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Issue Editor Foreword: Global Issues in Language Disorders Frameworks, Processes, and Policies

Section Editor(s): Hyter, Yvette D.; Battle, Dolores

doi: 10.1097/TLD.0000000000000017
Issue Editor Foreword

The authors have indicated that they have no financial and no nonfinancial relationships to disclose.

In an increasingly connected world, the need exists for a new global ethic....

Labronte et al. (2004–2012)

Global changes in the 21st century include technological advances resulting in instant information and communication, movements of people from their countries of origins to other locations, and transnational flows of goods, services, and practices. Such changes have resulted in a world that is increasingly interdependent. This interdependence results in opportunities for people around the world to come into contact with people from cultural, linguistic, and national backgrounds different from their own. In addition, language and communication cannot be understood in a global context without considering the social, cultural, economic, and ecological systems in which they exist. To be effective service providers, it is important for speech–language pathologists (SLPs) to be aware of the myriad ways language and language disorders are conceptualized, how policies affect service delivery, and the manner in which intervention services are practiced. Also, operating from a conceptual framework that incorporates multiple factors will help SLPs provide services in a globally responsive manner.

Language and language disorders are culturally defined. Of the 7,000 different languages in the world, 9 are the native language of at least 120 million people (Lewis, Simons, & Fennig, 2013). This includes 122 million people who speak Japanese and 848 million people who speak Mandarin. Although the number of languages spoken in the world can be overwhelming, this number pales in comparison with the variety of cultures around the world. When one considers regions, countries, communities, families, and other social constructs and the changes that have evolved historically and politically within those social constructs throughout humanity, it is not surprising that there are significant differences in cultural views on what constitutes a language disorder in various parts of the world.

When researchers conduct studies of language and language disorders, they often look for differences, but it is equally as important to look for similarities across the social, political, and geographical constraints that unite our understanding of global issues in language and communication disorders. The authors of the articles in this special edition of Topics in Language Disorders (TLD) include persons from five different regions of the world—United States, Japan, Israel, Brazil, and South Africa. Although different geographically, these authors describe similar factors that influence the delivery of services. They focus on specific issues involved in language and communication disorders in their region with a focus on cultural, geopolitical, economic policies, as well as language and related processes that have affected the study of language disorders and the provision of language services in their particular region.

This special issue begins with a concept article providing “A Conceptual Framework for Respons-ive Global Engagement in Communication Sciences and Disorders” by coeditor Yvette Hyter (2014). Hyter's article emphasizes the importance of understanding that communication and its disorders cannot be separated from the sociolog-ical and political factors that influence all aspects of life in a global world. This article expands discussions of cultural competence that have taken place in speech–language pathology for at least four decades. Early discussions of cultural competence in the United States were centered on multiculturalism, with particular focus on African American dialects or Ebonics from the historical and social constructs of civil rights of the 1970s and early 1980s. However, as immigration policies and the economic, social, and political realities of the world changed, the conversation expanded to include Latino/Hispanic cultures and languages, and later to include Asian populations and languages. Now it is time to expand the conversation in new ways. As the world has become more interconnected through technology and more transient through travel, immigration, and migration, concepts of cultural and linguistic diversity have expanded to recognize the diversity of nations and peoples around the world. Throughout history what counts as a language and cultural diversity typically involves issues of statehood, geopolitics, economics, literary traditions and writing systems, and other influences of power, authority, and culture. Hyter emphasizes the need to apply a critical analysis framework to take cultural competence to new levels.

The discussions in the remaining issue articles expand on and exemplify concepts explained by Hyter, bringing attention to the similarities of consideration of language around the globe while highlighting the unique issues in particular regions. The second article, “Developmental Reading Disorders in Japanese—Prevalence, Profiles, and Possible Mechanisms,” examines the structure of language and its influence on reading disorders in Japanese. In it, authors Tanaka Welty, Menn, and Oishi (2014) discuss differences in Japanese orthography, explaining differences in Kana and Kanji orthographies and their implications for understanding dyslexia in Japan. The Kana syllabary used by beginning and early readers is highly transparent and phonologically predictable. Because there is a one-to-one relationship between syllables and symbols, fewer early readers are identified as having difficulty with reading. The authors explain, however, that as reading tasks evolve in the later grades, Kanji logographic orthography is used in which one symbol may have several pronunciations and have different meanings depending on linguistic context. This is accompanied by an increase in the number of children identified with reading disorders. Tanaka Welty et al. use case studies to illustrate that the increasing complexity of reading tasks in the later grades requires not only the understanding of more advanced phonological awareness in Kanji but also more complexity in decoding for comprehension of abstract concepts.

