Augmentative and Alternative Communication

ISSN: 0743-4618 (Print) 1477-3848 (Online) Journal homepage: http://www.tandfonline.com/loi/iaac20

Considerations for the Provision of Services to

Bilingual Children Who Use Augmentative and
Alternative Communication

Gloria Soto & Betty Yu

To cite this article: Gloria Soto & Betty Yu (2014) Considerations for the Provision of Services to
Bilingual Children Who Use Augmentative and Alternative Communication, Augmentative and
Alternative Communication, 30:1, 83-92, DOI: 10.3109/07434618.2013.878751

To link to this article: http://dx.doi.org/10.3109/07434618.2013.878751

Published online: 28 Jan 2014.

Submit your article to this journal

Article views: 1178

View related articles

View Crossmark data

Citing articles: 3 View citing articles

Full Terms & Conditions of access and use can be found at

http://www.tandfonline.com/action/journalInformation?journalCode=iaac20

Download by: [SFSU San Francisco State University] Date: 13 September 2016, At: 12:39
Augmentative and Alternative Communication, 2014; 30(1): 83–92
© 2014 International Society for Augmentative and Alternative Communication
ISSN 0743-4618 print/ISSN 1477-3848 online
DOI: 10.3109/07434618.2013.878751

FORUM NOTE

Considerations for the Provision of Services to Bilingual Children

Who Use Augmentative and Alternative Communication

GLORIA SOTO∗ & BETTY YU

Department of Special Education and Communication Disorders, San Francisco State University, San Francisco, CA, USA

Abstract
Augmentative and alternative communication (AAC) service providers are increasingly serving a significant number of clients
from culturally and linguistically diverse backgrounds. In this paper, we discuss general considerations and future research
needs relevant to the use of AAC strategies and techniques with bilingual children, specifically, issues related to the scaffolding
of communication and language development in more than one language, and the selection and customization of AAC systems
for bilingual children. We do so by first reviewing key research on bilingualism with children with communication disabilities
and its implications for research and practice in the AAC field. We propose the use of a sociocultural approach to AAC service
delivery and argue for the support of both languages needed by the child to fully participate in his or her communicative
environments. Implications of the sociocultural perspective and future research needs are also presented.

Keywords: AAC; Bilingualism; Language; Culture

Introduction The provision of educational and clinical services to

children with communication disorders from culturally
The continued population movement of the last few
and linguistically diverse backgrounds presents com-
decades – from developing countries into industrialized
mon challenges to professionals around the world and
ones and from rural areas into big cities – has resulted
in an unprecedented increase in the number of children has received increased attention from researchers and
and families from culturally and linguistically diverse professional organizations in Australia, Canada, the
backgrounds being served by clinicians and educators United Kingdom, and the United States (Williams &
world wide (e.g., Arnaiz & Soto, 2003; Jordaan, 2008; McLeod, 2012). Many of the challenges revolve around
Williams & McLeod, 2012). The Multilingual Affairs four main issues: (a) how to accurately assess a child’s
Committee of the International Association of Logope- communicative ability in more than one language (e.g.,
dics and Phoniatrics recently surveyed speech-language De Lamo White & Jin, 2011;), (b) how to best sup-
pathologists in 13 countries: Belgium, Bulgaria, Canada, port language development in bilingual children with
Denmark, England, Iceland, Ireland, India, Israel, disabilities that affect their language learning (e.g.,
Malaysia, Malta, South Africa, and Sweden. In all, 92% Kohnert, 2010; Williams & McLeod, 2012), (c) what
of the respondents reported working with bilingual cli- language to use in intervention (e.g., Gutierrez-Clellen,
ents (Jordaan, 2008). Likewise, Kritikos (2003) reported 1999; Kohnert, 2010), and (d) how to counsel families
that 95% of SLPs in the US work with at least one client who speak another language and come from a different
who comes from a home where a language other than culture (e.g., Yu, 2013).
English was spoken. Rossi and Balandin (2005) noted While many of the challenges inherent in working
that 16% of Australians speak a language other than with bilingual children with communication disorders
English in their homes. Consequently, professionals in also apply, professionals working with bilingual chil-
these countries will likely be involved in developing and dren with augmentative and alternative communication
implementing educational and clinical services for chil- (AAC) needs face additional challenges specifically
dren and families who may not speak the same language related to the selection, customization, and implemen-
or share the same cultural background. tation of AAC strategies and techniques. The purpose of

∗Correspondence: Gloria Soto, Department of Special Education and Communication Disorders, SFSU, 1600 Holloway Avenue, San Francisco, CA 94132,
USA. Tel: ⫹ 1 415 338 1757. Fax: ⫹ 1 415 338 0566. Email: gsoto@sfsu.edu

(Received 18 March 2013; revised 28 October 2013; accepted 15 November 2013)

