Interpreters and language assessment: Confrontation ...

Advances in Speech–Language Pathology, Vol. 6, No. 4, December 2004, pp. 247 – 252

Interpreters and language assessment: Confrontation naming and interpreting

MARIA KAMBANAROS1,2 & WILLEM VAN STEENBRUGGE1 Department of Speech Pathology and Audiology, School of Medicine, Flinders University, Adelaide, Australia, 2Department of Speech and Language Therapy, School of Health and Welfare, Technological and Educational Institute, Patras, Greece Int J Speech Lang Pathol Downloaded from informahealthcare.com by University of Windsor on 07/01/10 For personal use only.

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Abstract There has been an increase in issues regarding the involvement of interpreters in the assessment of language disorders in bilingual individuals. Most publications focus on overall issues, such as the respective roles of the speech pathologist and interpreter, the need for teamwork, the need to share information about the assessment methods and materials used, and the need for a three stage process of briefing, interaction and debriefing. The current article stresses the need for speech pathologists to share more of their professional knowledge with the interpreter, specifically knowledge about typical responses and behaviours of clients that form essential data or evidence in the diagnosis of a particular disorder, for example bilingual aphasia. This point is illustrated by a small case study of translated responses of a bilingual individual with aphasia during confrontation naming in the native language.

Introduction Previous publications on the use of interpreters during the assessment and diagnosis of the language and communicative impairments of bilingual clients have mainly focussed on general issues concerning the respective roles of speech pathologists and interpreters, and procedures to improve the effectiveness of working with interpreters (see below). The main aim of this paper is to stress that speech pathologists should not only provide interpreters with information about the aims, materials, methods, and procedures etc. that will be used during the assessment, but they should also share more specific information about the evidence and data on which assessment and diagnosis are based, i.e., likely behaviours and responses by the client. This will be illustrated on the basis of naming errors in the native language made by a 58 year-old Greek-English client with aphasia who was assessed on a non-standard object naming test. The clinician was assisted by an accredited, professional interpreter with previous experience interpreting during aphasia assessments. Providing the most appropriate services for bilingual individuals with aphasia is a major challenge facing speech pathologists in multilingual and multicultural societies like Australia. Like most western countries, Australia is faced with a greying popula-

tion, including its migrant population. An increasing number of culturally diverse and bilingual individuals are ageing (Hugo, 1999) which puts them at a greater risk of suffering from age-related, acquired language disorders such as dementia or aphasia. Consequently, there will be a steady increase in the number of bilingual clients with aphasia who require the services of speech pathologists for assessment, diagnosis and treatment of their communicative difficulties in one or both of their languages. A previous survey of speech pathology departments of the major hospitals in Australia suggested that between 15.8 and 22 percent of their clients with aphasia were bilingual (Whitworth & Sjardin, 1993). Assessment of the bilingual client’s native or first language (L1) is also warranted since a substantial number of bilingual clients with aphasia may have had poor command of English before the stroke. For instance in the 1996 ABS Census, approximately 24 % of Italian, 32 % of Greek, 44 % of Vietnamese, and 45 % of Chinese speakers are reported not to speak English well or not to speak English at all (Hugo, 1999). Therefore, there is general acceptance among speech pathologists that assessing bilingual clients in one language (L2) only does not reliably reflect the precise nature of the acquired language disorder, nor the client’s actual (i.e., bilingual) communicative abilities and impairments (Baker,

Correspondence: Dr Willem van Steenbrugge Department of Speech Pathology/ School of Medicine, Flinders University of South Australia, FMC level 7E, PO Box 2100, Adelaide SA 5100. Tel: + 61 8 8204 5956. Fax: + 61 8 8204 5935. E-mail: willem.vansteenbrugge@flinders.edu.au ISSN 1441-7049 print/ISSN 1742-9528 online # The Speech Pathology Association of Australia Limited Published by Taylor & Francis Ltd DOI: 10.1080/14417040400010009

