Pakistan Journal of Professional Psychology: Research & Practice
2006, Vol. 1, No. 1, 1-9
Psychosocial Correlates of Speech-Language Impairment in the Context of
Bilingual Learning Environment in a Multi Cultural Setting
Aman Ullah Khan
Language impairment is a major social and health problem. Most of the speech problems are the result
of psychosocial correlates in cross-cultural / cross-linguistic perspectives. Hypotheses were
formulated relevant to pro-active mother-child verbal transaction, bilingual families, medium of
instruction, and religious institutions (madressahs). Research entailed a questionnaire administered on
speech-language disorders at the educational institutions / and OPD referrals, diagnosed as speech-
language disorders, non-organic in Karachi SouthWest District. The data so collected were subjected
to chi-square testing. In terms of the stated objectives, overall results of the research study supported
two of the hypotheses pertaining to proactive mother-child verbal transaction, and madressah
education (religious institution / school), whereas the other hypotheses remained deficient of the
required support for the hypothesized variables like mother-father tongue compatibility i.e.
monolingual families and medium of instruction.
development of faulty speech-language faculty in a
While speech-language impairment is considered
child in various research studies. In the proactive
a major social and health problem, it is quite difficult
mother-child relationship, the main focus is on the
to define the impairment solely and simply with
early social environment which is critical for language
reference to the attributes of a person's speech. For
development and that in infancy this environment is
most practical purposes, speech-language pathology
provided largely by a mother or mother substitute who
may be defined as speech defects with features of
feels affection for the child (Robert & Glucksberg,
speech that tend to create personal problems that are
1977). Proactive verbal transaction may be defined as
handicapping or potentially handicapping
an active participation in verbal exchange of
interpersonal relationships (Bloodstein, 1984).
utterances between mother / caregiver and child within
Speech-language disorders may be classified into four
a social environment, duly marked with love, care, and
main categories: stuttering (fluency) / cluttering
compassion (Robert & Glucksberg, 1977). With
disorders, disorders of articulation, voice disorders,
reference to this context, maternal deprivation called
and language disorders (Evelyn & Rees, 1972).
hospitalism is another important phenomenon and is
Various studies have established the fact that
defined as either separation from the mother or
“functional” and “organic” factors tend to interact in
inadequate maternal care resulting in retarded growth,
complex ways to determine the quality of any
increased susceptibility to disease, higher infant
communication (John, 1976). The major sources of
mortality, and a delay in general maturation including
organic disorders are: structural discords, neurological
the acquisition of language. The symptoms of
disorder, auditory disorders, endocrinological
hospitalism may also occur at home when an infant
disorders (cretinism), etc. On the other hand,
receives insufficient maternal care (Robert &
functional disorders of speech may be due to either
Glucksberg, 1977).
faulty learning (a disorder of learning) or faulty
Bilingualism is another important area that has
motivation, i.e. heightened drive states such as anxiety
been viewed with concern by some of the research
or other motivation that conflict with normal speech
studies carried out in the educational, and socio-
which account for 70-80% of speech language
cultural perspective. A number of studies (Hakuta &
pathology (Cornett, & Chabon, 1988).
Various
Garcia, 1989; Lambert & Peal, 1972; Lindholm, 1991)
psychological theories attempt to explain the
have suggested that bilingual students actually have an
dynamics of speech language pathology in the light of
advantage over monolinguals . For example, speakers
sociological conditions and their impact on the mind
of two languages show more cognitive flexibility.
resulting into the undesirable symptomatology.
