Bilingualism and Language Development with Jacquilyn Carcamo
Raising a child in a bilingual household? Hear from bilingual speech-language pathologist, Jacquilyn Carcamo, as she discusses language development and the many common misconceptions held by families, educators and even therapists in supporting children learning to speak more than one language. She provides guidance in determining whether a bilingual child is struggling with a language disorder or if their difficulties are due to learning a second language. In addition to her clinical expertise, Jacqui touches on her personal experience growing up in a bilingual family.
Jacquilyn Carcamo, MA, CCC-SLP, is a certified and licensed speech-language pathologist at The Parish School and The Carruth Center in Houston. She has experience in pediatric and adult settings, working with patients with a variety of communication, swallowing and feeding disorders, as well as working with culturally and linguistically diverse populations. She is Hanen-certified in “It Takes Two to Talk” and “More than Words.” She enjoys furthering her education in communication disorders and staying current with research-based practice. Jacqui has a passion for naturalistic intervention and family collaboration. In addition to her work at The Parish School, Jacqui provides freelance consulting, training and resources to speech-language pathologists who work with culturally and linguistically diverse populations through Habla Cadabra SLP.
Hello, and welcome to Unbabbled, a podcast that navigates the world of special education, communication delays, and learning differences. We are your hosts, Stephanie Landis and Meredith Krimmel, and we're certified speech language pathologist who spend our days at The Parish School in Houston, helping children find their voices and connect with the world around them. In this week's episode, we speak with speech-language pathologist, Jacquilyn Carcamo about assessment and treatment of bilingual children with communication disorders. Jacqui works at The Parish School and Carruth Center in Houston, Texas providing group and individual therapy. She is experienced in pediatric and adult settings, working with patients with a variety of communication, swallowing and feeding disorders and is Hanan certified. Jacqui's passionate about collaborating with families and continuing to grow and learn as a clinician throughout the episode, Jacqui discusses ways assessment and intervention may differ for a child who speaks multiple languages based off current research and best practices. She also highlights the importance of family-centered practices and speaks to common misconceptions held by families, educators, and therapists. In addition to her clinical expertise, Jacqui touches on her personal experiences growing up and living in a bilingual family.
Welcome. We are once again, live here on a TSHA convention for talking to Parish School's own Jacqui Carcamo. We are so excited to have you here chatting with us about bilingual therapy today.
I'm so excited to be here. Thank you for having me on.
Yes. So we'll start off really super easy. Can you define what it means to be bilingual?
Well, it's actually not that easy to define, but sorry. No, but it's a perfect question. Bilingualism means using two different languages. I think for a lot of people that means using two languages equally well, but it doesn't, it just means being able to understand and use two different languages, but bilingualism is definitely a spectrum and even one person might use their two languages in different ways, in different periods of their lives. So it's never a static bilingualism. It is always ever changing.
That's great to know, because even for me, I thought that there might be one set. Like you have to meet these criteria to be labeled bilingual. And we do have so many families that will come in and say, well, I don't know if they really are bilingual because only their grandparents talk to them in this language and they respond in English, but they understand it. So would that qualify as being bilingual?
Yes. You know, and we do have kind of different levels of ways that we like to classify bilingualism. And so part of a speech language pathologist job, when the parents are coming in is to really ask those questions, like the ones and get that information, like the ones that you're getting about. Okay, well, who, and that child's life is using those different languages. How often are they getting those languages? What's the input, what's that exposure. And then is the child using any of that language at all? So it really, for us, it's just kind of, when we're looking at doing any sort of evaluation and figuring out what the communication is like at home, that's a really important piece to a bilingual evaluation too, is figuring out the different languages that are coming in and the needs for communication for that child.
For children who are bilingual, are there any differences in the red flags that parents would be looking for in early language development between a child that is bilingual and a monolingual child?
A little bit. I would say in general, bilingual children develop at similar rates to monolingual children. So we're kind of looking for very similar developmental milestones. When you have a child that maybe is acquiring that second language a little bit later, and they're still kind of developing fluency. So say like, we have a child that is their first language is Spanish, and then they go to school and they're start learning, starting to learn English. And then that's a lot of times where we'll get a referral of, we're concerned about this child's language, learning ability. A lot of things that you'll kind of see and think, Oh, language learning, difficulty like difficulty paying attention difficulties with expression, maybe errors in grammar, you're going to see those. And so it's the SLPs job is to dig a little bit deeper and kind of see whether or not it's because of that language difference. And that they're still in that process of learning the second language or if there's a true language disorder.
