How Not to be a Karen SLP – Part 4

Image courtesy of Geralt on

Systems of Oppression in Speech-Language Pathology Evaluations

Recently, I read an excellent diary by one of my favorite contributors on a political site I enjoy. The poster talked about her experiences as a young, Black student in America’s public schools and how her ability to take standardized tests set her apart from her peers. She talked about how that sense of being ‘other’ was implicit in the way she was treated during her K-12 years because school, and standardized testing especially, was her “talent.”

To some extent, I can relate. I had a very different school experience. I never spent more than 4 years in a single district. I attended 3 high schools in 2 states, moving after my freshman year and again after my junior year. I was always the “new kid.” I was always seen as the outsider. But, the one thing that was always easy for me was taking standardized tests. It’s my “talent” too. I didn’t study for the ACT or SAT. I didn’t study for the GRE. I didn’t study for the Praxis. I never had to study for those things because I “get” the logic of the testing format. When you’re the “new kid”, those skills don’t exactly win friends and influence others. They generate resentment.

The diarist’s post made me think that I needed to get my thoughts down about systems of oppression within speech-language pathology.

Let’s take a bit of a history lesson regarding education itself. Initially, education was designed to be a system of oppression. Only those with privilege could access the best educations. That generally meant only men who enjoyed the privilege of power and oppression of others could access education. The masses were intentionally excluded from education because those who were educated and in power did not want to share the power. Fast forward a few thousand years from the invention of writing systems and we can see that education is still a form of power and oppression. In this country, people of color were excluded from attending the same schools as White children until the 1950s and 1960s. It wasn’t that long ago that Brown v. Board of Education did away with explicit “separate but equal” school resources for children of color and White children.

Today, in the US, the quality of the education you receive is very dependent on your zip (postal) code. If you live in a more affluent area, you are more likely to have highly qualified teachers who remain in their jobs for the entire academic year than if you live in a less affluent zip code. You are more likely to have access to the newest technology. You are more likely to have access to physical education, music, and art classes in school. You also are more likely to have access to a computer and internet access at home (a substantial problem laid bare by the pandemic.)

If you are a student of color or a student with disabilities, you are more likely to be disciplined than White students. This discrepancy begins in preschool. Imagine a preschooler being suspended or expelled for behavior in the classroom. It happens – every day in the classrooms of children of color. Often, especially at these young ages, the discipline occurs over issues that have cultural roots. This includes differences in how children interact with adults, expectations of gender roles (e.g., in some cultures, even young boys are not expected to clean up after themselves), and differences in how language is used across cultures or socioeconomic levels (e.g., some “swear words” in mainstream culture may not be offensive in other cultures or in different SES levels.)

Now, let’s look specifically at issues related to speech-language pathology. I’ve written before about the inclusion of very mainstream culture parenting practices on assessments used with very young children. Parents very quickly pick up they are answering “no” to a lot the questions they are being asked. The implicit message that they are not parenting their very young children “correctly” is reinforced by well-meaning early intervention specialists who only provide mainstream culture parenting suggestions. This includes only providing suggestions for mainstream culture foods during feeding therapy. Not all cultures have a literate tradition like mainstream American culture. A literate culture generally uses very linear stories (think Disney movies and summer blockbuster here). There’s a predictable pattern to them. Cultures that have an oral tradition tell stories very differently. The story lines are not as linear. The characters may change. There may be a different purpose to the story than the one stated. The audience may be expected to participate in the telling of the story. However, when SLPs evaluate school-age children’s ability to tell stories, we often do not take cultural differences into account when judged the ‘completeness’ of the story. The tools we use generally judge children’s stories against the mainstream culture, linear, literate narrative structure.

Vocabulary assessment is another area where we see an implied preference for mainstream culture, literate language. Think about the words included on popular receptive vocabulary tests. Think about the format of these tests. The examiner speaks a single word aloud without any other context and the examinee is expected to point to the picture that depicts the word that was spoken. Except…that’s not how children learn language. They don’t learn individual words in a vacuum. They learn language in context. And, that context matters. It is possible to know what a word means in one context, but not another (one aspect of partial word knowledge). Vocabulary also tends to be regional and cultural. For example, what do you call the elements that heat up on the stove when you cook? I call them “stove eyes.” You might call them “burners.” Is my vocabulary level lower because I don’t call them, “burners”? Is my vocabulary level lower because I call it “ride” instead of a “car”? Unfortunately, the answer to those questions on popular receptive vocabulary tests is yes. Through our research, my colleague and I have identified a subset of items on a widely used receptive vocabulary test that appear to be challenging for African American speaking children (Mason & Bass, 2020). Much of the difficulty appears to stem from the context in which the items are presented and tested. There are enough items that it equates to about 1/2 standard deviation difference in performance in preschool and kindergarten.

Rather than looking at the function of language for children from CLD environments, our assessment and evaluation tools focus primarily on the structure of children’s utterances. I will be the first to acknowledge that both structure and function are critical to becoming a mature language user. However, the question becomes whose structure is the standard? Is it MAE? In that case, many children who speak dialects that differ widely from MAE like AAE or Appalachian English will be overidentified as having language impairments by the very nature of the contrastive dialect differences. Children who are learning ESOL also will be overidentified as being language impaired. Many children learning ESOL may not be learning MAE; that fact must be considered when determining whether a child presents with a language difference or language disorder. I also would add that the opinions of adults who speak the dialect or language the child speaks also are important. What do mature speakers of the dialect or language think of the child’s functional language skills? What have they noticed that is different from other children or adults in the community?

In dysphagia/swallowing evaluations, most clinicians do not discuss family food preferences. This is a mistake. Let’s take rice as an example. Mainstream culture diets generally do not include many rice-based dishes. But, in many other cultures, rice is a staple carbohydrate. Depending on how it is cooked and served, rice can be a high risk food for people with difficulty with bolus preparation or manipulation, difficulty with an efficient first swallow, and difficulty clearing rice from the oral cavity after the initial swallow. In many cultures, rice-based dishes also contain mixed textures which also may be challenging for people with swallowing difficulties. If you work with feeding and swallowing issues, when was the last time you asked your clients about the family foods they eat and they way they prepare them when you discussed diet needs?

Next post, let’s talk about systems of oppression in speech-language intervention.

As always, thank you for reading and I look forward to your comments!

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