Abstracts of the program from the 6th European CPLOL Congress

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A multilingual and multicultural Europe. A challenge for speech and language therapists

1. Language Rehabilitation of Aphasic Persons in Multilingual Societies: Theoretical Bases, Clinical Procedures, and International Perspectives

Jose G. Centeno
Speech-Language Pathology & Audiology Program
Department of Speech, Communication Sciences, & Theatre
St. John's University
Jamaica, New York, United States of America

Working with aphasic individuals in multilingual societies imposes challenges on speech-language therapists (SLTs). Aphasic speakers may use two or more languages in their pre-stroke routines (that is, bilingual or polyglot speakers, respectively). They may also use different languages daily (i.e., Italian-Spanish, German-English-French, etc.) and have different life experiences. Therefore, accurate clinical distinctions between post-stroke aphasic disorders and pre-morbid language skills require realistic assessment. Yet, formal tests that are linguistically and culturally suitable to bilingual or polyglot patients may not be available. Moreover, appropriate diagnosis requires in-depth understanding of the factors participating in the post-stroke language recovery of bilingual/polyglot speakers, such as neurolinguistic, psycholinguistic, sociolinguistic, and socioeconomic variables. During intervention, planning effective therapy programs needs to acknowledge many interacting variables, such as personnel availability, and the patient’s language proficiency and acculturation. This presentation will discuss theoretical principles guiding diagnostic and therapeutic procedures with bilingual/multilingual aphasic persons, based on Spanish-English bilinguals in the United States. Because the examination of clinical procedures with bilingual/multilingual patients in other countries may provide helpful insights, it is hoped that this presentation will also contribute to the collaborative exchanges among SLTs in different countries and provide useful input that may be applied in other multilingual communities.

Key words: aphasia, bilingualism, multilingualism, testing, therapy.

2. Age of acquisition effects on naming performance in Frisian-Dutch bilingual speakers with Alzheimer dementia

Wencke S. Veenstra
Department of Neurology, University Medical Centre Groningen
Groningen, the Netherlands

Nick Miller
Speech Language Sciences, University of Newcastle
Newcastle, United Kingdom

Mark Huisman
Department of Psychology, University of Groningen
Groningen, the Netherlands

We investigated the effects of age of acquisition (AoA) on naming performance in twenty-six Frisian-Dutch bilinguals suffering from Dementia of the Alzheimer Type (DAT). An experimentally designed picture-naming task and rated AoA measures were used to assess naming performance for both languages. Consistent with findings from healthy speakers we expected AoA to effect word retrieval in the present speakers.

A significant effect of AoA on naming performance was found in both languages, indicating that words acquired early in life are better preserved and retrieved in mild to moderate Alzheimer’s dementia. No difference in languages was found, the bilingual Alzheimer patients showed problems in lexical retrieval in both L1 and L2. However, our patients demonstrated more inappropriate code-switching within the Frisian setting (L1) than within the Dutch setting (L2) but always chose the appropriate language in conversation. A qualitative analysis of the error responses investigated the nature and locus of naming deficits. No differences in overall error distribution were found between languages nor for both early and late acquired words. This naming study showed a significantly higher percentage of semantically than visually related errors. These findings have important implications for understanding problems in lexical retrieval in bilingual Alzheimer patients and the development of more adequate language and neuropsychological tests for bilingual individuals with neurological impairment.

Key words: Age of acquisition, bilingualism, picture naming, dementia

3. Increasing SLI – an international myth or a fact?

Sinikka Hannus
Myyrmäki Health and Social Welfare Centre
Vantaa, Finland

Kaisa Launonen
Department of Speech Sciences
University of Helsinki
Helsinki, Finland

Many clinicians in different countries agree that the numbers of SLI have been constantly rising during the last decades. As a conclusion of their review, Law & al. (1998) summarized, however, that there is no evidence of a real increase in the numbers of speech and language delay in the period of 1967—1997. Differences in the classification of children’s language impairments make it difficult to estimate the prevalence of these impairments and to compare estimates between countries.

A retrospective study was made in a Finnish town with around 170 000 inhabitants. The results of the study, covering years 1989–1999, showed a statistically significant increase in the numbers of SLI diagnoses (F80.1 and F80.2): in age group 0—6 years from 0,09% to 0,84%, and in age group 0—15 years from 0,04% to 0,69%. The same increase was found in delayed speech and language; if these numbers are put together with the numbers of SLI, the prevalence in age group 0—6 years increased from 0,4% to 2,5%. No single change in organization, health care system or the way the services were carried out, explained this increase. Even though the prevalence of SLI in Finland shows lower numbers than in many international studies, the increase during the 11 years of the follow-up can be considered to be remarkable.

Key words: special language impairment, prevalence, children

4. Specific language impairment in a bilingual context

Jan de Jong
Antje Orgassa
Anne Bakker
Fred Weerman
Amsterdam Center for Language and Communication
University of Amsterdam
Amsterdam, the Netherlands

Bilingual children with language problems present us with a confound that has to be solved. After all, delays in the L2 development of these children may be caused by either poor learning of the second language or by a specific language impairment (SLI) that by definition affects their learning of L1 and L2 alike. Systematic study of the two factors and their interaction is needed to identify the respective influence of language impairment and bilingual language learning processes.

SLI manifests itself differently across languages and cross-linguistic studies have led to a better understanding of SLI. Still, even within one language SLI children constitute a heterogeneous group. In a group of bilingual SLI children this heterogeneity is excluded: both languages can be compared within one and the same subject.

Our research project focuses on language production by Turkish-Dutch bilingual children with and without SLI. The linguistic focus is on inflection in two domains: the inflectional phrase (IP) and phenomena related to inflection, and the Determiner Phrase (DP). The clear typological contrasts between L1 (Turkish) and L2 (Dutch) are helpful in teasing apart language-specific and impairment-induced influences.
In our presentation we will present first results from the tasks that address Turkish and Dutch. We will report the differences between children with and without language impairment. In addition, we will draw conclusions on the differences and similarities that are found in the children’s L1 and L2. Finally, the practical implications (in terms of diagnostic assessment) will be discussed.

5. Culturally competent students and professionals in speech and language therapy – working in a culturally diverse Europe

Julie Marshall
Juliet Goldbart
Research Institute of Health and Social Change
Faculty of Health and Social Care
Manchester Metropolitan University
Manchester, United Kingdom

Speech and Language Therapy (SLT) students and qualified SLT’s increasingly need to be competent to work in culturally diverse settings. Also, as both students and qualified SLTs become more geographically mobile, there is a need to consider how the SLT professions, across Europe and beyond, ensure that their members develop cross–cultural competence.