They have more linguistic possibilities available for
Proactive mother-child relationship is one of the
containing situations they encounter because of their
important areas considered relevant to the
multiple-language abilities (Lindholm, 1991). In turn,
2
AMAN ULLAH KHAN
this permits them to solve problems with greater
development of speech-language pathology in the
creativity. On the contrary, Mehdi (2002) has
educational system of Pakistan. According to Abbas
maintained that there is always a possibility that
(2003) the educational system in Pakistan
children exposed to two different languages might
encompasses Urdu and English medium of instruction
experience speech delay if their linguistic exposure is
parallel to madressah system that is mainly
unevenly distributed. When that happens, a young
characterized by Arabic and 'Dini Ulum' (religious
child can experience hesitation and confusion,
teachings) taught in highly stressful environmental
especially when it comes to communicating in the
conditions at some of the religious institutions
language to which he or she has been inadequately
(madressahs). The concept of bilingualism /
exposed. To prevent this from happening, Mehdi
multilingualism has been critically examined in the
(2002) suggests that one parent should speak the
perspective of fear and stress and various speech
native language with the child while the other the
disorders.
second language. Then children would be able to
In Pakistan, there is a strong need to ascertain
associate each parent with a different sound and
incidence of speech-language impairment. Amongst
language pattern .
the cases come for help, many are not diagnosed with
In the context of bilingualism / multilingualism
speech impairment and go unnoticed because of low
vis-à-vis medium of instruction in Pakistani school
awareness. These cases otherwise can be managed,
system, according to Mansoor (2001) medium of
and hence are a source of genuine concern (Mehdi,
instruction is one of the most decisive factors in school
2002). This study has been carried out to explore the
achievement of the children. Bilingualism by
incidence of speech- language pathology,
definition implies a learning process where at least two
classification, etiological factors and its psychosocial
languages are involved. Pakistani students have a
correlates in particular reference to cross-cultural and
multilingual and a multicultural background where
cross-linguistic perspective. The study, therefore, aims
Urdu is the mother tongue of only 7 percent of the
at a careful investigation of finding out various
population and a host of regional languages such as
environmental (non-organic) factors responsible for
Punjabi, Sindhi, Balochi, Pushto, Seraiki, Gujrati,
speech-language pathology in South/ West district,
Memon / Kachi, Hindko, and Brohi along with their
Karachi.
numerous dialects are spoken by the majority. The
Based on the findings of the currently available
methods of instruction adopted: Urdu, English,
literature, certain hypotheses were formulated to
Arabic, and any other local language are generally
ascertain the degree of relationship between the
perceived as posing a threat to the regional learners
psycho-social variables (correlates) and speech-
having their mother tongue different from that of the
language pathology as follows:
prevalent medium of instruction at their educational
Hypothesis 1: Pro-active mother-child verbal
institution (Mansoor, 2001). In speech-language
transaction is positively related with speech-language
developmental perspective, the dichotomy may result
development.
in various types of disorders. Thus, it calls for a
Hypothesis 2: Monolingual families (mother-
scientific study of the factors working in bilingualism /
father tongue compatibility) as compared to bilingual
multilingualism vis-à-vis medium of instructions in
families are positively related to speech-language
our school system.
development.
According to Rehman (2003) the situation in some
Hypothesis 3: Incompatibility of mother tongue
areas in both urban and rural parallel educational
vis-à-vis medium of instruction in the educational
institutions of 'madressah' are functioning with a
institution is related to speech-language pathology.
mixed medium of instruction i.e. Arabic and Urdu.
Hypothesis 4: Children studying at religious
This further compounds the situation. In addition,
institutions ( madressahs) display greater
English and Urdu are taught till the Intermediate
susceptibility to speech-language pathology.
(Class-12) or Graduation (Class-14) as compulsory
subjects. All the educational policies underscore the
Method
importance of mother tongue on education at the
primary level, except in Sindh, where, Sindhi language
Sample
is also an alternate medium of instruction till High
School (Rehman, 2003). Rahman has carried out an in-
For the purpose of this study, the probability
depth analysis of the impact of bilingualism /
sampling procedures were adopted (Guilford, 1956).
multilingualism (Urdu, English and Arabic) in the
A list of registered educational institutions established
SPEECH-LANGUAGE IMPAIRMENT
3
in Karachi South-West District was procured by the
concomitants of prolongations or repetitions of short
researcher from the Department of Education, Sindh.
