Black Children With Developmental Disabilities Receive Less Augmentative and Alternative Communication Intervention Than Their White Peers: Preliminary Evidence of Racial Disparities From a Secondary Data Analysis

In the paper

“Rates of attrition were relatively consistent across race (14% and 16% losses for Black children and white children, respectively).”

In the paper

“Early language, communication, and AAC intervention are critical to support better long-term outcomes (Drager et al., 2010; Parsons et al., 2011; Romski et al., 2015).”

What the sources say

• Not checked yetcites Drager et al., 2010
• Not checked yetcites Parsons et al., 2011
• Not checked yetcites Romski et al., 2015

In the paper

“Given that no previous research has examined the evidence for racial disparities in AAC service delivery, post hoc methods are an appropriate place to start, as they allow for the initial exploration of a potential phenomenon, as well as the generation of hypotheses to be tested with more rigorous methods (Hollenbeck & Wright, 2017).”

What the sources say

• Not checked yetcites Hollenbeck & Wright, 2017

In the paper

“Children with developmental disabilities and CCN often have the most extensive service delivery needs and thus may be at the greatest risk from inequities in services.”

In the paper

“Parents report that delays in diagnosis for developmental disabilities are at least partly related to health care providers ignoring parent concerns and/or implicitly providing racially biased care (Dababnah et al., 2018).”

What the sources say

• Not checked yetcites Dababnah et al., 2018

In the paper

“For children with developmental disabilities and CCN, access to AAC services is essential to support their participation in education, social development, language and communication skills, and future life outcomes (e.g., Drager et al., 2010; Romski et al., 2015).”

What the sources say

• Not checked yetcites Drager et al., 2010
• Not checked yetcites Romski et al., 2015

In the paper

“Mann–Whitney U tests are appropriate for comparing two independent samples of nonparametric data (Hinton, 2014), as in this research question.”

What the sources say

• Not checked yetcites Hinton, 2014

In the paper

“The results of this study suggest that even when Black children receive AAC services, there are significant racial disparities in the reported amount of AAC service delivery, and these disparities persist over time.”

In the paper

“Research suggests that the prekindergarten years have a formative impact on the long-term racial disparities observed in educational achievement (Braun et al., 2010; Farkas, 2003).”

What the sources say

• Not checked yetcites Braun et al., 2010
• Not checked yetcites Farkas, 2003

In the paper

“Post hoc data analysis addresses a novel, a priori research question using data previously collected for a different research aim (Hollenbeck & Wright, 2017).”

What the sources say

• Not checked yetcites Hollenbeck & Wright, 2017

In the paper

“The current data set did not allow for investigation of what causal factors may have been associated with the decrease in AAC service provision over time for both white and Black participants observed in these data.”

In the paper

“Nonetheless, children may have differed on unreported, relevant factors (length of time since AAC provision, AAC proficiency, type of AAC system, etc.).”

In the paper

“These factors could potentially impact not only the availability of material resources to provide AAC systems but also access to professionals with sufficient training in AAC intervention or the time in the school day to provide it.”

In the paper

“Participants were not initially recruited with the aim of establishing equivalent groups of Black and white children.”

In the paper

“The disproportionately negative impact of these factors on Black and other children of color stems from a history of structural inequality established and maintained by systemic racism in the United States (Merolla & Jackson, 2019; Reskin, 2012; Williams & Cooper, 2019)”

What the sources say

• Not checked yetcites Merolla & Jackson, 2019
• Not checked yetcites Reskin, 2012
• Not checked yetcites Williams & Cooper, 2019

In the paper

“This same strategy may be effective in attaining greater equity in speech-language pathology services.”

In the paper

“AAC technology and access have changed substantially over the last decade (e.g., relatively greater access to free or lower cost tablet-based AAC applications)”

In the paper

“ASHA's standards for certification of clinical competence require practicum experiences with individuals from culturally and linguistically diverse backgrounds (Council for Clinical Certification in Audiology and Speech-Language Pathology of the American Speech-Language-Hearing Association, 2018)”

What the sources say

• Not checked yetcites Council for Clinical Certification in Audiology and Speech-Language Pathology of the American Speech-Language-Hearing Association, 2018

In the paper

“the degree to which all preservice programs can and do comprehensively provide these opportunities is inconsistent (Hammond et al., 2009).”

