20Q: Practical Strategies for Serving Students in Poverty with Potential and Identified Developmental Language Disorder and Their Families

From the Desk of Ann Kummer

I am so excited to introduce this edition of 20Q! Written by Dr. Celeste Roseberry-McKibbin, this article covers practical strategies that can be used by speech-language pathologists to improve the language, literacy, and executive function skills of children who are living in poverty.

Dr. Roseberry’s primary research interests are in the areas of assessment and treatment of culturally and linguistically diverse students with communication disorders. She is also very interested in service delivery to students from low-income backgrounds. Dr. Roseberry is well-known as an expert on these topics. What is less known is that she is also a passionate advocate and volunteer for improving the language and literacy skills of disadvantaged children. As she points out, one of the greatest predictors of reading and academic success is the availability of books in the home, yet families living in poverty cannot afford books. Therefore, she and her family (husband and son) and university students collect and distribute books to low-income children. Dr. Roseberry also has a website called Love Talk Read (https://lovetalkread.com/), which provides a place for book donations, gives information on how to start a book drive, and even provides guidance on how to become a “reading partner” for struggling readers.

Dr. Roseberry has a family history of service to others. In fact, she grew up in the Philippines (from ages 6 to 17), as the daughter of Baptist missionaries. She received her Ph.D. from Northwestern University. Currently, she is a Professor of Communication Sciences and Disorders at California State University, Sacramento and is also a part-time itinerant speech pathologist in San Juan Unified School District. She has over 70 publications, including 16 books, and has made over 370 presentations at the local, state, national, and international levels. Dr. Roseberry is a Fellow of ASHA, winner of ASHA’s Certificate of Recognition for Special Contributions in Multicultural Affairs, and recipient of the Excellence in Diversity Award from CAPCSD. She has received the national presidential Daily Point of Light Award for her volunteer work in building literacy skills of children in poverty.

After reading this article, you may want more information. Well, you are in luck. Dr. Roseberry is the author of the book entitled: Instant Insights on…Love, Talk, Read to Help Your Child Succeed. This book is a practical guide for parents on how to prepare their children to succeed in school by loving, talking and reading. This is a book to read and also to recommend.

Now...read on, learn and enjoy!

Ann W. Kummer, PhD, CCC-SLP, FASHA, 2017 ASHA Honors
Contributing Editor 

20Q: Practical Strategies for Serving Students in Poverty with Potential and Identified Developmental Language Disorder and Their Families

Celeste Roseberry-
McKibbin 

1. I serve students in poverty who are in preschool, elementary school, and high school. Sometimes I feel like language-wise, these students are “so far behind the 8 ball” from a very early age that I don’t know where to begin!

It really does start at birth. The research of Fowler (1995) with low-income children from diverse backgrounds followed them from infancy through high school. In Group A, language stimulation strategies began at 4 months of age. In Group B, language stimulation began at 12 months of age. Fowler and colleagues’ longitudinal study of these babies showed that in high school, Group A substantially outperformed Group B on every cognitive, linguistic, and academic measure administered. We must do our best to educate families about language stimulation before the baby is even born, if possible. And we need to emphasize the importance of talking and reading from Day One. In many cultures, adults don’t talk to infants and young children—this is not consistent with their cultural values.

2. How can I help parents effectively stimulate the language of their infants and young children when they are in poverty and are struggling to even pay for rent and food?

That’s my population! Many of my families are migrant or even homeless. Many caregivers are nonliterate, and many do not speak English. Thus, I make sure my suggestions are ones that can be fit into daily routines and can be carried out in any language. I teach caregivers how to incorporate extensions. For example, at the store:

Child: “Cereal.”
Caregiver: “Yes, there is some cereal on the shelf and we will buy it.”

In my most recent book, Love Talk Read to Help Your Child Succeed (Roseberry-McKibbin, 2018a), I give simple, practical suggestions for caregivers who may have limited formal education. If families don’t speak English, I use an interpreter.

3. My parents wrestle with so many odds: poverty, sometimes domestic violence, not having a partner, isolation, lack of a formal education….If I want parents to read or even look at books with their children, how do I simplify my suggestions so that they are “doable” for this population?

Great question! The following strategies can be implemented in any language by caregivers with minimal education, even if they don’t read and are only able to talk about pictures in books with their children. They can carry out these ideas in their primary languages (e.g., Spanish, Urdu, Tagalog). I ask my caregivers (mom, dad, grandparents) to CARE: (Roseberry-McKibbin, 2018a; 2018b):

Comment: “Look at Clifford the big red dog!”

