Diversity, Equity, & Inclusion in Early Intervention – Service Provision Part 1

In the last two posts, I’ve discussed my concerns about how eligibility is determined in early intervention. There are multiple issues – from the overreliance on outdated protocols that are not appropriate for children growing up in culturally and linguistically diverse environments to procedures that rely on (at best) shaky statistical methods to arrive at a mythical ‘percent delay’ based on the outdated, mainstream culture biased protocols.

One also has to understand that the prevailing attitude among EI professionals is that it’s better to enroll a child who doesn’t actually need EI than it is to miss a child who does. In more formal terms, EI is quite comfortable using evaluation protocols and procedures with poor sensitivity (mistakenly determining there’s a problem when there isn’t) and then compounding the problem by being more than willing to commit Type I errors (false positives).

On the surface of it, the ‘it won’t hurt anything’ attitude seems like it shouldn’t be problematic. But, remember, parents are being told there is something wrong with their child’s development. And, frequently, the determination that there is something ‘wrong’ is based on mainstream culture standards, including Mainstream American English. Different does not mean disordered.

Different does not mean disordered.

Again, I want to restate that I believe EI professionals believe strongly in the need for EI and I believe that they have the families’ best interests at heart. But, they are overwhelmingly middle-class and mainstream culture. And, they are unaware that they consistently recommend practices and suggestions that may not be appropriate for the families they serve.

I’ve seen the results and consequences of this myself and in real time. I’ve seen a wonderful, experienced Latina mom get so frustrated with the mainstream culture white women telling her how to feed her child with Down syndrome that she slammed the spoon on the table and walked out of the room. All because of how the EI interventionists were phrasing what they were saying and the way it was being interpreted in Spanish. I’ve seen less educated moms humiliated in front of EI professionals in meetings because they weren’t able to sign their names in cursive and/or write the numbers in dates. It’s not just me. There has been quite a bit of research published in this area because of the cultural mismatches: https://doi.org/10.1044/persp3.SIG14.40

One of the frequent complaints of Latina moms is one of my complaints – that there is a big disconnect between the family’s concerns and the suggestions provided by EI professionals. Families generally are concerned because their children are not able to tell adults or other children what they want. In other words, families are concerned about the children’s expressive language skills. All too often, however, EI professionals recommend strategies that are (supposedly) focused on children’s receptive language skills (e.g., adults should narrate what they’re doing when interacting with children; following 1- and 2-step directions).

I think overreliance on addressing receptive language skills stems from the persistent assumption that receptive language skills precede expressive language skills. I want to point out this is an assumption largely based on the fact that children are able to demonstrate understanding of things said to them before they are able to use oral language. But, oral language is only one form of communication. It is true that hearing is the only fully developed sense present at birth in humans and that we think this is an evolutionary advantage for oral communication development. We also know that babies are able to differentiate their mothers’ voices from others’ voices shortly after birth. We know that certain sounds and voices are soothing to babies because they become calmer when we do those things in their presence. But, the very first communication skill babies clearly master in the first few weeks of life is to differentiate their cries. That’s right, babies first learn how to express their needs and wants well before they are able to respond to their own names or follow another person’s point.

I could drop an adult off in a situation where they didn’t speak the language and they still would be able to buy a train ticket or order in a restaurant or ask where the bathroom is because communication is more than the words that come out of our mouths. Actually, the reason an adult is able to meet their own needs without being able to speak the language is because they are able to expressively communicate what they need to others. And, they are able to persist in making sure their needs get met and repair communication breakdowns when they are not understood.

So, like many families involved in EI, I’m at a loss to understand why one of the first recommendations made to all families who are concerned about their child’s expressive communication is to provide more receptive input about anything and everything. In EI parlance, this recommendation is called “narrating.” This recommendation generally is followed up by a recommendation to use child directed speech (CDS). CDS is a mainstream culture, generally middle- and upper-class phenomenon. Most lay people call it ‘baby talk.’ It’s most definitely not universal and there is no support for its use in the literature aside from the fact that babies and young children seem to like it. It doesn’t improve the rate of language acquisition nor does it appear to have an impact on early vocabulary acquisition.

What does have an impact on overall language development? The quantity of opportunities for children to use their developing language skills in interactions.

I’ve discussed how to provide the opportunities in previous posts. And, I’ll write up the adaptations I’ve developed in the next post or two.

For now, I’d like you to think about how SLPs can be less ‘Karen’ in our interactions with parents of young children from CLD populations. How can we as a profession go from telling others how to be more mainstream culture to truly supporting families who may come from very different parenting perspectives?

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