What the sources say

• Not checked yetcites Hammond et al., 2009

In the paper

“One effective route to decreasing racial disparities in health care has been to diversify the health care workforce (Williams & Cooper, 2019).”

What the sources say

• Not checked yetcites Williams & Cooper, 2019

In the paper

“research consistently demonstrates that many potentially mediating factors at the child, family, classroom, and school levels systematically disadvantage Black children and other children of color (Merolla & Jackson, 2019; Reskin, 2012; Williams & Cooper, 2019)”

What the sources say

• Not checked yetcites Merolla & Jackson, 2019
• Not checked yetcites Reskin, 2012
• Not checked yetcites Williams & Cooper, 2019

In the paper

“it is important to acknowledge that these results may reflect a larger ongoing pattern of racial inequity in access to AAC systems and services for Black and other children of color with developmental disabilities.”

In the paper

“Research suggests that both promoting empathy for individuals from different communities and addressing issues of inequality from a social justice perspective have positive results on minimizing prejudice and discrimination (Stephens et al., 2021; Whitford & Emerson, 2019).”

What the sources say

• Not checked yetcites Stephens et al., 2021
• Not checked yetcites Whitford & Emerson, 2019

In the paper

“The current research used post hoc analysis methods.”

In the paper

“Overall, the study sample is quite small, insular, and especially lacking in sufficient numbers of Black participants.”

In the paper

“it is possible that the schools attended by Black children were systematically underresourced compared to the schools attended by white children.”

In the paper

“The ratio of white children as compared to Black children in this sample is notably unbalanced, though this ratio does represent the demographics of Topeka and Wichita per the 2010 Census (U.S. Census Bureau, n.d.).”

What the sources say

• Not checked yetcites U.S. Census Bureau, n.d.

In the paper

“These domains of systemic racism intersect, creating a dynamic, complex, mutually reinforcing set of subsystems across societal domains (Hayes-Greene & Love, 2018; Reskin, 2012; Williams & Cooper, 2019).”

What the sources say

• Not checked yetcites Hayes-Greene & Love, 2018
• Not checked yetcites Reskin, 2012
• Not checked yetcites Williams & Cooper, 2019

In the paper

“Preliminary research in education suggests that white teachers' expectations for Black students may be 30%–40% lower than Black teachers' expectations (Gershenson et al., 2016).”

What the sources say

• Not checked yetcites Gershenson et al., 2016

In the paper

“both Black and white participant groups experienced attrition from study initiation to study completion. However, though the number of participants lost varied by group, the percentage was similar and did not appear to differentially impact either gender or diagnostic categories.”

In the paper

“Within Black communities, schools often have fewer resources than those in white communities (Darling-Hammond, 2013).”

What the sources say

• Not checked yetcites Darling-Hammond, 2013

In the paper

“It is important to note that the data set used in this study is quite dated”

In the paper

“Underresourced schools may have larger classrooms, less trained staff, or higher caseloads for teachers and SLPs.”

In the paper

“The small sample of Black children limits not only the statistical power of the results but also the generalizability of these data.”

In the paper

“Evidence suggests that racial segregation persists across public schools in the United States (Rothstein, 2019).”

What the sources say

• Not checked yetcites Rothstein, 2019

In the paper

“systemic racism in the United States is pervasive across domains and institutions—not only in education but also in health care, housing, law enforcement, child welfare, and so forth (Hayes-Greene & Love, 2018).”

What the sources say

• Not checked yetcites Hayes-Greene & Love, 2018

In the paper

“The definition of “direct” AAC intervention provided to teachers by Brady (2016) could have also impacted estimates of the amount of intervention per week, if teachers misunderstood or interpreted “direct” intervention differently.”

What the sources say

• Not checked yetcites Brady (2016)

In the paper

“The ordinal nature of the scale also minimizes the specificity of measurement.”

In the paper

“These categories reduced the precision of the data and may have obscured the actual variability in amount of AAC intervention.”

In the paper

“This lack of representation in research populations may mask issues of inequity in access to appropriate services or even aggravate the problem further”

In the paper

“the Council on Academic Accreditation (CAA) for Audiology and Speech-Language Pathology established revised DEI standards for graduate program accreditation that will go into effect on January 1, 2023 (CAA, n.d.).”

