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University of Iowa News Release

Aug. 25, 2003

UI Speech Pathologist Examines Cultural Differences, Speech Issues

Due to growing minority populations, American society is seeing an increase in the diversity of cultures and ethnicities. With this diversity of cultures comes diversity of language and speech patterns.

Physicians can unknowingly misdiagnose these patterns, which differ from standard American English, as a need for speech impairment or disorder assessment, according to a speech pathologist in the University of Iowa College of Liberal Arts and Sciences.

In an article published in the July 2003 issue of the journal Pediatric Annals, Amy Weiss, Ph.D., UI associate professor of speech pathology and audiology, discusses the growing pattern of speech and language differences in the United States and the growing need for public awareness of recognizing differences versus actual disorders.

The problem is two-fold, Weiss said. Both over- and under-referral of speech disorders have become mainstream issues. These issues call attention to a growing need for training and awareness of doctors and health care professionals who work with diverse populations to understand what truly constitutes a developmental disorder and not a developmental difference.

Over-referral happens when children without English as their dominant language are diagnosed with a speech and language disorder when, in reality, the problem lies in learning the English language. The process of learning a language must be separated from the diagnosis of a disorder, Weiss said.

For example, educators and speech-language pathologists alike have, in the past, often mistakenly considered nonstandard English dialects, of which African-American English is only one example, to be incorrect attempts to speak English. As a result, some children who speak African-American English have been diagnosed inaccurately as demonstrating a language disorder when, in fact, they were using a different language system, the article noted.

"If a child does not demonstrate a problem in their dominant language but they have trouble with English, it is most likely a case of learning a second language, not a language disorder," Weiss said.

Under-referral of children with legitimate speech and language disorders has also become a problem.

"Without the proper training, a child could be misdiagnosed as just having trouble learning a second language," Weiss said. "But if a child demonstrates the disorder in their dominant language, the problem stretches beyond a simple language barrier."

Heightened awareness and training regarding this issue is of growing importance, Weiss said. In order to correctly refer each patient, physicians and families alike must enter each situation with an open mind.

Most training of professionals who work with the public -- such as physicians, teachers, and public servants -- remains based on white, middle-class culture and values, which increasingly do not necessarily fit every clinical situation and probably never did, Weiss noted.

"We need to remember that not all families have the same culture or beliefs, regarding medicine, treatment and disorders," she said. "Every case must be seen with open eyes and with as few assumptions as possible."

Speech and language disorders have certain stigmas and assumptions about intellect, but professionals serving minority publics must strive to overcome these biases to ensure that their patients receive the best care, Weiss added.

"Anyone working with the public must be aware of these issues. They are not just of concern to health care professionals," she said.

Sometimes the assistance of a translator or cultural expert is needed to help ease understanding between patients and health care providers. These aides can offer insight into cultural beliefs that might affect a family's decision, or help a speech pathologist or physician determine if a patient has a disorder in their dominant language.

"Not everyone operates the same way in this world. We need to remember this, and we need to ensure we have the right tools to offer the best service possible, not just in speech-language pathology, but everywhere in the health professions," Weiss said. "The proper training and awareness is essential to ensure cultural differences are not misdiagnosed as disorders."

STORY SOURCE: University of Iowa Health Science Relations, 5135 Westlawn, Iowa City, Iowa 52242-1178

CONTACTS: Media: David Pedersen, 319-335-8032, david-pedersen@uiowa.edu. Writer: Tiffany Bronk