This paper will consider three topics:

• A recent study of the experiences of present and past international students who studied SLT in the UK (Marshall, Goldbart, and Evans, 2004; Goldbart, Marshall and Evans, 2005)
• How one UK university seeks to develop its students’ cross-cultural competence
• The work of a professional body (the Royal College of Speech and Language Therapists) to develop the cross-cultural competence of international SLTs coming to work in the UK.

Data will be presented, followed by discussion and sharing, by the audience, of experiences in other parts of Europe, in order to share good practice and to make recommendations for future developments in professional cross-cultural competence.

Key words: cross-cultural competence, international students

6. Widening diversity in speech and language therapy education/profession

Nita Madhani
Department of Language and Communication Sciences
Department Speech and Language Therapy, Redbridge Primary Care Trust
City University
London, United Kingdom

The Royal college of Speech and Language Therapists (RCSLT) survey in 1999 on the diversity of the workforce showed that 1.5% of speech and language therapists (SALTs) are from Black and Minority Ethnic (BME) backgrounds. This is in the context of the 2001 census showing that 7.9% of the UK population are from BME backgrounds. This is in stark comparison to professions like dentistry and medicine. Research indicates that there is a lack of awareness in BME communities in Speech and Language Therapy (SLT) as a profession. Furthermore an understanding of and response to different cultural and ethnic backgrounds is crucial to service oriented professions such as SLT.

The challenges faced by the profession are in widening the diversity of SLT students to ensure a more diverse workforce. Career events are driven by the assumption that if students are given more information they will make better decisions about their future careers. For BME communities the process is somewhat different as decision making about careers is socially and culturally embedded.

This paper looks at ways of attracting students with greater linguistic and cultural diversity to the SLT profession and the responsibility required of Higher Education Institutes and others to support/mentor students throughout their academic career.

Key words: Diversity, Career, Ethnic Minority, Mentoring , Challenges

7. Influence of educational level in aphasia testing: experiences from standardizing the Portuguese version of the AAT (Aachener Aphasie Test)

Martin Lauterbach
Language Research Laboratory
Neurological Clinical Investigation Unit
Faculty of Medicine
Lisbon, Portugal

The stratification of normative data for demographic variables is frequently used in order to obtain reliable results in neuropsychological testing. In Portugal with its heterogeneous population in terms of education the normative data of the Portuguese version of the AAT for healthy controls (N=156: male=58, female=98) showed a pronounced effect of education. The Token Test turned out to be the subtest that is less influenced by educational level. Contrarily in the Naming subtest less educated subjects made a significantly more errors. When the stimulus material consisted of photographs instead of line-drawings the number of errors decreased significantly. The qualitative analysis of the naming errors turned out that 40% of the errors were perceptive ones; thus they were caused by a failure outside the linguistic system. Using the same stimuli in an auditory comprehension task the same number of errors as in the naming task was observed; the errors were mostly related to semantic-perceptive distracters.

There is no ceiling effect in the performance of healthy subjects due to educational differences.

ducational level influences not only linguistic but also perceptive capacities, or the mediation between these two stages of processing. The premorbid knowledge and capacities of the aphasic subject seem to exert a strong influence on the test outcome and have to be taken in account. The stratification of AAT scores for educational level might be useful, not only in the Portuguese population.

Key words: aphasia testing, normative data, educational effect

8. Are clang and bank as easy to say for English speakers with apraxia of speech as German speakers saying Klang and Bank?

Nicole Lallini
Nicolas Miller
David Howard
Speech section, School of Education, Communication & Language Sciences
University of Newcastle upon Tyne
Newcastle upon Tyne, United Kingdom

If breakdown in apraxia of speech is wholly dependent on motor processes, then words that are identical or near identical in English and German (e.g. Bank-bank, Klang-clang, weiss-vice) should show similar error patterns across the two languages.

We investigated this in a pilot study looking at cross language issues in diagnosis of apraxia of speech by comparing error patterns of 4 German and 4 matched (on the English and German versions of the Aachen Aphasia Test) English speakers with apraxia of speech speaking a list of 500 such paired words.

Error profiles across the two languages showed no correlation when simply looking at the total number and types of errors (e.g. substitutions, omissions). However, when error profiles were adjusted to take account of other word variables such as frequency, phonological neighbourhood density, and phonotactic predictability, then profiles became much more compatible.

We discuss these findings in relation to the definition of apraxia of speech and with regards to making comparisons of speakers across languages.

Key words: apraxia of speech, cross-linguistic, differential diagnosis, speech production.

9. PC-assisted therapy for apraxia of speech with the programm ‘Speech Trainer’

Julia Funk
RehaNova Köln
Neurologische/neurochirurgische Rehabilitationsklinik GmbH
Köln, Germany

The illustration of complex articulatory movements is integral part of therapy for apraxia of speech. Yet, PC-assisted therapy is used hardly ever in this context. The software “Speech Trainer” (free of charge) is a new therapeutic aid that visualizes articulation and coarticulation by means of dynamic animations. First empirical evidence for the efficacy of Speech Trainer is provided by a single case study. Speech Trainer was evaluated in therapy for a patient with severe, chronic apraxia of speech. The evidence of this as well as further studies points to the fact that

1. the animation of Speech Trainer is well understood by the participants and useful for their own speech
2. Speech Trainer is an effecitve therapeutic aid in modeling articulatory movements.

Key words: Speech disorders, PC-assisted therapy, apraxia of speech, model of articulation, therapeutic aid.

10. Explanation of differences regarding the acquisition of the Dutch language comprehension between Turkish and Moroccan Toddlers

Jenta J. Sluijmers
Amsterdam Municipal Health Service of Amsterdam
Child Care department - speech language therapy
Amsterdam, Netherlands

Robert Lindeboom
Academic Medical Centre of Amsterdam
Department of Clinical Epidemiology and Biostatistics
Amsterdam, Netherlands

Frans Pijpers
Anneke Kesler
Amsterdam Municipal Health Service of Amsterdam
Child Care department
Amsterdam, Netherlands

Objective: The aim of this retrospective trial is to investigate whether there are differences in the development of the Dutch language comprehension between toddlers with a Turkish (n = 105) or Moroccan (n = 126) migrant background, as well as to identify demographic, social-pedagogic and medical factors related to the observed differences.

