Spanish/English Questionnaire for Parents of Bilingual Children Who Stutter

About the authors:

lourdesLourdes Ramos-Heinrichs works in the Boston public schools as a bilingual speech and language therapist and a specialist consultant in fluency and fluency disorders. She offers telepractice services for adults who stutter.  She has extensively collaborated in ASHA SIG4 organization on issues that impact people who stutter.
sandraSandra Garzon is a bilingual speech and language therapist working at Boston Public Schools. She continues attending worldwide stuttering conferences and seminars, including workshops at the Michael Palin Center.  She is working toward achieving her BCS-F and continuing deepening her understanding of bilingualism and stuttering.
ednaEdna J. Carlo, M.S. CCC-SLP is an Associate Professor at the University of Puerto Rico, Speech-Language Pathology Program.  She is the author of several publications about stuttering in Spanish speakers.  She is currently conducting clinical research about stuttering diagnosis and intervention with Spanish-speaking populations.

This paper presents a bilingual questionnaire for parents of children who stutter (CWS). The questionnaire elicits important information from parents on how the stuttering is impacting the everyday social/cognitive/emotional life of the child. The questionnaire can be filled out by Spanish speaking parents of CWS and submitted to the child’s local school to request speech-therapy services; or for inclusion in assessment files, for children already in process of evaluation. When children are being referred for a stuttering evaluation, speech-language therapists can utilize the questionnaire by asking parents to provide the information to better understand the stuttering history and how it impacts the family. The information obtained, in conjunction with other assessment data, can be helpful for identification of stuttering issues specific to that child, and for development of a plan that addresses the specific concerns of the family.

The use of parent questionnaires allows the assessor to understand the real stuttering concerns in the natural environment of the child, as perceived and experienced by the caregiver. Stuttering behaviors can be variable and manifest in different ways in various settings and with various audiences. Parents, who know their child best, can be excellent contributors of pertinent information through the questionnaire. The questionnaire becomes an essential component to the evaluation process as it adds pertinent information that can only be obvious to people intimately acquainted with the child. Stuttering is a speech-language impediment with social-cultural-genetic associations that originate within the child’s family. Standardized testing may only reflect a small window into the child’s stuttering world. Therefore, in order to more fully understand the child’s stuttering background, through the questionnaire initially, the family can be engaged into a collaborative partnership. The questionnaire reveals special cultural and linguistic challenges faced by ELL (English Language Learners) children who stutter, such as concerns that bilingualism exacerbates the stutter; or, on the other extreme, parents exerting huge amounts of pressure on a child who struggles with bilingualism to maintain the home language.

Many professionals and families believe that bilingualism causes or makes the stuttering worse. This questionnaire includes one section that elicits information about the parents’ beliefs and concerns about bilingualism and stuttering. Contrary to what many people believe, research shows no relationship between bilingualism and stuttering. In many communities, being bilingual is rather the norm than the exception, and bilingualism in childhood does not increase one’s chances of developing stuttering. As Shenker, Lim et al (2014) stated, bilingualism continues to be misunderstood and parents and educators pose doubts and questions about whether being bilingual negatively impacts the child’s communication development. This questionnaire attempts to capture parents’ opinions and perceptions about bilingualism; and, how they view the development of stuttering in their children and the impact on the family’s cultural identity. Clinicians can use this information for purposes of counseling and educating the family about concerns on bilingualism, cultural identity and decisions to develop the home language in addition to English.

Ramos-Heinrichs et al. (2008) pointed out that language differences present a major obstacle for Speech and Language Pathologists(SLPs) in the US when trying to reach out to Latino families. Language barriers between the school and the home impact the adequacy of assessment and treatment in thousands of ELL children who stutter in American schools. Education experts agree on the importance of integrating families in their children’s education, and federal laws mandate that legal communications with non-English speaking families be delivered in a language that the families can understand (No Child Left Behind Act, 2001).

