The population increase from 1990 to 2000 reflected the largest growth recorded by the U.S. census in American history—and more than 18% of the American population over the age of 5 speaks a language other than English in the home (Perry & Mackun, 2001). With those demographic changes, ASHA members needed to be able to provide clinically appropriate services to clients from diverse cultural and linguistic backgrounds.
The 21st century brought new growth and a new set of challenges. Nationwide, bilingualism increasingly became viewed as a strength. ASHA followed the U.S. Department of Education's lead in referring to children as "English-language learners" as opposed to "limited English-proficient." With these shifts came accompanying changes in treatment goals for speech-language pathologists, who began to focus on providing and building a language system for the client in the client's home language. All of these changes were the result of sweeping demographic changes and research on bilingualism conducted over several years.
According to Kathryn Kohnert, a professor in the Department of Speech-Language Hearing Sciences at the University of Minnesota, research over the past decade on typically developing children learning two languages has established a strong database for considering social, cognitive, and communicative relationships in dual-language learners with communication weaknesses and has provided tentative responses to a number of clinical questions. Kohnert, whose research focuses on speech-language development and use in bilingual children and adults, has received two ASHA grants for projects on multicultural activities and received ASHA's 2006 award for Special Contributions in Multicultural Affairs.
"Research at the intersection of communication disorders and bilingualism, however, is still in its infancy," Kohnert said, "and we need methodologically rigorous research on all disorder types with bilinguals, not just specific or primary language impairment in children in Spanish and English. There is a complete dearth of studies in some disorder areas, including autism, stuttering, and traumatic brain injury.
ASHA embraced the available research and its findings, infusing multicultural issues into its documents. "Every client has a culture, just as every clinician has a culture," states one ASHA document, Knowledge and Skills Needed by Speech-Language Pathologists and Audiologists to Provide Culturally and Linguistically Appropriate Services. One of the purposes of this policy document is to ensure that communication sciences and disorders students learn how to serve patients of all ages within the context of their cultural and linguistic backgrounds.
Bilingualism, second-language acquisition, and linguistic diversity issues have moved into the mainstream, Kohnert said. "There are more clinicians with expertise in serving linguistically diverse learners, more resources available to support their efforts, and more investigations at the intersection of bilingualism and communication disorders," she said. "We have advanced most over the past decade in assessment with speakers of different languages. Alternative methods of gathering information, including ethnographic interview techniques, systematic observation in natural settings, measures of learning such as dynamic assessment, and portfolio sample analysis have become common tools.
"In addition, the assessment of both languages of bilingual clients is also now considered key," Kohnert said, "and many more clinicians are developing skill in working with interpreters/translators or bilingual paraprofessionals."
At ASHA, multicultural issues were addressed further in professional development programs and in The ASHA Leader. The Office of Multicultural Affairs developed into an office that existed as an integral practice unit that ensured that ASHA considered all populations in its work. Staff units across the national office began to ensure that multicultural issues were reflected in their work—for example, by including multicultural issues in ASHA's public policy agenda and in topics for clinical questions for evidence-based systematic reviews.
As the decade comes to a close, Kohnert said, "I hope we move confidently beyond the question of ‘Which language should be supported in bilingual individuals with language impairment?' to ‘How can we support both/all languages so that bilingual individuals can be successful in their diverse environments?'"
ASHA has long been in the forefront of professional organizations' efforts to infuse multiculturalism into their work, and we expect to continue this work in the years to come.