Methods: The absolute differences in the language comprehension were measured by using the Dutch version of the Reynell Comprehension Language Scales, expressed in a Language Comprehension Quotient (LCQ). All factors which were correlated to the LCQ-score, were being further examined using a multiple linear regression technique.

Results: toddlers from a Turkish background (mean age 41.5 months) showed a significant lower LCQ-score, both at the first and second measuring point as compared to children from a Moroccan background (mean age 41.8 months) (55 vs. 61 LCQ and 61 vs. 76 LCQ, p = < 0.01). The variability in LCQ at the second measuring point and the differences between the first and second test could both not be explained by the Turkish or Moroccan mother tongue (p = 0.81 and, p = 0.51 respectively). However, the frequency of family, friends and neighbours speaking Dutch in the presence of the children demonstrated an explained variability (r2) in LCQ of 50%.Conclusions: Turkish toddlers have lower Dutch language comprehension skils than Morrocan toddlers. Interventions such as improving the possibilities to hear Dutch from family members and neighbours, as well as providing suitable information regarding the bilingual education, could possibly contribute to a decrease in these differences.

11. The acquisition of writing in a bilingual setting: mutual interferences of Portuguese and German

Edith Menke
Clara Loureiro
Beatriz Dias
Martin Lauterbach
Language Research Laboratory
Neurological Clinical Investigation Unit
Faculty of Medicine of Lisbon
Lisbon, Portugal

Children that attend a bilingual school learn simultaneously two different phoneme-grapheme correspondence-systems (PGC-S). The PGC-S of each language does not give unequivocal rules how to write all words of this language. In order to solve these ambiguities the children must learn context rules and written word forms. Beside those intra-language ambiguities the other language realizes certain phonemes differently, what leads up to inter-language ambiguities. This additional demand can cause specific interference errors.

We started a longitudinal study in the German School in Lisbon, in which we dictate the children German and Portuguese Words and Neologisms. The stimuli are controlled for inter-language ambiguities and phonemes that only exist in one of the languages. Order of presentation (words and neologisms) is controlled for as well as the language in which the instructions are given. Number and type of error are the independent variables. The children are grouped according whether they are truly bilingual or German/Portuguese is their first language. Comparison are made between second, third and forth grade and between children that are monolingual either in German or Portuguese and the bilingual children. We expect language interferences for the children with a clear dominant mother tongue, especially for phonemes that exist in both languages with a different realization.

Key words: bilingualism, phoneme-grapheme correspondence, acquisition of writing

12. Language competence in successive bilingual children in Germany

Annette Fox
S. Vogt
University of Applied Sciences / Europa Fachhochschule Fresenius
Speech Therapy
Idstein, Germany

In Germany the majority of children growing up bilingual fall into the category of successive bilingualism. The children mostly from migration background with both parents being non-native German speakers start learning German once they start kindergarten by the age of three to four years. They attend kindergarten for two to three years until schooling starts by the age of six. Language support for learning German is not a general offer available for bilingual children in kindergartens. Thus the children's language competences in German often are the result of what the child happened to pick up during kindergarten hours by itself. This does not necessarily lead to age appropriate language abilities in comparison to their monolingual German-speaking peers once they enter school.

For the past four years a large scale language screening project assessing language abilities in kindergarten children within the town and region of Idstein, Germany, has looked at the difference and similarities of language competences in mono- and bilingual children. The aim of this presentation is to describe the findings and discuss the influence of language support courses within kindergartens on German competence. Further, possible indicators for differentiating language disorders from low language abilities in the second language German will be discussed.

Key words: bilingualism, children, language competence, German, language support

13. Cross-border domain-specific accreditation standards in SLT

Hilde Chantrain
Lessius Hogeschool
Antwerp, Belgium

Hetty Ebben
Fontys University of Professional Education
Department of Speech and language therapy
Eindhoven, Netherlands

The aim of the project: To determine domain- specific standards for the beginning speech language therapist.

The methodology of the project: By mean of questionnaires we determined which competencies are important for a SLT and at what level a BA and a MA in SLT should master these competencies.
Phases of the project:

• Questionnaire on the requirements of the field and of the educational programmes has been send to graduates of all SLT departments in Flanders.
  
• Questionnaire on the entrance competencies of newly graduated SLT in Flanders and in the Netherlands.
  
• Comparison of the entrance levels and the requirements of the field and the educational programmes.
  
• Draft of minimal standards based on the results of inquiries in Flanders and in the Netherlands.
  
• Suggestions for adaptation of curricula in SLT related to the results of the project.
  
• Inquiry on entrance levels in the field of SLT.
  Results of the project:
  
• The field and the SLT training programmes deem 64 domain specific- competencies very important. Professionals from all fields agree on this.
  
• All competencies except 1 require a “ satisfactory” or a “ higher” level of mastery.
  
• The field as well as the training programmes request a different mastery level for BA and MA in a restricted number of competencies.

Based on the results of the project we created 1 list of minimum standards for SLT’s.

Key words: competencies, cross-border project, educational programmes SLT, entrance levels, mastery level

14. Bilingualism at the early stages of education in Poland

Magorzata Rocawska

Abstracts will be published soon.

15. What is meant by ‘re-educate’? Introductory essay to the speech and language therapy profession in Europe

Emmanuelle Lederlé
Université de Nancy
Université de Mont Saint-Aigan
Nancy, France

The content of this essay came from interrogations (caused by)arising from the title chosen for the next congress: "Multicultural and Multilingual Europe: a challenge for (the) speech therapists ". It seemed necessary to me to clarify certain terms and to work out their significance together.

From a socio - linguistic point of view, examining the concepts to which these terms refer, involves discovering which concepts different members of the linguistic community have built and which have been formed by professionals and specialists in the field of speech and language therapy within this community.
The way this profession is viewed and practiced in different countries has been and still is the object of much deliberation within the commissions in the CPLOL

Our goal is not – due to the extent of the task - to try to review the concept of our (profession in each European country, but to reveal and to instigate consideration arising from data on this profession as presented in a Doctorate of Language Science in France. This essay will be interactional and examine notions such as ‘re-education’ – ‘co-construction’ – ‘knowledge’ – ‘savoir-faire’. It will imply changes in perspective on the profession.