And if there is a true language disorder, would you see it in both languages?
Yes. And that's a really great point. Meredith is that you, um, you have to see a language disorder in both languages for it to actually be a disorder. If you're only seeing errors or difficulties in one language, then it's not truly a communication disorder.
And if a parent is concerned that their child might have a language disorder and they are bilingual, should they seek out a bilingual therapist and should they seek one out who's whose bilingualism is in both of the child's languages?
Yes. Ideally in a perfect world, that's who they would go to. I'm not super up to date on all my statistics. The last time I checked, it was around like 5 to 7% of all speech language pathologists are bilingual. So the likelihood of them finding one is a little bit tricky. Our national association, ASHA has a area where a parent can go, it's called ASHA ProFinder and they can type in their area and they can type in the language that they speak and it'll show any certified bilingual speech, language pathologists that speak both of those languages. That is something that they can do. All SLPs are required to have that cultural competence and to be aware of these, these sorts of issues. And so the SLP that you are are going to, they should be able to advise you and to have some resources in order to provide an evaluation, but they might need to utilize other things. If you cannot find a bilingual speech language pathologist that speaks your language, so they might need to utilize an interpreter or really work with you to kind of figure out how, how to get the information that they need to make an accurate assessment and diagnosis.
Are there parent questionnaires that can be used?
Yes, yes. And a lot of the parent questionnaires, there's really great ones that are available. I use a combination of different questionnaires that are, um, just available through like Columbia University. There's different assessments that we have. And a lot of what we want to know as a speech-language pathologist, we want to know what the home life is like and what the home communication is there. So I think for any evaluation, but particularly for a bilingual evaluation, having that parent be a collaborative part of that assessment is really important.
A question I get from a lot of bilingual parents is, well, should we just focus on one language? Should we stop speaking the home language? And should we just focus on English since we're in an English school? What are your recommendations there?
Yes. Okay. This is a great, beautiful question and a really important one. Cause it's one that I hear a lot too. No, you should not stop speaking your home language. One of the things that we see a lot is especially in children that have maybe more severe communication difficulties is when they start getting therapy services, because we do have a limited amount of bilingual speech-language pathologist is a lot of times kids will even that are not in therapy. When they start school, we see a big language loss in that home language, and that's really detrimental to their, their growth and their development. That home language is the language that we use to pass on our cultural values, to pass on the way that we as families, how we work. We use that a lot for the emphasis of what we're talking about. And then also parents, when their home language, their native language, they're also much more effective communicators in that, in that language. And so when we take that away and we say, Oh, let's just switch to English. We actually see a big difference in the way that that communication quality can change. And that really impacts, you know, the child's development too, because we know as SLPs, that quality is so much better than just the quantity, right?
Yeah. It changes their quality of life. It takes away that cultural importance and it takes away the way that they can communicate with their other families. You know, we have many families that want to make sure that their children can speak with their extended family members. And that's huge. And we want to support that as well, right?
Yes. I mean, who doesn't want to, I mean, it would be so sad if your kids couldn't speak with your parents. Like if children can't speak with their grandparents, right. We have a lot of grandparents who maybe only speak the native home language.
No, that's exactly true. And it is really sad because it happens quite often that, you know, parents will receive that recommendation to let's just focus on English or let's just focus on the academic language because you know, your child has a severe communication difficulty and language learning is already really hard. So let's focus on that one and you really do see a huge impact in the child's ability to communicate in other contexts outside of school. And family is really important. And when we think about children with severe communication disorders, their family interactions are going to be really, really crucial interactions for them for the rest of their life. And so when we impact that, then it can have a really detrimental effect on the child's quality of life.
I love that the whole child and the whole family, that's a great approach. What does an assessment look like for a child that's bilingual awesome.
