The Effect of Self-Reported Visual Impairment and Sleep on Cognitive Decline: Results of the Hispanic Community Health Study/Study of Latinos.

BACKGROUND: Visual impairment could worsen sleep/wake disorders and cognitive decline. OBJECTIVE: To examine interrelations among self-reported visual impairment, sleep, and cognitive decline in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Miami-site. METHOD: HCHS/SOL Miami-site participants ages 45-74 years (n = 665) at Visit-1, who returned for cognitive test 7-years later (SOL-INCA). Participants completed the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ), validated sleep questionnaires and test for obstructive sleep apnea (OSA) at Visit-1. We obtained verbal episodic learning and memory, verbal fluency, processing speed, and executive functioning at Visit-1 and at SOL-INCA. Processing speed/executive functioning were added to SOL-INCA. We examined global cognition and change using a regression-based reliable change index, adjusting for the time lapse between Visit-1 and SOL-INCA. We used regression models to test whether 1) persons with OSA, self-reported sleep duration, insomnia, and sleepiness have an increased risk for visual impairment, 2a) visual impairment is associated with worse cognitive function and/or decline, and 2b) sleep disorders attenuate these associations. RESULT: Sleepiness (ß= 0.04; p < 0.01) and insomnia (ß= 0.04; p < 0.001) were cross-sectionally associated with visual impairment, adjusting for sociodemographic characteristics, behavioral factors, acculturation, and health conditions. Visual impairment was associated with lower global cognitive function at Visit-1 (ß= -0.16; p < 0.001) and on average 7-years later (ß= -0.18; p < 0.001). Visual impairment was also associated with a change in verbal fluency (ß= -0.17; p < 0.01). OSA, self-reported sleep duration, insomnia, and sleepiness did not attenuate any of the associations. CONCLUSION: Self-reported visual impairment was independently associated with worse cognitive function and decline.

A Decade of Disproportionality: A State-Level Analysis of African American Students Enrolled in the Primary Disability Category of Speech or Language Impairment.

Purpose This study aimed to determine if African American students were disproportionately represented between the years of 2004 and 2014 in the primary disability category of Speech or Language Impairment (S/LI) under the 2004 reauthorized Individuals with Disabilities Education Improvement Act. Method S/LI enrollment data from the Office of Special Education Programs and general enrollment data from the National Center for Education Statistics were analyzed to compare the risk of primary S/LI category enrollment of African American students to that of all other students. Risk ratios with 99% confidence intervals were calculated for each state across the 10 years studied. Results An average of 75% of states disproportionately represented African American students in the S/LI category each year; on average, 62% underrepresented African American students, and 14% overrepresented them. A post hoc analysis of the relationship between African American student representation and population densities revealed that states with high African American population densities almost exclusively underrepresented African American students and states with low densities tended toward a proportionate representation. Conclusions African American students were largely underrepresented in the category of S/LI in the years studied. These findings, alongside historic and chronic overrepresentation in other categories of special education, are discussed in the context of the fragmented harm theory ( Payne, 1984 ; Voulgarides, 2018 ; Voulgarides, Zwerger, & Noguera, 2013 ) and the disability rights and critical race theory ( Annamma, Connor, & Ferri, 2013 ). Supplemental Material https://doi.org/10.23641/asha.7967024.

Does Speaker Race Affect the Assessment of Children's Speech Accuracy? A Comparison of Speech-Language Pathologists and Clinically Untrained Listeners.

