Bilingual speech and language therapist, Johanna Pino Grisales, supports English-speaking families in understanding how to address speech and language difficulties in English and Spanish. She also supports families with a family member suffering from what we know as dysphagia, a swallowing disorder. Johanna is ASHA certified (American Speech-language-Hearing Association) and currently providing in-person (only in Barcelona) and tele-therapy consultations.
Supporting bilingual families address speech and language difficulties
How did your interest in speech therapy evolve?
I started my career studying journalism in my hometown Medellin, Colombia. I had always been attracted by the idea of giving others a voice through my writing, so it became my starting point. Then, I migrated to the United States when I was 17 years old and came across the field of speech and language pathology for the very first time during my sophomore year in college. This field gave me the opportunity not only to support others in their ability to communicate better but allowed me to explore other areas where speech and language pathologists also play an important role. I found this particularly fascinating as it also helped me to explore different areas, until I identified the ones that I felt most comfortable with including speech and language disorders in English/Spanish bilingual children, dysphagia, aphasia, cognitive impairments, and orofacial myofunctional therapy.
Understanding my interests in the field supported me in the process of developing a community for those who also shared the same interests. This is how Disfagia Máster was born. Disfagia Máster is a website with resources in the field of swallowing disorders for Spanish speaking providers. Spanish speaking speech language pathologists (SLP) face a lot of challenges when searching for evidence-based resources, as most of them are published in English. I noticed that being a bilingual provider allowed me to create a bridge for my colleagues while also allowing me to keep up to date with the latest research in the field.
What does a speech therapist do?
Most of the people unfamiliar with the field of speech and language pathology assume that our scope of practice only covers speech and language disorders. However, we can do a lot more!
According to the American Speech-Language-Hearing Association (ASHA), it is within the scope of practice of an SLP to provide services in the following areas: fluency, speech production, language, social skills, cognition, voice, resonance, feeding and swallowing, auditory habilitation/rehabilitation. Other elective areas include accent modification, transgender communication (e.g., voice, verbal, and nonverbal communication), preventive vocal hygiene, business communication, professional voice use, among others.
How has your own experience with bilingualism influenced your work with bilingual families?
I started learning English at the age of 17 when I first moved to the United States. I was the first generation in my family to attend college in a foreign country, so I had a lot on my shoulders. The adaptation process took a while, and it wasn’t until the fifth year in the USA when I finally started feeling a lot more comfortable with the language, and the culture. It was also around that time when I started noticing that my linguistic abilities in Spanish had declined. It took me longer to recall words in Spanish, and I was always debating between my “Spanglish” to convey a message. Some people assumed that I had consciously decided to forget my native language, but it wasn’t necessarily that. I was simply accommodating two languages in my brain, and that took some effort, even until this day.
Bilingual children are more likely to be over-diagnosed with a speech and/or language impairment. This diagnosis can negatively affect not only the quality of life of a bilingual student, but it can also influence his/her interactions with the immediate environment. Additionally, resources are not efficiently allocated potentially leaving other students without services due to the lack of bilingual providers available. I became very conscious about this issue and decided to gather the necessary tools to make sure I could identify a child with a speech/language disorder, from a child that is simply showing the signs of someone who is learning a second language. It takes effort and practice to identify the differences, however, it is a very rewarding experience being able to make the appropriate recommendations based on the data.
What should parents do if they suspect their child has a language disorder?
If parents suspect their child having a speech and language disorder, they should first address it with their pediatrician to identify if the child is meeting his/her milestones. If the pediatrician determines that a comprehensive speech and language evaluation would be appropriate, then the next step will be to look for the right provider. Some schools have their own speech and language pathologist, but some others don’t. Just try to explore what resources you have available within your community. If you have a bilingual child, make sure you find someone that’s competent in both languages.
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If getting the opinion of a pediatrician is not possible, a good starting point would be also discussing your concerns with your child’s school teacher. They can also share with you their perspective based on their interactions in the classroom, and together, you can decide if the next step would be getting an evaluation from a speech and language pathologist. I like to recommend parents to be mindful about the fact that speech and language skills do not develop in isolation, or in a lineal manner. A lot of variables need to interact. Consider for example the child’s mental wellbeing. Dramatic life changes (e.g., moving into a new country, parents separation, death) can influence a child’s speech and language development.
Learning 2 languages simultaneously is not always easy. If children are struggling with a bilingual environment, how can parents tell if it is due to the acquisition of a second language or is specifically a language disorder?