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1995). Given the relatively small number of bilingual speech pathologists in Australia (Hand et al., 2000), most bilingual clients will be assessed in their native language by monolingual, English-speaking speech pathologists with the assistance of professional or family-based interpreters. Roger (1998) reported that a large number of Australian speech pathologists, approximately 95%, used either a family member or a professional interpreter to translate the English assessments into the client’s L1. Therefore, there has been an increase in the interest in clinical practice relating to bilingual language assessment and the use of professional interpreters by monolingual speech pathologists (e.g., Baker, 1995; Clark, 1998; Isaac, 2002; Isaac & Hand, 1996; Kambanaros, 2002; Langdon, 2002; Langdon & Cheng, 2002; Langdon & Quintanar-Sarellana, 2003; Roberts, 1998, 2001; Van Steenbrugge, 2000). Most publications mainly focus on general recommendations and guidelines for best practice to enable speech pathologists to work more effectively with interpreters, including: .

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General issues regarding intercultural health care and speech pathology, covering important issues such as: Perceptions, beliefs and attitudes towards health care, disease and communication disorders which are influenced by the client’s, and clinician’s, cultural background (e.g., Fuller, 2003; Olthuis & van Heteren, 2003; Isaac 2002). Necessity for the speech pathologist and interpreter to work as a team. For example, the speech pathologist and interpreter should prepare for the bilingual assessment and share information about the purpose of the bilingual assessment, they should observe each other’s verbal and nonverbal communication to guard the clarity of the message(s) to the bilingual clients and to each other (see Langdon & Quintanar-Sarellana, 2003). Respective roles and responsibilities of speech pathologists and interpreters. For instance, the speech pathologist should understand the important aspects of bilingual language processing, as well as be familiar with the methods and processes involved in assessing and diagnosing communicative and language impairments in bilingual clients. The speech pathologist is also considered to be in ‘control’ of the assessment, and should brief the interpreter about the aims, language tasks, and procedures used in the bilingual assessment. Furthermore, the interpreter will expect the speech pathologist to stipulate the required method of interpreting (see below), and to provide relevant background information about the clients and their specific aetiology (Isaac, 2002; Langdon & Quintanar-Sarellana, 2003). Speech pathologists often ask inter-

preters for their analysis and opinion about the appropriateness or the deviations from the norm of language used by the client compared to the client’s language community (Clark, 1998). However, this is not intrinsically part of the brief, role or responsibility of the interpreter. Many interpreters are reluctant to provide this information as volunteering judgements about the client’s use of their native language might be perceived as incompatible with their professional code of ethics (AUSIT, 1996). Instead, interpreters are often more comfortable with their prescribed role as: (1) the interviewer or the client’s main communicative partner, (2) a professional guided by the clinician, and (3) as the mediator and informant of any cultural differences or culturally sensitive issues (Faust & Drickey, 1986; see Isaac, 2002). However, accredited Interpreters in Australia will be less comfortable with a fourth role mentioned by these authors which is the interpreter as the client’s advocate and asking questions on behalf of the client. Bound by their Code of Ethics with an emphasis on upholding impartiality and accuracy in the interpretation and translation, Australian interpreters will perceive their prime role as ‘facilitator of communication’ rather than ‘client advocate’. Therefore, it is unlikely that they will ask questions or provide suggestions which are not initiated by the client (or the clinician for that matter). Interpreters are also expected to have strong language skills in the two languages and to understand the two cultures to enable them to translate from one language into the other. Generally, one of two interpreting methods is applied: simultaneous interpreting, i.e., translating what is being said in the one language into the other language at the same time as the client or clinician is speaking or consecutive interpreting, i.e., translating from one language into the other after the speaker has finished (Isaac, 2002; Langdon & Quintanar-Sarellana, 2003). Consecutive interpreting can take many forms, including word-for-word interpreting, sentence-by-sentence interpreting or summary interpreting. Word-for-word interpreting is often deemed to be inappropriate for communication across two languages, as it makes it difficult for the interpreter to convey both the content and intent of the message or the utterance(s). Thus, sentence-by-sentence or summary interpreting is often recommended as the most appropriate style (Isaac, 2002). On the other hand, specific tasks during a language assessment, such as word comprehension and production or sentence comprehension and production in the native language will lend themselves for word-for-word interpreting.