Purpose: Some pronunciation patterns that are normal in 1 dialect might represent an error in another dialect (i.e., [koʊl] for cold, which is typical in African American English [AAE] but an error in many other dialects of English). This study examined whether trained speech-language pathologists and untrained listeners accommodate for presumed speaker dialect when rating children's productions of words. This study also explored whether effects of presumed race on perceived speech accuracy are mediated by individuals' knowledge and beliefs about AAE and their implicit attitudes about race. Method: Multiple groups of listeners rated the accuracy of a set of children's productions of words that have a distinct pronunciation in AAE. These were presented in 1 of 3 conditions: paired with no visual stimulus (to assess baseline accuracy) or paired with either African American children's faces (to suggest that the speaker uses AAE) or European American children's faces (to suggest that the speaker does not use AAE). Listeners also completed a set of measures of knowledge and attitudes about AAE and race, taken from previous studies. Results: Individuals in both groups rated children's productions more accurately when they were presented with African American children's faces than when paired with European American faces. The magnitude of this effect was generally similar across the 2 groups and was generally strongest for words that had been judged in the baseline condition to contain an error. None of the individual-differences measures predicted ratings. Conclusions: Assumptions about speaker attributes affect individuals' assessment of children's production accuracy. These effects are robust across trained and untrained listeners and cannot be predicted by existing measures of knowledge and attitudes about AAE and race.

Racial-Ethnic Differences in Word Fluency and Auditory Comprehension Among Persons With Poststroke Aphasia.

OBJECTIVES: To examine aphasia outcomes and to determine whether the observed language profiles vary by race-ethnicity. DESIGN: Retrospective cross-sectional study using a convenience sample of persons of with aphasia (PWA) obtained from AphasiaBank, a database designed for the study of aphasia outcomes. SETTING: Aphasia research laboratories. PARTICIPANTS: PWA (N=381; 339 white and 42 black individuals). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Western Aphasia Battery-Revised (WAB-R) total scale score (Aphasia Quotient) and subtest scores were analyzed for racial-ethnic differences. The WAB-R is a comprehensive assessment of communication function designed to evaluate PWA in the areas of spontaneous speech, auditory comprehension, repetition, and naming in addition to reading, writing, apraxia, and constructional, visuospatial, and calculation skills. RESULTS: In univariate comparisons, black PWA exhibited lower word fluency (5.7 vs 7.6; P=.004), auditory word comprehension (49.0 vs 53.0; P=.021), and comprehension of sequential commands (44.2 vs 52.2; P=.012) when compared with white PWA. In multivariate comparisons, adjusted for age and years of education, black PWA exhibited lower word fluency (5.5 vs 7.6; P=.015), auditory word recognition (49.3 vs 53.3; P=.02), and comprehension of sequential commands (43.7 vs 53.2; P=.017) when compared with white PWA. CONCLUSIONS: This study identified racial-ethnic differences in word fluency and auditory comprehension ability among PWA. Both skills are critical to effective communication, and racial-ethnic differences in outcomes must be considered in treatment approaches designed to improve overall communication ability.

Variation in Vowel Duration Among Southern African American English Speakers.

PURPOSE: Atypical duration of speech segments can signal a speech disorder. In this study, we examined variation in vowel duration in African American English (AAE) relative to White American English (WAE) speakers living in the same dialect region in the South to characterize the nature of systematic variation between the 2 groups. The goal was to establish whether segmental durations in minority populations differ from the well-established patterns in mainstream populations. METHOD: Participants were 32 AAE and 32 WAE speakers differing in age who, in their childhood, attended either segregated (older speakers) or integrated (younger speakers) public schools. Speech materials consisted of 14 vowels produced in hVd-frame. RESULTS: AAE vowels were significantly longer than WAE vowels. Vowel duration did not differ as a function of age. The temporal tense-lax contrast was minimized for AAE relative to WAE. Vowels produced by females were significantly longer than vowels produced by males for both AAE and WAE. CONCLUSIONS: African American speakers should be expected to produce longer vowels relative to White speakers in a common geographic area. These longer durations are not deviant but represent a typical feature of AAE. This finding has clinical importance in guiding assessments of speech disorders in AAE speakers.

Public attitudes toward-and identification of-cluttering and stuttering in Norway and Puerto Rico.

