Research With Culturally and Linguistically Diverse Populations: Practice With Little Evidence

The term culturally and linguistically diverse (CLD) encompasses a diverse set of groups and individuals. Given the rapid increase in numbers of individuals from CLD populations, it is critical that the research base in communication sciences and disorders keep pace with the growth in that population. Clearly, it has not. I often receivee-mails from clinicians asking me to answer some variation of the question, “Do you know of any studies addressing methods of assessment and treatment for culturally and linguistically diverse populations? I have been searching for articles across all areas of study that might overlap with speech-language pathology, but I have had little success. Any help you can offer would be greatly appreciated.”

When I receive such inquiries, I try to be as helpful as possible. Unfortunately, my correspondents are often disappointed with my response—that there are relatively few published studies in this area. In fact, most studies specifically exclude individuals from CLD populations, especially if they are bilingual or are merely exposed to more than one language. Moreover, relatively few researchers focus specifically on CLD populations. Published research on cultural and linguistic diversity bears this out. A search of three journals published by the American Speech-Language-Hearing Association (ASHA)—American Journal of Speech-Language Pathology (AJSLP), Journal of Speech, Language, and Hearing Research, and Language, Speech, and Hearing Services in Schools—reveals that, since 1991 (when AJSLP was first published), only 42 papers included the term culturally andlinguistically diverse (or some variation) in the title/abstract. Results of more specific searches revealed 118 papers included bilingual in the title/abstract; 91, African American; 13, Latino; 6, Hispanic; and 5, Asian. It should be noted that some of these articles are not data-based research studies. Clearly, research data in peer reviewed journals are scarce. It is interesting to note, however, that the majority of papers in these areas were published in the past decade, which suggests that the pace and quantity of research on CLD populations is increasing. Additionally, there are no ASHA systematic reviews related to CLD populations.* There are, however, a few practice documents in this area (ASHA’s Cultural Interface Grid), including American English Dialects (ASHA, 2003), Bilingual Speech-Language Pathologists and Audiologists: Definition (ASHA, 1989), Definitions of Communication Disorders and Variations (ASHA, 1993), Knowledge and Skills Needed by Speech-Language Pathologists and Audiologists to Provide Culturally and Linguistically Appropriate Services (ASHA, 2004), and Social Dialects (ASHA, 1983).

Despite the increase in publication of papers related to CLD populations, significant gaps remain in the understanding of language development and disorders in this group, thus limiting the ability of clinicians to conduct evidence-based practice (e.g., Dollaghan, 2007). Practice then is conducted based on relatively little evidence. Clinical practice is grounded mostly in clinical judgment and the family’s/client’s goals rather than in research. That is, there is a practice-based evidence (PBE) focus that “can range from unsystematic observational evidence obtained by practitioners about the effectiveness of their treatments to systematic research that evaluates in-depth, comprehensive information about patient characteristics, processes of care, and outcomes” (Horn & Gassaway, 2007, as quoted in Kamhi, 2011, p. 62).

The sparse number of articles related to CLD populations highlights the research gap with this varied population. There are a number of issues related to closing this gap. First, there is significant variation in those included under the term culturally and linguistically diverse. That term subsumes topics ranging from accents to dialects to bilingualism to English-as-a-second-language instruction to cultural competence. Moreover, there are cultural and linguistic considerations across each and every domain of language. This range and variation need to be accounted for in research with CLD populations (Centeno & Gingerich, 2007). Second, the vast majority of studies that include CLD populations focus on receptive and expressive language, with some studies related to phonology but few studies focusing on hearing, voice, fluency, and swallowing. Third, almost all studies with CLD populations are cross-sectional in nature. Very few studies are longitudinal, although there are some exceptions (e.g., Rojas & Iglesias, 2012). Thus, the changing nature of this population is not robustly captured. Fourth, the effects of a variety of socio-linguistic factors on the speech and language skills of individuals from CLD populations have not been adequately examined (e.g., Goldstein, Bunta, Lange, Rodriguez, & Burrows, 2010; Hammer et al., 2012). The CLD population is heterogeneous, and thus, its divergent cultural and linguistic environments need to be considered. Finally, more researchers who are interested in focusing their work on CLD populations must be recruited. These researchers should focus on a language domain (e.g., syntax, phonology, or morphology, pragmatics) and include participants from CLD populations. There is no doubt, however, that researchers need a broader and deeper understanding of the cultural and linguistic backgrounds, environments, and mores of participants in research projects.

References

American Speech-Language-Hearing Association. (2004). Knowledge and skills needed by speech-language pathologists and audiologists to provide culturally and linguistically appropriate service [Knowledge and skills]. Available from www.asha.org/policy/.

American Speech-Language-Hearing Association. (2003). American English dialects [Technical report]. Available from www.asha.org/policy/.

American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and variations [Relevant paper]. Available from www.asha.org/policy/.

American Speech-Language-Hearing Association. (1989). Bilingual speech-language pathologists and audiologists: Definition [Relevant paper]. Available from www.asha.org/policy/.

American Speech-Language-Hearing Association. (1983). Social dialects [Position statement]. Available from www.asha.org/policy/.

Centeno, J., & Gingerich, W. (2007). Ethical and methodological considerations in clinical communication research with Hispanic populations.In J. Centeno, L. Obler, & R. Anderson (Eds.), Studying communication disorders in Spanish speakers: Theoretical, research, & clinical aspects (pp. 99–109). Clevedon, UK: Multilingual Matters.

Dollaghan, C. (2007). The handbook of evidence-based practice in communication disorders. Baltimore, MD: Brookes.

Goldstein, B., Bunta, F., Lange, J., Rodriguez, J., & Burrows, L. (2010). The effects of measures of language experience and language ability on segmental accuracy in bilingual children. American Journal of Speech-Language Pathology, 19, 238–247.

Hammer, C. S., Komaroff, E., Rodriguez, B., Lopez, L., Scarpino, S., & Goldstein, B. (January 2012, online). Predicting Spanish-English bilingual children’s language abilities. Journal of Speech, Language, and Hearing Research.

Kamhi, A. G. (2011). Balancing certainty and uncertainty in clinical practice. Language, Speech, and Hearing Services in Schools, 42, 59–64.

Rojas, R., & Iglesias, A. (2012). Bilingual language development of English language learners: Modeling the growth of two languages. In B. Goldstein (Ed.), Bilingual language development and disorders in Spanish-English speakers (2nd ed., pp. 3–30). Baltimore, MD: Brookes.