0:19:59 Tiffany: That makes a lot of sense, and then it can also be applied across multiple languages. It seems like the techniques you have are really focusing on a broader issue and you've really delved into really thinking about as very specifically Jamaican Creole...

0:20:15 KW: Yes. Yes.

0:20:17 Tiffany: But it just is such a broader context, everything you're saying can be applied to multiple languages...

0:20:21 KW: Yes, yes, yes.

0:20:23 Tiffany: Very cool and very needed. Cause it is, like you said...

0:20:24 KW: Oh, thank you.

0:20:26 Tiffany: With SLPs you're like, "How are you gonna know all these languages?" But having cultural humility and competence, as you mentioned, but also having these kinds of tools. And I wanna dig a little deeper into what you found... I think the listeners will appreciate hearing even more about what you found with standard English versus Jamaican Creole, to think about how this might be applied even to the languages in their context, because I know speech pathologists have been thinking about this depending on where they are. , when you for instance did, I wanna think back to when you're talking about using Phon. Is it Phon?

0:21:01 KW: Mm-hmm. Phon, yes. Phon.

0:21:03 Tiffany: I see it written, but I really don't see it that much. And I think that's so amazing. And using the ICS format, what did you find... You found good sensitivity-specificity, what were some of the differences that you found and were they what you expected and what were you... And also how are you... You mentioned... Of course, I'm gonna throw you like 10 questions, so... You mentioned that you think about your audience. Is your audience actually in Jamaica or is it in the States, or both? And then, when you get that disseminated, how is that kind of impacting their practice?

0:21:43 KW: Okay, so in terms of... And yes, I glossed over one of the things I do do to respond to that first question you asked, is that I do offer an education abroad program or an international experience program through my university that brings faculty and students in CSD, in Communication Sciences & Disorders, both in speech pathology and in audiology to come on this service, a broad experience where they get a cultural immersion, hands-on experience working with children and cultures that's different from the North American, United States, midwestern culture, cause University of Cincinnati is in the Midwest, and most of our students are from that midwest area that attend University of Cincinnati.

0:22:27 KW: Some of them have never been outside the United States, much less outside Ohio. And so I have taken some first time on a plane to go to Jamaica, and I believe that it's... Cultural competence can be enhanced in the classroom, it can be. But I feel it's far more effective when we think about experiential learning where they are immersed in this exchange. I always say to my students, "When you see the whites of the student eyes, you might forget everything you have learned. But don't worry, it'll come back. Have notes with you, make notes."

0:22:59 KW: So part of the preparation is that I've developed a course that goes along with the actual trip, and so they have to participate in the course first, where the course is based primarily on getting them ready to work with this population, but having an understanding more broadly about multilingualism, multiculturalism. I talk about the culture we're going to be immersed in is the Jamaican culture. And that one of the biggest parts of the Jamaican culture is not just its language but the food. And I say the food is very good and I prepare them, I say, "Bring elastic waistlines because there might be a bit of a stretching occurring." Cause when I go, I eat and they all eat. I go, "Don't come to Jamaica dieting, that just is not the way to experience the culture."

[chuckle]

0:23:42 KW: And that Jamaica has the fourth best ice cream in the world at Devon House and, oh, it is outstanding. And the students all... We go there every year, and they get to consume the lovely ice cream. But more importantly, they work with the parents, the children, the teachers, the staff at the school, learning to navigate all these different exchanges. Not everything can be scripted, but because my program is part of a research study, they are all part of my IRB, so Institution Review Board, so they've all been appropriately trained.

0:24:17 KW: There are some things you can't really train well. It comes with the practice and there might be just a natural affinity in some people, some people might be more uncomfortable in being in a foreign setting. And so we try to prepare them as much with audio materials and videos of the culture, showing how we've done the testing, all the activities, and then how we adapt in order to be culturally appropriate and responsive to the populace.

0:24:42 KW: And so I have them understand, What are my goals for this project? So, there are team members when we go. They understand part of the aims. I don't tell them all the aims, cause I don't want them testing to an outcome, they have an understanding, a sort of the gestalt of the project. And 2020 would have been our 8th year...

0:25:05 Tiffany: Wow.