Interpreters and language assessment

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Specific strategies for working more effectively with interpreters Apart from overall strategies to facilitate a team approach, such as establishing rapport, consideration of the sensitivities around cultural differences, sensitivity towards verbal and nonverbal communication, acknowledgement and respect of each other’s specific roles and expertise etc., there is also a need for a three stage process of (pre-assessment) briefing, interaction and (post-assessment) debriefing (BID) to ensure more positive outcomes of bilingual language assessments that involve the participation of professional interpreters (Langdon & Quintanar-Sarellana, 2003). It is now widely accepted that a pre-assessment briefing should be organised between the speech pathologist and interpreter. Isaac (2002, p. 94) provides a sensible list of issues that should be addressed, ranging from the overall aims and objectives of the bilingual language assessment, i.e., session goals, to preparing the interpreter for unfamiliar physical presentations of some of the clients. The main aim of the current paper is to demonstrate that the pre-assessment briefing with the interpreter should also include a specific discussion about typical verbal and non-verbal responses by bilingual clients specifically those responses which speech pathologists commonly use in the diagnosis. This point will be illustrated on the basis of naming errors in the native language made by a 58 year old Greek-English client with aphasia who was assessed on a non-standard object naming test. The clinician was assisted by an accredited, professional interpreter with limited experience interpreting during aphasia assessments. The session was conducted in the presence of a bilingual, Greek-English speaking, speech pathologist (the first author). Confrontation naming was selected because this relatively simple language task seems to lend itself best for word-for-word translation of the client’s correct and incorrect responses from the native language (L1) into the second language (L2). Furthermore, there is often little ambiguity about the correct (L1 and L2) target word during confrontation naming. Case study TK was a 58-year old male who had migrated from Greece with his parents at the age of fourteen. He suffered a left fronto-parietal CVA in July 2001. He reported that he had been fluent in Greek and English before his stroke, but that he had no formal English education. English had been his primary language since his migration to Australia. TK was married to a non-Greek speaking wife and owned a restaurant in rural Australia. Family members confirmed that he was conversationally fluent in both Greek and English before the stroke.

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TK was assessed by a monolingual, English speaking speech pathologist with the assistance of a professional Greek-English interpreter who was asked to translate the Greek responses into English. The speech pathologist had limited experience assessing bilingual clients with an acquired language disorder. The interpreter had limited previous experience of interpreting during a language assessment of bilingual aphasia. The speech pathologist and interpreter had not worked together before, and as the interpreter arrived late for the session, there was little time for a comprehensive pre-session briefing, and no time to go over the picture materials and discuss correct target responses in Greek. TK was assessed on the English and Greek version (translated by the Psychology Department of the University of Ioannina, Greece) of the Boston Diagnostic Aphasia Examination (BDAE) (Goodglass & Kaplan, 1983). These two BDAE assessments were conducted by a Greek-English bilingual speech pathologist in two separate sessions. TK’s overall residual language ability as reflected in the BDAE rating scales for conversational language was very similar in Greek and English. TK’s residual naming ability was further investigated in both languages to assess the level of language breakdown during confrontation naming. The non-standard naming task reported below was part of a more comprehensive language assessment to determine the nature of the underlying naming impairment in Greek and English (Kay, Lesser, & Coltheart, 1992). The Greek non-standard naming task was administered by a monolingual, Englishspeaking speech pathologist using a Greek-English, accredited interpreter. The interpreter was instructed to conduct a word-for-word translation during this task. The Greek responses were translated into the most appropriate English equivalents, i.e., the meaning of the Greek word was translated into English. The translated responses were orthographically transcribed by the monolingual speech pathologist. TK’s naming performance was very poor in his native language (4 items correct). However, his naming errors were of particular interest with respect to the aims of the current study. They comprised code switches (6), circumlocutions (5), semantic substitutions (3), and phonological substitutions (5). Examples of the naming errors are displayed in Table I. Although a substantial number of erroneous responses in Greek comprised phonological errors, for instance phonemic substitutions: ‘skili’ for ‘skini’ and metathesis: ‘vraka’ for ‘varka’, these erroneous responses were translated according to their meaning, ‘dog’ and ‘underwear’ respectively. Consequently, these responses were initially classified as semantic paraphasias and (semantically) unrelated paraphasias. Generally, the presence of semantic errors are considered to provide further

