Language and Literacy
Promotion in Low Income and
Bilingual Children
Mariana Glusman, MD
Medical Director
Reach Out and Read Illinois
Assistant Professor of Pediatrics
Northwestern University
Feinberg School of Medicine
Vignettes
Is this 3 year old delayed?
Spanish speaking parents
Older sister speaks English to him
Bilingual preschool
Puts two words together (Some
English some Spanish)
Can follow two part commands
Mom understands him, strangers
don’t
Affectionate with family, shy with
strangers
Older sister was more advanced at
this age
What would you advice
this 5 year-old’s parents?
Spanish at home. English in school.
Mother has no concerns.
Speaks in clear sentences in Spanish at home.
Likes to pretend she is a princess
Plays well with her cousins.
Recognizes many letters. Writes own name.
At school is very shy and hardly speaks.
Teacher is worried.
Answers you in single words.
•
•
Is this normal?
Should they start talking with her in English
at home?
Should this 18 month-old’s
parents read to him in English?
Parents speak English as a
second language.
Should you give him
bilingual books?
What if you only have books
in English?
GOALS
• Understand the magnitude and etiology of
language and literacy disparities for children of
low SES and for multilingual children in the US
• Recognize normal and abnormal language
development in dual language learners.
• Learn when to refer for Speech Therapy
• Learn about strategies to promote language and
literacy development Reach Out and ReadLeyendo Juntos, Thirty Million Words Initiative
Today
1. Language Development
2. Bilingual Language Development
3. Interventions that promote language
and Literacy in low SES and Dual
language learners.
1. Language
Development
Language Development
1. Brain Development
2. Parent-Child Relationship
3. Literacy Development
4. Poverty
Language Development
http://emedia.leeward.hawaii.edu/hurley/Lin
g102web/mod5_Llearning/5mod5.3_acquisiti
on.htm
700 New
Neural Connections per Second
Source: Huttenlocher, University of Chicago, 1979
Use it or loose it
Neural Pathways in the
Developing Reading Brain
How do these neural pathways
form?
What factors stimulate synaptic
connections?
How are connections sustained?
Early Brain and Child
Development
• Interaction of genes and experience
• The active ingredient is the “serve and
return” interaction with parents and
caregivers
• Based on secure relationships
Key aspects of responsive
parenting impacting
language/cognition
• Richness of verbal input – labeling objects and
actions (Weizman, 2001)
• Verbal scaffolding – structuring language interaction
to meet child’s needs; providing child with language
that they need (Vygotsky, 1978; Snow, 1977)
• Verbal responsivity – responding to vocalizations
with imitations or expansions, engaging in backand-forth conversation and asking questions (Hart
and Risley, 1994)
Average word acquisition
(receptive language)
• 12 to 16 months: around 40 words
• 16-24 months: 130 more new words
(Bates et al., 1994)
• Between 2-5 yrs.: up to 3000 words per
year (Nagy & Herman, 1987)
Meaningful Differences in the Everyday
Experience of Young Children
Hart and Risley (1995)
Measured how many words
children heard from 9-36
months.
Low SES kids have
a 30 million word
word deficit!
Why is that important?
Vocabulary is a key indicator for
school success as early as kindergarten
Language development sets the
foundation for literacy development.
Early Literacy Development
Dialogic Reading
 Awareness of books
More complex
vocabulary and
syntax. More
“serve and return”
interactions
Motivation to
learn to read.
Reading is fun!
Understanding
of printed
words; what
they represent
Using
background
knowledge
and strategies
to obtain
meaning from
print
Why Early Literacy Matters
Early Language and Literacy Skills
Kindergarten readiness
3rd grade Reading Proficiency
Graduation from High School
Path to success in school and life
Generational Cycle
Reading
Difficulties
Decreased
language
skills
Poverty
Poverty
More than one out of five children in the US
live in poverty (NCCP 2013)
(16,000,000)
“…early childhood is the best
investment.”
-James Heckman, Nobel Prize Winning Economist
“Investment in early education … helps reduce
the achievement gap [and] the need for
special education, increase the likelihood of
healthier lifestyles, lower the crime rate, and
reduce overall social costs. … Every dollar
invested in high-quality early childhood
education produces a 7-10% per annum
return on investment.”
Heckman, J. The Economics of Inequality, The Value of Early
Childhood Education, American Educator. (Spring, 2011)
Recap
• The brain develops incredibly fast in the first 5
years of life.