Normally, children with a language disorder struggle to communicate in both L1 and L2. Therefore, the same deficits should be reflected in both languages. While some children might present with limited language abilities in the L2, this doesn’t necessarily mean that they have a language disorder. Parents should look for some of the following red flags: A child that doesn’t like to engage or initiate conversations, a child that is unable to follow instructions in their native language (e.g., Mark, can you please go to your room and look for your blue baseball cap and your red jacket?), child has trouble producing certain speech sounds in their native language (be mindful about the age as some speech sounds are not fully mastered until a certain age).
What are orofacial myofunctional disorders (OMD)?
Orofacial myofunctional disorders are defined as abnormal movement patterns of the face and the mouth that might interfere with normal growth and development of the muscles. OMDs may interfere in how the muscles of the face and mouth are used for eating, talking, and breathing. Some examples of OMDs include drooling, bruxism, tongue thrusting (pushing the tongue out when eating, drinking, or talking), articulation impairments, malocclusions, open mouth posture. Some of the possible causes can include but are not limited to lack of intervention, airway obstructions, deviated septum, sleep disorders, craniofacial disorders, sensory motor dysfunction, thumb sucking.
Are there any things parents can do at home to encourage their child to stop sucking their thumb?
Thumb sucking is a very common habit in infants and young children. It helps children feel calm, happy, and safe while exploring the world. The problem arises when the front teeth start erupting, possibly resulting in bite problems and/or protruding teeth. If parents are concerned about prolonged thumb sucking affecting their child’s dentition, they should first contact the child’s dentist. The dentist will determine the course of treatment which in some cases can require orthodontics. Speech and language pathologists who specialize in orofacial myofunctional disorders, can guide parents in decreasing and possibly eliminating this habit.
Parents can…
- Support the child at home by creating calendars used as visual reinforcers to remind the child how many days have passed with his/her thumb dry.
- Identify moments during the day, so they don’t have to quit thumb sucking all at once but step by step (e.g., no thumb sucking while shopping).
- Use a little bandage overnight to avoid thumb sucking during sleep.
- Identify stressors in the child’s environment and work on reducing them (e.g. fighting in front of the children). Remember that children also engage in thumb sucking habits when stressed, nervous or anxious.
- Read stories to their children around thumb sucking to raise awareness about the issue.
The child’s involvement, participation, and motivation are crucial to succeeding in this task!
How does orofacial myofunctional therapy work?
First, it is important to understand that orofacial myofunctional therapy can only happen in conjunction with other professionals (e.g., pediatrician, dentist, ENT specialist). It is through the collaboration of all these professionals that the best results can be achieved. When we as SLPs receive the referral, we start by obtaining the child’s medical history. We would like to know about any known allergies, medications, etc. The assessment then continues evaluating the child’s oral rest posture, body posture, resting facial features, and the overall function of the orofacial structures. Based on the clinical findings the goals are established and the frequency and the duration of the services is determined. It is important to understand that to be eligible to participate in this kind of therapy, the client needs to be able to follow instructions.
What can cause swallowing issues and how does a speech pathologist help with swallowing issues?
Swallowing disorders (also known as dysphagia) can be defined as the difficulty to pass food, liquids, or medication from the mouth to the stomach. Dysphagia can be secondary to various etiologies including but not limited to congenital disorders, head and beck cancer, traumatic brain injuries, stroke, neurodegenerative disorders, post-intubation, etc. In some countries, like in the United States, speech and language pathologists are considered the primary provider that can assess, diagnose, and treat swallowing disorders. The SLP determines if the patient exhibits signs and symptoms of dysphagia, and if the support of instrumental assessments is required. By instrumental assessments we refer to exams that can help us visualize where the food, liquids, and medications are going. Our primary goal is identifying ways to protect the airway (breathing pipe) and ensure that the patients are getting all of their nutrients. Quality of life is a major goal as well.
What is the most rewarding aspect of your work?
The most rewarding aspect of my job is to increase the quality of life of my clients. We as SLPs support very crucial activities of our daily lives (e.g., communicating, understanding language, eating, etc). Each client is different, and it is truly my pleasure to be able to make recommendations and target goals according to their specific needs. I love seeing the face of my clients when people can understand them better, when the frustration levels decreased once they are able to convey a message, or when they are happy to be able to eat a meal for the first time in a long.
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