Key words: Re-educate, interaction, co-construction, professional practices, representations

16. The progress of Finnish language in multilingual children in a multicultural day-care group

Anna Palojärvi
Ruskeasuo School
Helsinki, Finland

Kaisa Launonen
Department of Speech Sciences University of Helsinki
Helsinki, Finland

An increasing number of multicultural and multilingual children attend day care in many European countries, including Finland. Many of these children have poor second language skills, and they need assistance to develop these skills. Speech therapists need to evaluate also their language skills, and to determine whether their eventual problems are caused by difficulties in second language learning or language impairments. In present study, progress in Finnish language learning of six multicultural (native languages Arabic and Albanian), four to five-year-old children was followed. In the daily programme of their day care group, special emphasis was placed on supporting their Finnish language skills. Evaluations, made before and after a six to nine-month follow-up period, consisted of clinical measures and interviews of the day care personnel and children’s parents. Additionally, the personnel and the researcher made notes on the children’s progress. Finnish skills of all children advanced at all sub-areas. In each test or test component, the children whose initial skills were the weakest, advanced the most. Children’s native language skills also seemed to play a role in their learning of Finnish. In spite of their progress, all children fell behind the average of children in their age group, still after the follow-up period. These findings suggest that intensive communication in a small group may have a positive effect on multicultural children’s second language development.

Key words: multilingualism, second language learning, intensive interaction, multiculturalism, evaluation

17. Childhood language disorders: practice of speech and language therapy with multilingual clients - comparison of the service provision in Germany and the UK

Christine Lachmann
Munich, Germany

The presentation will focus on the comparison and evaluation of the SLT service provision for bilingual and multilingual children in Germany and the UK concerning the following aspects:

• Use of standardised assessment procedures with multilingual and multicultural clients, interpretation of results
  
• Use of translators to obtain objective assessment results in both languages
  
• Work with bilingual co-workers to assess and treat clients in their mother tongue
  
• Other possibilities to diagnose a language disorder in a mother tongue different from the therapist's
  
• Importance of the SLT´s knowledge of cultural background of clients
  
• Speech and Language Disorder vs. Second Language Acquisition
  
  Difficulty:
  
• Involvement of parents in the therapy process
  
• Language use in multilingual families: SLT´s recommendations
  
• Availability of treatment in client's mother tongue

The conclusion will try to generalise the findings and include some suggestions for
improving the training of SLTs and the service provision for multilingual clients in
order to be better prepared for a multilingual and multicultural Europe.

Key words: multilingual children, bilingual co-workers, speech and language therapy vs. second language acquisition, childhood language disorders, assessment procedures

18. EVAS –Evaluation of preschool language programmes with children from immigrant background

Karin Schakib-Ekbatan
Department for Education
Heidelberg, Germany

Fundamental language skills are crucial for learning in all areas and in the long run essential for a successful participation in society. Pre- and elementary school children from immigrant background and with limited proficiency in German are at special risk of literacy difficulties. Experiences of the past decades have shown that an effective intervention has to start prior to school. However, the few existing pre-school language programmes have, so far, not been evaluated regarding their effectiveness. On behalf of the Landesstiftung Baden-Württemberg and as part of the EVAS longitudinal study (2005-2008) a total of 640 children with and without immigrant background will participate in various specific and unspecific language programmes. Data on school achievement, assessed during the first two years of elementary school, will be used for evaluation. The question at hand will be how and by means of which programme chances of successful schooling and literacy acquisition of children from immigrant background can be increased on a long-term perspective. Language related skills and cognitive abilities will be assessed using a pre- and post-test design. Supplementary data will be assessed by parents’ and teachers’ questionnaires. Design and first results of the pre- and post tests prior to school will be presented and discussed.

Key words: migration, preschool children, education, language programme, longitudinal study

19. Successful treatment of vocal fold palsy in a language different from patients and therapists mother tongue

Sabine Hofmann
Studio logopedico ‘Mindworks’
Terni, Italy

Only two month after appearance of first symptoms the patient was correctly diagnosed and subsequently got taken into therapy. Not only voice quality was impaired but also respiratory problems and dysphagia for liquids were present, the sphincteric function of glottis in general was compromised. Muscle tone especially in the neck region and in the right arm was increased. No abdominal movements were visible during respiration.

Following Schlaffhorst-Andersen method in a first stage therapy focused on perception and regulation of muscle tone and respiration through passive exercises. Next step was conscious reaction on motor impulses. All exercises were proposed in the patient’s respiratory rhythm respecting the pause after expiration. In this way it was soon possible to observe positive respiratory reactions like deeper inspiration and sigh-like expiration. Voice exercises mired at perception of minimal sufficient force and maximum coordination (e.g. respiration – pushing/pulling impulses – phonation). In standing position impulses provoke reactions in regulation of balance, this ameliorates muscle tone, the patient got physically hold and supported. All these exercises having specific goals and being chosen according to individual condition do also have a more general meaning that regards relational aspects and variety of possible stress reactions by using indirectly the physical experience and non-verbal communication during exercises as basic concepts for unconscious metaphoric elaboration.

In part non-verbal communication may assure successful treatment even if patient and therapist come from different cultures, while gender difference is considered to be more critical.

Key words: vocal fold palsy, Schlaffhorst-Andersen method, therapeutical relation, non-verbal communication, metaphors.

20. Speaking fundamental frequency differences in German/English bilinguals

Wiebke Scharff Rethfeldt
Bremen, Germany

Nicholas Miller
University of Newcastle-upon-Tyne
Newcastle, United Kingdom

Many studies point to cross language differences in speech parameters – such as degree of aspiration, voice onset times. The existence of such differences raises the question as to whether and how such differences are realised by bilingual speakers and whether these differences influence speech-voice therapy.

One neglected characteristic that may differ across languages and that has implications for the diagnosis and treatment of voice disturbances concerns speaking fundamental frequency (SFF). Although several studies have found that SFF differs across languages, it is not clear how far differences are realised by bilingual speakers.

We examined SFF in matched pairs of monolingual German and English speakers and in highly proficient bilingual individuals speaking in German and English. Results confirm that SFF differs across German and English monolinguals. Furthermore it shows that the bilinguals use significantly different SFF values for each language, with a higher SFF for English than German. However, SFF was produced significantly different from their monolingual counterparts in both their English and German, with values intermediate between SFF values found for the monolingual speakers.

We discuss these findings in relation to issues in the diagnosis and treatment of voice change in bilingual speakers.