The Stuttering Inventory for Latino Families (SILF), an English-Spanish bilingual inventory presented at an ASHA Convention (2009), demonstrated an initial attempt at developing an inventory that is linguistically and culturally sensitive to the Latino population. The Spanish questions were developed based on input from SLPs from various Latin America countries including Puerto Rico, Colombia, Mexico, Guatemala and Argentina. For clarity to target population, the questionnaire was provided for feedback to select parents in Mexico and Colombia. Questions that were confusing to parents were either edited or eliminated. The authors (Ramos-Heinrichs et al., 2009) based their inventory on important scientific principles in stuttering research. They used the OASES (Yaruss & Quesal, 2006) as a model for inclusion of important content and structure in the SILF. Adaptations of other established inventories were included (Healy et al., 2004; Esckelson & Morales, 2000; Dodge & Ramig, 2005). The SILF was designed according to International Classification of Functioning, Disability and Health (ICF), a framework established by the World Health Organization (WHO, 2001), which specifies the importance of the following factors: impairment affliction, daily limitations, environmental restrictions, and contextual social reactions.

This bilingual stuttering questionnaire is a shortened version of the SILF; but it retains the major components of the SILF, including overt stuttering behaviors, cognitive/emotional reactions to stuttering, attitudes and reactions of caregivers, and bilingualism. The creation of this shortened version of the SILF is an effort to provide a free of charge downloadable bilingual questionnaire that can be used to obtain important information from families on stuttering background and other related cultural/linguistic factors. The questionnaire requires yes/no as well as open-ended responses, and space is provided for questions or comments. At the bottom of the questionnaire a brief narration provides basic information about stuttering.
A caveat is that this questionnaire is created solely for purposes of gathering information that can be helpful when used in conjunction with other assessments for better understanding of the clinical needs of the bilingual CWS. Presently, this questionnaire has not been research tested and data has not been collected to support diagnostic or research purposes. The authors hope that continued interest in the questionnaire will result in its further development for clinical and research validity.

 

 

References

Dodge, D. M. & Ramig, P. R. (2005). Handout A: Historial médico del habla, lenguaje, y audición. Thomson Delmar Learning, A part of the Thomson corporation. Greenwood Village, CO.

Esckelson, D. M. & Aguirre-Morales, A. (2000). Disfluencies/Stuttering: Questions for Parents. Spanish Phrasing for SLPS. [electronic version]

Healy, E. C., Trautman, S. Lisa & Susca, M. (2004). Clinical Applications of a Multidimensional Approach for the Assessment and Treatment of Stuttering. Contemporary Issues in Communication Disorders, Vol. 31, pp. 40-48

No Child Left Behind Act (2001). U.S. Department of Education, Public Law 107110.
Ramos-Heinrichs, L., Hansberry M. L., and Garzon, S. (2008). Employing Latino Value Orientations to Facilitate Success in Stuttering Treatment. SIG 4 Perspectives on Fluency and Fluency Disorders. http://sig4perspectives.pubs.asha.org/article.aspx?articleid=1766831&resultClick=1

Ramos-Heinrichs, L. , Sandra Garzon, S. , Selle, H., and Yaruss, S. (2009). Stuttering Inventory for Latino Families (SILF). Convention Presentation. http://www.asha.org/events/convention/handouts/2009/1655_ramos-heinrichs_lourdes/

Shenker R.C., Lim V.P.C (2014). Assessment and treatment of bilingual persons who stutter: What clinicians want and need to know. Presentation at 10th Oxford Dysfluency Conference. 17-20 July 2014, St.Catherine’s College, Oxford, UK.
World Health Organization (2001). International Classification of Functioning and Disability and Health (ICF). Geneva: World Health Organization.

Yaruss, J. S. & R. W. Quesal (2006). Overall Assessment of the Speaker’s Experience of Stuttering (OASES): Documenting Multiple Outcomes in Stuttering Treatment. Journal of Fluency Disorders. 31 (2006) 90-115

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Comments

Spanish/English Questionnaire for Parents of Bilingual Children Who Stutter — 25 Comments

  1. Hello,
    I am currently doing some research on bilingualism and stuttering and I found this paper and questionnaire very informative. I do have one question: When the parents or caregivers complete the questionnaire, is there one question or section of the questionnaire that stands out to be the most helpful in understanding the clinical assessment and needs of the child?
    Thank you for your time,
    Tammie

    • Dear Tammie, thanks for your interest and for commenting on the bilingual questionnaire. You rose a very important question, which partly is explained in the article attached to the questionnaire. In brief, the clinician can examine the responses section by section, or question by question to extract the information that is most pertinent for the particular case at hand. I find each question valuable for making diagnostic/treatment decisions and for understanding the needs of the child/family. Our hope is to generate enough interest by this article to motivate researchers as yourself to obtain normative data. In short, no statistical data is available at this time.