0:25:06 KW: With COVID-19, all program abroad were cancelled. So, we did not get to go, but we have been going since 2013 with students in different level, so undergraduates, Master's, PhD and AUD students all working together, experiencing peer leadership. So, one day you're in charge, the next day you're taking orders. So, I mix the roles, so no one becomes too comfortable in the one role. And they're all learning from each other. Having audiology students as part of the experience has improved how I actually collect audiological information about the populace, and I didn't think about doing before, I'm thinking, "Oh, I probably should have done that, why didn't I think of that?"

0:25:46 KW: So, each cohort that comes informs changes for the next cohort and even in the current collecting of data. So that is one other aspect, and in part of that research, that's how we actually translated and validated the Intelligibility in Context Scale with one of our students having been awarded a SPARC award from ASHA to validate the Jamaican Creole version of the ICS Intelligibility in Context Scale, which is freely available from the Charles Sturt University website. Multilingual Children's Speech, that's what it is. Multilingual Children's Speech website.

0:26:23 Tiffany: I'll put it on the recourses for sure.

0:26:26 KW: Yes, yes, yes. And it's freely available, and what's unique about this particular version of the ICS in this language, cause it's actually translated in over 60 different languages. Jamaican Creole is one of the 60 different languages, and we include an audiological component. So, it's available in audio to be listened to and then completed in pen and paper format. With the help of a clinician, we did that because Jamaican Creole as a language is actually historically oral versus the English, which is the language, the lingua franca of the nation and the classroom has a historical written tradition.

0:27:04 KW: So because of the disparities between the language, and as a researcher you try to eliminate the confounds and you equalize anything that might be an extraneous factor in influencing your outcome, I presented both the English version and the Creole version audiologically. This was the first time this was ever done for the ICS and we represented a deviation in this methodological approach. So, I did, and the audiological version, the audio recording is available online, it can be downloaded and listened to by anyone.

0:27:32 KW: I did the Jamaican Creole version and I had my colleague do the English version. And so parents listen to those recordings and complete the forms. What would be important in other context, and it can be audiologically recorded in other settings, is for languages with low written tradition and for parents and respondees who have low literacy rates. That would also be responsive to this, so that's another way of responding to a contextual factor in the profile of working with children and parents who don't speak the language you speak, or for children and family who might speak the same language you do, but are maybe illiterate. So that's another way of being responsive.

0:28:11 KW: And so, one way we completed our validation study and it has shown that even with the audiological methodological change, it doesn't impact the validity, because we had, we've got very strong, valid results from... So, the psychometric properties were strong, and there is a correlation between... Because the ICS measure is actually a proxy evaluation, so parents report on their observations of their child's ability to be understood by seven different listeners of varying authorities.

0:28:49 Tiffany: Okay.

0:28:50 KW: And then you rate them on a five-point scale. And I think... You know, of course I'm going to doubt myself that I got that correct, but I'm pretty sure that, it is a five-point scale. I just have to double check. [laughter]

0:29:03 Tiffany: Yes, always. [chuckle]

0:29:06 KW: And so it's how intelligible is a child to you, to family members that live with you, to family members who don't live with you, to the children's friends, to strangers, to teachers, and to people, more acquaintances.

0:29:26 Tiffany: Oh, that's great.

0:29:27 KW: And so you ask... The same questions are posed on the Creole version and on the English version. It was very funny to look at some of the parents cause they didn't quite... If you don't hear it in such an educational setting to be so proper, because Jamaican Creole is more the language of the home than the language in formal settings, but there have been movements to trying to increase bilingual education in schools, but it's not yet there. They tried it once, it wasn't as successful as they wanted it to be, and they being within Jamaica, the educational system. And that did not work out, but it's not been abandoned, it's something that will be revisited down the road.

0:30:06 KW: And so, we use the recording, and in the sensitivity-specificity study we took it to another level to understand if using these audio recordings in both of these languages, can we still get results that highlight, that the tools are able to distinguish difference and disorder or typical development and disorder development, and our evidence showed that we still can, in fact, do so.

0:30:31 Tiffany: Oh, that's fantastic. And when you talk about the different... You know, the oral versus the written, is it... When you say that there's been attempts in education there, what do you mean by that? Do they integrate it or is it only...