speech segments are described. Scoring of responses
A combined sample of around 100 participants was
ranged from 0 to 45. The reliability of .84 and validity
drawn from the educational institutions as well as
of .89 qualify the instrument for clinical and research
through referrals from PAF Masroor Hospital / Aero-
purposes. The SSI Test Form is divided into four major
Medical Institute, Psychiatric Centres and Clinics.
areas: frequency, duration, physical concomitants, and
The actual sample, however consists of 93 cases of
severity conversion tables for children and adults.
speech-language disorder after ruling out physical and
Stimulus material was used to elicit conversation from
organic causes of speech-language pathology such as
the non-reader and to provide reading materials for the
mental retardation, autism, head injuries, cleft palate,
reader. The severity of a person's stuttering can be
aphasia, larynxgectomy etc. The analyses of the data
ascertained by comparing his/her scores to the
was carried out on 93 participants with speech-
normative data presented in the form of percentiles
language pathology.
from very mild to very severe categories. A single
numerical score of the SSI provides an assessment of
Measures
severity and a reference point for measuring clinical
changes in language fluency.
Questionnaire for demographic information and
speech-language pathology information:
Procedure
The researcher designed a questionnaire
comprising of 60 items. The questionnaire included
After seeking consent from the participants and
information regarding the participant, his/her family
explaining the purpose of the research, the
and speech disorder, e.g. name, age, sex, residential
questionnaire regarding demographic, family and
address, type of educational institutions, medium of
illness information was individually administered to
instructions, academic progress at the school, parents
each of the respondent and his/her family members.
availability at home (number of hours), parents'
marital an consanguinity status, occupation, monthly
The investigator examined the tongue movement,
income, family extension (joint/nuclear), mother-
lip movement and oral structure deviation anomalies
tongue compatibility (bilingual / multilingual), order
in the participants. He also asked participants about
of birth, history of physical / psychiatric illness and
speech pathology, etc.
physical causes of symptoms. After ruling out the
physical basis of symptoms, diagnostic scales were
Stuttering Severity Instrument (SSI):
used to determine the severity, i.e. very mild, mild,
moderate, severe, and very severe. To ascertain the
To ascertain the cases of stuttering disorders, SSI
cases for stuttering disorders, SSI diagnostic scale was
diagnostic scale was administered. The SSI attempts
then administered.
to meet the criteria of simplicity, objectivity, and
sensitivity of fluency changes of clinical significance.
Results
It is reliable, valid and usable with children and adults.
The frequency, duration and associated physical
The results are presented in the following Tables.
Table 1
Distributions of the sample by overall diagnosis of the speech- language disorders (N = 93)
Sr. No
Overall Diagnoses
Sample Code
Frequency
Percentage
1
Very Mild
A
11
11.82
2
Mild
B
25
26.90
3
Moderate
C
24
25.80
4
Severe
D
18
19.35
5
Very Severe
E
15
16.12
Almost half the cases fall into mild to moderate categories
4
AMAN ULLAH KHAN
Table 2
Distribution of the sample with age at the time of diagnosis, the duration of speech-language disorder,
medium of instruction & types of institution.
Sr. No
Age at Diagnosis
Sample Code
f
%
1
Less than 6 years
A
34
36.56
2
6 to 10 years
B
45
48.38
3
11 to 15 years
C
14
15.06
Duration of the Disorder
1
Less than 3 years
A
9
9.70
2
3 to 5 years
B
52
55.90
3
6 to 8 years
C
28
30.10
4
9 to 11 years
D
4
4.30
Sr. No
Medium of Instructions
1
English
A
07
7.3
2
Urdu + English
B
12
13.00
3
Urdu
C
51
55.00
4
Arabic + Urdu
D
23
24.70
Types of Institution
1
Public School (HS)
A
07
7.50
2
Public School (NS)
B
63
67.75
3
Madressah (RS)
C
23
24.65
Table 2 shows that most diagnoses were made
education in an Urdu medium school and almost
before the age of 11, most participants with speech
two-third of the sample was from the Public normal
language pathology were having the disorder from
schools.