Ask Questions: “What do you think Clifford is going to do next?”

Respond: “Oh, you’re right, he is going to eat his food.”

Extend: (Child says “Clifford bark.”) “Yes, Clifford barks because he is hungry and is happy to have food now.”

4. That sounds doable, given the situation my families are in. Is there anything else I should share with them about language stimulation for their infants and toddlers?

Yes. For so long, we said “talk to your child.” We’re still saying that! But we have gotten away from what I call the “waterfall of words” to an increased emphasis on responding to the baby’s initiations (Tamis-LeMonda, 2001; Marklund et al., 2015).

5. Do you have research to support this?

In a recent Swedish study, Marklund et al. studied the 1;6 year old children of 2 groups of parents: 1) fast responders, and 2) slow responders. In Group 1, the parents who responded quickly to their toddlers’ verbal and nonverbal initiations had children whose language skills—especially vocabulary-- grew very quickly. On the other hand, the children of slow-responding parents lagged behind. Tamis-Lemonda et al. (2001) showed the same thing here in the U.S. The most important thing is for parents to respond immediately to their children’s initiations, both verbal and nonverbal.

6. I want my parents to read with their children, but they have few-no books in their homes. What are the consequences of this?

I was galvanized by the statistic from the One World Literacy Foundation (2018) that for 4th graders who end 4th grade reading below grade level, 2/3 will end up in prison, on welfare, or both. Over 70% of our prison population in America cannot read above a 4th grade level. Some states base their estimates of the number of prison cells they will need in the future partially upon the number of 3rd graders who are reading below grade level!

7. I have a very limited budget. How do I get books for my students to read and to keep at home?

You can start your own collection. Some years ago, I collected a few hundred books for a graduate student’s thesis. It was so rewarding that I continued the book collection; at the time of this writing, my university students and I have collected and donated over 188,000 books to at-risk children in Sacramento, California. We have also sent books to children in developing countries around the world.

8. Can you give me specifics as to how I can go about collecting books?

My website, lovetalkread.com, has simple strategies for starting your own book drive. I promise that if you just start your book drive by word of mouth, books will come pouring in at a level that will astonish you. I have had undergraduate students collect 3,000+ books via word of mouth and social media. There is no paperwork involved—I promise!!—and it is so fun and gratifying. I’ll collect books and haul around those heavy boxes until I literally fall over. I never dreamed that my little project would reach so many lives locally and around the world.

9. What about parents who tell me that they are so tired that instead of reading or looking at books with their children, they just hand their children the phone as a babysitter?

As a mother myself, I remember being so exhausted when my son (not a sleeper!!) was little that I would have done just about anything to quiet him down so I could get work done or even take a small nap. But the American Academy of Pediatricians (2018) tells us that young children should be kept away from screens as much as possible with the exception of live video chat with relatives. If there is TV or a phone or iPad, there needs to be joint media engagement—a caregiver needs to view with the child and discuss what is being viewed.

10. Speaking of parents being tired, I often encounter this problem: when children misbehave, parents often resort to anger, threats, and even corporal punishment. Though I am not a psychologist or behavior specialist, sometimes I’m the only professional that parents turn to. Is there any advice or help I can give them to help them manage their children’s behavior through a verbal problem-solving format and not by means of yelling, threatening, or hitting?

Absolutely! My son Mark, when he was small, was very strong-willed. The tantrums were so exhausting and upsetting; power struggles abounded. One time, we argued about something for so long (when he was 3) that I said “You will do this because I’m the mommy and you’re the boy!” His little face crumpled into tears as he shouted “I am not a boy! I’m a superhero!” Around that time, a friend put a book into my hands that was an absolute lifesaver: Setting Limits with your Strong-Willed Child (MacKenzie, 2001).

11. Can you summarize the major takeaways that helped you?

First, anger and punishment don’t work; consequences do. Before I read the book, I’d threaten, cajole, plead, and finally get angry. I stopped doing that. I’d tell Mark to do something “Mark, please go get your pajamas on.” He’d ignore me and keep playing. Then I’d say “Mark, listen to Mommy. Please go and get your pajamas on. If you don’t start doing this by the time I count to 3, no video tonight. One, two, three. Oh, I see you chose not to obey me. No video tonight.” He’d cry and say he was sorry and beg for the video, running to his room to put his pajamas on. I’d hold my ground and not give in. For the first weeks I implemented this after he had turned 3, this was just a terrible time for us of tantrums and conflict. But I remained calm and firm. Eventually, he realized I meant what I said and he obeyed me the first time with no arguing. Our home was so much happier and more peaceful! I cannot recommend that book too highly!