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Table I. Examples of TK’s naming errors on the Greek naming test and their translations by the interpreter. Target

Response

Error

skini (rope) * pipa (pipe) porta (door) varka (boat) ziwaria (scales) roloi (watch) pisina (pool) tilefono (telephone) kremastra (coat-hanger) sidero (iron) tigani (fry-pan) stiftis (juice extractor) potistiri (watering can) skoupa (broom) skala (ladder) sfougari (sponge) katsarola (saucepan)

skili (dog) # tsipa (skin) prota (first) vraka (underwear) siwana (quietly) ora (time) nero (water) milas (speak) vazis ta rouha (put the clothes) patas ta rouha (press the clothes) vazis avga (put eggs) gia lemoni (for lemons) gia louloudia (for flowers) skoupa (broom) skala (ladder) sfougari (sponge) katsarola (saucepan)

phoneme substitution

Target wandi (glove) vourtsa (brush) aetos (kite) bota (boot) amaksi (car) tripani (drill)

Responses (code switches) Error gland code switch plus phoneme substitution

phoneme substitution and addition metathesis metathesis phoneme substitution (2x) and phoneme omission semantic substitution semantic substitution semantic substitution circumlocution/ description circumlocution/ description circumlocution/ description circumlocution/ description circumlocution/ description no error/ correct no error/ correct no error/ correct no error/ correct

push

code switch plus phoneme substitution / deletion

sky

code switch plus semantic substitution

legs

code switch plus semantic substitution

caro

code switch plus Greek suffix error (sing. Neuter)

drilli

code switch plus Greek suffix error (sing. Neuter)

* English translation between brackets underneath # translation by interpreter.

evidence in support of the diagnosis of a moderate to severe lexical-semantic impairment at the level of the semantic system (Kay et al., 1992). However as shown in Table I, a substantial number of erroneous responses during naming were phonologically and not semantically related to the Greek target word. Phonological errors are usually interpreted as (supporting) evidence for a language breakdown when retrieving the phonological word form (Nickels, 1997). The phonological relationship between TK’s responses and the target words was not picked up by the interpreter who was translating the meaning of the Greek words.

Consequently, the monolingual speech pathologist, relying on the translated responses, originally assumed that these responses were semantic paraphasias, albeit that some errors were considered to be well off-target, for instance ‘vraka’ (‘underwear’) for ‘varka’ (‘boat’). The client’s performance, the translations, and the analysis of the erroneous responses were subsequently discussed between the monolingual and bilingual speech pathologist after the session, during which the phonological relationship between Greek target word and some of the responses was pointed out.