83
84 G. Soto & B.Yu

this forum paper is to discuss (a) general issues relevant educational options for bilingual children, Rolstad,
to the provision of AAC services to bilingual children, Mahoney, and Glass (2005) found that immigrant
most specifically the challenges presented when there children who maintained their home language were
are two languages in the child’s environment; and (b) more likely to graduate high school and to develop
issues related to the selection and customization of AAC close family and cultural connections associated with
systems for children who are bilingual. We do so by first social integration and emotional health than those who
reviewing key research on bilingualism that is relevant lost their home language. Kohnert (2010) reports that
for children with communication disabilities and by continued support of the home language during the
examining its implications for research and practice preschool years is related to later cognitive and aca-
in the AAC field. We then discuss issues related to the demic gains. In addition, bilingualism has been asso-
provision of culturally and linguistically relevant AAC ciated with stronger performances in metalinguistic
services to children from bilingual backgrounds, espe- reasoning, attentional control, working memory, and
cially those from minority-language families. We pro- symbolic representational skills (Adescope, Lavin,
pose the use of a sociocultural approach to AAC service Thompson, & Ungerleider, 2010). In a recent study,
delivery and argue for the support of both languages bilingualism was found to be related to delays in the
needed by the child to fully participate in his or her onset of cognitive decline in older adults (Bialystok,
communicative environments. Our discussion is largely Craik, & Luk, 2012)
speculative at this point and is intended as a starting
point to advance the field’s understanding of and to
Bilingualism in Children with Communication
stimulate future research into these issues.
Disabilities
While there is ample data on the advantages of
Bilingualism in Children with Typical
bilingualism for typically developing children, many
Development
professionals and parents are still fearful of speak-
Children become bilingual to different degrees and by ing more than one language with children who have
following different paths. For some children, exposure significant communication disorders (Yu, 2013). They
to more than one language begins very early in life and worry that bilingualism would be too taxing for chil-
simultaneously, as family members and care provid- dren who are already struggling with language, or may
ers speak two different languages to the infant. But for further delay the acquisition of one or both languages
many children, the exposure to a second language hap- (Gutierrez-Clellen, 1999). The assumption is that if
pens later in life, when they enter the educational setting the child has difficulty learning one language, learning
and begin interacting with a broader community. When two would be even more difficult and could exceed his
children are exposed to additional languages at age 3 or her learning capacity (Kohnert, 2013). As a result,
years or older they are considered to develop sequential parents are routinely advised to stop speaking their
bilingualism (Kohnert, 2010). home language with a child who has communication
The degree to which children can become proficient disabilities (Kay-Raining Bird et al., 2005; Kohnert,
speakers of two or more languages, whether learning 2013; Yu 2013). Similarly, professional services to bilin-
simultaneously or sequentially, depends on whether gual children are often delivered only in the majority or
they have enough exposure to both languages and are socially dominant language.
provided with frequent and meaningful opportunities to To date, only a small number of studies have compared
use and develop each linguistic system. In cases where the performance of bilingual and monolingual children
the home language is not actively supported at school, with communication disorders. Several researchers have
the child will have limited opportunities to use his or found that bilingual children with specific language
her home language outside of the family or the immedi- impairments present the same pattern and extent of
ate community, and is at risk of becoming receptively deficits as monolingual children with specific language
bilingual. Children who are receptively bilingual may impairments on measurements such as IQ tests, aca-
continue to understand their home language to some demic performance, standardized language tests, and
extent, but have little or no expressive skills. In some measurements of the use of obligatory tense morphemes
situations, the home language may be accorded low (Gutierrez-Clellen, Simon-Cereijido, & Wagner, 2008;
social status and perceived as a liability or a barrier to Håkansson, Salameh, & Nettelbladt, 2003; Paradis,
social integration. In such circumstances, acquisition Genesee, & Crago, 2010; Thordardottir, 2010). Bilingual
of the societally dominant or majority language may be children with Down syndrome have also been found to
favored and a child may lose skills and fluency in the perform comparably to monolingual children with Down
home language to the point where he or she gradually syndrome on standardized language tests, vocabulary
undergoes language attrition and even language loss inventories, and language sample analyses (Kay-Raining
(Fishman, 2006; Wong-Fillmore, 2000). Bird et al., 2005). Similar results have been found with
Language loss has been found to be associated with children with autism spectrum disorder, with no signifi-
low academic performance and social marginaliza- cant differences found in their social responsiveness, joint
tion. In a meta-analysis of studies comparing different attention skills, achievement of early language milestones,
Augmentative and Alternative Communication
 Bilingualism and AAC 85

or performance on standardized tests of vocabulary and with specific language impairments in terms of the
language (Hambly & Fombonne, 2012; Ohashi et al., number and types of morphological errors commonly
2012; Petersen, Marinova-Todd, & Mirenda, 2012). found in these children’s languages.
The findings of this emerging body of research echo The discrepancy between the findings of these studies
the findings of bilingual development research at large: and those found in Crutchley et al. (1997) is consistent
The performance of bilingual children with communi- with differences found for children with typical devel-
cation disabilities is comparable with monolingual peers opment across different types of settings. The children
with similar disabilities, at least in contexts that value in the Bruck (1982) and Paradis et al. (2003) studies
bilingualism. Also similar to typically developing bilin- were in environments that actively promoted and main-
gual children, bilingual children with disabilities can use tained bilingualism, also referred to as additive bilingual
their first language skills to facilitate the acquisition of environments (Bruck, 1982). For example, in Bruck’s
a second language. Perozzi and Chavez-Sanchez (1992) study, the children were from English-speaking homes
found that a group of bilingual Spanish-speaking first and were enrolled in French immersion schools by
graders with language delays were able to acquire new choice. In Paradis et al.’s study, all of the children were
vocabulary in English twice as quickly when they were from homes in which parents were using a one-parent-
introduced to the words in both Spanish and English one-language strategy, which suggested a conscious
rather than in English alone. Likewise, in a study of a investment in the transmission of both languages. In
bilingual child with specific language impairments who contrast, the children in Crutchley et al.’s study were
spoke English and Icelandic, Thordardottir et al. (1997) exposed to minority languages at home and English-
found that the child learned more English vocabulary only at school, and maintenance of home language was
when the target words were presented bilingually, in not identified as an explicit goal either at school or at
English and Icelandic; as opposed to monolingually, in home. Typically, in a context such as this, children tend
Icelandic. to make steady gains in the majority language, with
The available evidence suggests that social and skills in the home language declining over time, leading
environmental factors play a significant role in the to a subtractive bilingual situation (Fishman, 2006; see
bilingual development of children with typical devel- Paradis et al. (2010) for a further discussion of additive
opment or communication disabilities. For example, and subtractive bilingualism).
in a study of school children with SLI in England, The previously noted studies point to the fact that,
Crutchley, Botting, and Conti-Ramsden (1997) noted for both children who are typically developing and those
that the students who were exposed to languages other with communication disabilities, learning outcomes
than English at home stood out as a unique subgroup, have less to do with the number of languages being
performing more poorly than their monolingual learned than the conditions under which language is
classmates on a number of standardized assessments learned: the level of support for bilingualism at school
in English grammar, vocabulary, reading, articula- and in the community, the quality of exposure to both
tion, and narrative structure. The bilingual students languages, and the types of measures used to monitor
were also less likely to be placed in classrooms that language growth. The findings also highlight the fact
were seen as ideal by parents and teachers, and were that growing up bilingual is as much a sociocultural
more likely to be red-flagged as having emotional and and sociopolitical experience as it is a linguistic one
behavioral difficulties. These emotional and behavioral (Zentella, 1997). A purely child-focused psycholin-
problems were reported to worsen over time, even guistic approach to understanding bilingualism would
though the bilingual students were no different from miss the many other complex ecological factors affect-
their monolingual classmates on these measures when ing the learning and development of bilingual children
they first arrived in the program. These findings can- (Bronfenbrenner, 2005).
not be interpreted in isolation, as these children were The literature in bilingual communication disorders
immersed in contexts where their home language was suggests that children who are exposed to two languages
neither valued nor supported. may in fact benefit from a bilingual approach to inter-
Crutchley et al.’s study stands in contrast to that of vention (e.g., Gutierrez-Clellen, 1999; Kohnert, 2010,
Bruck (1982), which included bilingual children with 2013). There is no evidence to support the conclusion
specific language impairments from English-speaking that bilingualism is confusing or too taxing on the lan-
families who were enrolled in a French immersion guage-learning abilities of children with communication
school program. Bruck found that the children in the disorders. The research available thus far clearly shows
bilingual program performed similarly to children with that mediation in the home language does not impair
specific language impairments in a monolingual English or significantly slow the learning of a second language.
program on standardized tests of academic and language To the contrary, there is evidence that children can
skills in English. Both groups of children achieved lower benefit from an intervention that acknowledges the
scores compared to bilingual and monolingual children home language and culture and supports bilingual
without specific language impairments. Similarly, development, with gains in both the majority language
Paradis, Crago, and Rice (2003) found no significant as well as the home language (Restrepo, Morgan, &
difference between bilingual and monolingual children Thompson, 2013).
© 2014 International Society for Augmentative and Alternative Communication
86 G. Soto & B.Yu