21. Strengthening learning through interdisciplinary collaboration

Lynette Goldberg
Communication Sciences and Disorders

Sheila Gordon
Theatre and Dance

Nancy M. Dion
Physician Assistant Studies

Cheryl A. Hellmann
Media, Journalism, and Film
Missouri State University
Springfield, Missouri, USA

This presentation details an innovative, interdisciplinary approach to the study of vocal fold physiology in relation to vocal expression in performance. Students in Communication Sciences and Disorders and Theatre and Dance performed Shakespearean monologues and evaluated seven parameters of vocal production in these performances through perceptual analysis. This perceptual analysis followed students’ participation in a series of collaborative laboratory sessions emphasizing the use of flexible endoscopy to learn about laryngeal and vocal fold physiology. Additional visual aids included videotapes, medical images, articles and a model of the vocal tract. Pre- and post-testing documented significant increases in knowledge and understanding of vocal fold physiology and optimal voice use for both groups of students. Overall, both groups of students responded similarly to the perceptual analysis of vocal parameters in 10 randomly presented monologues. The one parameter in which significant group differences were evident was vocal inflection. The Theatre students were more critical in their perceptual evaluation of this parameter. These results and an analysis of students’ reflective comments in journals support this collaborative interdisciplinary approach to facilitate students’ understanding of the structure and function of the vocal mechanism and optimal voice use.

22. Multi-ethnic speech therapy

Christian Calbour
Nantes, France

The mother tongue and the language structure, which are specific of an ethnic group, seem to doom speech therapists to treatment in only one language. However, if they are increasingly confronted with plurality of languages as a consequence of population migrations and ethnic mixing, they must also confront the multiplicity of languages which is rife in their mother tongue. In fact, the explosion of traditional social classes into a multitude of social and dialectic tribes creates as many types of jargons; unstructured languages, without culture, with no communication with the outside world.

If speech and language therapy has, for a long time now, dealt with language-based pathologies resulting from bilingualism in migrant and refugee populations, it must now respond to the challenge of the multiplicity of languages. Having been too hastily assimilated into a “perfect language” model, speech therapists can not master all the mother tongues and the ways of speaking belonging to all the micro social groups that are rife in their own language. A language deprived of its maternal roots, the culture which underpins it and its social contexts is only a glossary. By integrating the whole family, with its ethnic group-specific linguistic, cultural and social references, into the therapeutic process, speech therapists can act effectively and coherently without making harmful changes to their usual methods. This ethnically-loaded speech therapy is more than a response to the challenge of plurilinguism, multilinguism and multiculturalism. It is the opening of hearts and minds that reinforces communication indispensable to peoples.

Key words: mother tongue – plurality of languages – multiplicity of languages –family speech therapy – ethnic speech therapy

23. Language and migration. Intercultural migration and logopedics

Francine Rosenbaum
Neuchâtel
Switzerland

The nature and role of intercultural mediation continue to be undervalued in dealing with migrants and their families, particularly at times when there are language and communication problems. The presentation briefly outlines its premises and applications as well as its impact on clinical logopedics, psychosociology and psychopedagogy. Using my clinical experience in the area of intercultural logopedics, I will show how qualified linguistic-cultural mediation enables one to question the assumptions and options at play (in institutions and in families) at times of crisis, in order to resolve the disturbances existing at the time and suggest, in mutually respectful ways, alternatives. The role of the work carried out by the trio of therapist, mediator and migrant client, consists in bringing to light inherent differences between the groups represented.

Qualified linguistic-cultural mediation is not translating; it is the interface between professionals and end-users, allowing those involved in talks with one another to ask questions about the cultural models that underpin aetiologies and their respective therapies.

Key words: ethnologopedics, migration, language disorders, intercultural mediation.

24. Crossed observations on translinguistic and transcultural experiences during speech-therapy “humanitarian” missions.

Elisabeth Manteau
Saxi-Bourbon, France

Syliva Topouzkhanian
Villeurbanne, France

This presentation aims to analyse translinguistic and transcultural experiences which occurred during speech-therapy “humanitarian” missions, particularly to Africa, to discover educational precepts useful to speech therapy practice in a country usually thought of as monolingual and monocultural: France. Once over the cultural shock of early missions, we are lead to ask questions about a number of concepts closely linked to cultural realities such as the way disability is represented, the status of handicapped people or indeed the social roles of speech, written language and imagery. These re-evaluations lead us to question the assumption that these concepts are shared in the families of the children we take care of in our French clinical practices. Moreover, the discovery of the linguistic and cultural mosaic of so-called Francophone countries, leads us to think about the French language, as it might be understood, used and lived in these same families, whatever their linguistic or cultural origins. The presentation will suggest guidelines for further thought, resulting from these experiences, aiming to improve our work in France or elsewhere, with children and their families with different languages and/or from different cultures.

Key words: francophony, plurilingualism, transculturalism, representations

25. The responses of bilingual children in a phonology screening instrument

Yvonne Wren
Research Speech and Language Therapist
Speech and Language Therapy Research Unit
Frenchay Hospital
Bristol, United Kingdom

Sue Roulstone
Faculty of Health & Social Care
University of the West of England
Speech and Language Therapy Research Unit
Frenchay Hospital
Bristol, United Kingdom

Many assessments of children’s speech and language are standardised for speakers of one language. Where children are bilingual or have learnt the language used in an assessment as an additional language, their responses to formal assessment may be different from those who only speak the language used in the test.

To investigate this issue in the development of a new screening assessment of children’s phonology, 32 children who were either bilingual or learning English as an additional language were assessed using both the new assessment and a standardised test of children’s phonology (the DEAP). Some of these children had phonological impairment while others did not.

The responses of these children to the new screening assessment was compared to that of the standardised test. The reliability of the screening assessment in identifying children who were bilingual or learning English as an additional language needing referral to speech and language therapy was then compared with the reliability for children who spoke only English.

A qualitative analysis of the particular difficulties faced by children who are bi- or multilingual in the phonology screening assessment was also carried out. Implications for the use of this assessment with this population and issues to consider when other single language assessments are used with bilingual children are discussed.

Key words: phonology, bilingualism, assessment.

