Use of Monolingual English Guidelines to Assess Stuttering in Bilingual Speakers

Abstract

Speech-language pathologists can identify stuttering in multiple languages,even if they do not speak the language. However, due to differences in languagedevelopment, multilingual speakers have been documented with higherlevels of typical disfluencies in their speech than monolingual speakers. Thesehigher levels of disfluency put multilingual speakers at greater risk of misdiagnosis as individuals who stutter, due to poor understanding of the nature of the manifestation of stuttering in two or more languages and reliance on monolingual-English diagnostic criteria. The purpose of the present systematic review is to explore how stuttering is identified in multilingual speakers who are described as participants who stutter, and whether monolingual English-speaking guidelines were the most commonly used reference for determining the presence of stuttering.

Prevalence, severity and risk factors for speech disorders in US children

“…Studies examining speech patterns of typically fluent Spanish-English bilingual speakers report higher rates of disfluencies that are characteristic of a speech disorder (specifically stuttering) compared to monolingual English speakers (Byrd, Bedore & Ramos, 2015;Smith, Choo & Seitz, 2022). Relatedly, typically fluent Spanish-English bilingual children are more likely to be misdiagnosed with stuttering (Byrd, Werle, Coalson & Eggers, 2020). Symptoms were also more likely to be moderate or severe in children with comorbidity in the current study.…”

Linguistic Aspects of Stuttering

“…Numerous authors caution against using the monolingual norms for 2%–3% typical disfluencies (Ambrose & Yairi, 1999) to evaluate disfluency rates in bilingual children, as doing so will likely lead to misdiagnosis of stuttering in this group of children (Byrd et al, 2020; Eggers et al, 2020). Instead, observation for other behaviors associated with stuttering, such as tension, arrhythmicity, and sound prolongations, may be more appropriate when making a stuttering diagnosis in bilingual children (Byrd et al, 2020; Eggers et al, 2020).…”

Challenges of Treating Bilingual and Multilingual Stuttering

“…The selection of assessment tasks and speech samples is language-dependent and is subject to the clinician's and client's familiarity of the languages being spoken. Earlier diagnosis reports or clinician's individual judgment is often a less reliable method to assess stuttering severity ( 4 ). We suggest that standardized measures with data using diverse population groups need to be the focus among clinicians so that proper diagnosis and treatment can be offered to the clients.…”

“…So clinicians dealing with stuttering need to be trained to understand linguistic diversity and sensitize themselves to cater to the needs of multilingual populations. This would avoid false-positive identification cases and misdiagnosis of stuttering cases ( 4 ).…”

“…Apart from the rules of language dominance, language preferences play a pivotal role in language processing. Factors like the familiarity, proficiency, exposure, comfort, confidence, complexity, age of language learning, educational background, lifestyle, and so on, impact the personal choices and language preferences of the clients ( 4 , 6 ). The personal language preference of the client need not necessarily be in line with the rules of language dominance.…”