Çocukluk Çağı Dil Bozuklukları Değerlendirme ve Müdahalesinde Türkiye ve Amerika’nın Karşılaştırılması
Giriş & Amaç: Çocukluk çağı dil bozukluklarında ayırıcı tanı ve erken müdahale oldukça önem taşımaktadır. Dil terapilerinde çok çeşitli yaklaşımlar kullanılmakta ve her ne kadar yaklaşımlar arasında farklı sınıflamalar yapılıyor olsa da genel sınıflama klinisyen merkezli, çocuk merkezli ya da hibrit yaklaşımlar şeklinde yapılmaktadır. Dil ve konuşma terapistliği mesleğinin daha yeni olduğu Türkiye ile mesleğin daha eski bir geçmişe sahip olduğu Amerika’da kullanılan değerlendirme ve müdahale yaklaşımları ile birlikte mesleğin çalışma alanlarına yönelik yapılacak karşılaştırmanın hem uygulama hem araştırma alanına katkılar sağlayacağı düşünülmektedir. Bu gereksinimle bu çalışmada Türkiye ve Amerika’da yaşayan dil ve konuşma terapistlerinin ‘Özgül Dil Bozukluğu (ÖDB)’ ve ‘Gecikmiş Dil ve Konuşma (GDK)’ vakalarının değerlendirme ve müdahale süreçlerinde kullandıkları yöntemlerin karşılaştırılması amaçlanmaktadır. Yöntem: Çalışmada betimsel araştırma modeli kullanılmış olup verilerin toplanması amacıyla araştırmacılar tarafından 8 soruluk Türkçe ve İngilizce iki eşdeğer anket hazırlanmıştır. Çalışmada çeşitli kurumlarda hizmet veren Türkiye’den 56; Amerika’dan 128 toplamda 184 dil ve konuşma terapisti (DKT) katılımcı yer almıştır. Anketler katılımcılara çevrimiçi yollarla ulaştırılmıştır. Verilerin analizi için SPSS-20 paket programı kullanılmıştır. Bulgular ve Sonuç: Çalışma bulgularına göre Türkiye ve Amerika’da GDK ve/veya ÖDB şüphesiyle başvuran kişilerin yönlendirildiği uzmanların farklılık gösterdiği görülmüştür. Amerika’da değerlendirme için yönlendirmenin dil ve konuşma terapistinden farklı olarak ağırlıklı olarak psikoloğa, takibinde ise özel eğitim uzmanına yapıldığı dikkat çekmektedir. Türkiye’de ise öncelik çocuk psikiyatristine verilmektedir. Türkiye ve Amerika’daki DKT’lerin GDK ve/veya ÖDB’ye sahip bireyleri değerlendirirken kullandıkları değerlendirme araçları karşılaştırıldığında iki grup arasında istatistiksel olarak anlamlı bir fark bulunamamıştır. Türkiye’de ÖDB ve GDK müdahale süreçlerinde en çok kullanılan yaklaşımlar Fonolojik Farkındalık Yaklaşımı (x̄=2,78) ve etkileşim temelli yaklaşımlardan biri olan Floortime (x̄=2,48) iken; Amerika’da Oyun Temelli Yaklaşım (Play Based Approach) (x̄=2,90) ve Kolaylaştırıcı Görsel Stratejiler (Visual Strategies to Facilitate) (x̄=2,81) yaklaşımları olmaktadır. Her iki ülke için de en az kullanılan yaklaşım ‘Yazma Laboratuvarı Yaklaşımı (The Writing Lab)’dır.
Anahtar Kelimeler:
gecikmiş dil, özgül dil bozukluğu, dil ve konuşma terapisi, müdahale, değerlendirme, karşılaştırma
Assessment and Intervention in Childhood Language Disorders: A Comparison of Practices in Turkey and the USA
Introduction: Differential diagnosis and early intervention are quite important in childhood language disorders. A wide variety of approaches can be used in language therapies and these approaches are divided into such classes as clinician-centered, child-centered or hybrid approaches. It is thought that the comparison about the assessment and treatment techniques for delayed language and Specific Language Impairment between the USA and Turkey where speech and language therapy field does not have an old history may contribute to both practice and research. For that reason, it was aimed to compare the methods and approaches of assessment and treatment in cases of delayed language and specific language impairment between speech and language therapists who live in the USA and Turkey in this study. Method: The descriptive research model was used in this study and two equivalent questionnaires of eight questions related to assessment and treatment procedures in Turkish and English were prepared by the researchers in order to collect the data. 56 participants from Turkey and 128 participants from the USA, 184 participants in total, participated to the study. The corresponding author prepared the English version of the survey. The questionnaires were delivered to the participants online. SPSS-20 package program was used for the data analysis. Results & Conclusion: According to the findings, speech and language therapists work mostly at the rehabilitation centers in Turkey (32,14 %) while the speech and language therapists work mostly in schools (57 %) in the USA. It was found that there is no speech and language therapist who works in schools in Turkey, as there is no available position for speech and language therapists at schools in Turkey. The findings show that there are differences between the USA and Turkey about referenced experts/ professionals in cases of delayed language and specific language impairment referrals. It is noteworthy that in the USA reference for evaluation is mainly directed to psychologist and as a second professional to special education experts apart from speech and language therapist. Although referenced experts show variety in Turkey, reference is done most commonly to child psychiatrists. When the assessment tools for delayed language and Specific Language Impairment between the USA and Turkey were compared, there were no statistically significant differences between the two groups. Both groups prefer informal observation during assessment process. Survey findings also indicate that the most commonly used approaches for Specific Language Impairment and language delay were Phonological Awareness Approach (x̄=2,78) and Floortime, which is one of Relationship Based Approaches (x̄=2,48) in Turkey while the Play Based Approach (x̄=2,90) and Visual Strategies to Facilitate Approach were the most preferred ones in the USA. (x̄=2, 81). The least used approach for both countries was the Writing Lab Approach. In the intervention sessions of delayed language and Specific Language Impairment, the speech and language therapists in Turkey chose toys as materials (55, 3 %) while the ones in the USA mostly preferred books (36, 2 %) besides other variable options such as flashcards, games, pictures, videos, Ipad and core boards.