  2. As has been said before, thank you for this helpful questionnaire. I find it to be extremely useful and informative. My one question is why the questionnaire has questions asking about when the child speaks English and when the child speaks Spanish. Thank you again.
    – Cody

    • Hi Codie,

      Thanks for taking interest in the bilingual questionnaire. The main purpose of the questions in the bilingual section is to understand the use of each language, and the demands that the bilingual child is facing in natural settings. From the perspective of the demands/capacity model, we believe, we can guide parents on how to support the home language and monitor unnecessary pressures of linguistic performance, e.g. in academic settings. As it was explained in the article, the questionnaire has not been research tested and data has not been collected. At some future time, we would like very much to pilot the questionnaire and see what normative data or statistical information we can generate.

      • Hi Cody. In addition to the considerations that Sandra explained, the answers to the questions about fluency in different languages help us determine if the problem is related to differences in language proficiency (nondominant language) or if it is related to stuttering. I would expect stuttering in both languages.

  3. Lourdes, Sandra, and Edna, thank you for freely sharing your nicely done questionnaire! I really like how clearly it divides all the components that need to be addressed! You’ve done a lot of work to create a useful resources and I would certainly recommend it to clinicians serving families of bilingual children who stutter. May I add it with proper attribution to the Stuttering Home Page?

    Are you aware of the 176 page book “Spanish Phrasing for SLPs” written by Dorothy Miranda Esckeson and Adulfa Aguirre Morales and published in 1998? Years ago they gave me permission to add the section they did on “stuttering” to the Stuttering Home Page and later gave me permission to have PediaStaff who had the staff and equipment to do the work easily, make a PDF copy of their entire book. The entire book covers Spanish Phrasing not only for stuttering, but also for articulation/phonology, hearing, language and voice. The stuttering section begins on page 40 and includes 3 pages of yes/no questions as well as several additional pages of suggestions/information for parents and form letters in Spanish with English translation. They did a nice job, especially for SLPs serving a variety of speech-language and hearing disorders seen in an SLPs caseload. The direct URL is http://www.mnsu.edu/comdis/kuster2/therapy/spanishphrasingbookforSLPs.pdf

    • Sorry, Loudes – I see that they are listed in your bibliography! I should have known you knew about that resource!

    • Hi, Judith. Thank you for your comments. Originally, I was inspired by Dorothy Miranda Esckerson work with the the bilingual Spanish Phrasing for SLPs.

      Of course, it would be very nice to make this questionnaire available to as many SLPs as possible through the Stuttering Home Page and PediaStaff.

      Thanks for providing Dorothy’s URL link. I’ll check it out.

  4. This questionnaire is helpful resource for families who speak Spanish. Do you know if there are any resources available for families who speak other languages?

  5. Dear Lourdes, Sandra, and Edna,
    Thank you for sharing such complete questionnaire. I am sure it will prove to be a very useful resource for many clinicians serving families of bilingual children who stutter. I was glad to see that your questionnaire attempts to capture parent’s opinions and perceptions about bilingualism to help clinicians counsel and educate families about their bilingualism and cultural identity concerns based on the provided information. I have a friend whose Cuban family stopped speaking Spanish at home because the clinician treating her brother back then suggested it would be best for him (to avoid confusion and facilitate his academic development). This was evidently a mistake because, as you mentioned in your paper, research shows no relationship between bilingualism and stuttering or any other speech/language disorder. Do you think adding information regarding research and bilingualism somewhere on the questionnaire help families and even professionals realize this misconception?
    I looked over the questionnaire and would like to humbly provide you with a few suggestions.
    Question:
    4. Does he/she often stop for a moment before saying another word?
    In Spanish it is asking if the child stops/interrupts his/her breathing for a moment before saying a word.
    This could probably be a better wording: “Su niño/a frecuentemente para seguido por un momento (o hace pausas) antes de decir otra palabra”?

