Abstract
Silvia and Antonio Juarez described their 4-year-old son Emanuel as often happy. Emanuel came from a bilingual home and spoke both Spanish and English. His favorite activities were reading and playing with his iPad over-and-over again. Reading was a favorite pasttime and something that the Juarez's felt he did well. While he was described as “loving to engage people,” it was not clear that his efforts were successful nor was it clear that they were reciprocated. Briefly observing Emanuel's interaction with his parents, it was noted Emanuel used echolalic phrases and engaged in repetitive and restricted behaviors, toe walking, and finger flicking. These behaviors were noted to be unusual and warranted further evaluation. The Juarez's primary concern was regarding Emanuel's “talking and being able to hold a conversation.” Through speech and language therapy, the family expected that Emanuel's communication skills would improve, and he would be able to participate in conversations and talk in sentences.
TopIntroduction
According to ASHA’s Code of Ethics, “…individuals who serve the ASD population should be specifically educated and appropriately trained to do so” (American Speech-Language-Hearing Association [ASHA], 2016, 2019a). To decrease diagnostic error attributed to over or under-diagnosis, cultural and linguistic variables reflecting the home and community environment must be considered in planning screenings and diagnostic testing. The selection of culturally and linguistically appropriate measures begins with identifying screening and assessment instruments that are psychometrically sound and/or sensitive to distinguishing differences from disorders (ASHA, 2019b). Culturally responsive screening procedures for differentiating Autism Spectrum Disorders (ASD) from other developmental disorders and differences examine such behaviors in the context of cultural norms for eye gaze, joint attention, response to one’s name, showing/pointing to desired items, nonverbal communication, pretend play, imitation, and language development (American Psychological Association [APA], 2013; ASHA, 2019a).
This chapter examines the above variables as critical factors for consideration in culturally responsive service delivery. Their relevance in service delivery is then illustrated in a case study of Emanuel, a simultaneous bilingual 4-year-old child with a suspected diagnosis of Autism Spectrum Disorder (ASD). The case study of Emanuel is significant in that it illustrates the complexities of culturally responsive service delivery addressing the following issues.
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Social and cultural variables
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Bilingual language assessment
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Bilingual service delivery
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Assessment and treatment of ASD
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Family-centered partnerships
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Interprofessional teaming/practice (IPP)
The case study concludes with a plan of care that is supportive of Emanuel’s ASD and Spanish/English communication needs while engaging in family-centered services and interprofessional practice/teaming.
Autism
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by deficits in the following areas.
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Social communication and social interaction (verbal and nonverbal)
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Restricted repetitive, stereotypic behaviors, interests and activities
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Inflexible adherence to routines
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Restricted interests and activities
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Hypo/Hypersensitivity to sensory input
(APA, 2013; ASHA, 2019a)
Key Terms in this Chapter
Bilingualism: Is having the ability to engage in communication involving more than one language. Proficiency across languages may exist on a continuum, fluctuating according to age, time, language environment, communicative partner, setting, etc. The acquisition of a second language also exists along this continuum and is referred to as simultaneous or sequential bilingualism (ASHA, 2019e AU59: The in-text citation "ASHA, 2019e" is not in the reference list. Please correct the citation, add the reference to the list, or delete the citation. ; Kohnert, 2013 ; Paradis, Genesee, & Crago, 2011 ). Simultaneous bilingualism reflects the introduction of two languages at the same time, at birth or soon thereafter (ASHA, 2019e AU60: The in-text citation "ASHA, 2019e" is not in the reference list. Please correct the citation, add the reference to the list, or delete the citation. ; Kohnert, 2013 ; Paradis, Genesee, & Crago, 2011 ). Sequential bilingualism is the introduction of a second language after some level of proficiency has been developed in the primary or native language. This typically occurs after 3 years of age (ASHA, 2019e AU61: The in-text citation "ASHA, 2019e" is not in the reference list. Please correct the citation, add the reference to the list, or delete the citation. ; Kohnert, 2013 ; Paradis, Genesee, & Crago, 2011 ).
Acculturation: Reflects cultural behavioral changes that occur as a result of the interaction or cultural mixing between an individual’s native culture and the dominant or majority culture. The consequence is a bicultural blending that potentially impacts, language, traditions, values, roles, beliefs, etc. ( Hyter & Salas-Provance, 2019 ; Ovando, 2008 ).
Evidence-Based Practice: Reflects the guiding principles of high-quality health care and clinical practice and guides best practice in good decision making. In the clinical practice of speech-language pathology and audiology EBP is the integration of clinical expertise/expert opinion, external scientific evidence, and client/patient/caregiver perspectives (ASHA, 2019c AU62: The in-text citation "ASHA, 2019c" is not in the reference list. Please correct the citation, add the reference to the list, or delete the citation. ; Kohnert, 2013 ).
Interprofessional Practice (IPP): Also known as interprofessional collaborative practice involves the partnership or teaming of healthcare, education and/or multidisciplinary service providers for the delivery of the highest quality comprehensive services across settings (Kirsch, 2019 AU64: The in-text citation "Kirsch, 2019" is not in the reference list. Please correct the citation, add the reference to the list, or delete the citation. ).
Family-Centered Services: Give recognition to families across the lifespan for the essential role they play in service delivery. The values, beliefs, cultural practices, diverse experiences and perspectives that families bring are recognized and respected in culturally responsive quality health care (ASHA, 2019e AU63: The in-text citation "ASHA, 2019e" is not in the reference list. Please correct the citation, add the reference to the list, or delete the citation. ).
Autism Spectrum Disorder (ASD): Is a neurodevelopmental disorder characterized by deficits in the following areas: social communication and social interaction (verbal and nonverbal communication); restricted repetitive, stereotypic behaviors, interests, and activities (e.g., speech, movement, object manipulation, etc.); inflexible adherence to routines; restricted interests and activities; hypo/hyper sensitivity to sensory input ( APA, 2013 ; ASHA, 2019a AU58: The in-text citation "ASHA, 2019a" is not in the reference list. Please correct the citation, add the reference to the list, or delete the citation. ).