3-5 years, almost half the participants received
SPEECH-LANGUAGE IMPAIRMENT
5
Table 3
Distribution of the sample by mother-tongue of the respondents' mothers
Sr. No
Mother-tongue (Mothers)
Sample Code
f
%
1
Urdu
B
21
22.57
2
Sindhi
C
22
23.65
3
Balochi
D
4
4.30
4
Punjabi
E
25
26.88
5
Makrani
G
3
3.23
6
Kachi / Memon
J
10
10.75
7
Pashto
N
4
4.30
8
Hindko
O
4
4.30
Table 3 shows that Urdu, Sindhi and Punjabi were
the most frequently spoken languages at home.
Table 4
Relationship between the mother-child verbal transactions and speech-language pathology: (df = 4)
Grades on Speech Language Pathology Assessment Scale
Mother-child
Very
Very
Transactions
Chi-square
mild
Mild
Moderate
Severe
Severe
High Average
35.7 (5/14)
21.42 (3/14)
21.42 (3/14)
14.30 (2/14)
7.15 (1/14)
Average
8.70 (6/69)
27.50 (19/69) 29 (20/69)
21.75 (15/69) 13.5 (9/69)
19.17*
Low Average
0 (0/10)
30 (3/10)
10 (1/10)
10 (1/10)
50 (5/10)
* = p < .05
In Table 4 analysis of chi-sqaure shows a
proactive mother-child verbal transaction for
significant difference in result pertaining to
speech-language development.
Table 5
Relationship between monolingual / bilingual families and speech-language pathology: (df=4)
Mother-Father
Grades on Speech Language Pathology Assessment Scale
Compatibility
Very
Very
(Mother Tongue)
Chi-square
mild
Mild
Moderate
Severe
Severe
Compatible
11.42 (8/10) 25.70 (18/10) 24.27 (17/10) 21.42 (15/10) 17.13 (12/10)
1.19
Incompatible
13.04 (3/23) 30.42 (7/23)
30.42 (7/23)
13.04 (3/23)
13.04 (3/23)
(n.s)
n.s = non-significant
The results in T able 5 shows no significant
families with regard to speech-language pathology.
difference between monolingual and bilingual
6
AMAN ULLAH KHAN
Table 6
Relationship between the mother-tongue (MT) compatibility with medium of instruction (MOI) and
speech-language pathology (df = 4)
MT /
Grades on Speech Language Pathology Assessment Scale
MOI
Very
Very
Compatibility
C hi-square
mild
Mild
Moderate
Severe
Severe
Compatible
25 (4/16)
12.5 (2/16)
37.5 (6/16)
18.75 (3/16)
6.25 (1/16)
(B) vs (b)
Low compatibility 7.14 (5/70)
31.42 (22/70) 22.8 (16/70)
20 (14/70)
18.57 (13/70) 9.99*
(BCDEGHI)
vs (ab+jb)
Very low
28.57 (2/7)
14.28 (1/7)
28.5 (2/7)
14.28 (1/7)
14.28 (1/7)
compatibility
(BCEG) vs (a)
Note: Mother tongue = MT, A = English, B = Urdu, C = Sindhi, D = Balochi E = Punjabi, G = Makrani, F = Katchi/Memon
N = Pashto, O = Hindko, J = Arabic. Medium of instructions = MOI, a = English (MOI), b = Urdu (MOI),
ab = English & Urdu (combined MOI), j = Urdu & Arabic (MOI)
* = p < .05
The Chi-square analysis shows a significant effect
instruction and speech-language pathology.