    17. Do other children tease or make fun of the way your child talks?
    In Spanish it’s missing the preposition “de” (of).
    ¿Se burlan o se rien los otros niños del modo de hablar DE su hijo/a?

    For questions 20. and 21, in Spanish it says “the child” instead of “your child” like in all the other questions.
    20. Do you feel embarrassed by your child’s speech?
    ¿Siente usted vergüenza de cómo habla el niño/la niña? → Siente usted …SU niño/a.

    21. Do you feel that speech therapy can improve your child’s communication skills?
    ¿Cree usted que la terapia del habla le puede ayudar al niño/la niña a comunicarse mejor?
    → Cree usted que … ayudar A SU niño/a a comunicarse mejor?

    Thank you very much for your time,

    -Samantha Mendoza

    • Hi, Samantha. Thank you for reading the paper so throughly. I do appreciate your suggestions. The questionnaire is definitely a work in progress, and revisions like yours are valuable. Lourdes

    • Hi Samantha. Thank you for your revisions and comments. Information on bilingualism and stuttering would be an accompanying document to the questionnaire. Thanks for the suggestion.

    • Hi Samantha,

      Thanks you for taking the time and read over the questions. Yes, the questionnaire is a work in progress and we appreciate all revisions. There is so much room for improvement and after looking at the questions I also found better ways to reword them.

      4. Su niño/niña frequentemente para por un momento (o hace pausas) antes de decir otra palabra?

      17. Se burlan o se rien los otros niños del modo en que habla su hijo?

      We will definitely take in consideration adding up more information regarding bilingualism and the misconceptions. Any suggestions would be highly appreciated. Sandra

  6. Dear Lourdes, Sandra, and Edna,
    This is a great resource. Considering how the Spanish/English bilingual population is growing in the U.S., it is so necessary that resources like this are developed to provide services for that growing population. Thank you for sharing.

  7. Good morning, Lourdes, Sandra, and Edna,

    Thank you for sharing your work. Tools like this questionnaire will be helpful in the challenging process of assessing and treating bilingual children.

    I am interested to know more about how severity and type of stuttering compares across the languages of a bilingual child who stutters. For example, do sequential bilinguals who stutter exhibit increased severity of stuttering in their L2? Are there patterns in types of stuttering across languages, e.g., repetitions as dominant type across both L1 and L2?

    What has been your experience in this area? Do you know of any studies that have made such comparison?

    Thank you,
    Libby

  8. Hello,

    This is great! Thank you for sharing. I found it interesting how some professionals and family members believe that bilingualism can exacerbate stuttering. But it’s also great that research evidence has shown us otherwise. I just thought it would be interesting to see something like this in other languages, as well (i.e. Tagalog & English bilinguals).

    Once again, thank you for sharing!

    Best,

    Jamie

  9. Dear Lourdes, Sandra and Edna.

    I’m glad to see that the questionnaire is bilingual–but just as important– it was written in a relatively clear manner for bilingual parents of different socio-economic status. I’ve met many parents who were given different types of questionnaires in Spanish related to autism but who could not understand the academic language used in it. This one is also more dialect-neutral.

    Thanks!

    • Hi Yan,

      Thank you. Yes, we made the effort to make the questionnaire very accessible to parents and easy for them to complete. You are welcome to use it with your clients and report back to us of any feedback you have. My email: sgarzonc10@gmail.com

      Sandra

  10. Thank you so much for creating and sharing this valuable resource! I am a multilingual graduate student in speech-language pathology with hopes of working with multilingual populations, and I am always on the lookout for tools specifically tailored to these clients and families. Do you ever find it difficult to design materials for Latinos as a whole, rather than for specific subpopulations?

    • Hi, Robert. You are coming into the profession with great assets. You will be able to help many people from diverse cultures/languages to communicate. In terms of designing materials for Latinos as a whole is not too complicated. It does take some effort and time to search for the materials, which come from three main sources: the ones you create yourself, the ones you google, and the onces that are commercially available. Networking and collaborating with other bilingual SLPs is the bet way to obtain or create the materials you need.