Cultural and Linguistic Adaptations of Early Language Interventions: Recommendations for Advancing Research and Practice

Cross-cultural adaptation and validation of cognitive emotion regulation questionnaire: a systematic review

Background

The Cognitive Emotion Regulation Questionnaire (CERQ) is an important instrument for assessing the perceived effectiveness of emotional regulation strategies. It has been adapted into numerous regional languages worldwide. This systematic review seeks to explore the various versions of the CERQ, focusing on their processes of linguistic and cultural adaptation, as well as their validity and reliability.

Methods

Articles were systematically extracted from the literature review using search engines such as PubMed, Google Scholar, Web of Science, and Scopus. The focus was on identifying studies published in English between the years 2000 and 2024. This review also encompassed various versions of the CERQ that had been adapted and validated to accommodate linguistic and cultural differences.

Results

The original database yielded 1,476 search results. After filtering out duplicates, 420 articles were examined. Following a review of the titles and abstracts, 21 studies were identified for further evaluation. Ultimately, 13 versions were chosen for the final analysis.

Conclusion

This review offers an in-depth insight into the difficulties faced in cross-cultural adaptation and the psychometric assessment processes. Notably, the predominant approach for translation identified in the reviewed literature was Brislin's classic back-translation model. The findings demonstrate strong test-retest reliability, excellent internal consistency, and reasonable construct validity across various languages, affirming the usability of the translated versions of the CERQ in different linguistic contexts.

Developmental and Functional Outcomes Amongst Culturally and Linguistically Diverse Autistic Children

Children typically learn by attending to other people. Autism traits may impact access to social stimuli fundamental to early learning, increasing children's likelihood of a learning disability. Recent reports have highlighted that Autistic children from minority backgrounds have a higher likelihood of co-occurring intellectual disability. This study aimed to firstly confirm that early autism traits are concurrently and prospectively associated with lower developmental quotients, and secondly to examine the developmental and functional gains in Culturally and Linguistically Diverse (CALD) and non-CALD Autistic children following one year of Group-based Early Start Denver Model (G-ESDM). Secondary data on 114 non-CALD and 91 CALD Autistic preschoolers receiving the G-ESDM was utilised to address the study aims. Children were administered the Autism Diagnostic Observation Schedule (ADOS) at entry into the service. The Mullen Scales of Early Learning and the Vineland Adaptive Behaviour Scales-II were administered at both entry (Time 1) and 12 months later (Time 2). While no concurrent associations were found between autism traits and Developmental Quotient (DQ), significant associations were found prospectively with ADOS scores at Time 1 and DQ at Time 2, holding for both groups after controlling for DQ at Time 1. Autistic children made significant gains in cognition and functional behaviour following one year of early therapy, with no differences between the two groups. The results indicate that young Autistic children make significant gains in early development and add to the sparse research on the developmental and functional outcomes of Autistic children from CALD communities.

Designing Cultural Adaptations of Caregiver-Implemented Interventions for Latinx Caregivers of Children Who Use Augmentative and Alternative Communication: Key Considerations

PURPOSE

Caregivers play a critical role in their children's development and serve as their primary communication partners. Family interactions provide the most naturally occurring opportunities for children with complex communication needs to learn language in the context of family routines. A growing body of research suggests that caregivers can effectively support their children's use of augmentative and alternative communication (AAC) systems when provided with appropriate training and coaching through caregiver-implemented interventions (CIIs). However, the efficacy of these interventions remains untested among culturally and linguistically diverse caregivers. Given the increasing diversity in the United States, there is a pressing need to develop CIIs that align with the cultural and linguistic preferences of diverse families.

METHOD

Using the Ecological Validity Framework and the Checklist for Cultural Adaptations, this tutorial explores considerations for culturally adapting caregiver-implemented AAC interventions for Latinx caregivers of children with AAC needs. The aim is to ensure that interventions are relevant, meaningful, and respectful of cultural and linguistic practices. Through carefully crafted cultural adaptations, interventions can achieve greater acceptance by caregivers.

RESULTS AND DISCUSSION

This tutorial suggests a series of cultural adaptations to ensure accessibility, sustainability, and success of caregiver-implemented AAC interventions for Latinx caregivers of children with AAC needs. By incorporating cultural and linguistic considerations into the intervention design, we can enhance its acceptability among Latinx caregivers. This, in turn, can lead to improved outcomes in AAC implementation within the home environment.