PURPOSE: The study sought to compare public attitudes toward cluttering versus stuttering in Norway and Puerto Rico and to compare respondents' identification of persons known with these fluency disorders. METHOD: After reading lay definitions of cluttering and stuttering, three samples of adults from Norway and three from Puerto Rico rated their attitudes toward cluttering and/or stuttering on modified versions of the POSHA-Cl (for cluttering) and POSHA-S (for stuttering). They also identified children and adults whom they knew who either or both manifested cluttering or stuttering. RESULTS: Attitudes toward cluttering were essentially unaffected by rating either cluttering only or combined cluttering and stuttering on the same questionnaire in both countries. The same was also true of stuttering. Attitudes were very similar toward both disorders although slightly less positive for cluttering. Norwegian attitudes toward both disorders were generally more positive than Puerto Rican attitudes. The average respondent identified slightly more than one fluency disorder, a higher percentage for stuttering than cluttering and higher for adults than children. Cluttering-stuttering was rarely identified. CONCLUSION: Given a lay definition, this study confirmed that adults from diverse cultures hold attitudes toward cluttering that are similar to-but somewhat less positive than-their attitudes toward stuttering. It also confirmed that adults can identify cluttering among people they know, although less commonly than stuttering. Design controls in this study assured that consideration of stuttering did not affect either the attitudes or identification results for cluttering. EDUCATIONAL OBJECTIVES: The reader will be able to: (a) describe the effects-or lack thereof-of considerations of stuttering on attitudes toward cluttering; (b) describe differences in public identification of children and adults who either clutter or stutter; (c) describe differences between attitudes toward cluttering and stuttering in Norway and Puerto Rico.

Resourcing speech-language pathologists to work with multilingual children.

Speech-language pathologists play important roles in supporting people to be competent communicators in the languages of their communities. However, with over 7000 languages spoken throughout the world and the majority of the global population being multilingual, there is often a mismatch between the languages spoken by children and families and their speech-language pathologists. This paper provides insights into service provision for multilingual children within an English-dominant country by viewing Australia's multilingual population as a microcosm of ethnolinguistic minorities. Recent population studies of Australian pre-school children show that their most common languages other than English are: Arabic, Cantonese, Vietnamese, Italian, Mandarin, Spanish, and Greek. Although 20.2% of services by Speech Pathology Australia members are offered in languages other than English, there is a mismatch between the language of the services and the languages of children within similar geographical communities. Australian speech-language pathologists typically use informal or English-based assessments and intervention tools with multilingual children. Thus, there is a need for accessible culturally and linguistically appropriate resources for working with multilingual children. Recent international collaborations have resulted in practical strategies to support speech-language pathologists during assessment, intervention, and collaboration with families, communities, and other professionals. The International Expert Panel on Multilingual Children's Speech was assembled to prepare a position paper to address issues faced by speech-language pathologists when working with multilingual populations. The Multilingual Children's Speech website ( http://www.csu.edu.au/research/multilingual-speech ) addresses one of the aims of the position paper by providing free resources and information for speech-language pathologists about more than 45 languages. These international collaborations have been framed around the World Health Organization's International Classification of Functioning, Disability and Health (ICF-CY) and have been established with the goal of supporting multilingual children to participate in society.

Variability in the language input to children enhances learning in a treatment context.

PURPOSE: Artificial language learning studies have demonstrated that learners exposed to many different nonword combinations representing a grammatical form demonstrate rapid learning of that form without explicit instruction. However, learners presented with few exemplars, even when they are repeated frequently, fail to learn the underlying grammar. This study translated this experimental finding in a therapeutic context. METHOD: Eighteen preschool children with language impairment received conversational recast treatment for morpheme errors. Over a 6-week period, half heard 12 unique verbs twice each during recasts (low-variability condition), and half heard 24 unique verbs (high-variability condition). Children's use of trained and untrained morphemes on generalization probes as well as spontaneous use of trained morphemes was tracked throughout treatment. RESULTS: The high-variability condition only produced significant change in children's use of trained morphemes, but not untrained morphemes. Data from individual children confirmed that more children in the high- than the low-variability condition showed a strong treatment effect. Children in the high-variability condition also produced significantly more unique utterances containing their trained morpheme than children in the low-variability condition. CONCLUSION: The results support the use of highly variable input in a therapeutic context to facilitate grammatical morpheme learning.

