Are These Speech Errors Related to International Adoption?

Happy National Adoption Month! Adopting a child is a momentous occasion in the life of a family and parents are eager to support development in any way possible. Certainly, any child can present with communication difficulty, regardless of whether they live with biological or adoptive families. But, when children have been adopted from a foreign country, additional questions may come up regarding whether challenges are related to learning a second language, or a sign of something needing to be addressed in therapy.

Luckily, a number of research studies have addressed this question, and resources are available for speech-language pathologists and parents alike to help with monitoring a child’s speech and language development as they are learning English and adjusting to life with their family.

Language Learning Concerns

The process of learning the language of an adoptive family is unique from most cases of learning a foreign language because very often, the child does not retain any knowledge of his or her native language (unlike when an adult decides to learn a new language, or when members of a family are bilingual and speak two languages at home). The scenario in international adoption has been called second-first language acquisition. The child who is adopted is learning a second native language, and most often very quickly loses proficiency in the first native language.

The challenge is identifying when a child may be struggling with learning words and phrases in English because of some underlying difficulty with his or her ability to learn any language. A few tips suggested by research in this area can help to guide decision making about whether a child may have a true language disorder, or just needs more time to get some momentum with English.

1) Does the child show good prelinguistic, nonverbal communication skills? Looking for good joint attention, eye contact, object permanence, gestural communication, etc, can help to suggest strong foundational skills for language acquisition that are promising for language learning prognosis, particularly in young toddlers.

2) Is the child learning to understand English rapidly? We expect kids who do not have an underlying language impairment to show rapid gains in English, particularly in their ability to understand new words and directions or questions depending on their age.

3) Was the child speaking their native language at an age appropriate level before being adopted? Any delays in the native language suggest that kids may be at risk for difficulty with learning English as well. While some delays could be related to lack of stimulation in the pre-adoption setting, it would still be a good idea for any reports of language delay in the native language to raise flags for close monitoring by a speech-language pathologist and a low threshold for when to provide regular services.

4) How old was the child when they were adopted? As a general rule of thumb, the younger a child is when adopted, and the more time that’s passed since adoption, the better we would expect them to be at speaking English. Plus, comparing standardized testing results with the normative data provided in the test manual becomes more reliable as well. For example, if the child was adopted before age two and has been living with their adoptive family for about a year, then using norms from standardized tests is reliable. In comparison, children who were adopted between three and four years of age need to have been living with their adopted family for 12 months before receptive language can reliably be tested using standardized norms, and for three years before expressive norms can be used. In the meantime, research suggests using a criterion cut off for expressive language concern of a standard score below 76 on the Clinical Evaluation of Language Fundamentals—Preschool 2nd Edition.

5) Are there any red flags for multiple system impairment or general developmental delay? If children present with any additional medical concerns, such as urinary, cardiac, or neurological issues, or have a known or suspected history of abuse or neglect, then risk for ongoing difficulty is likely to be higher. Informal assessment measures for therapy planning are indicated, regardless of age at adoption or time with the adoptive family.

Articulation Disorder or Second Language Learning?

Children not only need to learn the vocabulary and sentence structure of the adoptive family’s language, but also need to learn correct pronunciation of all the phonemes of that language as well. This can lead to questions about whether a given error pattern is caused by an underlying articulation or phonological disorder, or may just be reflective of the impact of the native language on the child’s English pronunciation.

In fact, in most cases, children acquire the sound system of the new language very quickly. Many researchers have reported that a majority of internationally adopted children have accurate articulation skills within a year after being adopted. This would suggest that residual errors after that time should be evaluated for possible articulation therapy services. Additionally, as noted above, if children have any co-occurring concerns with development or medical issues, a closer look at the phonological system is in order sooner rather than later. The American Speech-Language-Hearing Association has resources for understanding the native phonological system and potential impact on speakers learning English. Errors made outside of these lists (that are not age appropriate) are likely to be reflective of difficulty with learning the rules of English articulation and would suggest a need for therapy services.

A large number of children adopted internationally have a cleft palate. In these cases, articulation therapy is much more likely to be needed because of the myriad of additional issues that children with clefts face when placed in institutions prior to adoption, such as a late palate repair or untreated middle ear infections. For these reasons, children with clefts who are internationally adopted should be seen by an interdisciplinary cleft palate team as soon as possible after adoption (see the American Cleft Palate-Craniofacial Association for resources to find a team near you). Starting speech therapy services to work on articulation skills right away is generally recommended because of the high rate of cleft compensatory articulation impairment in kids who are adopted. These errors are deeply habituated and do not vanish with the repair of the cleft palate, and as such, there is no reason to wait to begin therapy until after surgery. Behavioral articulation therapy is effective in treating these errors, regardless of the physical status of the cleft palate repair.

In Summary

Kids who are internationally adopted can acquire English rapidly after arriving to live with their adoptive family, with little long term impact of their native language on their English development. Like all children, some will present with speech and/or language impairment, and because of the unique language learning environment, it can be tricky to tease apart a disorder in communication development from the natural learning curve expected when totally immersed in a new language (and most often no longer speaking the first!). The guidelines listed above are a short summary of findings from numerous researchers attempting to improve the accuracy of our early screening and evaluation efforts so that kids are not waiting to initiate services because we expect them to “catch up” eventually. Likewise, many children will learn English effortlessly and don’t require any special services. When in doubt, close monitoring and comparison to trends noted in research can help to make decisions about when to intervene.

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