Social Communication and Parent Verbal Responsiveness Across Interaction Contexts in Toddlers on the Autism Spectrum

PURPOSE

Interactions with caregivers during the ordinary activities that occur as families go about their everyday lives are critical to supporting children's acquisition of social communication and language skills. The purpose of this study was to examine child communication and parent verbal responsiveness across interaction contexts in 211 children (Mage = 20 months) on the autism spectrum (n = 121), with developmental delay (n = 46), or with typical development (n = 44).

METHOD

Families participated in up to eight activities during an hour-long, video-recorded home observation. We tested differences in the strength of associations between diagnostic group and interaction context using linear mixed-effects models, with child rate per minute of communication and proportions of parent follow-in comments and directives as outcome variables. Child communicative functions expressed across contexts were also examined.

RESULTS

Children across groups communicated at significantly higher rates per minute during book sharing and play with people compared to other interaction contexts. Most child communication was for the function of joint attention during book sharing, for social interaction during play with people, and for behavior regulation during necessary activities such as family chores and meals. On average, parents of children responded using proportionally more follow-in comments during book sharing and play compared to necessary activities, during which parents used more follow-in directives.

CONCLUSION

Results provide a glimpse into the dyadic communication that may occur within everyday activities at home, which supports the need for future intervention research and may aid clinicians seeking to identify activities that serve as important contexts for intervention.

Family-Centered Early Intervention Deaf/Hard of Hearing (FCEI-DHH): Cultural & Global Implications

This article is the third in a series of eight articles that comprise this special issue on family-centered early intervention for children who are deaf or hard of hearing and their families (FCEI-DHH). It highlights the origins of FCEI-DHH in Western contexts and well-resourced locations and emphasizes the role of culture(s) in shaping FCEI-DHH. This article also cautions against the direct application of the 10 FCEI-DHH Principles presented in this issue across the globe without consideration of cultural implications. Cultural perceptions of decision-making processes and persons who can be decision-makers in FCEI-DHH are explored. Deaf culture(s) and the benefits of exposure to DHH adults with diverse backgrounds are introduced. Structural inequities that impact families' access to FCEI-DHH programs/services and systems, within and among nations and regions, are noted. The need to consider the cultural influences on families is emphasized; this applies to all levels of FCEI, including the development of systems through implementation of supports.

Adapting a Clinical Practice Guideline for Management of Patients with Knee and Hip Osteoarthritis by Hong Kong Physiotherapists

Knee and hip osteoarthritis are common disabling conditions globally. Although numerous international clinical practice guidelines exist to guide physiotherapy management, not all recommendations issued from these guidelines can be translated to other contexts without considering the cultural acceptability and clinical implementability of targeted countries. Because the ADAPTE framework provides a robust methodology to adapt guidelines to the local context, this study used its methodology to adapt high-quality guideline recommendations to promote optimal physiotherapy care for knee and hip osteoarthritis in Hong Kong. The ADAPTE framework was used and modified to complete the adaptation process. International clinical practice guidelines were identified from eight guideline clearinghouses and six electronic databases. Two independent reviewers critically appraised the eligible guidelines using the AGREE II tool. We extracted and tabulated recommendations from high-quality guidelines. A voting-based consensus among interdisciplinary experts was conducted to decide on suitable recommendations for the Hong Kong context and whether there was a need to modify them. Pertinent recommendations were then translated into the traditional Chinese language. Our team members suggested modifying four tools and adding one to explore the patient's feedback on the recommendations, to the ADAPTE framework. The adaptation was performed on three high-quality guidelines. We adapted 28 and 20 recommendations for treating knee and hip osteoarthritis, respectively. We recommend a multimodal treatment for managing knee and hip osteoarthritis. Land- and aquatic-based exercises, patient education, and self-management were strongly recommended for patients with knee osteoarthritis. Land- and aquatic-based exercises were strongly recommended for patients with hip osteoarthritis. This is the first adaptation study in Hong Kong. It provides guidance to local physiotherapists on managing patients with knee and hip osteoarthritis. Future studies should test the effectiveness of implementing this adapted guideline to improve local physiotherapy care in Hong Kong.