of mother-tongue compatibility with medium of
Table 7
Relationship between the education at the religious institution (Madressah) and speech-language
pathology: (df = 4)
Grades on Speech Language Pathology Assessment Scale
Educational
Very
Very
Chi-square
Institutions
mild
Mild
Moderate
Severe
Severe
Liberal
28.57 (2/7)
14.28 (1/7)
28.57 (2/7)
14.28 (1/7)
14.28 (1/7)
Educational
Institutions
Normal
14.28 (9/63) 31.75 (20/63) 28.57 (18/63) 17.46 (11/63) 7.93 (5/63)
18.14*
Institutions
(Public/Private)
Religious
0 (0/23)
17.39 (4/23)
17.39 (4/23)
26.08 (6/23)
39.13 (9/23)
Institutions
(Madressah)
* = p < .05
The Chi-square results in Table 7 shows a
institutions with speech-language pathology.
significant effect of education in religious
SPEECH-LANGUAGE IMPAIRMENT
7
observed that speakers having capability of expressing
Discussion
themselves in two or more languages demonstrate
greater jumpstart in situational adaptability. The
In terms of the stated objectives, overall
combinations and permutations of words / vocabulary
results of the present study supported two of the
that they usually possess provide them with a wider
hypotheses pertaining to proactive mother-child
repertoire of linguistic possibilities for dealing with
verbal transactions, and madressahs' education, while
situations they encounter because of their multiple-
the other hypotheses remained deficient of the
language abilities. Also, this allows them to handle
required support for the hypothesized variables, like
situations with greater innovation and versatility
mother-father tongue compatibility (monolingual
(Lindholm, 1991). Mehdi (2002) however, has
families) and medium of instruction.
maintained that there was always the possibility that
In the context of psychological correlates, the
children exposed to two different languages might
has,present research study has attempted to develop an
experience speech delay if their linguistic exposure is
important area pertaining to proactive mother-child
unevenly distributed. To support this conjecture she
verbal transactions. The concept of verbal transactions
further explains that a young child can experience
implies that the early social environment is critical for
hesitation and confusion, especially when it comes to
language development (Robert & Glucksberg, 1977).
communicating in the language to which he or she has
The underlying inference is that in order to develop
been inadequately exposed. In order to prevent this
normal language, the child must have an emotionally
from happening, she suggested that children should be
satisfying relationship with the mother / mother figure
provided with a proactive environment, wherein they
or mother substitute (Bloodstein, 1984). Any denial or
can develop association with each of the parents
deprivation of this relationship may cause detrimental
speaking a different dialect and language pattern. This
effects on the normal language development of the
would necessitate on an environment where one parent
child. The most clear-cut example of psychosocial
would speak the native language with the child while
deprivation is physical isolation of a child from all
the other the second language (Mehdi, 2002).
social contacts, more commonly referred to as
The hypotheses in the present research did not
maternal deprivation. Studies have shown that its
uphold the assertion that the mother-tongue
effects on early development are far-reaching. They
incompatibility with the medium of instructions
include retarded growth, increased susceptibility to
(MOI) was related to speech-language pathology.
disease, higher infant mortality, and delay in general
Medium of instructions vis-à-vis bilingualism has
maturation, which includes the acquisition of
always been considered as one of the decisive factors
language (Robert & Glucksberg, 1977). Analysis of
in school achievement of the children and possibly
the results of the present study duly support the
speech language pathology. It is generally expected
relationship between proactive mother-child verbal
that children exposed to two different languages might
transactions and speech language development. It can
experience speech delay if their linguistic exposure is
safely be assumed that children with developmental
unevenly distributed (Mehdi, 2002). Apprehensions
language difficulties tend to reveal a few speech-
have been vocalized that the medium of instruction
language difficulties, such as late onset of language,
which is adopted (Urdu, English or Arabic) poses a
restricted use and comprehension of words, limited
threat to the regional learners having their mother
length of their utterances, and failure to grasp
tongue different from that of the prevalent medium of
grammatical rules needed to produce and understand
instruction at their educational institution (Mansoor,
language at a level appropriate to age.