• Interaction “serve and return” is needed for this to
occur.
• Language development is dependent on input.
• There is a 30,000,000 word gap in low SES
children that is related to poorer academic
performance.
• There is a bidirectional relationship between
poverty and reading ability
• Any intervention needs to be done early to have
maximal effect.
Recap-Also for Dual Language
Learners!
• The brain develops incredibly fast in the first 5
years of life.
• Interaction is “serve and return” needed for this to
occur.
• Language development is dependent on input.
• There is a 30,000,000 word gap in low SES children
that is related to poorer academic performance. In
US overlap between DLL and low SES
• There is a bidirectional relationship between
poverty and reading ability
• Any intervention needs to be done early to have
maximal effect.
2. Bilingual Language
Development
Multilingual Families in the US
are Diverse
Different ethnic groups
Diverse set of values, practices, and resources.
Diverse SES
Countries of origin
• Mexico, Central and South America, Caribbean countries
(64%)
• Countries in Asia (23%)
• Europe and Canada (7%),
• Africa and the Middle East (6%) (Capps et al., 2005).
More than 350 languages but Spanish predominates
(72%)—eight million people— speak Spanish at home (Aud
et al., 2011).
Bilingual Development is Multifactorial
•
Setting
•
•
•
•
•
Similarity of L1 and L2
Time
•
•
•
•
Girls vs. boys
Favorable attitude toward the dominant language group
Language ability
Language
•
•
Isolated families vs. enclaves where the dominant language spoken
Family SES, education level, and literacy skills
Parents’ desire to pass on their heritage language
Exposure to each language (by native and non-native speakers)
Person
•
•
•
•
(Bornstein 2013)
Age (or developmental status) of language learner
Duration of exposure
Historical time-“three-generation rule.”
Mechanism
•
•
•
•
Proportion of parents’ L1 vs. L2 use
Reward/discouragement of desirable/undesirable language use
Observation and modeling by L2 learners
Direct instruction involving formal tuition, curricula, and school classrooms
Benefits of Bilingualism
• Neural pathways for
language learning
stay open longer
• Increased cognitive
flexibility and
metalinguistic ability
• Slower memory loss
with aging
True or False?
Early exposure to two languages
leads to delays T/F
FALSE (but a little bit true!)
Early exposure to two languages
does NOT lead to delays
• With time, the human brain is able
to learn two languages as easily as
one
• Initial vocabulary in each language
may be smaller but, when you
include both languages the total
vocabulary is usually the same
Longitudinal Studies of SpanishEnglish Bilingual Children in South
Florida
(Hoff et al.)
• Study 1
• 47 Spanish-English bilingual children
• 56 English monolingual children, matched for SES
• 22 months to 4 years
• Study 2
• In progress, over 150 bilingual and 40
monolingual children
Compared bilingual and monolingual
children from similar educational
background
Monolingual sample
30
30
25
25
20
20
15
Mother
10
Bilingual sample
Father
15
10
5
5
0
0
Mother
Father
Learning two languages takes
longer than learning one
language
Vocabulary
Bilingual children lag 3-4
months on average
behind monolingual
children, when looking at
each individual language
Learning two languages takes
longer than learning one
language
They also lag
behind in
grammatical
development for
each language
(Hoff et al.)
Learning two languages takes
longer than learning one
language
Even in reaching the
milestone of
combining words
Note that by 24-25
months months they
are not statistically
different
(Hoff et al.)
Total language growth is
comparable
The children are not
confused or impaired,
they are learning more
The reason for the lag is:
• Language development
depends on language
experience
• Children who hear two
languages must hear
less of each
(Hoff et al.)
True or False?
Bilingual code-mixing is a sign of
confusion T/F
FALSE:
Bilingual code-mixing is NOT a
sign of confusion
• Code-mixing aids in communication:
– 2 languages used appropriately
– they code-mix to fill proficiency gaps
– code-mixing is grammatical
• Social norm in many families
• Sometimes there’s no good translation
True or False?
Early and frequent exposure to
English is better T/F
FALSE: Early and frequent
exposure to English is NOT
better
• Bootstrapping: Strong HOME language
skills facilitate English learning
– A larger vocabulary in the home language and a richer
knowledge of the world are particularly helpful for literacy
development, and for developing the kinds of skills that you need
in school.
•
•
•
•
Using language to read
Critical thinking
Problem solving
Telling stories
Quality of English exposure matters
over and above quantity of exposure
• Proportion of input from native
speakers
• Exposure to more speakers may be
better than exposure to a limited
number of speakers
Hoff et al.