0:30:46 KW: Yes. So, they did try to integrate it in the classroom, so having teachers teach the Creole and then teach the English like in a bilingual education project, similar to what they do... It's like in Canada, like French immersion.

0:30:56 Tiffany: Yes.

0:30:57 KW: Or, you know, so they have both the two languages... In Canada for example, English and French are the two primary languages and so they're taught in schools, but not all schools have them. Some schools are monolingual English, some are monolingual French. But it's sort of the same model of bilingual education that was applied there, but one factor that has been sort of a barrier is that no one... The teachers weren't themselves taught this language in the classroom when they were young. So, you're coming in sideways at this issue, and so it's trying to find a way how we're gonna go back far enough to educate the educator. And also historically, there has been a tiered relationship between the Creole and the English.

0:31:44 KW: So the Creole has been associated with more slavery, lack of education, poverty. Whereas English, it was the language of the masters, you know, the language of high society, and so there's this tendency to want to downplay speaking the Creole and up-play, so to speak, the use of English. Where proficiency varies in any bilingual context, and I use the term bilingual intentionally, because I'm putting a binary system between Creole and not Creole. There is research suggesting, and it is true that there's a Diglossic society, so there's a continuum, the post-Creole continuum in most Caribbean societies around the world.

0:32:26 KW: And what I have chosen is to look at it as a bilingual argument, so people refer to lects, so it's the acrolect and the mesolect, acrolect is closest to English, mesolect is the middle variety and basilect is the most dissimilar to English. But I look at basilect and mesolect as not acrolect. And then within there, you can see features that are not English. So, depending on your focus, so a linguist might wanna make that distinction, but for me as a speech and language pathologist, it's English or not, that's... We're more binary, and to help with the translation of that in the speech and language pathology world, I chose the bilingual route and using techniques like Phon where I can answer questions about things such as what is speech variability, a diagnostic marker.

0:33:17 KW: I didn't begin my research with this, I noticed that within the Jamaican context, that one word could be produced multiple ways, but it didn't change the accuracy. So, the word pig could be pig, piggy, pigga, pigs and still, it was still the lexical item 'pig.' It didn't mean pigs was more than one pig, it was just a pig. Variability is something that has yet to be reconciled in terms of its role as a diagnostic marker of disorder versus is it just a typical variation in development?

0:33:52 KW: And so using Phon has helped to streamline completing those analysis, cause what you need to do when you're now going to analyze variability in a more scientific experiment, is, you want to artificially force the children to say the same word repeatedly, but of course, spaced according to a certain protocol and using Phon we have found that within the Jamaican context, and because it's the Creole with that continuum I mentioned, there is more tolerance of viability. So, there's phonemic variation in... Like lengthening for example, is a distinction in the Jamaican context, but it's not for English.

0:34:30 KW: So depending on how you code, what is variable versus what is not variable, you're going to see differences, and we did see those differences in the Jamaican context in bilingual Jamaican English speakers, but not in the English context where we attributed that to our coding and we used transcription-based methods informed by Phon, which is a computerized program, but our next stage is to move to the acoustic level using Praat to see how spectographic analyses help to inform variability and they might be more sensitive to changes that we're not picking up using more transcription-based methods.

0:35:06 Tiffany: And that makes a lot of sense and such a powerful approach to get to use the acoustics with your transcription method. That seems to make a lot of sense. And I'm wondering, what's the speech pathology context down there in Jamaica?

0:35:21 KW: In Jamaica, it's an excellent question. It is minimal.

0:35:26 Tiffany: Okay.

0:35:27 KW: So I am one, and I'm counted in the number, cause I actually have my speech therapy license in Jamaica as well to do this work. I said, I'm gonna do this the right way. I'm respecting the culture, that's another way of being responsive. Sometimes in Jamaican context, and a lot of Caribbean context, people come from North America and Europe saying, "Well, we know, we don't have to follow the rules," but I lead by example with my students, I find out the rules as much as I am able to, learning along the way, and so, there are maybe 10 speech pathologists in the island, maybe. All foreign trained because there's no local program. One of the local programs is in Trinidad & Tobago but they had restricted entry at the time, just to students from Trinidad & Tobago. And so there have been talks about getting one in Jamaica. It has not yet happened but the talks have not yet been abandoned.