A Sociocultural Approach to Bilingualism and AAC There are compelling reasons for the maintenance of
the home language for children with complex commu-
In this paper, we propose the use of a sociocultural
nication needs. Failure to develop and implement an
approach to serving children with AAC needs who live
intervention plan that supports long-term development
in bilingual environments. From a sociocultural perspec-
and maintenance of both languages for bilingual chil-
tive, language learning is rooted in children’s participa-
dren will limit interpersonal interactions between fam-
tion in culturally meaningful activities (Thorne, 2000).
ily members, and natural opportunities to practice and
It takes years of interaction with mature language users
generalize linguistic skills across contexts. As Kohnert
for children to attain adult-like skills. These interactions
(2013) points out, the recommendation to target only a
reflect the cultural values and social practices of those
single language for bilingual children with communica-
who speak the language. This theory argues that lan- tion disorders takes language out of its social context
guage use has a profound effect on children’s develop- and ignores its fundamental role as an enculturation
ment because language not only develops through par- tool. Not using the home language with a child with a
ticipation in socio-cultural activities but also mediates disability can exacerbate the disability and marginalize
participation (Martin, 2012). him or her even further from family and community.
The sociocultural theory of learning carries several Language is not a finite resource, even for children
important implications for children with AAC needs with disabilities; rather, it is a dynamic system that is
in bilingual environments. For example, because com- expanded with rich input and diverse opportunities
munication is a situated activity, children’s ability to for its use. Recommending that a family stop using the
participate – regardless of the presence or absence of home language with a child with disabilities presumes
communicative disabilities – is dependent on access that language use is a conscious choice. In many fami-
to the languages that mediate participation. In addi- lies, the decision to speak only one language with the
tion, children in bilingual environments are socialized child with communicative disabilities will significantly
through different languages so that they can understand impact interaction dynamics. Family members may
the range of cultural meanings that are available across find it difficult to include the child in conversations,
linguistic communities. They also draw on the linguistic or for the child to maintain relationships with family
resources available across languages in order to display members and friends who do not speak the targeted
a fluid array of cultural competencies that are expected language (Wong-Fillmore, 2000). Family members may
of them (Garrett & Baquedano-Lopez, 2002; Ochs & also find the practice of speaking only one language dif-
Schieffelin, 1984). If we conceptualize language as a ficult to maintain. For example, in an interview study
tool for contextualized meaning-making and not just an of bilingual parents of children with autism spectrum
abstract mental system, then we are also able to recog- disorder, Yu (2013) found that many of the parents who
nize that the use of more than one language, rather than committed to speaking only English with their children
causing confusion, opens up opportunities for the child eventually went back to speaking bilingually or to speak-
using AAC to achieve shared meaning. Moreover, given ing primarily Chinese. Even though each of the parents
the importance of families and social networks in the was proficient in English, they reported that there were
provision of successful AAC intervention, the linguistic things that they could not adequately communicate in
and cultural capital that they possess should be recog- that language alone. In some cases, it was because the
nized and valued. ideas they wished to convey had no cultural or linguistic
There is a convergence of opinions that educators equivalents in English. Some spoke English exclusively
and clinicians should support and work closely with at work and in other formal settings and found it dif-
families so that they can maintain and pass their lin- ficult to speak English in domestic contexts and inti-
guistic and cultural heritage on to their children with mate situations. Others said it simply “felt unnatural.”
and without disabilities (Artiles & Ortiz, 2002; Center Parents who believed or were told that bilingualism was
for Applied Linguistics, 2005; Martin, 2012; Mueller, detrimental for their children felt guilty and viewed their
Singer, & Carranza, 2006; Waterman & Harry, 2008). inability to speak only English as a failure.
Likewise, many consider that interventions for children Although there has been an increase in research into
with communication disabilities should be conducted in issues related to bilingualism in children with com-
both the children’s home and school languages, with an munication disorders, very little attention has been
emphasis on the home language when it is the children’s directed toward issues concerning bilingualism for chil-
stronger language (Gutierrez-Clellen, 1999; Gutierrez- dren with complex communication needs who require
Clellen, et al., 2008; Kohnert, 2010, 2013; Kohnert, AAC. This gap has long been recognized as an urgent
Yim, Nett, Kan, & Duran, 2005). The assertion to sup- concern (Bridges, 2004; Bridges & Midgette, 2000;
port two languages is based on not only the cognitive Huer & Saenz, 2002; Rossi & Balandin, 2005). Plan-
and social advantages that have been identified for typi- ning for intervention for children who live in bilingual
cal children and adults, but also the evidence suggesting communities presents additional challenges for profes-
that, all things being equal, bilingual learners with dis- sionals working in the area of AAC, as they will need
abilities are not at a greater disadvantage for language to develop and support communication strategies and
acquisition than their monolingual peers. techniques that facilitate communication and language
Augmentative and Alternative Communication
 Bilingualism and AAC 87