Interpreters and language assessment

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Discussion Previous publications on the involvement of interpreters during the assessment of bilingual language impairments stress the need for a three stage process (BID) of pre-assessment briefing, interaction and post-assessment debriefing with the interpreter (Langdon & Quintanar-Sarellana, 2003). Suggestions about the content of the briefing centre mostly on general conditions surrounding the assessment, such as reviewing the respective roles of the speech pathologist and the interpreter, the required interpreting method, the assessment methods and specific materials used, information about the client’s background and medical history (Isaac, 2002; Langdon & Quintanar-Sarellana, 2003). The main aim of the current paper was to demonstrate that the briefing should also include a more specific discussion of the evidence or data speech pathologists commonly rely on to arrive at a diagnosis of the language impairment in question. This was illustrated in a simple naming task in a case of bilingual aphasia, in which the dominant naming errors were incorrectly categorised as semantic rather than phonological paraphasias. Confrontation naming was selected because this relatively simple language task seems to lend itself best for word-forword translation of the client’s correct and incorrect responses from the native language (L1) into the second language (L2). Furthermore, there is often little ambiguity about the correct (L1 and L2) target word during confrontation naming. The majority of TK’s incorrect responses were phonologically related to the Greek target word. This case study with a representative sample of TK’s responses showed that these responses could be easily misinterpreted and misclassified if the interpreter is unaware of responses often made by clients with aphasia. This is particularly the case when the interpreter is unaware of the fact that responses from clients with aphasia are frequently either phonologically or semantically related to the correct target word. As the phonological nature of most of TK’s errors was not identified, it was virtually impossible for the speech pathologist to accurately diagnose the nature of the underlying naming impairment for Greek. This may lead to a misinterpretation of the true nature of the underlying naming impairment in one (or both) of the bilingual individual’s languages. As Paradis (2001) acknowledged, there is the real danger of misdiagnosis if aphasic symptoms are not correctly identified in both languages. TK’s naming problem in Greek was considered to arise at the lexicalsemantic level given the fact that a large number of his naming errors were categorised as ‘semantically unrelated to the target’. However, as most errors were phonological in nature, it is more likely that the level of language breakdown occurred at the phonological level.

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This small case study shows the difficulty faced by the monolingual speech pathologist in accurately diagnosing TK’s underlying naming impairment and consequently, select the most appropriate therapy approach for the remediation of his naming difficulty. Previous studies have shown that the efficacy of the remediation of naming problems might be dependent upon the nature of the underlying impairment and matching a therapy approach, either phonologically or lexical-semantically based (see Nickels, 2002, for a review). The examples of TK’s responses in the Greek naming task and their translations presented in this paper show that a misclassification of the errors made by bilingual clients can easily arise, even during consecutive word-for-word translation in a naming task. The likelihood of such misclassification of errors is greater when there is a lack of knowledge and information about aphasic behaviours on the part of the interpreter. Of course, the lack of experience on the part of the speech pathologist and the interpreter would also have been contributing factors in this case study. Interpreters are bound by their professional code of ethics (AUSIT, 1996) to ‘‘not alter, make additions to or omit anything’’; but to ‘‘relay accurately and completely everything that is said’’; and to convey the ‘‘whole message’’, i.e., provide no summary of statements but to render a meaningbased interpretation of what was said. Consequently, interpreters usually focus on the content of the message and pragmatic inferences rather than the appropriateness of grammar, lexical-semantics or phonology. Often, this style of interpreting will match the speech pathologist’s aims, for instance when assessing the (residual) communicative abilities of bilingual clients. However, this style of interpreting may not be appropriate in specific language tasks as was illustrated by the current case study. The different aims and goals of specific language tasks should be addressed in a pre-assessment briefing with the interpreter. In addition, the speech pathologist should share and discuss information about typical error patterns and other correct and deviant (language) behaviours of the client, in particular those that are important in the diagnosis of the specific language disorder, e.g., aphasia. Providing this information will also make interpreting easier for interpreters as they will gain a better understanding of when to focus on content and intent of the client’s message during interpreting and when to focus on the specific linguistic features of the correct and incorrect responses. Any discussion about the quality of the client’s responses with the speech pathologist is best undertaken during a debriefing session shortly after the assessment. Working effectively with the interpreter(s) is essential for all speech pathologists when assessing and diagnosing bilingual clients with specific language disorders, e.g., (bilingual) aphasia. A good