Addressing Cancer Disparities Through Community Engagement: Lessons and Best Practices

Cancer disparities continue to be a significant public health challenge, disproportionately affecting certain communities in terms of incidence, mortality, and access to quality care. Addressing these disparities requires a multifaceted approach that involves not only healthcare professionals and researchers but also the active participation and collaboration of the affected communities themselves. Community engagement has emerged as a promising strategy to reduce cancer disparities and promote health equity. This review article synthesizes the existing literature and examines the role of community engagement in addressing cancer disparities. It explores various approaches and best practices utilized in community engagement initiatives to empower and involve diverse populations in the fight against cancer. The review discusses key lessons learned from successful programs and identifies challenges faced in implementing such initiatives. The article highlights the importance of cultural competence, trust-building, and meaningful collaboration between stakeholders, including community leaders, healthcare providers, researchers, and policymakers. It emphasizes the significance of tailoring interventions to specific community needs, acknowledging cultural differences, and fostering a two-way exchange of knowledge and resources. Moreover, this review investigates the impact of community engagement on cancer prevention, early detection, treatment adherence, and survivorship outcomes. It sheds light on the role of community-based participatory research and other innovative strategies in generating evidence and facilitating the translation of research findings into real-world interventions. In conclusion, this review underlines the potential of community engagement in addressing cancer disparities and promoting health equity. By involving communities as active partners in cancer control efforts, healthcare systems can design more effective and sustainable interventions. This approach not only contributes to reducing cancer disparities but also fosters a sense of ownership and empowerment within the communities affected, paving the way for a more equitable and inclusive healthcare landscape.

The importance and challenges of improving early identification of language abilities: a commentary on Gasparini et al. (2023)

Finding early predictors of later language skills and difficulties is fraught with challenges because of the wide developmental variation in language. Gasparini et al. (Journal of Child Psychology and Psychiatry, 2023) aimed to address this issue by applying machine learning methods to parent reports taken from a large longitudinal database (Early Language in Victoria Study). Using this approach, they identify two short, straightforward item sets, taken at 24 and 36 months, that can adequately predict language difficulties when children are 11 years of age. Their work represents an exciting step towards earlier recognition and support for children with Developmental Language Disorder. This commentary highlights the advantages and challenges of identifying early predictors of language in this way, and discusses future directions that can build on this important contribution.

Remote First-Language Assessment: Feasibility Study With Vietnamese Bilingual Children and Their Caregivers

PURPOSE

There is a shortage of bilingual speech-language pathologists (SLPs) in the United States. For Vietnamese, less than 1% of SLPs speak the language compared with a Vietnamese American population of > 2.1 million. This study examines the feasibility and social validity of remote child language assessment with the help of a caregiver to address the need for first language assessments among Vietnamese-speaking children.

METHOD

Twenty-one dyads of caregivers and typically developing children (aged 3-6 years) completed two assessment sessions in their first language, Vietnamese, using Zoom videoconferencing. Sessions were counterbalanced between two conditions in which either the clinician or the caregiver was the task administrator. Children's language samples were elicited using narrative tasks. Social validity was also assessed through caregiver and child questionnaires at the end of each session.

RESULTS

There were no significant differences between conditions on language sample measures nor the measures of social validity. Both caregivers and their children felt positively about the sessions. The caregivers' feelings were related to their perception of children's feelings about the sessions. Children's feelings were related to their Vietnamese language proficiency, caregiver-reported language ability, and whether they were born outside of the United States.

CONCLUSIONS

Findings build the evidence base for telepractice as an effective and socially valid service delivery model for bilingual children in the United States. This study supports the potential for caregivers as task administrators in a telepractice setting, making assessment in a child's first language more feasible and accessible. Future investigation is needed to extend results to bilingual populations with disorders.

Early Identification of Children at Risk of Communication Disorders: Introducing a Novel Battery of Dynamic Assessments for Infants

PURPOSE

Many children with communication disorders (CDs) experience lengthy gaps between parental reporting of concerns and formal identification by professionals. This means that children with CDs are denied access to early interventions that may help support the development of communication skills and prevent possible negative sequelae associated with long-term outcomes. This may be due, in part, to the lack of assessment instruments available for children younger than 3 years of age. This study therefore reports on promising preliminary data from a novel set of valid dynamic assessment (DA) measures designed for infants.

METHOD

We recruited 53 low-risk children and two groups of children considered to be at high risk for CDs (n = 17, social high risk, and n = 22, language high risk) due to family members with language and social communication difficulties. The children were between 1 and 2 years of age and were assessed using a battery of five DA tasks related to receptive vocabulary, motor imitation, response to joint attention, turn taking, and social requesting. A set of standardized measures were also used.