development across the different languages and contexts to evaluate developmental and clinical history, current
in which the child using AAC participates. level of achievement in both languages, and the ability of
Professional support for two languages does not nec- the child to learn or use language in a variety of contexts
essarily mean that both languages must be supported at and with multiple communication partners (De Lamo
the same time, in the same way, or by the same inter- et al., 2011; Gutierrez-Clellen & Peña, 2001; Kohnert,
ventionist (Kohnert, 2013). Rather, supporting two 2010; Langdon, 2008; Soto, 2012). The most infor-
languages in a bilingual child who uses AAC means mative combination of methods will change with the
that the intervention plan will be consistent with the child’s age, but in all cases, the methods must include
child’s previous experiences as well as his or her cur- (a) observations of the child in natural environments
rent and future communication needs. A bilingual per- during interactions with peers and family members; (b)
spective accepts the child’s communicative experiences interviews with family members; (c) language samples;
and accumulated abilities with the family members as and (d) performance in language comprehension and
an essential resource on which to build. Therefore, an production tasks at a variety of levels (e.g., single word
accurate assessment of a child’s communicative ability is vocabulary, words in discourse, morpho-syntax, figura-
critical to designing an intervention plan that addresses tive language and narrative) in all of the languages to
the child’s current and future needs. which the child is exposed and within all interaction
environments.
Assessment Considerations
Collaborative Goal Setting
Identifying a child’s true communicative abilities and
needs in two languages is a challenge because there are In a number of studies with culturally and linguistically
very few bilingual measures and few bilingual profes- diverse families, parents and other family members
sionals who can administer and interpret the results. expressed appreciation for the use of AAC at school and
Proficiency in any language is dependent on a number recognized that the AAC system was critical to their
of factors, including age, intensity of exposure, and child’s social and academic participation, yet they did
opportunities for use. AAC professionals should be not convey any desire or need to use it at home. When
aware of typical developmental patterns of language asked to identify the reasons, parents mentioned a series
learning in both simultaneous and sequential bilingual of barriers to successful implementation of AAC strate-
children and how these may vary in children with dis- gies and techniques in the home, including (a) language
abilities, including those with complex communication intervention conducted only in the school language;
needs (see Kohnert & Medina, 2009; Kohnert, 2010 for (b) language and cultural barriers between parents and
extensive reviews on language development patterns for professionals; (c) communicative limitations of the AAC
children with communication disorders). device; (d) irrelevant vocabulary; (e) culturally inappro-
An additional consideration for assessment relates priate symbols and messages; and (f) lack of culturally
to the variability of languages and language proficiency and linguistically accessible, family-centered instruction
among bilingual children with complex communication on how to use the device at home (Kemp & Parette,
needs. The languages in a bilingual child’s life are in 2000; McCord & Soto, 2004; Pickl, 2011; Stuart &
many ways interwoven and inseparable and, at the same Parette, 2002). In a series of related studies, Parette and
time, these languages may play highly specific roles colleagues (cited in Bailey, Parette, Stoner, Angell, &
across the different contexts of a child’s life. Assess- Carroll, 2006) interviewed a total of 67 family members
ments that examine a child’s languages separately or from diverse cultural and linguistic backgrounds and
neglect the genre-specific nature of code choices, tend found that “(a) families across all ethnic groups want
to underestimate competencies. For example, Bedore, to be involved with professionals in AAC decision mak-
Peña, García, and Cortez (2005) found that when bilin- ing; (b) families want more information, education, and
gual children’s performances on vocabulary tests were training regarding AAC; and (c) ethnicity impacts deci-
scored conceptually rather than monolingually – that is, sion making in AAC” (p. 51).
when performances were analyzed and scored for the Prior to the introduction of an AAC system, the fam-
meaning of the responses regardless of the language in ily of a child with complex communication needs will
which they were produced – the participants achieved already have established patterns of communication.
scores that were comparable to monolingual children. Understanding the existing interaction dynamics within
When their performances were scored monolingually, a family is a critical element when recommending and
however, the scores for bilingual children were lower designing AAC techniques and strategies (Parette,
than those for monolingual children (see Bedore et al., Brotherson, & Huer, 2000). In setting a culturally and
2005). linguistically responsive plan of action, professionals
To minimize language bias, De Lamo et al. (2011) need to include the family’s input about their preferred
advocate for the use of a sociocultural approach to language and communication needs, views on the child’s
assess the communicative abilities of bilingual children communicative disability, and level of involvement and
with communicative disorders. This approach uses a participation with which they are comfortable. Cultural
combination of methods and data from multiple sources differences are likely to influence not only the roles that
© 2014 International Society for Augmentative and Alternative Communication
88 G. Soto & B.Yu

