ACQ Vol 13 no 3 2011

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ACQ Volume 13, Number 3 2011 149
The LLBA search yielded 114 results of which 19 proved
to be about intervention, ranging from 2010 to 1982. Three
were dissertations and not available, three were reviews,
one was in a foreign language, leaving six identified as
research studies on this topic. Studies conducted before
1990 were excluded. PsychInfo yielded six results, which
ranged from 1983 to 2009. Only one was on intervention
and that was not a research study. Only two of the six
were also found by the LLBA search and the others
were not relevant. CINHAHL replaced “bilingual” with
“multilingualism” and “language impairment” with “language
disorders”. It brought up 50 hits from 2010–1997, 18 of
which were not in the LLBA search but 13 of these were
non-research papers or other sources such as book
reviews or magazine articles not reported in LLBA. The
remaining five were not relevant to intervention. This left six
research articles to review, which are listed in Table 2 with a
summary of the purpose of the study, the key findings and
level of evidence.
The Cochrane database did not bring up any relevant
articles. However, speechBiteTM brought up 10 under
“bilingual child” of which four proved relevant. Where
possible, the speechBite TM database provides a rating for
the quality of the studies listed as seen in Table 3. None of
the relevant studies rated more than 3 out of 10 suggesting
low methodological quality overall. It should be noted that
while the speechBITE TM database recognises the clinical
value inherent in well-designed single case experimental
designs, these are currently not rated.
This comprehensive search for relevant literature
highlights that a limited number of high quality intervention
studies have been conducted in the field. To look further at
the quality of this research, Table 4 provides an example of
a critically appraised article for one of the studies to provide
more in-depth insight into the nature of research in this area
following the EBP guidelines.
Review articles
Relevant review articles on the topic were used to expand
the search strategy and to explore expert opinion in the
field. In 2010, two journals had issues devoted to the topic,
Applied Psycholinguistics 31, and the Journal of
Communication Disorders 43. The second contained two
important reviews of the research evidence, one by
Thordardottir (2010) and one by Kohnert (2010), along with
a number of other relevant research articles. A 2006 edition
of Topics in Language Disorders was also devoted to this
topic, and included another review by Goldstein (2006).
Please see Table 5 for a list of the review articles. The
review articles all confirm the paucity of research in the field
and that the available evidence tends to be from the weaker
people the same is what is meant by “not discriminate[ing]”,
then their position is indeed supported. However, cultural
competence and social justice principles are consistent in
their presentation that “equity” does not mean “treat all
people the same” but rather “treat all according to their
need”, and that “respect” and “culturally appropriate”
means going beyond our own cultural understandings
(Martin, 2009).
Interestingly, when reviewing the code of ethics of the
New Zealand Speech-Language Therapists’ Association
(NZSTA) you find that they have taken the discussion a
little further. For example, articles 1.6–1.8 indicate that
SPs “advocate that all clients irrespective of age, ethnic
background, … should have access to speech language
therapy services … acknowledge and allow for individuality
of clients including race, age, religion, culture”, and “respect
the rights of and be sensitive to factors such as a client’s
race, age, religion, culture”, and, at article 3.5, “offer these
services to clients in a manner which does not discriminate
on the grounds of race, religion, culture” and further: “4.4
Members shall ensure that the research is in accord with
the Treaty of Waitangi”. The accreditation standards for
programs that train SPs in New Zealand have an entire
section on working with the Treaty of Waitangi, which is
a legislated requirement. Terms such as “advocate”, “be
sensitive to”, and “respect the rights of” are somewhat
stronger in their implications. You feel that drawing upon
these principles, a SP does have an ethical responsibility
to consider and address the sociocultural needs of the
individual clients that they are working with in practice.
Looking for the research evidence
So far then, these documents can support the idea that
practices in multicultural and multilingual contexts should
be different to those of monolingual ones. While you are
aware of expert opinion in the field that supports this view
(Battle, 2002; Kohnert, 2010; Roseberry-McKibbin, 2007),
you know that you will require more evidence to advocate
the need for this shift in thinking to your colleagues. General
points regarding the need to adapt services can certainly be
made. But the arguments put forward suggest there are
some specific questions that require answers. They are:
1. Does the evidence indicate that bilingualism is
“harder” for children with language difficulties than
monolingualism?
2. Does the evidence indicate that SPs can – or can’t –
effectively or competently offer any services in languages
that they do not speak well?
3. Is there evidence that supporting multilingualism has any
benefits for learners, particularly those with language
difficulties?
To answer these questions, the process of searching the
research literature was undertaken. Popular databases for
speech pathology intervention research were first used in
attempt to find high quality bilingual or multilingual treatment
studies. Review articles and expert opinion on the topic
were also sourced as outlined below.
Databases
The Language and Linguistic Behaviour Abstracts (LLBA),
PsychInfo and CINAHL databases were searched, and in
order to find any systematic reviews or previously appraised
articles on the topic, the Cochrane library and speechBiteTM
databases were also used. The search terms are listed in
Table 1. The search was limited to oral language, excluding
studies on speech and literacy.
Table 1. Concept map to generate keywords
Client group Intervention Comparative Outcomes
search terms search terms Intervention
Possible Possible No particular No particular
search terms: search terms search terms search terms
• child* • language used. used.
• bilingual* intervention Interested in Interested in
• language • bilingual effect of the any outcome.
impair* or intervention intervention
language only.
disorder*
* Indicates a truncated string (will pick up “child”, “child’s”,
“children”, “children’s” etc.)