National women's knowledge of stroke warning signs, overall and by race/ethnic group.

BACKGROUND AND PURPOSE: Recognition of stroke warning signs may reduce treatment delays. The purpose of this study was to evaluate contemporary knowledge of stroke warning signs and knowledge to call 9-1-1, among a nationally representative sample of women, overall and by race/ethnic group. METHODS: A study of cardiovascular disease awareness was conducted by the American Heart Association in 2012 among English-speaking US women ≥25 years identified through random-digit dialing (n=1205; 54% white, 17% black, 17% Hispanic, and 12% other). Knowledge of stroke warning signs, and what to do first if experiencing stroke warning signs, was assessed by standardized open-ended questions. RESULTS: Half of women surveyed (51%) identified sudden weakness/numbness of face/limb on one side as a stroke warning sign; this did not vary by race/ethnic group. Loss of/trouble talking/understanding speech was identified by 44% of women, more frequently among white versus Hispanic women (48% versus 36%; P<0.05). Fewer than 1 in 4 women identified sudden severe headache (23%), unexplained dizziness (20%), or sudden dimness/loss of vision (18%) as warning signs, and 1 in 5 (20%) did not know 1 stroke warning sign. The majority of women said that they would call 9-1-1 first if they thought they were experiencing signs of a stroke (84%), and this did not vary among black (86%), Hispanic (79%), or white/other (85%) women. CONCLUSIONS: Knowledge of stroke warning signs was low among a nationally representative sample of women, especially among Hispanics. In contrast, knowledge to call 9-1-1 when experiencing signs of stroke was high.

Speech-language pathologists' assessment and intervention practices with multilingual children.

Within predominantly English-speaking countries such as the US, UK, Canada, New Zealand, and Australia, there are a significant number of people who speak languages other than English. This study aimed to examine Australian speech-language pathologists' (SLPs) perspectives and experiences of multilingualism, including their assessment and intervention practices, and service delivery methods when working with children who speak languages other than English. A questionnaire was completed by 128 SLPs who attended an SLP seminar about cultural and linguistic diversity. Approximately one half of the SLPs (48.4%) reported that they had at least minimal competence in a language(s) other than English; but only 12 (9.4%) reported that they were proficient in another language. The SLPs spoke a total of 28 languages other than English, the most common being French, Italian, German, Spanish, Mandarin, and Auslan (Australian sign language). Participants reported that they had, in the past 12 months, worked with a mean of 59.2 (range 1-100) children from multilingual backgrounds. These children were reported to speak between two and five languages each; the most common being: Vietnamese, Arabic, Cantonese, Mandarin, Australian Indigenous languages, Tagalog, Greek, and other Chinese languages. There was limited overlap between the languages spoken by the SLPs and the children on the SLPs' caseloads. Many of the SLPs assessed children's speech (50.5%) and/or language (34.2%) without assistance from others (including interpreters). English was the primary language used during assessments and intervention. The majority of SLPs always used informal speech (76.7%) and language (78.2%) assessments and, if standardized tests were used, typically they were in English. The SLPs sought additional information about the children's languages and cultural backgrounds, but indicated that they had limited resources to discriminate between speech and language difference vs disorder.

Maximizing health literacy and client recall in a developing context: speech-language therapist and client perspectives.

BACKGROUND: In the field of speech-language therapy, limited research has been conducted with regards to health literacy and client recall. However, speech-language therapists frequently provide a considerable amount of information for clients to understand, apply and review in order to manage their (or their child's) health. AIMS: This study aimed to investigate (1) issues around clients' health literacy and recall of information; and (2) how these issues can be overcome in speech-language therapy in a developing context. METHOD & PROCEDURES: An exploratory study was undertaken with specific focus on speech-language therapists and their clients who had previously received treatment for dysphagia, voice disorders (including laryngectomies), and cleft lip and/or palate management. They were recruited at public tertiary hospitals and primary healthcare clinics in Cape Town, South Africa. Data were gathered through focus group discussions and qualitatively analysed using a content-driven immersion/crystallization style. OUTCOMES & RESULTS: Five themes and 13 subthemes were identified. Speech-language therapists currently use mostly low-technology strategies to manage issues of health literacy and client recall, and frequently view poor outcomes as being related to clients themselves and a lack of compliance. CONCLUSIONS & IMPLICATIONS: An understanding of context, intercultural health literacy and client-provider concordance are important factors that should inform the clinical practice of speech-language therapy. There is a need to develop effective strategies for information provision and review post-consultation. Speech-language therapists have an important mediating role in cross-cultural communication.