the family members are willing and able to play in teach- children with whom they share both languages. More
ing their child but also those they expect professionals often than not, there will be a mismatch between the
to fulfill (Hwa-Froelich & Vigil, 2004). languages spoken by the professional and the child.
In order to make intervention relevant to any family, Although it is essential to increase the number of bilin-
it is important to elicit family members’ perceptions of gual clinical professionals, the mismatch between cli-
meaningful intervention goals (McCord & Soto, 2004; ents and professionals will likely persist in the future.
Pickl, 2011). It is imperative that service providers As Kohnert (2013) indicates, the key issue is to identify
reach out to family members to include their perspec- ways in which interventionists can facilitate language
tives and create an open communication climate that development of a language they do not speak.
would support an exchange of ideas. Professionals Bilingual intervention may include direct systematic
may need to schedule home visits in order to provide teaching of certain forms and functions implemented by
the family members with an opportunity to share their professionals and indirect intervention through collabo-
ideas and to observe the families’ interactive routines ration with parents and family members, peers and others
(Stuart & Parette, 2002). During these visits, profes- to be supportive communication partners (Kent-Walsh
sionals who do not speak the family’s language will need & McNaughton, 2005; Kohnert, 2010). Strengthening
to use bilingual and bicultural interpreters that are able skills in a child’s home language will necessarily involve
to indicate to families that they are valued members other individuals who share similar cultural and language
of the intervention team (See Hwa-Froelich & Vigil, experiences as the child. Kohnert (2013) describes at
2004 and Kummerer, 2012 for excellent descriptions length collaborative strategies to facilitate development
of issues and strategies for culturally respectful commu- of home language by coaching parents, peers and para-
nication skills). Communication through an interpreter professionals to implement language facilitation strate-
is a complicated task (Langdon, 2008). It slows down gies. The term “coaching” connotes helping parents
and changes the dynamics of communication, making towards their own goals, rather than training them to
conversations more cumbersome and prone to mis- perform some pre-determined tasks.
interpretation by both parties. It also deprives family To date there are no published studies documenting
members of the privacy they may need to discuss their clinical or educational approaches with bilingual chil-
family member’s needs. Service providers must recog- dren who use AAC. In the absence of direct evidence,
nize and be sensitive to these difficulties. In order for AAC professionals will have to draw principles and
interpreters to be effective, they must be proficient in strategies from related disciplines such as bilingual spe-
both the language of the family and that of the profes- cial education (e.g., Mueller et al., 2006) and bilingual
sional, and able to understand and appreciate the subtle intervention for children with language disorders (e.g.,
cultural nuances of meaning for each party. In addition, Thordardottir, 2010). These include (a) working with
interpreters should understand the relevant professional family and community members to reinforce learning
jargon and the clinical/educational processes involved in across the home, community, and school; (b) under-
the event for which they are providing services (Seal, standing and supporting the gradual process of second
2000). language acquisition; and (c) acknowledging that sec-
Given the lack of fully qualified bilingual/bicultural ond language learning is not helped by an eradication of
interpreters, professionals may need to rely on bilingual the first language but rather is built on a strong founda-
family members or family friends to act as interpreters. tion of first language and culture (Artiles & Ortiz, 2002;
While at times this may be the only option available, Kohnert, 2010; Langdon, 2008). Further investigation
using non-professional interpreters adds a layer of com- is critically needed to explore fundamental questions
plexity to the interaction. Difficulties may arise from role regarding the most effective strategies to improve the
conflicts, a lack of training, and a lack of knowledge of communicative competence of children who use AAC
the issues being discussed. In addition, family members and live in bilingual communities.
may feel embarrassed to discuss intimate matters with
other family members or friends. In turn, the interpreter
AAC Implementation at Home
may censor or change what is being disclosed to mini-
mize family exposure or shame. All families promote their cultural values through child
socialization practices and social interactions (Hwa-
Froelich & Vigil, 2004). Family roles and obligations
Intervention Considerations for Bilingual
are taught and manifested specifically through language
Children
as well as nonverbal behaviors. To increase involvement
The ultimate purpose of AAC intervention is to help of culturally and linguistically diverse families, profes-
children reach their full potential as communicators and sionals should design communication systems that are
maximize their participation in their communities (e.g., reflective of the family’s cultural values and inclusive of
social, academic, and occupational/vocational). AAC their linguistic practices, and model the use of AAC in
professionals serving bilingual children may or may communicative contexts that are culturally appropriate
not share the languages of their families. Sometimes, and increase the child’s affiliation (i.e., belonging) with
bilingual professionals provide intervention to bilingual the family and community.
Augmentative and Alternative Communication
 Bilingualism and AAC 89

As previously noted, there are many factors that way children learn and use each language in different
can impact the use of AAC at home, including socio- communities. As Yong (2006) indicates, an understand-
economics, language and educational barriers, con- ing of the underlying structure of the target language
flicting cultural values, and mismatched expectations is essential to the development of an AAC system. Two
between families and professionals (see Bailey et al., different languages may require different modalities,
2006; Binger, Kent-Walsh, Berens, Del Campo & Rivera, different vocabulary and vocabulary layouts, different
2008; McCord & Soto, 2004; Pickl, 2011). Sometimes, representations, and different grammars (e.g., Baker &
professionals may misinterpret the reasons why the fam- Chang, 2006; Nakamura, Iwabuchi, & Alm, 2006).
ily does not use AAC at home, and may even feel that In a study designed to compare intervention out-
parents themselves, including their language and their comes for two individuals learning different AAC sys-
cultural practices, are impediments to the successful use tems in two different languages (English and Manda-
of the system; they may not understand the underly- rin), Yong (2006) noted that different grammars often
ing cultural or socio-economic dynamics and judge the required using different motor planning for access,
families’ behavior as unengaged or uncooperative. different teaching strategies, and different clinical inter-
A clear understanding of the family members’ val- vention materials. In a related study, Nakamura et al.
ues and beliefs regarding AAC can help create a more (2006) compared how Japanese and English speakers
respectful relationship regarding the implementation of formulate and interpret picture-based sentences. They
recommendations. Often, parents complain that work- concluded that English speakers used word order as the
ing on AAC skills with their children feels too much like main cue while the Japanese speakers required the use
“therapy” or “homework.” For instance, professionals of grammatical markers to understand sentence struc-
may suggest a range of strategies to enhance the child’s ture. Clearly, the development of bilingual AAC systems
communication at home (e.g., encouraging requests, will require a deep understanding of the two languages
offering choices, engaging in dialogic book reading), but and their pattern of development (see Andres, 2006 and
these may require parents to modify the ways in which Baker & Chang, 2006 for an overview of foundational
they already interact with their child. Parents may not issues involved in the development of an AAC system for
see the need to use any communication aid to achieve Mandarin). Bilingual systems should also be designed
communication purposes that they are able to meet in such a way that the child could easily code-switch
successfully without the interference of a “machine” between languages as needed. Further research into
(McCord & Soto, 2004). Instead of assuming that AAC strategies to scaffold language development and code
will be helpful to the family, professionals should ask the switching for bilingual children who use AAC is criti-
parents about communicative situations in which they cally needed.
wish their child could participate and target those situa- To make the AAC device truly relevant to the
tions as contexts for intervention. family, AAC systems should include not only the home
Parents have been found to be supportive of inter- language but also representations that incorporate
ventions that are embedded within the family’s natural glosses, designs, colors, and referents that are compat-
milieu (Kummerer, 2012; Kummerer & Lopez-Reyna, ible with the home culture and represent vocabulary
2006; Nunes & Hanline, 2007). To that end, profession- that is functional and culturally valued (Andres, 2006).
als should consider activities that build on what parents Existing studies point to differences in how individu-
know and already do, for instance, helping them use als from different cultures rate the iconicity of different
AAC techniques in the context of playing with a younger symbol sets (e.g., Bornman, Alant, & Du Preez, 2009;
child or having a personally meaningful conversation Huer, 2000). This has led to the development of indig-
with an older child. Further investigation is needed to enous AAC systems in several countries, most notably
explore the range of interactive contexts that are favored in China (Andres, 2006) and India (Bhattacharya &
by families across different cultures for communication Basu, 2009).
and language intervention.
Conclusion
Selection and Customization of Bilingual
Serving the AAC needs of bilingual children presents
AAC Systems
a number of challenges to professionals. The evidence
Family members often express frustration at the fact base in this critical area remains sparse and therefore
that AAC systems do not include their home languages the considerations presented in this paper are merely
or vocabulary that is relevant and functional in the home suggestive and largely speculative. We have put forth an
(McCord & Soto, 2004; Pickl, 2011). Thus, a main argument for a sociocultural approach to serving chil-
challenge AAC professionals face when serving bilin- dren with AAC needs who live in bilingual communities.
gual children is the development of a communication This argument is motivated by the preservation of cul-
system in a language they may not speak or understand. tural and linguistic heritages, the promotion of positive
In creating a bilingual AAC system, it is not enough to regard for minority languages and linguistic diversity,
simply translate the same vocabulary into a different and emerging evidence of the benefits of bilingual inter-
language; a truly bilingual AAC system would reflect the ventions for children with communication disorders.
© 2014 International Society for Augmentative and Alternative Communication
90 G. Soto & B.Yu