The native speaker effect (Hoff et al.):
The relation between English use at home and 4-year-old
children’s English and Spanish vocabulary
1 native English, 1 native Spanish parent
2 native Spanish parents
80
70
70
60
60
50
50
40
40
30
30
20
20
10
10
0
0
0
20
40
60
80
Percent English spoken at home
English vocabulary score (EOWPVT)
100
0
20
40
60
80
Percent English spoken at home
English vocabulary score (EOWPVT)
100
More on the native speaker effect (Hoff et
al.):
The relation between English use at home and 4-year-old
children’s
English
and Spanish
vocabulary
1 native English,
1 native Spanish
parent
2 native Spanish parents
80
80
70
70
60
60
50
50
40
40
30
30
20
20
10
10
0
0
0
20
40
60
80
Percent English spoken at home
100
0
20
40
60
80
Percent English spoken at home
English vocabulary score (EOWPVT)
English vocabulary score (EOWPVT)
Spanish vocabulary score (EOWPVT)
Spanish vocabulary score (EOWPVT)
100
What about children with
delays?
• Children who have speech delays are
still capable of leaning more than one
language at their level of potential
• Limiting their instruction to English
may be detrimental
True or False?
Young children are linguistic sponges
T/F
FALSE: Language is not
“absorbed” passively
• Wide (innate) individual differences in rates of
language learning
– Language learning takes time
– Requires interaction (media exposure not enough)
– Depends on quality of learning environment
• language for social communication
• language for thinking and literacy
3. Interventions
Interventions based on science of
language development
Children’s language evolves primarily through
parent/child Interactions, “going back and forth” (serve &
return)
The brain’s “architecture” is shaped by early experiences.
Parents talking and reading with their child builds
specific skills and connections. (repetition matters)
Differences in children’s skills are measurable as early as
9 months of age (starting early matters)
Thirty Million Words
Initiative
TMW Provides parents with:
1. Knowledge of child language
development (Curriculum-3 T’s: Tune
in, Talk more, Take Turns)
2. Belief that THEY can have an impact!
3. Tools and FEEDBACK (video modeling
and LENA)
Reach Out and Read!
The Reach Out and Read Model
Advice: Encourage parents to read aloud daily
and offer age-appropriate advice
Books: From 6 months-5 years, clinicians give
children a brand new, developmentally
appropriate book at well child visits
Environment: The practice is made into a
literacy-rich environment with posters, gently
used books, library information and volunteer
readers where feasible
Anticipatory Guidance
• Teaching HOW to enhance linguistic
environment
• How to make joint reading be
– A time to learn words and concepts
– A time to make connections between
books and the world
– A time to have a conversation
– A time to link reading, learning, and
enjoyment
Using the Book for
Developmental Surveillance
• Books are introduced early in the visit and
used as a surveillance tool
• Books are integrated into the exam within
the context of other anticipatory guidance
- not as one more thing to do
• Capitalize on “teachable moments” during
shared observation between the provider,
the parent/caregiver, and the child
ROR in Real Time
Racial and ethnic difference in
parent/child reading
90%
80%
70%
60%
50%
Latino
40%
Black
30%
white
20%
10%
0%
Read to daily
Less than
daily
Never
Number of
books
Flores et al. Arch Pediatr Adolesc Med. 2005;159:158-165.
Leyendo Juntos
Leyendo Juntos
Reach Out and Read’s
Initiative for Spanishspeaking families
• Information for parents
• Information for providers
• Online course
Leyendo Juntos
Materials
• Recommended Book Lists
• Handouts for Parents
– How do I Make Reading Fun?
– Go to the Library!
– Getting Ready for School
• Handouts for Volunteers
– Spanish Phrases and Questions
– Tips for Reading Aloud to Non-English Speaking Children
• DVD– modeling interactive reading
(Bellevue)
What books should you
choose?
• Spanish
• Bilingual
• English
How do I make reading fun?
Online Course
•
•
•
•
•
•
Demographic information
Cultural information
Bilingualism
Anticipatory Guidance
How to identify language delay
When to refer
Anticipatory Guidance
to enhance language
•
•
•
•
•
•
•
•
•
Talking about traditions
Telling family stories
Singing traditional songs
Telling poems, making them up!
Sayings and riddles
Playing with language
Encouraging development of writing
Praising emergent literacy behaviors
MODELING BOOK SHARING
How do you evaluate language
development in a child when you don’t
speak the language?