0:36:19 KW: But, so yes, it's very, very small, so services in the schools, the model that we use in North America, it's not there, it's more under Ministry of Health. It's more of a health-based model, and I think what they're trying to do is move closer to education model. When I went, I had spoken and I talked about the ICF, when I say it's mine, it's not mine, it's the World Health Organization's, but I do apply it. And the benefit of... Because what... The International Classification or Functioning, Disability and Health, it's a mouthful, applies a biopsychosocial model, which incorporates medical and social, because the medical does relate, but it doesn't always have to be linear, so if we think about someone who had a laryngectomy for example. And this is a female, you removed the larynx because it had the cancer and... Or part of the larynx, and now they have to work on having speech therapy to reproduce their voice, but now the voice quality is not as good, they might sound more raspy and more male.

0:37:24 KW: So medically speaking, the cancer is gone, but when you think about how well they're participating, it's very low, the restriction is that they feel very self-conscious about how they sound, and so they participate less with others. So, this model helps us understand... It's not necessarily this linear, it's a multi-directional way in which contextual factors can impact on participation and body functioning, that could result in two people with the same medical condition having very different outcomes.

0:37:58 Tiffany: I think that's a really important approach to use, and I think it's not used as much as it could in the language disorder aspect, childhood language disorder. And I know myself even being at a rehab institute, it's been... It's used more readily, but my students could apply this, and I love the work you've done in this way because it gets at using this functionality and thinking and applying it more in childhood language disorders, it seems to be so critically important to do.

0:38:25 KW: Oh thank you, thank you. And I'll plug that ASHA, it's actually the... It is the framework of a scope of practice, both in speech pathology and audiology, but not many people realize that. I'm always tooting that horn, I plug that in there, and it's been adopted by multiple associations of speech pathology around the world. Australia, Canada, so just as an example of other places that have already adopted this framework for their scope of practice.

0:38:49 Tiffany: I think that's really important, and one of the things I hear you saying too, a lot is about getting your work out there and getting it accessible. And one thing I noticed, when I was researching what you are up to. So many things you're up to, is that some of your materials were on the LEADERS project site and I wanted to draw attention not only to those materials, but also about the LEADERS project. So, can you tell me more about the LEADERS project and how this relates to the work with Jamaican children.

0:39:18 KW: Yes, so the LEADERS Project is a website. It's developer is Dr. Cate Crowley at Columbia University. She's a speech language pathologist, but with also a Degree in Law, so she applies law to this area of speech pathology. And she has worked across the spectrum, working... She has an education, abroad program that she goes to in Africa, and she works with Cleft Palate training, providing resources to increase the sustainability of services there. So, she partners with doctors, similar to a Doctors Without Borders application. And she also takes students to increase the ability of local practitioners to support speech and language within their own community, sort of a more organic experience, and one of the tools that she uses is the speech language assessment materials, the SLAM...

0:40:18 Tiffany: Yes.

0:40:19 KW: Cards. And the way in which I have been able to collaborate with Cate, Dr. Crowley, is that I approached her because I was interested in documenting narrative competence in the Jamaican context from the lens of a Speech Language Pathologist, and I didn't really have any resources that I had available to me that I wanted to be able to use. So, I thought about what was already there. I go, "Do I need to reinvent the wheel?" We have to be responsive in that I shouldn't use materials that the children aren't gonna be able to respond to. And so when I approached Cate and I saw these pictures and we talked, she was so helpful. They were willing to adjust the images so they looked more like Jamaican children, and that they included Jamaican artifacts, the Jamaican flag. And the story line, there's one about a bunny in a classroom, which is something that Jamaican kids have in the one school we go to for example, they have a rabbit not a rabbit, sorry a turtle.

0:41:13 KW: But they do have rabbits too that they use. So I knew that this was an ecologically valid artifact in terms of a storyline. And then the other one for English that we use is, you don't bring a dog home. No dogs are allowed inside the house in Jamaican society. It's not as cultural here to have the dog on the bed as it is in North America. And so that concept wouldn't be foreign to the children. So also my colleague in Jamaica, Professor Hubert Devonish, was able to translate the items for the Jamaican Creole story into Jamaican Creole. So that then we use that when talking to the children, so they heard the story in Creole, which is a bunny goes to school versus hearing it in English, which is a dog comes home.