We also raise a number of key issues pertaining to cul- promote or constrain generalization of skills within and
turally and linguistically responsive service delivery in across languages.
the areas of assessment and intervention, including the In the absence of evidence-based practice in this
selection and customization of bilingual AAC systems. largely unexplored area, one way to proceed would be to
Across these areas of concern, we highlight the need for first identify professionals who are successful at work-
using assessment and intervention strategies that meet ing effectively with parents and children who use AAC
the unique needs of bilingual children and families. A and live in bilingual communities. Systematic analysis
socio-cultural approach can be used to understand the of their practices might help identify the skill sets pro-
needs and perspectives of bilingual children and their fessionals need to learn to effectively scaffold commu-
families throughout the service delivery process. In nication and language development in two languages
addition, professionals must be knowledgeable about meditated by AAC. We encourage all practitioners
the unique learning and development trajectories of who work with children from bilingual backgrounds
bilingual children. The use of bilingual strategies is to contribute practice-based evidence and inform a
crucial for assessment and intervention, even when research agenda. Practitioners can complete care-
their implementation must be mediated by interpret- fully crafted case studies documenting the challenges,
ers and other adults who act as cultural liaisons. Both procedures, and outcomes of bilingual interventions.
the examination of bilingual children’s competencies in This type of sharing could prove to be a valuable
the assessment stage, and the development of new skills resource to professionals and could serve as a stimulus
in the intervention stage, need to be considered in the for the establishment of a rigorous research agenda.
context of cultural practices that are meaningful to the
children’s families and communities of membership.
Barriers that continue to impede culturally and Author Note
linguistically responsive service delivery for bilingual We would like to thank Janice Light, Mats Granlund,
children who use AAC also need to be addressed. For and the three reviewers for their helpful suggestions
example, the lack of diversity among professionals serv- during the review process of this manuscript.
ing children with complex communication needs, and
especially the insufficient numbers of bilingual profes- Declaration of interest: The authors report no conflicts
sionals, makes it difficult for children to access service of interests. The authors alone are responsible for the
providers who have a deep knowledge of their com- content and writing of this paper.
munication needs. In addition, there continues to be a
critical need for high quality personnel preparation to
help both monolingual and bilingual practitioners gain References
relevant knowledge and skills in the delivery of cultur- Adescope, O., Lavin, T., Thompson, T., & Ungerleider, C. (2010).
ally competent services. Because of the complexities A systematic review and meta-analysis of the cognitive correlates
involved in meeting the needs of clients across diverse of bilingualism. Review of Educational Research, 80, 207–245.
Andres, P. (2006). Developing an appropriate icon set for a Mandarin
communities, there must also be systemic and sustained
Chinese augmentative communication system. International
structural and administrative supports for service deliv- Journal of Computer Processing of Oriental Languages, 19,
ery, including increased time for collaboration and ser- 275–283.
vice coordination. Arnaiz, P., & Soto, G. (2003). Special education in Spain at the
We hope that the information offered and the posi- beginning of the 21st century: The challenge to educate in an
unequal and multicultural society. Journal of Inclusive Education,
tions taken in this paper serve to engage AAC practi-
17, 375–388.
tioners and researchers in more in-depth discussions Artiles, A., & Ortiz, A. A. (Eds.). (2002). English language learners with
about culturally and linguistically responsive service special education needs: Identification, assessment, and instruction.
delivery as it pertains to bilingual children with AAC McHenry, IL: Delta Systems.
needs. We also hope to stimulate further conversations Bailey, R., Parette, H. P., Stoner, J. B., Angell, M. E., & Carroll, K.
(2006). Family members’ perceptions of augmentative and
about the actions that might be taken across profes-
alternative communication device use. Language, Speech, and
sional and academic communities in AAC to realize the Hearing Services in Schools, 37, 50–60.
aspirations for high-quality service provision for this Baker, B. R., & Chang, S. (2006). A Mandarin language system
growing population of clients. Further investigation is in Augmentative and Alternative Communication (AAC).
critically needed in order to advance our understand- International Journal of Computer Processing of Oriental Languages,
19, 225–237.
ing and improve practice, in particular with regard to
Bedore, L. M., Peña, E. D., García, M., & Cortez, C. (2005).
the implications of bilingualism for system design and Conceptual versus monolingual scoring: When does it make a
customization; and with respect to the development difference? Language, Speech, and Hearing Services in Schools, 36,
of effective strategies to scaffold language for children 188–200.
who use AAC and live in bilingual communities. Future Bhattacharya, S., & Basu, A. (2009). Design of an iconic communication
aid for individuals in India with speech and motion impairments.
research into the effectiveness of a variety of direct and
Assistive Technology, 21, 173–187.
indirect intervention strategies is needed. In addition, Bialystok, E., Craik, F. I. M., & Luk, G. (2012). Bilingualism:
to improve intervention efficacy with bilingual children Consequences for mind and brain. Trends in Cognitive Sciences,
who use AAC, it is essential to understand factors that 16, 240–250.