RESULTS

The DA tasks showed high levels of interrater reliability and relationships with age across a cross-sectional sample of children from the low-risk group. Three tasks showed moderate to strong correlations with standardized measures taken at the same age, with particularly strong correlations between the DA of receptive vocabulary and other receptive language measures. The DA of receptive vocabulary was also the only task to discriminate between the three risk groups, with the social high risk group scoring lower.

CONCLUSIONS

These results provide preliminary information about early DA tasks, forming the basis for further research into their utility. DA tasks might eventually facilitate the development of new methods for detecting CDs in very young children, allowing earlier intervention and support.

Chinese-English speaking family perspectives of augmentative and alternative communication use with their children

INTRODUCTION

Culturally and linguistically diverse families who have children with complex communication needs (CCN) often have limited access to augmentative and alternative communication (AAC) devices and interventions due to the lack of services that acknowledge their families' cultural and linguistic needs. Despite the increasing need for culturally responsive services, little is known about Chinese-English speaking families' perspectives and experience related to AAC use and services. The objective of this study was to understand the perspectives and experiences of Chinese-English speaking family members of children who use AAC use.

METHODS

This study employs a qualitative descriptive methodology approach. The researchers conducted individual or group semi-structured interviews with 10 adult family members (mother, father, and grandparent) from four Chinese-English speaking families in the U.S. and Canada who have a child who uses AAC (ages 3-8).

RESULTS

Chinese-English speaking families have high acceptance and satisfaction with their child's AAC as long as they see the benefits of the AAC system. Mothers and siblings play unique roles in supporting home AAC practice given frequent engagement with and observed influence on the child who uses AAC. Family members indicated goals in building stronger family connections, but noted that the child's speech difficulties interfered with this goal. Chinese-English speaking families felt they can overcome limitations resulting from lower English language proficiency, but still find difficulties in obtaining resources because of the Western expectations of advocacy. Additionally, service providers' lack of responsiveness related to family goals could prevent families in obtaining AAC resources.

CONCLUSIONS

The findings suggest the need for family-centered services with cultural sensitivity and humility for those serving Chinese-English speaking families with children who use AAC. Additionally, involving family members beyond the mother within services may improve both family functioning and child communication.

Speech-Language Pathologists' Support for Parents of Young d/Deaf Multilingual Learners

Increasing cultural and linguistic diversity among children and families brings new challenges for early intervention professionals. The purpose of this study was to identify the specific roles and needs of speech-language pathologists (SLPs) who practice in early intervention settings with culturally and linguistically diverse families of d/Deaf multilingual learners (DMLs). Thirteen SLPs completed an online survey about their practices and needs. Interviews were conducted with five parents of DMLs. Results showed that SLPs have lower self-satisfaction with families of DMLs compared to mainstream families. Parents were highly satisfied with the support they received. Both groups of participants reported a need for specific tools or adaptations, especially if there was no shared language. Thematic analysis identified three themes: communication and partnership, professional resources for responding to diversity, and diversity of parental profiles. This article provides an insight into the perspectives of both professionals and culturally and linguistically diverse parents, and identifies specific aspects of early intervention services with parents of DMLs: developing partnership in the context of cultural and/or linguistic differences, discussing topics related to multilingualism, and providing highly adaptable family-centered services.

Cultural Adaptation of Parent-Implemented Early Communication Interventions: A Scoping Review

PURPOSE

Parent-implemented early communication interventions are commonly delivered to culturally and linguistically diverse families. Although there is evidence from fields such as public health or psychology, there is little guidance regarding what elements to culturally adapt for parent-implemented speech-language pathology interventions. This scoping review addresses this gap by identifying parent-implemented early communication interventions that have been culturally adapted and describing which intervention components were adapted. Definitions of culture, use of adaptation frameworks, and adaptation guidelines, policies, and recommendations are also reported.

METHOD

The databases Cumulative Index to Nursing and Allied Health Literature, MEDLINE, PsycINFO, and Embase via OVID were searched. Supplementary search methods, including hand-searching of references and a gray literature search, were also conducted. Covidence software was used to deduplicate, collate, and review articles. Population, intervention, study, and cultural adaptation data were extracted and synthesized using the Ecological Validity Framework.