Relationships between ophthalmological and neuropaediatric findings in children adopted from Eastern Europe.

PURPOSE: This study aimed to evaluate and relate visual function, ocular dimensions and neuropaediatric findings in adoptees from Eastern Europe. METHODS: We studied 72 of 99 children, born during 1990-95 and adopted from Eastern Europe to western Sweden during 1993-97. The children (mean age 7.5 years, range 4.8-10.5 years; 41 boys, 31 girls) were examined after a mean period of 5 years post-adoption by a multidisciplinary team. Correlations between ophthalmological findings and neuropaediatric data were analysed. RESULTS: Bivariate and regression analyses indicate a significant positive correlation between visual acuity (VA) and perceptual organization (p < 0.001), as well as between strabismus and verbal comprehension (p < 0.02). Fetal alcohol syndrome (FAS) was correlated with low VA (p < 0.02), subnormal stereovision (p < 0.009) and small optic discs (p < 0.02). Small head circumference was related to low VA (p < 0.015) and small optic discs (p < 0.03). Furthermore, small optic discs were related to low birthweight (p < 0.005) and preterm birth (p < 0.01). Large optic cups were correlated with poorer perceptual organization (p < 0.02). CONCLUSIONS: In this group of adoptees from Eastern Europe, ophthalmological findings were correlated to neuropaediatric findings, especially those arising from prenatal adverse events resulting in growth deficiency and central nervous system damage. Therefore, it is important and valuable with an ophthalmological examination in children adopted from Eastern Europe.

Complications of otitis media in Indigenous and non-Indigenous children.

In Australia, three to five children die each year because of otitis media complications, and 15 children will suffer permanent hearing loss each year as a result of otitis media. Extracranial complications occur most commonly, and include mastoiditis, cholesteatoma and otitis media with perforation. Intracranial complications are less common, and include meningitis, brain abscess and lateral sinus thrombosis. In Australia, approximately 60% of extracranial and intracranial complications of otitis media occur in children. The contrasting rates of childhood otitis media among Indigenous and non-Indigenous children have implications for the frequency and types of complications occurring in both groups. Otitis media with effusion and acute otitis media predominate among non-Indigenous children, whereas chronic suppurative otitis media (CSOM) occurs most commonly among Indigenous children. The incidence of mastoiditis in Australia is low by international standards (2/100,000 children), but cholesteatoma rates among Indigenous children in Australia are higher than previously estimated (up to 10% in CSOM). A high rate of chronic tympanic membrane perforation occurs among Indigenous children, estimated to be as high as 80%. Intracranial complications of otitis media are uncommon, but are potentially life-threatening and are more likely to occur among Indigenous than non-Indigenous children. Reduced access to medical care, lower socioeconomic status and remote living conditions mean that levels of early childhood hearing loss among Indigenous children are likely to be underestimated. This has implications for early childhood speech and language development and education.

Child maltreatment: a global issue.

PURPOSE: This article explains why children with speech and language impairments are at increased risk for having experienced abuse, neglect, and trauma and how maltreatment may vary across cultures. METHOD: International literature on maltreatment is reviewed in order to provide frameworks for identifying what constitutes maltreatment across cultures; how cultural variations in discipline practices impact maltreatment; and professionals' roles in treatment when they encounter children who have experienced abuse, neglect, or trauma. CONCLUSION: Speech-language pathologists and audiologists are required to document and report any instance of suspected child abuse. To intervene effectively with children and families from diverse cultures who experience maltreatment, professionals must understand when a practice causes harm and be able to modify childrearing practices in culturally acceptable ways.

