November 27, 2009

Difference vs. disorder: Indigenous Australian children

Bethany Toohill submitted her honours thesis titled: Childhood speech impairment: Co-occurrence with language, hearing, pre-literacy, and oro-motor impairment in Indigenous and non-Indigenous Australian children. Her thesis was undertaken as part of her Bachelor of Health Science (Speech Pathology) (Honours) degree and was co-supervised by Jane McCormack and myself.

Here is the abstract of her thesis:
Speech impairment is the most commonly identified communication impairment in children. Within Australia and other Western nations, speech-language pathologists (SLPs) typically implement an impairment framework to identify communication difficulties in children. Speech impairment has been found to co-occur with other impairments, such as language, hearing, pre-literacy and oro-motor impairment; however, there is no consensus within the literature as to the extent of co-occurrence. Clinical practice is changing with the introduction of a social framework, focused on children’s social, personal and environmental factors. The current study is guided by both the impairment framework and one aspect of the social framework, cultural and linguistic diversity.

Data from speech, language, hearing, pre-literacy and oro-motor assessments with 151 Australian preschool children (143 non-Indigenous and 15 Indigenous children), were analysed using an impairment framework to determine rates of co-occurrence. Additionally, a social framework was applied via a contrastive analysis to determine the effect of dialectal difference on identification and severity of speech impairment, for the Indigenous children who may speak Australian Aboriginal English.

The co-occurrence rates were high for children with speech and language impairment (46.5%), speech and hearing loss (39.5%), and speech and pre-literacy impairment (68.1%). Speech and oro-motor impairment was identified in fewer children (11.9%).

The contrastive analysis resulted in a statistically significant increase in all Indigenous children’s percent consonants, vowels and phonemes correct. For seven children, their speech impairment severity category improved following the contrastive analysis and one child moved from being considered as having speech impairment to being within the typical range after consideration of dialect.

Childhood speech impairment can co-occur with language, hearing, pre-literacy and oro-motor impairment. These combined difficulties can impact an individual not only through childhood but into adult life. SLPs must consider more than a child’s speech errors when deciding on areas for intervention. Additionally, SLPs should consider the integration of both the impairment and social frameworks to ensure a more holistic assessment of children with speech impairment. For children of culturally and linguistically diverse backgrounds, it is imperative that SLPs consider the social contexts within which children communicate to offer culturally and linguistically relevant and appropriate services.