Yes. So an a bilingual assessment, it is more time consuming. I will say that, um, it really involves a very thorough case history. So case history, in general, as we take your medical information, we want to have some idea of developmental information. You know, if there's a family history of any speech and language difficulties, that's pretty standard. Um, like we talked about before, we also take a lot of information about language use and language exposure. We kind of want to know who's speaking to your child and what language, how often, how long have they been exposed to the different languages? How many years, and just their level of, of like proficiency and both of those language. So that's the first part. And then we also want to do, we may or may not use standardized assessment. There's not a ton of standardized assessments out there for bilingual children. There's a lot more that have been coming, especially within the last, um, say like 10 to 15 years. So we might have a standardized assessment. Standardized assessments can be really tricky because in the U S in particular, the variations and proficiency and fluency for children can really vary as far as bilingualism. So it's kind of hard to standardize something when we don't have a standard bilingual. So that's, that's tricky, but we have them. And we use them because having standardized tests is often what insurance companies really like. Then we also like to do things called, um, we love language sampling. And I think anybody that knows me knows that I love language sampling, no matter what kind of evaluation that it is, but language sampling is considered one of those gold standards for bilingual assessment. It tells us so much about a child's conversational ability. I read an article last year, too, that was combining the standardized bilingual assessment that we have plus a language sample. And you can get almost 96% diagnostic accuracy using those two in combination. So that's really helpful. So you're going to do some things standardized. You're going to do a language sample, and then you're also going to use dynamic assessment. So dynamic assessment is also something that we use a lot in motor speech evaluations. And what that is, is where you test the child. Then you give them the opportunity to learn by giving them whatever cues and scaffolding and prompts you can to see how, um, stimulable they are to that particular skill that you're trying to assess. And then you test them again for a lot of bilingual kids sometimes because they've learned that language, um, they've had less access to specific concepts in different languages. It's just a problem of they haven't had those opportunities. So we provide those opportunities during an evaluation. We provide them with a little bit of help, and then we see how they respond to that. So I guess the big things for bilingual eval would be a very thorough case history. Some of, um, objective assessment, uh, would actually, it's all pretty language sample and then dynamic assessment.
Can you go into a little more detail about what an, a language sample would look like?
Yes. Language samples vary depending on the age of a kid with the little ones that I work with, language samples are typically with a collected within play or conversation. So basically I pull out play doh or some toys and I follow the child around and I don't use any specific prompts or cues. If I say anything, it's more comments or very open ended questions. And I just let the child talk and I write everything down that they say. So for me, it's a really functional snapshot of how this child is using language within one of, as, as contextualized as I can make it with older kids. We use a lot of narrative language samples where we'll pull out a book like a wordless picture book and have them tell us a story. What's really cool about language samples, as you can do them in whatever language and because it's not dependent on so much prompting, you can pull it out and have a child use it. And maybe even a language that you don't speak, and you can go and take that to an interpreter or to another person that you have on your team that may use that language and they can help you analyze it too. So that's very helpful.
So as a parent of a bilingual child, how do we know that we're finding a therapist who can really give us a true bilingual assessment? Is, is there any way for us to know that this is a speech-language pathologist who can do a very thorough bilingual assessment?
I would talk to the therapist and let them know, yes, we are bilingual and ask them about what their plans are to do, what, what they plan to do for the assessment. I would ask them about their experience working with bilingual clients and what their plans are, and, and also just their beliefs about therapy in general. If you want to leave that conversation feeling really heard and understood and encouraged in your family's bilingualism. If after that conversation, you don't feel encouraged about being bilingual, then that's probably not the therapist that is going to give you a good bilingual evaluation.
In thinking about treatment. How would you approach treatment differently? Do you do it in both languages? Do you focus on?