0:41:59 KW: So the same child, we're doing a within language and between language comparison using these two different stories. And what was different... And so Cate was willing to help with the drawings and making those comprehension questions available. So those were the questions that were translated in the Creole context. We didn't only want to look at accuracy, we wanted to look at how well the children were able to respond to questions of varying complexity. So, we use the Marion Blank question hierarchy, which has not yet been used really in looking at some of these well-published studies looking at narrative competence in bilingual context. And so we wanted to get that out there. One of the limitations we had was that we did not consider story-telling per se in Creole. It was a story-telling task based on a story we translated. But we did not... We were interested primarily in more of the story grammar elements because in Jamaica, the language of the classroom is English.

0:43:03 KW: So we wanted to know, are the children prepared for that English requirement in the classroom setting? So, the next level of our study will be to then consider the storytelling within a Jamaican story. Because Jamaican Creole has that African influence from West Africa. It's very possible that there are West African influences in a Jamaican story, which was one of my favorite books growing up, was the Anansi stories, who was a very crafty spider, who was always trying to connive everyone else to his advantage. And so that's more of a West African story. But there's a similar concept that there's a moral applies in almost all stories around the world.

0:43:50 KW: And when we think about story grammar elements, generally speaking around the world, they are similar. And then in some settings, the children based on the context therein might assimilate more to that story and grammar element. So, we thought that there was still some face validity in our approach but naturally, it's a limitation in our study cause we did not also include that. But that's been the extent of my involvement with the LEADERS project. I hope I did it justice.

0:44:17 Tiffany: Oh yeah.

0:44:18 KW: I can provide the resource to it because they're a lot of... And these I should say, they're freely available on the website with the questions, and there are different stories and comprehension questions that accompany them, my colleague, Carol Westby, was the one who helped us code what was the complexity level of the comprehension question. And as you know Carol Westby is well known.

0:44:36 Tiffany: Yes.

0:44:36 KW: She works on narratives across different cultures. And so I was very honored...

0:44:40 Tiffany: Oh, that's great.

0:44:41 KW: To be part of this experience.

0:44:44 Tiffany: It's such a great resource when I was looking through it. I had heard of it, but then when I really looked through it, I was like, "Wow, this needs to be showcased. And I know a lot of people know about it already, but I'll put it into the resources, because it is a really important resource.

0:44:57 KW: Great. Great.

0:44:59 Tiffany: And I know you talked about your favorite book, but I wanna... Before... I'm looking at our time I wanna be mindful, but I do ask every guest a few questions, and I have so enjoyed this conversation. We've talked about so many different things, but I do wanna ask you, "What are you most excited about right now that you're working on?"

0:45:19 KW: Okay. Oh, there's so many things, I'm so excited about to be honest. It's just you never know as a researcher where your career will take you and my dissertation training had nothing to do with diversity, it was with specific language impairment in monolingual English-speaking, majority Caucasian grouping. And I happened to observe a child in a clinical context, who was from Jamaica, who was almost gonna be misdiagnosed, but my supervisor, knowing I was Jamaican, invited me to come in and said "Wait, aren't you from Jamaica? What's going on here?" And that's sort of planted a seed...

0:45:52 Tiffany: Mm-hmm.

0:45:53 KW: And then I started thinking about it, and then when I came to University of Cincinnati, I included that as one of my areas of study that I will be offering, not knowing it would actually become what it is today, and so in thinking about what I'm excited, we recently were awarded an NIH grant...

0:46:11 Tiffany: Oh, Congratulations!

0:46:12 KW: To examine this... Thank you very much. Examine how... The diagnostic contribution of their abilities based on production. Is it a diagnostic mark? And we're comparing monolingual children to the Jamaican children. And we're looking within the Jamaican context itself, between Creole and English, what does the variability tell us? And I'm very thankful to my colleagues and Anna Sosa and Toby Macrae who are consultants on this grant who made their dataset available for the monolingual comparison and to Tara McAllister at NYU and also Daph Naharro, who's our statistician, who will then work her wonderful ways with the numbers and tell us what we have found. And right now, we're waiting before we can go back to Jamaica again, with the Covid-19 that occurred, so we're in a little holding pattern right now, but I'm gonna say they're gonna find that vaccine and then we get to travel again and... So, I'm very excited about doing that.