26. Selective mutism associated with language disorder in the bilingual child: Issues concerning differential diagnosis

Maria Vlassopoulos
Dimitris Anagnostopoulos
University of Athens Medical School
Department of Psychiatry
Athens, Greece

Research suggests that the prevalence of selective mutism (SM) in children from immigrant backgrounds is considerably higher than that found in native speakers. The diagnosis of SM in immigrant/language minority children is however difficult, since some children may undergo a “silent period” during second language acquisition, which may be a consequence of normal bilingual language development. In contrast, bilingual children with SM usually present mutism in both languages, in several settings and for significant periods of time.

As well as a disposition towards social anxiety, many children with SM may have speech and language disorder/delay and other neurodevelopmental disorders.

Regarding the bilingual child, differential diagnosis must ascertain that the child’s failure to speak is not due to a lack of proficiency in the required language, in which case the diagnosis of SM would be excluded. Language or neurodevelopmental disorders must also be investigated.

This paper describes a multifactorial approach to assess the interdependent vulnerabilities of these children. Assessment should provide a comprehensive evaluation of all contributing factors, which in turn would carry important therapeutic and prognostic implications for the child and his family.

Two cases studies are presented of bilingual children with SM with language disorder. Treatment implications are discussed.

Key words: selective mutism, language disorder, bilingualism

27. Do reading speed tests really measure reading?

Carola Schnitzler
Gerheid Scheerer-Neumann
Department of Primary Education
University of Potsdam
Potsdam, Germany

Group reading speed tests always need to integrate other cognitive operations than merely reading (e.g. categorizing words) and it is an open question, how strongly results are confounded with the time it takes to perform these other operations. Three speed tests were applied to German primary school children from grade one to five (N=459): While first results seemed to suggest that reading speed tests measure some sort basic cognitive processing speed, selected correlations between the different tests and the data of poor readers indicate that the speed reading tests applied at least contain important components specific to reading.

28. Interpreters as assistant in multilingual speech-language diagnostics

Mirjam Blumenthal
Audiological Centre The Hague
Expertise centre of multilingualism and child development
The Hague, The Netherlands

In the Netherlands, multilingual children with a possible speech-language delay/impairment are usually referred to Audiological Centres for diagnostic purposes. The speech-language development is assessed by a multidisciplinary team. This assessment has to be performed in all the languages the children speak and/or understand. In most cases the assessor does not speak the child’s home language(s). As a consequence, a mediator who speaks the home language is needed. Interpreters are not trained to assist in this kind of work.

The work that the interpreter is asked to do is very different from the usual interpreters’ work. For example, the interpreter is asked to administer tests, listen to the child’s utterances, and if possible to give an opinion about it’s intelligibility or grammaticality. These are tasks for which special training is needed. In this project a training course meant to teach the interpreters what is needed for this kind of work was developed, and experimentally performed.

In this contribution the following will be elaborated:

• Content of the course
  
• Didactic methods used
  
• Evaluation
  
• Future plans

Key-words: interpreters, multilingual assessment, speech-language development, training course

29. Professional and parental cultures: their influence on service provision in Speech and Language Therapy

Julie Marshall
Julie Phillips
Juliet Goldbart
Research Institute of Health and Social Change
Faculty of Health and Social Care
Manchester Metropolitan University
Manchester, United Kingdom

Some authors, e.g. Pillay (2003) have suggested that our definitions of culture should be broader than traditional definitions, which often include only ethnicity, language and religion. It has been argued that culture should also encompass such influences as age, gender, sexuality, socio-economic status, educational background, (dis)ability, health etc. These broader definitions could also include consideration of the culture of being a parent and of being a professional.

The impact of membership of two sub-cultural groups (namely, parents of children with communication difficulties and Speech and Language Therapists), on the practice of speech and language therapy, is considered through the discussion of two recent pieces of research carried out in the UK. These are:

• Parents’ and Speech and Language Therapists’ explanatory models of language development/language delay;
  
• the views and experiences of parents whose children need to use augmentative and alternative communication.

Selected data from these two projects will be presented and the discussion will broaden to include consideration of other related research. The implications of parental and professional perspectives on the provision of appropriate services for the diverse residents of Europe will be discussed.

Key words: cross-cultural competence, language development, professional culture, parents

30. Speech and Language Therapy services for mulitlingual clients: the impact of official language construction and implementation

Aoifa Hayden
The Health Service Executive
Dublin, Ireland

This paper focuses on speech and language therapy service provision for bilingual and non-English speaking clients in the area formerly known as the Eastern Regional Health Authority (ERHA) in Ireland. It describes research conducted among speech and language therapists in this area involving quantitative (questionnaire) and qualitative (interview) methods. The data were analysed according to a model of official language construction and implementation, and furthermore compared with research to date on best practice for bilingual speech and language therapy clients.

The findings of the research indicate that most speech and language therapists in the ERHA work with bilingual or non-English speaking clients at least occasionally. Despite this, they are typically treated as anomalous and an assimilationist approach of ‘pushing English’ is regularly adopted. Many speech and language therapists are aware of this and acknowledge the shortcomings of the service. Comparing the findings to previous research indicates that current service provision does not typically reflect best practice. Rather, a lack of training and information in the area means that the societal construction and implementation of official languages and erasure of ‘other voices’ frequently determines the service provided.

Key Words: Bilingualism, official languages, service provision, best practice.

31. Recommendations for working with bilingual children

Marion Fredman
IALP Multilingual Affairs Committee
Zichron Yaacov, Israel

José G. Centeno
IALP Multilingual Affairs Committee
Speech-Language Pathology & Audiology Program
Department of Speech, Communication Sciences, & Theatre
St. John's University
Jamaica, NY, United States of America

The Multilingual Affairs committee of the International Association of Logopedics and Phoniatrics (IALP) conducted a survey of languages used in clinical services with bilingual children in several countries. Based on this survey it was decided that there is a necessity to provide guidelines for speech-language therapists, working with children in culturally and linguistically diverse communities. These children may be bilingual, multilingual, or monolingual speakers of a minority language.

The Multilingual Affairs committee, an international panel of speech–language practitioners, developed these guidelines using several sources of information. which included guidelines and position statements compiled by the South African Speech Language and Hearing Association, The American Speech-Language-Hearing Association and The Royal College of Speech and Language Therapists and clinical experience of members of the Multilingual Affairs Committee.

This paper will provide an overview of the guidelines developed to work with bilingual children in the areas of language impairment, phonology and literacy. Individual differences in language development and the importance of involving parents in decision making regarding language choice, will be emphasized. It is hoped that these suggestions will encourage therapists to formulate guidelines in accordance with the specific needs of their own linguistically and culturally diverse communities.