Yeah, well, that's the thing is there's no one bilingual child that looks the same. They all look different. And so that's going to be the same thing with treatment too. It's going to vary. I work a lot with the younger children and that focus on that home language is really important. If I find that that child is receiving a lot of one particular language, then that's really where I want to kind of focus my intervention. Um, if I'm working with school aged children and they're receiving pretty, you know, equal amounts, then that's kind of what I go with too. I look at well, how much is the input that they're getting? And that's going to be a way for me to, as a starting point of this is how much I'm going to give too. I will say that I only speak two languages only. I mean, and depending on the day and the time of day, you know, that's a little suspect at times, but there's patients that I've worked with that speak a second language that I don't speak. And so in that time I have to really utilize other, I really utilize a lot of parents in the assessment. The parent is a part of it, but they're not the ones that are responsible for assessment. We want as much objectivity as we can, but once we get to the intervention side, we want that parent really heavily involved. And we really want that parent to walk away feeling empowered and knowledgeable and able to communicate and use those strategies in their home language. So even if I don't necessarily speak that language, and there's a lot of languages that I don't speak, I always want that parent to be involved with me. So one thing that I might do is we might do that activity in English, and I might show how I do it, and I'll use materials that don't necessarily have to be only English, and then I'll have the parent with me. And then we can do that activity again, where the parent takes the lead and the parent is doing it in their home language. So there's a lot of different ways to do bilingual intervention depending on where the child is with their proficiency. I do like to have some support of that home language, no matter what the child's level of proficiency is, even if it's just talking about, you know, well, what is the pattern in this other language versus what it is that we're working on in English? A lot of times with my school aged kiddos, their English proficiency is like really, they're using a lot more English than they're doing in Spanish. That's where I work most is English and Spanish. And so I might just, it might just be a moment in the session that I'm like, Oh, you know, we're working on a plural S and this is the pattern that we use in order to add that plural S in English. Let me just for a second. Do, do you know how we do that in Spanish? And we just always, we always want to create that bridge and building that metal linguistic and awareness of how we use those two languages, um, just for our child to kind of have an idea of this is how I would transfer that knowledge and that pattern to the second language.
That's great. So you would want them overgeneralizing the English pant pattern into Spanish or whatever other languages yeah.
And always, and always opening the door to talk about both languages and feel comfortable using both languages.
Because code switching is such a great, pragmatic skill and understanding that, you know, when we are bilingual, it's a super power for us. It's our ability to really be able to, it's opening up a second world for us. We are able to communicate with more people than if we just spoke the one language, and we're also able to use that different perspective. So I really do encourage code switching in my sessions. I encourage that idea of, we need to have awareness of how we use those different things. I will say that when I'm selecting my therapy targets, I do try to find where those underlying deficiencies are very similar across both languages, because that's probably where I want to focus my attention.
Yeah. I work with a lot of school aged children, many who are also Hebrew. And so we will talk about the same thing. Well, in English, and when we speak, we write in this direction or we read this way, but in Hebrew they do it differently. And so these are the sounds that way. And even just though I know nothing about Hebrew, just having some differences and even they'll sometimes point it out and be like, yes, this is how I do it. And be like, yes, that's how you do it when you're doing Hebrew, but we have to switch right now. We're working and we're writing in English. Let's start over here.
Yeah. That's so perfect. And I think that's what our kiddos have so much trouble with. When you have a language disorder, it's hard to understand that pattern. And the more that we talk about those differences, then it really helps. Children start being aware of, Oh, there's patterns of the way that we structure language and that's where they really need the most support on. So that's beautiful.
That's so true because with our monolingual kids, we so rarely actually talk about the patterns of the language we teach the skill or the concept, but when you're teaching the pattern, it gives them a much broader picture of how language works.
And more and more research is showing that that's really great therapy for mano language kids, point out like, Hey, every time there's a plural, I'm putting an S on the end and specifically telling them, instead of seeing if they'lll naturally pick up on the clue there being an S yes.
Yes. Yeah. I think morphological awareness and syntactical awareness. And just to kind of briefly define that morphological awareness is just your understanding of the way that we use morphemes and how, if you change the morpheme of a word, then you can change the whole meaning of a word. Morphemes in English would be like adding that S sound to the end of a noun- to make it plural. So like, if I say a cat and cats, or I'm a different morphine might be like tenses and verbs. So if I add ING, then I'm using a verb right. In that moment. So run and running, or like past tense -ed. So those are really important for kids to know. They, that's why they don't use them as they don't understand. If I, if I don't include that, then I'm changing the whole meaning of the word.