0:47:15 Tiffany: And does it start now Karla? Or did you have to put it on hold?

0:47:19 KW: Well, actually no, we started... We got the grant last July...

0:47:23 Tiffany: Okay.

0:47:23 KW: And we were supposed to travel in March to Jamaica, March of 2020, and so we have other data that we have collected that we can start to sort of analyze...

0:47:35 Tiffany: Yeah.

0:47:36 KW: To get an understanding of the contribution of variability as a diagnostic marker using the Phon program and then we're also gonna use acoustics, looking at duration, and this is where doctor Toby Macrae, came in, getting us some protocols that we could follow to answer that question... And I just said "Keep doing what you're doing until you can." … has been very supportive. Institutions are working together, anyone collecting human subject data right now.

0:48:08 Tiffany: Yes.

0:48:09 KW: Pretty much... [chuckle]

0:48:10 Tiffany: Some projects are... It depends on the timing. Right, some projects are luckier than others in terms of timing, it sounds like maybe yours was a bit unlucky in the sense that you were getting ready to go, but maybe lucky that you weren't... You hadn't already been in the middle of it.

0:48:26 KW: Right, no, no, we already have a lot of data collected. And so I have three doctoral students going into their final year, and each of them will be focusing on three different projects using already collected data from the Jamaica project.

0:48:43 Tiffany: Right.

0:48:44 KW: And so, one is looking at functional communication, which is basically using your speech and language skills to be included with others. And we're using the intelligibility and context scale to look at functional speech, and we're using a measure called the focus on the outcomes of communication under six, that looks more broadly at functional communication across different areas, and so we're looking to see how is that related to speech sound production? Does it inform the profile? We don't know a lot about functional communication, even in monolingual children.

0:49:15 Tiffany: Yes.

0:49:16 KW: And in well-studied bilingual pairings, we don't know enough. So in understudied pairings, we know even less.

0:49:21 Tiffany: Yes.

0:49:22 KW: So we're hoping to fill that gap. Improve that knowledge base. My other student, Michelle Leon... So that was Leslie Kokotek. Michelle Leon is going to be building acoustical models to see how a variation in speech at a single word level, in terms of what I described earlier about how the same word can be produced differently, how it can inform difference and disorder in bilingual context and then Rachel Wright Karem is looking at using how adult models from the same linguistic community inform alternate scoring procedures. So, can we devise alternate scoring procedures based on adult models, so that when we look at those boundaries for what is average... What's below average, is there movement? When we have adult models versus when we don't, is there a change? And so she's looking at that as well as cross-linguistic effects between English and Creole.

0:50:22 KW: So I'm having all this excitement and we've applied the index of productive syntax, which is a language analysis tool to understand morpho-syntactic development in a bilingual context. And our study was able, which was published in LSHSS last year, was one of the first to look at applying this model, this analysis tool in both languages spoken by bilingual children. It's been used a monolingual context for children who do not speak English. In by dialectal context where children speak variations of the mainstream and in bilingual children, but only looking at English. So we have found that it can be appropriate cause it doesn't actually bias the child, in fact, it takes into consideration code mixing, it doesn't count against the child when code mixing occurs which is a naturally occurring phenomenon of being bilingual. And so we have this tool. But what we did notice is that not every morpho-syntactic structure is used well by all of these children, so modifications are needed. And so it was just very wonderful to see that we had a tool with a structure, it's a psycholinguistic model, applied psycholinguistics, available from Dorothy Scarborough.

0:51:37 KW: And using it was a very good learning experience for me to understand those sort of grammatical boundaries, between languages, and how it can be varied from a monolingual child, English-speaking, using those same grammatical boundaries, and so understanding what the differences are, maybe what similarities might exist is gonna be important for clinical practice. So, we made recommendations in that paper about how it could be applied to this population of children.

0:52:04 Tiffany: And also I think... Do you have a piece coming out in DLD and Me, on functional communication, did you write a piece there?

0:52:13 KW: Oh, I haven't written that yet... It's going through the process. It's going through the process. Yes.