Augmentative and Alternative Communication

 Bilingualism and AAC 91

Binger, C., Kent-Walsh, J., Berens, J., Del Campo, A., & Rivera, D. Kay-Raining Bird, E., Cleave, P. L., Trudeau, N., Thordardottir, E.,
(2008). Teaching latino parents to support the multi-symbol Sutton, A., & Thorpe, A. (2005). The language abilities of
message productions of their children who require AAC. bilingual children with Down syndrome. American Journal of
Augmentative and Alternative Communication, 24, 323–338. Speech-Langugage Pathology, 14, 187–199.
Bornman, J., Alant, E., & Du Preez, A. (2009). Translucency and Kemp, C., & Parette, H. (2000). Barriers to minority family
learnibility of Blissymbols in Setswana-speaking children: An involvement in assistive technology decision-making processes.
exploration. Augmentative and Alternative Communication, 25, Education and Training in Mental Retardation and Developmental
287–298. Disabilities, 4, 211–221.
Bridges, S., & Midgette, T. (2000). Augmentative/alternative Kent-Walsh, J., & McNaughton, D. (2005). Communication partner
communication. In T. Coleman (Ed.), Clinical management of instruction in AAC: Present practices and future directions.
communication disorders in culturally diverse children (pp. 285–333). Augmentative and Alternative Communication, 21, 195–204.
Needham Heights, MA: Allyn and Bacon. Kohnert, K. (2010). Bilingual children with primary language
Bridges, S. J. (2004). Multicultural issues in augmentative and impairment: Issues, evidence and implications for clinical
alternative communication and language. Topics in Language actions. Journal of Communication Disorders, 43, 456–473.
Disorders, 24, 62–75. Kohnert, K. (2013). Language disorders in bilingual children and adults
Bronfenbrenner, U. (2005). Making human beings human: Bioecological (2nd ed.). San Diego, CA: Plural Publishing.
perspectives on human development. Thousand Oaks, CA: Sage Kohnert, K., & Medina, A. (2009). Bilingual children and
Publications. communication disorders: A 30-year retrospective. Seminars in
Bruck, M. (1982). Language impaired children’s performance in an Speech and Language, 30, 219–233.
additive bilingual education program. Applied Psycholinguistics, Kohnert, K., Yim, D., Nett, K., Kan, P. F., & Duran, L. (2005).
3, 45–60. Intervention with linguistically diverse preschool children:
Center for Applied Linguistics. (2005). Parenting for academic success: A focus on developing home language(s). Language, Speech, and
A curriculum for families learning English research base. Retrieved Hearing Services in Schools, 36, 251–163.
from http://www.cal.org/services/parenting_bkground.pdf Kritikos, E. P. (2003). Speech-language pathologists’ beliefs about
Crutchley, A., Botting, N., & Conti-Ramsden, G. (1997). Bilingualism language assessment of bilingual/bicultural individuals. American
and specific language impairment in children attending language Journal of Speech-Language Pathology, 12, 73–91.
units. European Journal of Disorders of Communication, 32, Kummerer, S. (2012). Promising strategies for collaborating with
267–276. hispanic parents during family-centered speech-language
De Lamo White, C., & Jin, L. (2011). Evaluation of speech and Intervention. Communication Disorders Quarterly, 33, 84–95.
language assessment approaches with bilingual children. Kummerer, S., & Lopez-Reyna, N.A. (2006). The role of immigrant
International Journal of Language and Communication Disorders, mothers’ beliefs on parental involvement in speech-language
46, 613–627. therapy. Communication Disorders Quarterly, 27, 83–94.
Fishman, J. A. (2006). English only: Its ghosts, myths and Langdon, H. W. (2008). Assessment and intervention for communication
dangers. In N. Hornberger & M. Pütz (Eds.), Language disorders in culturally and linguistically diverse populations. Clifton
loyalty, language planning and language revitalization: Recent Park: Thomson.
writings and reflections from Joshua A. Fishman (pp. 179–194). Martin, D. (2012). A critical linguistic ethnographic approach to
Clevedon: Multilingual Matters. language disabilities in multilingual families. In S. Gardner & M.
Garrett, P. B., & Baquedano-Lopez, P. (2002). Language socialization: Martin-Jones (Eds.), Multilingualism, discourse, and ethnography
Reproduction and continuity, transformation and change. (pp. 305–360). New York: Routledge.
Annual Review of Anthropology, 31, 339–361. McCord, S. M., & Soto, G. (2004). Perceptions of AAC: An
Gutierrez-Clellen, V. F. (1999). Language choice in intervention ethnographic investigation of Mexican-American families.
with bilingual children. American Journal of Speech-Language Augmentative and Alternative Communication, 20, 209–227.
Pathology, 8, 291–303. Mueller, T. G., Singer, G. H. S., & Carranza, F. D. (2006). Planning
Gutierrez-Clellen, V. F., & Peña, E. (2001). Dynamic assessment and language instruction practices for students with moderate
of diverse children: A tutorial. Language, Speech, and Hearing to severe disabilities who are English language learners. Research
Services in Schools, 32, 212–224. and Practice forPersons with Severe Disabilities, 31, 242–254.
Gutierrez-Clellen, V. F., Simon-Cereijido, G., & Wagner, C. (2008). Nunes, D., & Hanline, M. F. (2007). Enhancing the alternative and
Bilingual children with language impairment: A comparison augmentative communication use of a child with autism through
with monolinguals and second langauge learners. Applied a parent-implemented naturalist intervention. International
Psycholinguistics, 29, 3–19. Journal of Disability, Development and Education, 54, 177–197.
Håkansson, G., Salameh, E. K., & Nettelbladt, U. (2003). Measuring Nakamura, K., Iwabuchi, M., & Alm, N. (2006). A cross-cultural study
language development in bilingual children: Swedish-Arabic on the interpretation of picture-based sentences. International
children with and without language impairment. Linguistics, 41, Journal of Computer Processing of Oriental Languages, 19, 239–248.
255–288. Ochs, E., & Schieffelin, B. B. (1984). Language acquisition and
Hambly, C., & Fombonne, E. (2012). The impact of bilingual socialization. In R. A. Shweder & R. A. LeVine (Eds.), Culture
environments on language development in children with theory: Essays on mind, self and emotion. New York: Cambridge
autism spectrum disorders. Journal of Autism and Developmental University Press.
Disorders, 42, 1342–1352. Ohashi, J. K., Mirenda, P., Marinova-Todd, S., Hambly, C.,
Hwa-Froelich, D. A., & Vigil, D. C. (2004). Three aspects of cultural Fombonne, E., Szatmari, P., & Thompson, A. (2012). Comparing
influence on communication: A literature review. Communication early language development in monolingual- and bilingual-
Disorders Quarterly, 25, 107–118. exposed young children with autism spectrum disorders. Research
Huer, M. B. (2000). Examining perceptions of graphic symbols across in Autism Spectrum Disorders, 6, 890–897.
cultures: Preliminary study of the impact of culture/ethnicity. Paradis, J., Crago, M., & Rice, M. (2003). French-English bilingual
Augmentative and Alternative Communication, 16, 180–185. children with SLI: How do they compare with their monolingual
Huer, M. B., & Saenz, T. I. (2002). Thinking about conducting peers? Journal of Speech, Language, and Hearing Research, 46,
culturally sensitive research in Augmentative and Alternative 113–127.
Communication. Augmentative and Alternative Communication, Paradis, J., Genesee, F., & Crago, M. (2010). Dual language development
18, 267–273. and disorders: A handbook on bilingualism and second language
Jordaan, H. (2008). Clinical intervention for bilingual children: learning. Baltimore, MD: Paul H. Brookes.
An international survey. Folia Phoniatrica et Logopaedica, 60, Parette, H. P., Brotherson, M. J., & Huer, M. B. (2000). Giving
97–105. families a voice in augmentative and alternative communication

