Support for Chapter 10

Working with Families at Psychosocial Risk and with Children Who are Bilingual/Dual Language Learners

In infancy and preschool, mastery of language skills is undoubtedly one of the most critical predictors of success in school and thus in the tasks of teenage and adult life: completing high school, maintaining employment, etc. Yet, language is the most commonly overlooked domain when health care providers screen for developmental-behavioral problems. Chapter 10 covers language skills and delays in detail and focuses on the:

  1. Typical but temporary language delays of children who are bilingual and dual language learners.
  2. Language delays of children with psychosocial risk factors—who rarely catch up to their peers without developmental promotion or other types of intervention.
  3. Toxic combination of bilingual/dual language learning when combined with psychosocial risk factors
  4. Language deficits and disorders that characterize many other developmental disabilities.

Too often we not only fail to take seriously language delays but also fail to consider whether psychosocial risk, absence of protective factors (also known as resilience) and/or other disabilities are present. Too often we fail to consider that children’s behavioral acting-out and social-emotional difficulties may be an emerging co-morbidity caused by frustrations with limited ability to communicate. 

So, in addition to using quality screening tools (see Chapter 4 and its web page), early detection is much aided by identifying risk and resilience factors. On this page of the website two freely downloadable tools followed by links to resources in promoting language development:

  1. The Family Psychosocial Screen (in English and Spanish) along with its scoring instructions. The FPS is used at new patient intake. Among its many subscreens are ones for parental depression, substance abuse, and lack of social support (along with parents’ level of education, ethnicity, etc.). The depression portion of the FPS (4 items) can be repeated in the second year of life to detect post-partum blues and are included at appropriate ages on the download well-visit forms in Appendix A.

  2. The Brigance Parent-Child Interactions Scale (in English and Spanish) in the parent report version. Also downloadable are the examiner observation and the scoring instructions for all versions of the instrument. The items indicate whether parents are sharing books, promoting language development, encouraging new learning, etc. We recommend using the BPCIS at 5 – 7 months and again at 15 months—followed by encouragement or copious developmental promotion (or referrals to parent training programs). We included the critical BPCIS items (examiner version) in the downloadable well-visit forms in Appendix A.

This calculator can be used to assign BPCIS scores for Risk and Resilience. It was created by Julius Weng, MD, for his ongoing research studies.

Other Resilience Measures

The Protective Factors Scale (PFS) is a “self-administered survey that measures protective factors in five areas: family functioning/resiliency, social support, concrete support, nurturing and attachment, and knowledge of parenting/child development.” Like the BPCIS, this measure is not a screen with distinct cutoffs for risk/resilience, but rather an adjunct for better understanding and addressing families’ strengths and weaknesses in promoting optimal child development.

Other Psychosocial Risk Measures

The Adverse Childhood Experiences Questionnaire (ACES) covers specific aspects of prior psychosocial risk such as foster care, parent incarceration, child abuse and neglect. ACES does not cover other significant and predictive risk factors such as limited parental education, poverty, housing and food instability, parental depression or limited social support. Although ACES has not been subjected to rigorous psychometric studies, it has been widely used in research. To register for and also download ACES (both teen self-report and child history via parent-report) click here.

The Safe Environment for Every Kid (SEEK) Questionaire covers in 16 yes-no questions, a wide range of psychosocial risk factors including parental depression, substance abuse, parental stress, intimate partner violence and food insecurity – that predict child maltreatment. SEEK is designed for primary care, has been subjected to rigorous psychometric studies, and is available in multiple languages. To download SEEK and its scoring algorithm, click here.  In addition, the SEEK website has helpful links to other measures, research studies and SEEK training opportunities.

Resources For Parents and Professionals

The sites below provide information on language promotion and intervention. IDEA programs are the optimal referral resource. If ineligible, refer to quality preschool and after school programs (e.g., Head Start, Early Head Start, Boys and Girls Club, parenting programs). Chapter 7 and its web page provide additional developmental promotion guidance. Chapter 5 and its web page provide links to IDEA and other services.

The American Speech and Hearing Association houses articles and policy statements on a wide range of issues including bilingual and dual language learning.

The National Association for Bilingual Education includes research reviews and training guidance for learning and teaching English as a Second Language.

The National Clearinghouse for English Language Acquisition website includes standards for assessment, state networking, and webcasts.

The United Kingdom Literacy Trust focuses on coaching parents to talk with their babies. Included are tip sheets in 13 languages including Arabic, Chinese, Portuguese, Turkish, Somali and Urdu.

Colorín Colorado! includes Spanish language resources to help parents promote language development through play.

The National Center for Hearing Assessment and Management at Utah State University includes videos, practice recommendations for primary care, newborn hearing screening and early childhood programs, research findings, and webcasts.

Talk Box was created by speech language pathologists to aid both trainees and parents. The site offers information on interventions including those parents can do at home (and which trainees can demonstrate to families as part of patient education).