Speech and language therapy service delivery for bilingual children: A survey of three cities in Great Britain.

BACKGROUND: Speech and language therapy (SLT) managers are expected to ensure that there are appropriate services available for bilingual and multilingual clients in order to ensure an equitable service to all clients. However, there is a paucity of data available to inform service planning. AIMS: To identify the level to which SLT services in three UK cities meet the recommendations of The Royal College of Speech and Language Therapists (RCSLT) Good Practice Guidelines. Socio-demographic information is provided about the number of children from ethnic minorities in the population and the proportion of (bilingual) children from ethnic minorities on the speech and language therapy caseload. Based on this information, it is estimated whether there is proportionate representation of bilingual children on SLT caseloads, and whether services are in place to meet the needs of those clients. METHODS & PROCEDURES: Population statistics were gathered from Census data and data were gleaned from Local Education Authorities. The study used a combination of interview and postal questionnaires to SLTs, with particular emphasis on the issues that may affect service provision. OUTCOMES & RESULTS: As in previous studies, it was difficult to find reliable data. However, two of the three cities studied appeared to be offering a proportionate service to both monolingual and bilingual children in terms of the relative numbers of children on caseloads. Only one city was confident that their SLT service was fully meeting the RCSLT Good Practice Guidelines on bilingualism, although all three cities were aware of them and appeared to be making an effort at varying levels to address the principles of those guidelines. CONCLUSIONS: There is a need for a change in how data on linguistic diversity in society are collected and disseminated, both at a national level and within SLT services, so that informed decisions can influence the future of quality services to minority groups.

A noncontrastive model for assessment of phonology.

The contrastive/noncontrastive model developed by Seymour and Seymour (1977) can be applied to the development of a dialect-sensitive phonological assessment that uses a single scoring and test format, regardless of a child's dialect. Through extensive field research, stimulus items were found that respect the phonotactics of African American English (AAE) (i.e., no targets are final consonants or final consonant clusters), yet are sufficiently demanding to show development in the age range from 4 to 9 years. Consonant clusters of varying levels of phonological difficulty are shown to discriminate between typically developing and phonologically impaired children of different dialect groups, Mainstream American English (MAE) and non-MAE. Implications for further diagnosis and remediation are presented.

Speech language pathology services in Kivalliq Region of Nunavut, Canada.

OBJECTIVES: To provide a review of Speech Language Pathology services in the Kivalliq Region of Nunavut, Canada, since its inception. Referral sources, reasons for referral and discharge will also be shown for seven of the communities in the Kivalliq Region. STUDY DESIGN: A quantitative and qualitative survey of the services received for the 26-month time period from January 2001 to February 28th, 2003. METHODS: A record review of Speech Language Pathology services was conducted. Referral sources in each community, the rate of referrals, reasons for discharge and changes in abilities of three clients were examined. RESULTS: The rate of referrals increased as the service became more familiar. Small increases in client abilities were noted over the specified time period. CONCLUSION: Speech Language Pathology services are being utilized more effectively as the referral sources become more familiar with the program.

Perceptions of the impact of speech, language, swallowing, and hearing difficulties on quality of life of a group of South African persons with multiple sclerosis.

The present study investigated perceptions of speech, language, swallowing, and hearing difficulties and the relative impact of these problems on quality of life (QOL) in a group of South African persons with multiple sclerosis (MS). A questionnaire was used to elicit information regarding the difficulties experienced and the perceptions of their influence on QOL. Of the 30 respondents, 56.7% experienced speech problems and 63.3% reported language difficulties, with 62% of those feeling that these speech and language difficulties impacted on QOL. Fifty percent reported swallowing problems with 53% of those perceiving an influence on QOL. Twenty-three percent of participants experienced hearing problems with 44% expressing the view that their QOL was influenced. These findings are discussed with regard to their implications for the education and counselling of individuals with MS and their families, incorporation of speech-language pathologists and audiologists into management teams, and further research.