• Must rely on parental report (via interpreter)
• Have a high index of suspicion if a parent voices
concern.
• Keep in mind that parental expectations may be low
• Ask about specific language milestones (expressive and
receptive)
• Obtain information about the child's entire language
system
• Ask the parents how this child compares to other
children
• Ask about how the child is doing in school (if in
preschool or daycare).
Other questions you can ask:
• What concerns do you have?
• What does your child like to play?
• Does your child play “pretend”?
• How does your child tell you what he/she
wants? Does he/she use words or gestures?
• Does he/she know and use names of family
members?
• Does he/she talk while playing?
The ROR book can be a helpful
tool
• Point to the pictures, ask simple questions and have the
interpreter tell you what the child says.
• How much of what the child says can the interpreter
understand?
• Ask the interpreter to ask the parent to point to the
pictures so you can observe.
– Does the child readily answer?
– Are the child and parent comfortable with the book?
– Does the child show joint attention
• Points to the pictures?
• Looks at the pictures that parent is pointing at?)
When do you refer?
• Not meeting language milestones-taking both
languages into account
– No words by 12 to 15 months
– Not pointing by 15 to 18 months
– Does not know colors and numbers by age 4 (if taught!)
• Wondering whether or not the child can hear
• A history of language issues or a learning disability in
native language
• Family history of reading, writing or learning difficulties
• Low phonological awareness in either native language or
in English.
• Teacher concerns about delays (converse not the case)
When do you refer?
Even when not technically delayed,
children from low SES backgrounds
and DLL environments can benefit
from environmental enrichment and
targeted language and literacy
promoting interventions
Vignettes
Is this 3 year old delayed?
Spanish speaking parents
Older sister speaks English to him
Bilingual preschool
Puts two words together (Some
English some Spanish)
Can follow two part commands
Mom understands him, strangers
don’t
Affectionate with family, shy with
strangers
Older sister was more advanced at
this age
What would you advice
this 5 year-old’s parents?
Spanish at home. English in school.
Mother has no concerns.
Speaks in clear sentences in Spanish at home.
Likes to pretend she is a princess
Plays well with her cousins.
Recognizes many letters. Writes own name.
At school is very shy and hardly speaks.
Teacher is worried.
Answers you in single words.
•
•
Is this normal?
Should they start talking with her in English
at home?
Should this 18 month-old’s
parents read to him in English?
Parents speak English as a
second language.
Should you give him
bilingual books?
What if you only have books
in English?
Recap-Again!
• First 5 years of life are crucial for brain
development.
• “Serve and return” Interaction
• Language development is dependent on input
• 30,000,000 word gap
• In US overlap between DLL and low SES
• Bilingualism is NOT a cause of delay
• ROR and TMW are evidenced-based, parent
driven, successful early intervention
programs.
Bottom line
• Give the ROR book at the BEGINNING of
the visit!
• Use the book for developmental
surveillance
• Give anticipatory guidance
• MODEL how to use the book!
• Get trained (ROR and Leyendo Juntos)
Bottom Line (cont.)
• “3-T’s” Tune in, Talk More, Take Turns
• The quantity and quality of input matter
• Parents should speak and read in the
language most comfortable to them
• Mixing Languages is ok
• Exposing children to native speakers is
very important (the more, the better)
• TV/Media does not count as exposure
Bottom Line (cont.)
• Children that appear delayed need to be
referred, evaluated and treated
• Children from low SES may need
enrichment even if not diagnosed
impairment
• Pediatricians, early childhood educators,
home visiting programs can work
together to give parents tools to help
children develop to full potential.
In the News!
Thanks to
Perri Klass, MD
National Medical Director, Reach Out and Read
Professor of Pediatrics and Journalism, New York University
Marilyn Augustyn, MD
Medical Director, Reach Out and Read Massachusetts
Associate Professor of Pediatrics, Boston University Medical Center
Dipesh Navsaria, MPH, MSLIS, MD
Assistant Professor of Pediatrics
University of Wisconsin School of Medicine and Public Health
Erika Hoff, PhD
Professor of Psychology, Florida Atlantic University
Director Language Development Lab
Dana Suskind, MD
Professor of Surgery, The University of Chicago, Pritzker Medical
School.
Gretchen Hunsberger
Director of Program Quality and Provider Training
For more information:
www.reachoutandread.org
mglusman@luriechildrens.org