0:52:19 Tiffany: Yes, yeah, I saw that, it came across and I was thinking, "Oh, that's perfect timing, we'll make sure... " It'll probably be out by the time this is out or close to, so we'll get that up because that would be so great cause you've talked about a lot, and when you put it all together in that piece. I thought it was so clear and well done, and that'll be a great piece to have on the resource page too, in terms of functionality and all of these different types of measures coming together. I think that's fantastic.

0:52:44 KW: Lovely, thank you, thank you.

0:52:46 Tiffany: with the project, and so glad that you... It's a bit COVID proof, I say that...

0:52:51 KW: Yes. It's COVID proof.

0:52:52 Tiffany: You've got the…You've got the data, you've been going through it for some time, and I'm very hopeful will get back. So, you did mention it briefly, but what is your favorite book from childhood?

0:53:03 KW: Okay. So, I mean, it's so hard to pick one. My mom was a librarian, right? So, we had a library at home and she worked in publishing, and so we were all about books growing up, and we couldn't watch... Our television time was dictated by how many books we read, so one book equaled one-hour of television, it didn't matter how many pages were in that book, she didn't... So, either big book or little, it didn't matter, and so I learned to read very quickly...

0:53:30 Tiffany: That's brilliant.

0:53:31 KW: Because I liked watching TV.

0:53:32 Tiffany: I'm gonna steal that from your mom, Karla.

0:53:34 KW: That is right. I didn't think it was brilliant when I was a child because I wanted to watch TV. And so I remember my mom would read us the Anansi stories and rather than just read it, she would act it out, and we'd sit and we'd dramatize and role play, and so in my mind those Anansi stories were very fond memories of being together with my sisters and my parents, so it was... I really enjoyed those story times, and also, I have to say, my mom also had us read the Berenstain bears, so there was always an experience like you know, going to the dentist or negotiating and sharing, and so she would always use them as this moral compass guide about these different ways we should learn to be behave. I'm thinking "Mom, they are not even real. Why are we thinking about how bears... And bears can't even talk, why are we even thinking about this?"

0:54:24 Tiffany: Oh, I'm with... I think your mom and I are really connected because I have to say, I use the Berenstain bears too and when we were moving here from Nebraska several years ago, I got the Berenstain bear moves, and then when my son was going to kindergarten, Berenstain bears go to kindergarten. The Dentist... I'm with it, I'm with it, I'm like.

0:54:43 KW: Oh there you go. I'd love to tell her. She... And then the other book that as I grew up, I really enjoyed, Nancy Drew and Hardy Boys. And so I feel like picking a favorite story is hard because each of them sort of represented a time in my life that I can then relate back to, and so if I were to sort of say one group of books, that would be what they are.

0:55:07 Tiffany: That's awesome. Well, I have to say, I ask everyone this question but I've avoided it myself because on my first website, I wanted to have something unique for each student, and I asked them to give me their favorite book, but I never chose, and then I finally had to commit. I was with you on the Nancy Drew, and I've reluctantly committed because it's really hard, but I can't help but ask people because I think it's such a critical period of childhood and then also just even now, people have their favorite books they like and they go back to. I appreciate you going out on the limb and choosing a book it's very helpful. Well Karla, what an amazing discussion. I cannot wait to share all of this great information with the listeners.

0:55:30 KW: Oh, thank you.

0:55:32 Tiffany: I really appreciate it and I'm really hopeful you'll be back to traveling to Jamaica sooner... Sooner than later for sure.

0:55:38 KW: Yes, yes, thank you. And I thank you so much for this opportunity to talk about this, and I feel very blessed by what I'm doing. They say if you love what you do, you never work a day in your life and I have to tell you that I feel that. I don't really work at it because I really enjoy it, it makes me happy to do this work. And so, thank you very much for allowing me to be able to share this about the work that I do, so thank you.

0:56:26 Tiffany: Thank you too.

56:28 Tiffany: Check out www.seehearspeakpodcast.com for helpful resources associated with this podcast including, for example, the podcast transcript, research articles, & speakers bios. You can also sign up for email alerts on the website or subscribe to the podcast on apple podcasts or any other listening platform, so you will be the first to hear about new episodes.

Thank you for listening and good luck to you, making the world a better place by helping one child at a time.