12. It sounds like this would not just help behavior—I’d think it would be best for the child’s language development too?

Absolutely. Giving choices and consequences is so helpful for building children’s cause-and-effect skills. And I believe it helps develop theory of mind as well. Children learn that their negative behavior truly affects other people, and they learn to be more empathetic and giving. This can only be helpful to their social relations with others as they become less self-focused and more aware of others’ needs. 

13. In terms of dealing with behavior, can you tell me a little more about your direct experiences in working with students in poverty who come from less-than-ideal home backgrounds?

I work several days a month as an itinerant SLP in the public schools. I serve at-risk teen young men who are sex offenders in a high security school that is one step away from juvenile hall. I also serve at one of the district’s highest poverty schools; the school is K-5, and we have a Head Start as well. My precious children often come from homes with multiple problems; one of my students, Vincent, is being raised by his grandma because his parents hung themselves. One of the girls saw her mother murdered by her domestic partner. A girl recently told me that her uncle just got out of jail. One boy was so hungry that I gave him the apple I had brought to eat for lunch. He ate all of it, even the core. He reported that his drunk uncle had had a car accident and the pets in the car were killed. And he added that his grandparents had just moved in with his family because “their floor broke.” I could go on! But what these students all have in common is home lives that are very chaotic, unstructured, and lack boundaries. Sometimes in my therapy sessions, these students will throw my game chips around, grab items, try to cheat in a game….I always look them straight in the eye and call them on their behavior.

14. I think that my students’ behavior is so influenced by their home lives, which are often unstructured, chaotic, and unpredictable. I only see students twice a week for 30 minutes in a group. Can you give me examples, from your own work in the schools, of how you have worked effectively with these students in terms of choices and consequences?

Here is an example. During a group therapy session, a girl I will call Araceli upended my game board and chips went flying everywhere around the therapy room. I said “HEY! Araceli, I did not like that and I feel angry at what you did. Please pick up those chips right now.” (she did) I said ‘You will not get a sticker today because of your behavior. But you know Miss Celeste cares about you a lot, and I know you will not do that again. When you come back, I know you will have good behavior and earn your sticker.” What’s so weird is that for Araceli and many other children with whom I’ve set boundaries, they run up and hug me the next time they see me. And they do not engage in the behavior again!

Anthony is another example—I just saw him a few days ago. A precious boy with severe ADHD, Anthony comes from a chaotic home like most of the children whom I serve. He had tried to run away from me at one point as we walked from the special day class to the speech room, and I’d had to run really fast after him so he wouldn’t run into the parking lot. I was furious! I told the lead SLP Debbie about it because she knows him much better than I do. She got eye-to eye with him and talked to him loudly and very sternly about why his behavior was unacceptable. She spelled out clear consequences if he did it again. When I see Anthony now, he runs up and hugs me long and hard. I am so touched, because these precious children are just crying out for loving boundaries and structure. They know I love them and that I care for them, and that I will not tolerate misbehavior. They feel safe, and their increased speech and language skills reflect the more peaceful and productive therapy sessions that we experience.

15. The terms “grit,” “resiliency,” and “growth mindset” are so popular right now. But how do I instill these values in students who have so much tragedy in their lives? We know that working on increasing language skills will not be successful if students have given up hope and no longer want to try.

For us as SLPs, these terms and the characteristics they embody are about executive functioning skills and delayed gratification. The combination of a developmental language disorder, poverty, difficult home lives, and family tension are the “perfect storm” for a future of dropping out and possibly becoming involved with the criminal justice system and/or welfare.

16. Can you share a recent example of how you helped students with executive functioning skills in your own clinical work?

Sammy, a 16-year old sex offender whom I currently serve, is a biracial student with a cochlear implant and a long string of multiple offenses. His family lives in great poverty. He was abused himself. Dad recently was released from prison for aggravated assault with a deadly weapon, and Mom drinks and abuses drugs. I’ve been seeing Sammy for speech-language therapy for almost 2 years at the safe (high security) school he attends (one step above juvenile hall), and we at the school are overjoyed at his progress. I talk to him all the time about making good choices so he can achieve his dream of becoming an auto mechanic. To my great happiness, he is doing so well that he will be mainstreamed into a regular high school next year.