Right. And as they get older, the reading comprehension, because they didn't even realize that it was a story that happened in the past, because they're not picking up on the -ed or the past tense verbs. Yeah, yeah. Which is completely different talking about morphemes and morphological differences in English as it is in many other languages.
So, and one of the things that I want to add too, is, um, kind of slightly off topic is a lot of times with our children that are bilingual, when we provide bilingual approaches and bilingual intervention, the progress is actually better than if they just had one monolingual and they were just focusing on one language. And I think part of it is because you spend so much time really explaining and bridging those differences and it gives children a much deeper insight into that structure and the pattern of language.
Yeah. I just, I love the idea of all speech-language pathologists being out there, like encouraging and supporting this bilingualism, because I feel like a lot of times you have these families who almost don't want their children to speak the native language. They're worried, it'll impact them. So to walk into a specialist clinic or to a classroom and hear that their bilingualism is appreciated and supported and encouraged could really help the families too, because I know there's a lot of concern sometimes with the families, with their home language and how it will impact their child's success.
Yes. Yeah. And some of the things that we see just patterns in the field too, is a lot of times because parents feel that that's sort of like shame and guilt that we've used that home language. And we haven't, um, we don't use English that there's a lot of, um, yeah, there's, there's shame and there's fear, and they also feel less empowered to support their children. And I've worked with families too, that they have told me, no, I don't want you to support that home language at all, because I just want my child to speak English. And it's really hard on them. And it's hard on the other extended family members too, because then they also feel shamed. And so the child just ends up getting fewer and fewer opportunities because even as the monolingual therapist, there's so much that we can do to support we can, so we can support our families and helping them and making them feel empowered that they can communicate and interact with their children in really meaningful ways. And I think in ways that are way more meaningful than what we could ever do.
Yeah. Because some of those very basic strategies of helping support language can be done by parents in either English or Spanish or Mandarin or whatever language that they end up speaking in the home. Yeah.
Yes. A theme that we found on a lot of our podcasts is that parent involvement is crucial. Right? So this is just another example of that. When parents are observing in a part of therapy, they can take it home and do it in their home language and apply it in their home language. That's awesome. Yeah.
Yeah. Is it common for parents to want to come in and say, yes, we are bilingual, but we don't want them to be speaking our home language.
Yes. I feel like that's really common. And I think that is a big fear of parents when they come in, that they want their children to learn English as quickly and as expertly and efficiently as they can. And we've talked a little bit about that. I thought I would share a story about my own life. My dad came to the U S when he was 15 years old and, um, his whole family came at the same time. They all worked to learn English. And then whenever he came down to Texas, he married my mom who, um, is from Tennessee. So she just speaks English and growing up, he only spoke to us in English. Our, our house was English only, but every single Sunday, we would go over to his family's house. And we were surrounded by Spanish. So I got exposed to it a lot as a child, but I didn't grow up speaking it. And my grandparents, they only spoke Spanish. And I remember always feeling very, not isolated. That wouldn't be the right word, but I felt like very hampered because I couldn't communicate with my grandparents in the same way that my cousins could. And actually both my sister and I, as soon as we had access to Spanish, like in high school and college, we immediately went to go learn it and speak it. And my dad now he talks to us a lot about, wow, that's one of his biggest regrets is just that he was so worried about not using Spanish with us. And now he really kind of sees how that has impacted, um, all of his children's lives and our ability to really effectively communicate with our extended family and then also to form really deep and meaningful relationships with them. So when I was learning Spanish, I had, I already had a child. And so, um, with him and my husband also grew up speaking Spanish only, but we had established sort of this context already of we, we speak English with each other. And so once you establish a certain context, it's really hard to break that. And so a lot of times with parents too, they're like, once you establish it in the home language, when you break it off, it feels really awkward. So with our child too, it's been a process for us to figuring out when can we use Spanish? When can we bring that in? That feels natural for both of us and for us, we've had to make it really context specific. And we talk a lot about, well, you know, this side of the family uses Spanish and this is what language is most comfortable for for all of us. So when we go over here, this is what language we're going to use. And I think in the U S because we're so English centric, that that can feel really hard, especially cause they know, Oh, we're bilingual. So you can understand me when I speak English. One of the best things that I love to do is to just go on vacations in Spanish speaking countries. And, you know, we'll tell our son beforehand, Hey, you know, this is the language that is being spoken here and out of respect and out of honor for this culture, this is the language that we're going to use. And I find when I do that, that's when my son really thrives and he really appreciates and enjoys that. But I also go into it, knowing that I'm playing a longterm game with him, I want him to be bilingual. He doesn't have to be a fluent Spanish speaker tomorrow. The best thing that I can impart in him is that love and honor and respect for his, all the cultures that he's exposed to and providing him opportunities where he can see those other perspectives, see that other way and be able to feel supported and encouraged to learn Spanish, but then also to feel supported, encouraged to use English.