2001). In the present research study, it was claimed
The research hypothesis stating that the
that monolingualism was positively related to speech-
mother-father tongue compatibility (monolingual
language development. In other words, the test results
families) was positively related to speech-language
supported the null hypothesis that claimed
development as compared to bilingual families, was
incompatibility of mother-tongue vis-à-vis medium of
not supported. The inference may therefore lead to the
instruction which was not positively related to speech
conclusion that there is no significant difference
language pathology. However, there is much evidence
between monolingual and bilingual families with
to suggest that children who are bilingual are not at an
regard to speech-language development (see Table 8).
intellectual disadvantage as compared to children who
However many studies have suggested that bilingual
are monolinguals. To support this further, there has
students may have an edge over students who are
been a growing body of research that suggests that
monolinguals (Hakuta and Garcia, 1989;Lambert &
people who speak more than one language may well
Peal, 1989; Lindholm, 1991). Generally, it has been
have some cognitive advantages over monolinguals
8
AMAN ULLAH KHAN
(Lindholm, 1991). In the perspective of bilingual /
indoctrinated in a 'Munazra' style (debate), loaded with
cross-linguistic and cross-cultural impact on the
emotive tone; more rhetoric and less substantive. The
communication disorders, some important studies
critics are of strong conviction that unnecessary and
have been carried out by Hakuta & Garcia (1989),
excessive scolding and pounding of students in
Lambert and Peal (1972) and Lindholm (1991). These
madressah has induced a feeling of worthlessness
studies suggests that bilingual students actually have
among students and shaken their self-confidence.
an advantage over students who speak just one
Moreover, critics allegedly blamed madressah for
language. For example, speakers of two languages
indulgence in ever increasing incidence of
show more cognitive flexibility. They have more
homosexuality. (Abbas, 2003). Due to strong hold and
linguistic possibilities available for dealing with
authoritarian attitude of some of the religious teachers,
situations they encounter because of their multiple
a child studying in the madressah may develop anxiety,
language abilities. In turn, this permits them to solve
tension and physiological abnormalities. His / her
problems with greater creativity (Lambert & Peal,
emotional, physical, social and psychological
1972). Bilingual students are also better aware of the
development is arrested due to various types of anxiety,
rules of language and they may understand linguistic
tension, depression and aggression which in a way may
concepts more readily (Hakuta & Garcia, 1989).
help explain the adverse effects on the speech-language
In the context of existing parallel education
development of the students studying at these
system in Pakistan, which includes both Urdu and
madressah (Shahid, 1992).
English Medium of instruction and the madressah
The conclusion as to the susceptibility of
educational system, which includes Arabic and Urdu
children to speech-language disorders in view of the
languages. The hypothesis seeking relationship
environmental conditions that exist in our madressah
between the children studying at the religious
system needs a cautious approach with due skepticism.
institutions (madressahs) and susceptibility to speech-
Ironically, the environmental conditions, that have
language pathology provides important indicators on
been cited for being responsible for speech disorders at
the environmental conditions that exist in these
madressahs, are also prevalent in Urdu / English
educational systems. This suggests what remedial
Medium Schools, though with varying degrees. While
measures may be taken to overcome the delays in
cognizant of the environmental conditions that are
speech-language development. The data collected,
present in both the parallel systems, labeling the
however, shows that the children studying at the
madressah only for the negative outcome would be an
religious institutions (madressahs) display greater
oversimplification of the fact. The supporting data in
susceptibility to speech-language pathology. In the
this study, therefore, needs a more detailed scrutiny
perspective of educational system prevalent in
through subsequent researches in speech-language
Pakistan, the hypothesis stating that children studying
pathology with larger sample size, to ascertain the
at the religious institutions (madressahs) do not display
validity of this assertion. The future research in this
greater susceptibility to speech-language pathology is
area may involve cohort studies, so that the exact
of utmost importance.
contours along with the complexities of the speech-
Educational system in Pakistan is plagued with
language pathology could be ascertained for better
a number of dichotomies like out-dated curriculum,
prognosis.
faulty methodology, defective examination system,
low budgets, etc (Abbas, 2003). Of all these, parallel
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