But unfortunately, when I saw Sammy last week, he was distraught because he found out that his mother is continuing to abuse and neglect his 3 younger siblings. Last Friday he told me “I’ve been an adult my whole life.” His grades are falling and he is literally physically ill from worrying about his siblings. Fortunately, he has trained them to call 911 when they are being abused or neglected. He told me that they are now in foster care, and he is so relieved. But he’s sick and his grades have fallen. He was scheduled for surgery to put a cochlear implant in his left ear—he only has an implant in his right ear. But if he was sick, they’d have to cancel the surgery.

I reminded Sammy how much I cared for him—how much all of us at the facility cared for him. I told him that getting sick and getting Fs in school would not help his siblings at all. What would help them is for him to get As and Bs and perform well so that he could eventually land a solid job and perhaps support them financially. I reminded him that he was the sum of his choices, and that we were all rooting for him.  I told him how much I cared for him; I looked him right in the eye and said “Sammy, don’t you disappoint me.” This was effective, and he is getting back on track. He got well and was able to have a second cochlear implant put in last week. I’m so thrilled!

17. Can you tell us more about how you directly target executive functioning skills for students in poverty?

Students in generational poverty, where there is a culture of welfare, tend to not look beyond instant gratification today. They frequently have very low executive functioning skills. They don’t think about the future. Much of my job as their SLP is to help them look beyond today to tomorrow—and the next years. This is especially crucial with my teen sex offender young men who I see at the safe school which works on their rehabilitation. Because they committed the offenses before the age of 18, much can be expunged from their records and a bright future is still possible. Though I am not their counselor, it is within my purview as an SLP to target their problem-solving and executive functioning skills by helping them to project into the future and consider how it is influenced by their choices today. I rejoice in the knowledge that most of the teens I have worked with are now thriving, making good choices, and experiencing success in their lives. I am so privileged to be a stepping stone for students like Sammy. And at the end of the day, that is why we became SLPs in the first place: to experience the joy of making a positive and permanent difference in the lives of the individuals we serve. 

18. How do you show support and caring in a manner that is professional and within ethical bounds of our profession?

Students like 16-year old Sammy will improve only when they believe that we genuinely care about them as people. I am often asked how I have been able to make such a big difference for Sammy when I only see him a few times a month for speech and language. The answer? Sammy knows I love him. I buy him gifts for birthday and Christmas, as he lives in a group home and gets nothing from his biological parents. I encourage him constantly, and am always urging him to remember his dream of becoming an auto mechanic. We even made a vision board for New Year’s 2018 that he keeps in his room at the group home where he lives. When he is bored with the arcane and irrelevant language arts story that the class is working on, and I am trying to help him answer the comprehension questions at the end of the chapter, I tell him that yes, this story is as boring as all get out. But he needs to keep the big picture in mind. It’s OK to not like the story, but bombing the assignment will result in a low grade. Low grades will result in his dream getting postponed or not happening at all. My students in poverty need constant support to think about the future, where they see themselves, and how their choices today impact their lives tomorrow.

19. In your opinion, what is the “bottom line” advice for those of us who work with students and their families in poverty?

After my years in the profession, and so many hours of service to this population (including working directly on the streets with the homeless community), I feel like I have been blessed to become quite good at increasing the speech and language skills of at-risk children in poverty. But in the final analysis, here is what I have learned: more than anything, they need hope for a bright future. They need positive role models, encouragement, and someone who loves them and cares about them. I know that our professional journals and our university coursework don’t talk about this aspect, but it’s true. The students I work with thrive because they know I love them and will do anything to help them. Students with such great odds against them are not going to improve in their speech and language skills without a strong, warm, and supportive personal relationship with their SLP. It is this supportive relationship that is the foundation of speech and language therapy.

20. Any last thoughts?

When we work with students in poverty and their families, we can become sad and discouraged by the tremendous odds they face. But our feeling sad and overwhelmed does not help us serve them better. What keeps me going is constantly reading the new research and taking action—collecting and donating more children’s books, making simple youtube videos for that SLPs can share with caregivers (go to youtube and type in Celeste Roseberry), improving my therapy strategies….and, most of all, focusing on why I went into the profession in the first place: to make a positive and lasting difference by providing hope and a brighter future for those whom I serve.