Key words: Assessment, Therapy, Language impairment, phonology, literacy

32. Speech therapy in a multicultural context. Teaching children from working class and migrant families

Anette Walz
Jörn Puttkamer
Private practice
Halstenbek, Germany

The results of the PISA-study proved to be rather devastating for the Federal Republic of Germany. The German education system rather than providing the necessary support for children from socially marginalized families seems to have made it more difficult for them.

Pre-school and school education seems to be tailored to the needs of children from middle and upper-class- families whereas children from “disadvantaged” families often do not seem to receive help- speech therapy, occupational therapy and the like.

Two speech therapists will report on the experiences they have made working with such children and their families for16 years in a community centre near Hamburg . They will focus on questions such as:
­ What approaches might prove to be successful when trying to cater for the needs of working class/migrant families and their children?

­ How do these approaches differ, for example, from “conventional” speech therapy in a private surgery?
­ What factors conc. the living conditions and educational background of the family have to be taken into consideration in order to be able to work successfully with their children? What is necessary on the part of the institutions offering the assistance to ‘keep their doors open for such families and their children?
Working in a multi-professional team and the abovementioned special focus, has made a special kind of approach to speech-therapy possible.

33. The parent-child interaction approach

Shyamanih Hettiarachchi
City University
London, United Kingdom

The Parent-Child Interaction approach (Kelman and Schneider, 1994) and the Hanen Parent Programm (Manolson, 1992) are arguably the most widely used therapy approaches with children who have a language learning difficulty. The underlying premise is that changes to the ‘style’ of interaction between children and adults can maximize communicative opportunities and the language learning experience. These approaches are based on research in ‘western culture’ (i.e. Caucasian, middle class backgrounds), mostly from North America on ‘child-directed speech’ (Snow, 1999).

Within the growing multiculturalism and diversity in Britain and Europe, the challenge is to move beyond paying lip-service to ‘cultural issues’ and evaluate not only the linguistic but also the cultural appropriateness of therapy approaches. This study looks at two groups of Tamil or Bengali-speaking mother/child dyads (British South Asian communities). One group consists of mothers who have a child with language learning difficulties while the other group has children with typically developing language. It is an ethnographic study utilising aspects of both qualitative and quantitative analyses. The aim is to observe and document features of natural parent-child interaction during play and to investigate parental perceptions on the process of child language acquisition (socio-cultural views) and their role within this process. Initial evidence suggests that mothers take on a ‘teaching’ role during play and display interaction features which are dissimilar to their ‘western’ counterparts.

Key words: parent-child interaction, language acquisition, culture, perceptions, attitudes

34. Bilingual parents' language use in child-directed speech: four case studies of English-Finnish bilingual parents

Mia Morris
Anna-Maija Korpijaakko-Huuhka
University of Helsinki
Helsinki, Finland

Introduction: An increasing number of children in Europe are born into bilingual families. The linguistic context created by parents is a child's primary context of language development, and parents' use of language/s affects the child's language acquisition. Until recently little attention has been paid to the issues of language use that parents encounter as they raise their child bilingually. This study investigates parental models of bilingual language acquisition.

Method:Two types of data were collected from four bilingual parents. Interviews were aimed at collecting detailed information about the model of bilingual language acquisition employed. Videotape data from the parent-child dyad and the family triad was aimed at unveiling how the model is exercised in practice.

Preliminary results: Each bilingual parent had a main language of use. However, two parents adhered quite strictly to using only that language, while two switched more freely between languages. Parental language switching occurred in reaction to child initiated language switches or as a use of "personal loans", consistently employed borrowed words with equivalents in the other language. Parents were able to describe their use of languages in a detailed interview. The methods and results of this study can set the scene for more accurate evaluation and comprehension of the language contexts of a bilingual child and, if need be, for more precise guidance of bilingual parents.

Key words: bilingualism, language choice, language use, parent-child interaction, code switching

35. Cross-cultural similarities and differences in parents’ and speech and language therapists’ play: the influence on intervention for children with communication disorders

Julie Phillips
Juliet Goldbart
Julie Marshall
Research Institute of Health and Social Change
Faculty of Health and Social Care
Manchester Metropolitan University
Manchester, United Kingdom

The development of language and play are closely related (McCune-Nicolich, 1986; Ogura 1991). However there is evidence that play and attitudes towards it vary widely around the world. e.g. Lancy (1996). The cultural influences on people who live in Europe (including both parents of children with communication disorders and the professionals who work with them) are ever-increasing. Speech and Language Therapists (SLTs) in the UK, and elsewhere, often use play as medium of intervention for children with communication disorders of various types.

In order to use play to work successfully with families where a child has a communication disorder, the factors above need to be taken into account. SLTs need to acknowledge the possible differences between theirs and parents’ ideas, in terms of their views about play and they need to understand the diversity of cultural influences on parents.

In order to address some of these issues, data will be presented from two studies in the UK, as well as considering relevant theoretical perspectives on both play and culture.

The implications for the provision of appropriate services for the diverse residents of Europe will be debated.

Key words: play, parents, cross-cultural influences

36. Bilingualism at an early stage: is it an advantage or a handicap?

Nicole Denni-Krichel
Strasbourg, France

Many children, in France as in most of our European countries, come from families where the family language is different from the official language. This phenomenon is part of the plural construction of our societies, and it cannot be ignored or changed. However, and even though almost half of the world population is bilingual, bilingualism at an early age is not considered as a normal phenomenon, but as an exception. What could be the role of speech and language therapy in bringing our society to understand that the ability to communicate develops whatever the number of languages small children are exposed to simultaneously?

Key words: family languages, mother-tongue, multilingualism, Europe, speech and language therapy, CPLOL.

37. Measuring phonological skills in adolescence

Ann French
Faculty of Health and Social Care
Manchester Metropolitan University
Manchester, United Kingdom

Adolescent language skills are relatively under-researched. A project has been set up to look at phonological abilities in students aged 11-12 years attending mainstream education. Aims are to

1. develop tests of phonological word knowledge, rhyme recognition and phoneme manipulation,
2. assess phonological ability and working memory in a random sample of 100 students,
3. examine the interaction between phonological performance and working memory,
4. identify developmental factors correlating with phonological skills, and
5. correlate phonological factors with educational progress.