Discussion of the geopolitics and social constructs of language and literacy continues in the article by Uziel-Karl et al. (2014), titled “Hebrew and Palestinian Arabic in Israel: Linguistic Frameworks and SLP Services.” This article, which results from cooperation between Israeli Jewish and Arab psycholinguists and SLPs, points to the intersection of history, social contexts, religion, and language. Uziel-Karl et al. present an informative discussion of modern and classical Hebrew and the various dialects of Arabic and Yiddish and their relationship to the politics and social history of the region. They discuss how the geopolitical issues affect the availability of culturally competent SLPs to assess and treat persons with language and literacy disorders in certain groups and the difficulty in either assessing students who speak multiple dialects of languages or assessing groups for whom there are insufficient normative data. In addition, they express concern that the treatment and diagnosis of language disorders are particularly challenging when serving Bedouins, speakers of Arabic, who live in the Negev desert region, and many of whom are impoverished. Uziel-Karl et al. also present results of a mapping study that documents areas of needs, such as a lack of Arabic-speaking SLPs to provide services to the people of the region. The article discusses preliminary efforts to address disparity of services between the Hebrew-, Yiddish-, and Arabic-speaking populations of Israel.

The need to address disparity of services across a region also is a theme of the article, “Speech–Language Intervention With Children With Autism Spectrum Disorders in Brazil,” by Fernandes, Amato, Defense-Netrval, and Molini-Avejonas (2014). Brazil is highly urban, with 81% of the population living in the urban areas of the south and northeast regions including Sao Paulo, Rio de Janeiro, Salvador, and Brasilia, the capital. Although services are available in these urban regions, there is a vast disparity of services available in the more isolated north and west-central regions of the country. The article describes the emergence of official policies regarding rehabilitation services and education to the children and adolescents with disabilities in Brazil, with particular focus on those with autism spectrum disorder (ASD), a relatively new area of recognized disability in the region. The authors present an overview of studies they have conducted in Sao Paulo to identify the most effective education and therapeutic alternatives for children with ASD. They identify the need for access to evidenced-based information about intervention options for intervention and support to make the best decision for children with autism and their families dependent on the realities of living in a country as vast and diverse as Brazil.

The issue concludes with an article, titled “Asking New Questions and Seeking New Answers: The Reality of Aphasia Practice in South Africa,” by Claire Penn (2014) from South Africa. This article addresses aphasia in another country with vast land mass and significant sociocultural disparities in the availability of services. South Africa, like Brazil, is a large, ethnically and culturally diverse country. Eleven official languages are spoken in South Africa, including English and Afrikaans; however, many persons also speak the unofficial Khoisan languages (Roy-Campbell, 2003). Since the ending of apartheid in 1994, there has been an emergence of policies to provide delivery of services to those in need; these policies have an impact on the delivery of services by SLPs. Penn describes policy changes in antidiscrimination policy and laws around language use and health and education, as well as services for persons with disabilities and the elderly. She focuses on aphasia assessment and intervention in the unique sociopolitical context of the country and how evidence-based relevant practice works with advocacy and social reform to further develop appropriate services.

In summary, the articles in this issue of TLD highlight common interests affecting the delivery of evidence-based services to those with communication disorders. The articles also point out vast disparities in the access to health care and services both within countries and across the globe. They provide insight into the disparity of appropriate services to the impoverished persons in the Bedouin communities of Israel, the nonurbanized regions of Brazil, and the outlying regions of South Africa. Health disparities are the systematic and “unfair and avoidable differences in health status seen within and between countries” (World Health Organization, 2014). The U.S. Department of Health and Human Services Healthy People 2020 (2010) emphasizes the need to recognize population-specific differences in the presence of disease, health outcomes, and access to care. It is hoped that readers of this special issue on global issues in language disorders will recognize as well the common search for conceptual frameworks and evidence-based practices to provide culturally effective and globally responsive services to all people regardless of where they may be in the world.

—Yvette D. Hyter

—Dolores Battle

Issue Co-Editors

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Fernandes F. D. M., Amato C. A. H., Defense-Netrval D. A., Molini-Avejonas D. R. (2014). Speech–language intervention with children with autism spectrum disorders in Brazil. Topics in Language Disorders, 34, 155–167.
Hyter Y. D. (2014). A conceptual framework for responsive global engagement in communication sciences and disorders. Topics in Language Disorders, 34, 103–120.
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