Yeah. I have both past clients and personal friends who they've had to just say, you know what, on every Wednesday, it's, we're speaking this language and this is where we're going to speak in our home. And once we're home, that's what we're speaking to each other because the child will be like, Oh, but can I just respond to you in English or the other way? And they're like, no, we want to make sure that we continue this as a family. This is part of our identity. And so we're going to slowly make sure that it's part of our families. Plus there are benefits of being bilingual, right?
That's what I was thinking. Like, it's the best thing you can do for your kids is to give them exposure and the opportunity to learn two languages at a young age. Because like you mentioned, a lot of these families are ashamed or worried about it because they're worried about their child's long-term success in an English, mostly English speaking country. But like, there are so many benefits to being bilingual. I mean, it's like the best thing you can do for your kid. Yeah.
If you're using a language other than English at home, you want to see if that is something that you've already established. You want to keep that there. And because there are, there are a lot of cognitive academic and social emotional benefits to continuing that home language use. So the best thing that the parents can do is if they are already using two languages at home to continue to use those languages at home, different families do it in different ways. I love, you know, just, I think it's easier to make, this is a context that we're going to use that that language in this is the day. This is the place and giving kids real ideas of this is when it's meaningful and useful for us to use that language. One of the things that I have found, um, to be really interesting over the last couple of years is this concept of, instead of talking about cultural competence, which is what we're supposed to be culturally competent is this idea of cultural humility, which I think is really beautiful. And it's the way that we just approach looking at cultures different than ours and honoring that. And walking in this idea of humility in that there's no one culture that is better than the other, and that there's never anything that we're going to, we're not going to ever know anything and know everything about a particular culture. I feel like when we use the word competent, it just implies like, Oh, okay, I've checked these boxes and I'm done. And I think all of us, um, and here would know that we're never done learning and we are never done listening. And I love that idea of whenever I'm working with a family of really listening to them and listening to their needs and also listening to how they live their life. And so to me, that's what cultural humility is, is I'm never going to know everything there is to know. I won't know everything about all the different cultures that I work with because each family is really unique and I always want to listen to them and hear what is important to them. And I think that's going to drive, um, the treatment plan. Yeah.
It shifts it from just knowing to understanding and embracing.
Seeking to understand there's diversity within a culture. Yeah. So you can't know everything about one culture because every family unit is their own culture within a culture. Exactly. Yeah.
Well, at the end of every podcast, we ask our podcast guests, one specific question we ask, if you had a piece of advice to give parents, it can be on the topic of bilingualism. It can be coming from a therapist side. It can be coming from a parent side as a parent yourself, whatever your one piece of advice would be, what would you give our listeners?
Oh, wow. I think the biggest piece of advice would just be to listen and listen to your children and understand that communication can take so many different forms. And the best thing that we can as parents and as therapists is to really just watch our children and really seek to hear them and understand them. And sometimes that just means backing off a little bit, being really quiet and just seeing what, what it is that they're trying to tell us.
That's good advice.
That is really great advice. Well thank you so much. I learned a lot while talking to you. So I am confident that this will be a great resource for other people too. We appreciate your time and expertise. Pleasure.
Thank you for having me.
Thank you for listening to the Unbabbled podcast. For more information on today's episode, please see our episode description for more information on The Parish School, visit parish, school.org. If you're not already, don't forget to subscribe to the Unbabbled podcast on your app of choice. And if you like what you're hearing, be sure to leave a rating and review a special thank you to Stig Daniels, Amanda Arnold and Stella Limuel for all their hard work behind the scenes. Thanks again for listening.