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working relationship is, among other things, dependent on the willingness to share essential information and professional knowledge as well as the implementation of good work practices for successful interaction, such as the implementation of the three stage (BID) process (Langdon & Quintanar-Sarellana, 2003) consisting of briefing, interaction and debriefing when assessing bilingual clients with a language disorder. Anticipated linguistic errors and other behaviours made by language disordered bilingual clients, e.g., clients with bilingual aphasia, should also be addressed in the briefing (and debriefing) sessions with the interpreter. In summary, the current case study highlights the need for a pre-assessment briefing session between the clinician and the interpreter during which the aims and purpose of the assessment are explained. As stressed above, it is suggested that clinicians should also provide interpreters with specific, detailed information about common responses by bilingual individuals (with aphasia or other language and speech disorders), and the importance of these responses in the diagnosis and management of disorders like bilingual aphasia.

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Isaac, K., & Hand, L. (1996). Interpreter-mediated interactions in speech pathology: Problems and solutions. Australian Communication Quarterly, 12, 32 – 36. Isaac, K. (2002). Speech pathology in cultural and linguistic diversity. London and Philadelphia. Whurr Publishers. Kay, J., Lesser, R., & Coltheart, M. (1992). Psycholinguistic assessments of language processing (PALPA). Hove: Lawrence Erlbaum Associates Ltd. Kambanaros, M. (2002). Naming errors in bilingual aphasia: Implications for assessment and treatment’’. Poster presented at the 10th International Aphasia Rehabilitation Conference. Brisbane. Langdon, H. (2002). Communicating effectively with clients during a speech-language pathologist/interpreter conference: Results of a Survey. Contemporary Issues in Communication Science and Disorders, 29, 17 – 34. Langdon, H., & Cheng, L. L. (2002). Collaborating with interpreters and translators: A guide for communication disorders professionals. Eau Claire, WI: Thinking Publications. Langdon, H., & Quintanar-Sarellana, R. (2003). Roles and responsibilities of the interpreter in interactions with speechlanguage pathologists, parents, and students. Seminars in Speech and Language, 24, 235 – 244. Nickels, L. (1997), Spoken word production and its breakdown in aphasia. Hove: Psychology Press. Nickels, L. (2002). Therapy for naming disorders: Revisiting, revising, and reviewing. Aphasiology, 16, 935 – 979. Olthuis, G., & van Heteren, G. (2003). Multicultural health care in practice. An empirical exploration of multicultural care in The Netherlands. Health Care Analysis, 11, 199 – 206. Paradis, M. (2001). Bilingual and polyglot aphasia. In R. S. Berndt (Ed.), Handbook of neuropsychology, 2nd edn. (pp. 69 – 91). Oxford, UK: Elsevier. Roberts, P. M. (1998). Clinical research needs and issues in bilingual aphasia. Aphasiology, 12, 119 – 130. Roberts, P. M. (2001). Aphasia assessment and treatment for bilingual and culturally diverse patients. In R. Chapey (Ed.), Language intervention strategies in aphasia and related neurogenic communication disorders, 4th edn. (pp. 208 – 230). Philadelphia: Lippincott Williams & Williams. Roger, P. (1998). Bilingual aphasia: The central importance of social and cultural factors in clinically oriented research. Aphasiology, 12, 134 – 138. Van Steenbrugge, W. (2000). The Need for clinical research in bilingual aphasia. In C. Lind (Ed.), Research, reflect, renew: Proceedings of the 2000 Speech Pathology Australia national conference (pp. 133 – 141). Adelaide. Whitworth, A., & Sjardin, H. (1993). The Bilingual person with aphasia-The Australian Context. In D. Lafond, Y. Joanette, J. Ponzio, R. Degiovani, & M. Taylor-Sarno (Eds.), Living with aphasia: Psychological issues (pp. 129 – 150). San Diego: Singular Publishing Group.