RESULTS

Twenty-one articles were included from the database and supplementary searches. No studies defined culture, and only three used cultural adaptation models or frameworks to guide adaptation. Studies varied greatly in what they adapted; language adaptations, such as translation, were conducted most frequently, and intervention goals were rarely adapted. Only three studies obtained parent feedback to inform cultural adaptation for future recommendations.

CONCLUSIONS

More clarity in the reporting of cultural adaptation for communication interventions is required. Cultural adaptation frameworks are useful tools to guide adaptation but can be difficult to operationalize. Additional research in this area is necessary to help clinicians provide culturally responsive, parent-implemented communication interventions.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20416107.

Identity-Focused Practice in Augmentative and Alternative Communication Services: A Framework to Support the Intersecting Identities of Individuals With Severe Disabilities

PURPOSE

The purpose of this clinical focus article is to consider a framework of identity in provision of services to individuals with severe disabilities who use augmentative and alternative communication (AAC).

METHOD

Components of the framework for identity include personal, social, and cultural areas. These aspects are identified in extant literature on AAC services and discussed through the lens of the Communication Bill of Rights (National Joint Committee for the Communication Needs of Persons with Severe Disabilities in 1992). Identity-focused practice is discussed as being relevant to self-determination and quality of life among individuals with severe disabilities.

RESULTS

A case study illustrates identity-focused practice in delivery of services to an adolescent who uses AAC, considering personal, social, and cultural identities.

CONCLUSIONS

This clinical focus article proposes a theoretical framework and provides a practice example for addressing the intersecting identities of individuals with severe disabilities. Furthermore, this clinical focus article argues that identity is a basic human right and area in which additional efforts are needed in the application of AAC solutions.

Effects of a Computer Training to Teach Spanish Book-Sharing Strategies to Mothers of Emergent Bilinguals at Risk of Developmental Language Disorders: A Single-Case Design Study

PURPOSE

The purpose of this research is to examine the effects of a computer app-based training program for caregivers on caregiver behavior to enhance Spanish language in emergent bilinguals at risk for developmental language disorders.

METHOD

This study followed a single-case, multiple-baseline design. An app-based language training program was developed based on the Teach-Model-Coach-Review adult learning instructional approach. Six mothers were trained on three language-facilitation strategies (Completion, Distancing, and Questioning) while reading to their children in Spanish. The training focused on one of the three strategies at a time, and mothers were given access to training once a week. Mothers were recorded while they read to their children during three phases: prior to the training (baseline), during 2 training weeks (training phase), and after training was provided (maintenance).

RESULTS

A visual analysis of the data (percent nonoverlapping data complemented with Tau-U analysis) indicated a functional relation between the training program and the use of strategies by the participants for Distancing and Completion, and there was a less robust, moderate effect for Questioning strategy for a couple of participants.

CONCLUSIONS

The computer training may serve as a tool for instructors who want to educate Spanish-speaking mothers in the use of evidence-based language strategies at home. Further research is needed to determine how this parent training could result in long-term use of strategies during reading times and what factors are associated with the learning and subsequent use of these strategies with children.

Learning Words in Two Languages: Manipulating Exemplar Variability for Within- and Cross-Language Generalization

PURPOSE

This article aims to describe how exemplar variability can manipulate the word learning environment to maximize within- and cross-language generalization in Spanish-English bilinguals. Furthermore, we examined sources of individual variability that predicted word learning.

METHOD

Nineteen Spanish-English bilingual children participated in a word learning task presenting words in both languages. Children learned words either in a high variability condition (in which multiple exemplars are introduced with the target word) or in a no variability condition (in which the same referent is used with the target word). Word learning was tracked over the course of the training, and retention was examined once the training was discontinued. Children's generalization of referents within and across languages was also examined.

RESULTS

The exemplar variability effect was observed in within-language generalization trials, whereas cross-language generalization was less robust. Nevertheless, cross-language associations emerged in examining the role of language proficiency, such that semantic skills in English predicted word retention across languages. Similarly, children's propensity to code-switch during language production was positively correlated with retention of words learned in the high variability condition.

CONCLUSIONS

The findings show that Spanish-English bilingual children may make use of exemplar variability to support word learning in different ways compared with monolinguals. The exemplar variability effect interacts with children's acquired language skills and word learning abilities at the start of the intervention. This study provides preliminary evidence from which future research can develop word learning interventions that are responsive to the needs of multilinguals.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19241856.