Keywords:
Delayed language Specific Language Impairment, developmental language disorder, speech and language therapy, treatment, assessment, comparison,
___
- ASHA (American Speech- Language- HearingAssociation) (2019). Preschool Language Disorders. https://www.asha.org/public/speech/disorders/Preschool-Language-Disorders/ 22.05.2019
- ASHA (American Speech-Language-Hearing Association) (1993). Definitions of communicationdisordersandvariations. https://www.asha.org/policy/rp1993-00208/. 22.05.2019.
- Bishop D.V, Snowling M.J, Thompson P.A, Greenhalgh T, CATALISE Consortium (2016) CATALISE: A Multinational and Multidisciplinary Delphi Consensus Study. Identifying Language Impairments in Children. PLoS ONE, 11(7).
- Bishop, D. V. (2006). What causes specific language impairment in children? Current Directions in Psychological Science, 15(5), 217-221.
- Bishop, D. V., & Edmundson, A. (1987). Specific language impairment as a maturational lag: Evidence from longitudinal data on language and motor development. Developmental Medicine & Child Neurology, 29(4), 442-459.
- Bishop, D.V.M. & Adams, C. (1990). A prospective study of the relationship between specific language impairment, phonological disorders and reading retardation. Journal of Child Psychology and Psychiatry, 31(7), 1027-1050.
- Cable, A. L.,& Domsch, C. (2015). Systematic review of the literature on the treatment of children with late language emergence. International Journal Of Language & Communication Disorders, 1-17.
- Carter, J. A.,Lees, J. A., Murira, G. M., Gona, J., Neville, B. G., & Newton, C. R. (2005). Issues in the development of cross‐cultural assessments of speech and language for children. International Journal of Language & Communication Disorders, 40(4), 385-401.
- Cirrin, F. M., & Gillam, R. B. (2008). Language intervention practices for school-age children with spoken language disorders: A systematic review. Language, Speech, and Hearing Services in Schools.
- Conti‐Ramsden, G. ,Durkin, K., Simkin, Z., & Knox, E. (2009). Specific language impairment and school outcomes. I: Identifying and explaining variability at the end of compulsory education. International Journal of Language & Communication Disorders, 44(1), 15-35.
- Durkin, K., Simkin, Z., Knox, E., & Conti‐Ramsden, G. (2009). Specific language impairment and school outcomes. II: Educational context, student satisfaction, and post‐compulsory progress. International Journal of Language &Communication Disorders, 44(1), 36-55.
- Eisenberg, S. (2004). Structured Communicative Play Therapy for Targeting Language in Young Children. Communication Disorders Quarterly, 26(1), 29-35.Ervin, M. (2001). SLI: What We Know and Why It Matters. The ASHA Leader, 6(12), 4-31.
- Ervin, M. (2001). SLI: What We Know and Why It Matters. The ASHA Leader, 6(12), 4-31.
- Hawa V.V., Spanoudis G. (2014). Toddlers with delayed expressive language: an overview of the characteristics, risk factors and language outcomes. Res Dev Disabil.35(2):400-7.
- Joginder Singh, S.,Iacono, T., &Gray, K. M. (2011). A comparison of Malaysian and Australian speech-language pathologists' practices with children with developmental disabilities who are presymbolic. International Journal Of Speech-Language Pathology, 13(5), 389-398.
- McCauley, R. J.,& Fey, M. E. (Eds.) (2006). Treatment of Language Disorders in Children. Brookes Publishing. USA: Baltimore.
- Mcleod, S.,& Baker, E. (2014). Speech-language pathologists’ practices regarding assessment, analysis, target selection, intervention, and service delivery for children with speech sound disorders. Clinical Linguistics & Phonetics, 28(7-8), 508-531.
- Paul, R.,&Norbury, C. F. (2012). Language Disorders from Infancy through Adolescence. Elseiver Mosby. USA: Missouri.
- Prelock, P. A.,Hutchins, T., &Glascoe, F. P. (2008). Speech-language impairment: how to identify the most common and least diagnosed disability of childhood. The Medscape Journal of Medicine, 10(6), 136.
- Tervo, R.C.,&Kinney, C.A. (1981). The Child with Delayed Language: Assessment and Management. Can Fam Physician, 27, 1405-1412.
- Thal, D.J.,&Tobias, S. (1992). Communicative gestures in children with delayed onset of oral expressive vocabulary. J Speech Hear Res, 35(6), 1281-9.
- Tomblin, J. B.,Records, N. L., Buckwalter, P., Zhang, X., Smith, E., &O’Brien, M. (1997). Prevalence of specific language impairment in kindergarten children. Journal Of Speech, Language, and Hearing Research, 40(6), 1245-1260.
- Topbaş, S. (Ed.) (2015). Dil ve Kavram Gelişimi. Ankara: Kök Yayıncılık.
- Yayın Aralığı: Yılda 3 Sayı
- Başlangıç: 2018
- Yayıncı: Dil ve Konuşma Terapistleri Derneği