The first data collection will take place in early Spring 2006. The proposed presentation will report on findings to date, but also discuss methodological challenges in the construction of phonological tests, including:

• Lexical selection. Factors include word familiarity, indexed by word frequency or age of acquisition; word length; and phonological similarity.
  
• The need to measure phonological knowledge (i) independently of working memory (ii) without relying on literacy skills (which may be minimal for some students.)
  
• The inclusion of verb targets: verbs are particularly problematic for some students, and yet acquisition data is limited.

Multilingual students are likely to differ from monolinguals in phonological development. This group has been excluded from the first stage of the project in order to reduce the number of potential variables, but consideration will be given to the additional challenges involved.

Key words: Phonological recognition; phonological awareness; assessment; adolescence

38. KIDS – a direct approach in stuttering intervention for children and teenagers aged 2 to 17 years

Patricia Sandrieser
Katholisches Klinikum Marienhof / St. Josefs gGmbH
Koblenz, Germany

Peter Schneider
Universitätsklinikum RWTH Aachen
Aachen, Germany

‘KIDS’ is a direct approach for intervention with childhood and teenage stuttering. In this approach, the child’s speech patterns and child’s` and parents` awareness and their beliefs about stuttering are modified simultaneously. The programme is based on the understanding that stuttering is a dynamic multifactorial disorder. The techniques trace back to the classic programmes of stuttering modification but they are adjusted to the needs of the different age groups. Preschool children and children from basic elementary school are treated individually in attendance of one of their parents. The goal of therapy is to establish a technique that enables the child to control the moments of stuttering and to get the self-concept of a competent speaker. This individual sessions aim to remove secondary behaviour and to facilitate remission. Parallel to the individual therapy, both parents are invited to attend a parental evening group that meets 5 times. Topics like the development of stuttering, the goals of different therapy approaches, stuttering and school and stuttering and society are introduced and discussed. The aim of these evening sessions is to inform the parents about stuttering and to modify the communication environment if necessary. Teenage children are treated individually and in group sessions and the attendance of their parents at therapy is lesser and is arranged individually.

The presentation will give an overview of the important techniques in the different age groups and demonstrate the individual sessions in video examples.

Key words: stuttering, direct intervention, stuttering modification, parental counselling

39. Alzheimer’ Disease: speech and communication groups
­ The contribution made by the socio-cultural diversity of participants
­ The contribution made by contributors belonging to a variety of disciplines.

Brigitte Marcotte
Paris, France

Based on a study of clinical cases, reflections on dealing with communication problems in patients suffering from phases 2 and 3, advanced stage, Alzheimer’s disease.

1. How to set up groups?

• on what criteria, what assessments?
  
• establishing homogeneity without excluding patients with different types of pathology
  
• which practioners, contributions made by a second look, a second hearing. The role and specific skills of speech therapists.

2. Content?

• rites and rituals
  
• verbal and non-verbal communication, establishing appropriate and empathetic listening while aiming to avoid over interpretation
  
• taking into account participants’ previous knowledge and know-how
  
• restoring self- esteem, sociotherapy

3. What collaboration with families?

• mutual support
  
• controlling the illness, sharing the way with close relatives “the burden of old age can be lightened”

4. Ethical and physical extensions

• what really makes a human being?
  
• what is the place the old in our European societies?
  
• what do we expect of them, what are their duties?
  
  

40. Quality of life in cochlear-implanted children

Julia Friedrich
SPZ der Heinrich-Heine-Universitätsklinik Düsseldorf
Düsseldorf, Germany

The number of children with CI is increasing steadily. More than 50% of all patients receiving a CI are children. The benefit of implantation is mainly evaluated by the assessment of auditory skills, language development and educational placement. Currently subjective criteria, for example QOL, are taken into account. However, most of the studies still assess quality of life by using proxy reports (i.e. parents and therapists).

Method: A CI-specific questionnaire for German-speaking children was designed. A group of 11 children with CI aged 6-15 years were asked about their QQL. Additionally, parents and therapists were asked to evaluate the children’s QQL. Duration of implantation related to age was taken into account. Therefore children were divided into two subgroups.

Results: 3 couples of parent and child showed very dissimilar QOL evaluations. Two of them showed significant differences. The evaluation of QQL between therapists and children are assumed to be more comparable. There was no difference between the two groups of children. The hypothesis that the duration of implantation influences the QQL could not be confirmed.

Conclusion: More in depth analysis has to be done to investigate QQL in children with CI in more detail. Further validation of the questionnaire is intended.

Key words: CI- children, Quality of life, questionnaire.

41. The evidence base for the assessment and management of speech and language disorders, related to bilingualism of multilingualism.

Hanneke Kalf
Radboud University Medical Centre
Department of Allied Health, speech and language therapy
Nijmegen, The Netherlands

Currently ‘evidence-based practice’ is a recognized aspect of health care and health sciences. It implies that whenever there is scientific evidence for the clinical value of an assessment or treatment, it should be used to make the right decisions during interventions. In the relatively new field of multilingualism in speech and language therapy, the question rises: what is the evidence base and how to find and use it.
In this lecture several search terms are compared using different databases. PubMed is free accessible on the internet, but does it have enough journals indexed concerning studies on multilingualism and speech and language therapy, compared to PsycInfo or other databases? Some examples of how to interpret the evidence, currently available are discussed. There is quite an amount of evidence around communicative consequences of bilingualism and multilingualism, but controlled studies evaluating therapies are limited. Inevitable questions concerning methodology will be reviewed: what are relevant research questions and which scientific frameworks should be used. Finally, the way to exchange scientific and clinical experience in itself can be a multilingual problem.

Key words: evidence-based practice, methodology, databases, multilingualism, CPLOL.

42. The Europe of Babel: linguistic diversity as world heritage

Jean-Marc Kremer
Thionville, France

The project of building Europe is unique in the history of our people. For a long time we believed in the myth of the tower of Babel representing a curse for humanity; in other words that the diversity and great number of languages, and thus the lack of understanding between people, was a source of conflicts and wars.

What is the current state of our linguistic Europe (limited to the European Union of 25) : how many first languages, how many imported second languages, how many users for each of them, is there enough room for a new European or international neo-language, what would it mean to CPLOL. And especially for us language therapists in the context of free circulation of professionals within the Union, keeping in mind the necessity for a linguistic proficiency standard, the “qualifications” directive requires of our profession (among others). These are a few of the questions raised in this speech.

Key words : first language, second language, multilingualism, Europe, Speech and language therapy, CPLOL.