© 2014 International Society for Augmentative and Alternative Communication

92 G. Soto & B.Yu

decision-making. Education and Training in Mental Retardation Thordardottir, E. (2010).Towards evidence-based practice in language
and Developmental Disabilities, 35, 177–190. intervention for bilingual children. Journal of Communication
Perozzi, J. A., & Chavez-Sanchez, M. L. (1992). The effect of Disorders, 43, 523–537.
instruction in L1 on receptive acquisition of L2 for bilingual Thordardottir, E., Ellis Weismer, S., & Smith, M. (1997). Vocabulary
children with language delay. Language, Speech, and Hearing learning in bilingual and monolingual clinical intervention. Child
Services in Schools, 23, 348–382. Language Teaching and Therapy, 13, 215–227.
Petersen, J. M., Marinova-Todd, S., & Mirenda, P. (2012). Brief report: Thorne, S. (2000). Second language acquisition theory and the
An exploratory study of lexical skills in bilingual children with truth(s) about relativity. In J. Lantolf (Ed.), Sociocultural theory
autism spectrum disorder. Journal of Autism and Developmental and second language learning (pp. 219–243). Oxford: Oxford
Disorders, 42, 1499–1503. doi: 10.1007/s10803 -011-1366 University Press.
-y2194770910.1007 /s10803-011-1366-y Waterman, R., & Harry, B. (2008). Building collaboration between
Pickl, G. (2011). Communication intervention in children with schools and parents of English language learners: Transcending
severe disabilities and multilingual backgrounds: Perceptions barriers, creating opportunities. Retrieved from http://www.nccrest.
of pedagogues and parents. Augmentative and Alternative org/Briefs/PractitionerBrief_BuildingCollaboration.pdf.
Communication, 27, 229–244. Williams, C., & McLeod, S. (2012). Speech-language pathologists’
Restrepo, M. A., Morgan, G. P., & Thompson, M. (2013). The efficacy assessment and intervention practices with multilingual chil-
of a vocabulary intervention for dual-language learners with dren. International Journal of Speech-Language Pathology, 14,
language impairment. Journal of Speech, Language and Hearing 292–305.
Research, 56, 748–765. Wong-Fillmore, L. (2000). Loss of family languages: Should educators
Rolstad, K., Mahoney, K., & Glass, G.V. (2005). The big picture: be concerned? Theory into Practice, 39, 203–210.
A meta-analysis of program effectiveness research on English Yong, S. (2006). Comparison of outcomes of an augmentative and
language learners. Educational Policy, 19, 572–594. alternative communication system used by an English and a
Rossi, C., & Balandin, S. (2005). Bilingualism, culture and AAC. Mandarin Chinese speaker – A clinical perspective. International
Acquiring Knowledge in Speech, Language and Hearing, 7, 27–28. Journal of Computer Processing of Oriental Languages, 19, 263–273.
Seal, B. C. (2000). Working with educational interpreters. Language, Yu, B. (2013). Issues in bilingualism and heritage language
Speech, and Hearing Services in Schools, 31, 15–25. maintenance: Perspectives of minority-language mothers of
Soto, G. (2012).Training partners in AAC in culturally diverse families. children with autism spectrum disorders. American Journal
Perspectives on Augmentative and Alternative Communication, 21, of Speech-Language Pathology, 22, 10–24. doi: 10.1044/1058-
144–150. 0360(2012/10-0078)
Stuart, S., & Parette, H. P. (2002). Native Americans and augmentative Zentella, A. C. (1997). Growing up bilingual. Malden, MA: Blackwell
and alternative communication issues. Multiple Voices, 5, 38–53. Publishers.

Augmentative and Alternative Communication