What the sources say

• Not checked yetcites CAA, n.d.

In the paper

“in 2018, ASHA added cultural competency and diversity, equity, and inclusion (DEI) within the certification standards (Council for Clinical Certification in Audiology and Speech-Language Pathology of the American Speech-Language-Hearing Association, 2018).”

What the sources say

• Not checked yetcites Council for Clinical Certification in Audiology and Speech-Language Pathology of the American Speech-Language-Hearing Association, 2018

In the paper

“Additionally, classrooms that were larger or understaffed may have had a higher frequency of group-based activities, which teachers were told to disregard in their estimations if the activities did not directly target AAC intervention for the participating child.”

In the paper

“However, what teachers considered carryover “instruction” within their classrooms may have differed.”

In the paper

“However, it is reported in the data set as ordinal categories (i.e., never, less than 30 min, 30–59 min, 60–89 min, and 90+ min).”

In the paper

“The five aforementioned variables reflect the five domains of the social determinants of health (Healthy People 2030, n.d.).”

What the sources say

• Not checked yetcites Healthy People 2030, n.d.

In the paper

“Addressing racial inequality in only one domain (e.g., professionals' implicit bias) is unsustainable, as the influence of systemic racism in other intersecting, unaddressed social domains (e.g., underfunding of schools in Black communities) will continually seep back in (Hayes-Greene & Love, 2018).”

What the sources say

• Not checked yetcites Hayes-Greene & Love, 2018

In the paper

“It is important to note that this measure of AAC intervention per week reflects teacher report on an ordinal scale and thus does not directly represent the exact amount of time participants actually received AAC intervention in the classroom.”

In the paper

“Students who received 90 min of AAC intervention per week were grouped together with those who might have received substantially more (90+ min per week).”

In the paper

“evidence suggests that developing family peer advocate relationships (i.e., when families with similar needs, such as supporting a child with ASD, provide knowledge and support to one another) can increase knowledge about relevant services, as well as empower families to access those services successfully (Jamison et al., 2017).”

What the sources say

• Not checked yetcites Jamison et al., 2017

In the paper

“Students who received 5 min of AAC intervention per week and those who received 25 min were all grouped into the same category of “less than 30 min per week.””

In the paper

“This paucity of AAC intervention might be expected to negatively impact language development, education, social skills, and future life outcomes for these children with CCN, disproportionately affecting Black children.”

In the paper

“The original study conducted by Brady (2016) from which the current data were drawn was not designed to address questions of racial inequality. This limits the degree to which factors that may mediate the relationship between race and reported amount of AAC intervention can be explored within this sample.”

What the sources say

• Not checked yetcites Brady, 2016

In the paper

“Rates of attrition were relatively consistent across race (14% and 16% losses for Black children and white children, respectively).”

In the paper

“From preschool through secondary education, though Black and Hispanic children are more likely than their white peers to have a communication disorder diagnosis, they are less likely to receive intervention services (Black et al., 2015).”

What the sources say

• Not checked yetcites Black et al., 2015

In the paper

“Black children are more likely to be diagnosed with a communication disorder but less likely to receive speech-language pathology services than their white peers (Black et al., 2015; Morgan et al., 2016).”

What the sources say

• Not checked yetcites Black et al., 2015
• Not checked yetcites Morgan et al., 2016

In the paper

“post hoc analyses indicated that there were no statistically significant differences between the two participant groups with respect to gender, age, diagnosis (ASD or other developmental disability), language skills at study initiation, rate of child communicative acts, or adult communicative input at home (see Table 1).”

In the paper

“However, the same concerning trend of racial inequity in reported intervention services persisted, suggesting that the disparities extend beyond the scope of individual schools, classroom teams, SLPs, or teachers and offering evidence of the potential impact of structural racism on AAC intervention services.”

In the paper

“with Black and Hispanic transition-age youth with developmental disabilities having worse outcomes after high school than their white peers (e.g., lower rates of employment, independence, postsecondary enrollment, social participation, and access to health care; Eilenberg et al., 2019).”

What the sources say

• Not checked yetcites Eilenberg et al., 2019

In the paper

“For children with developmental disabilities and CCN, access to AAC services is essential to support their participation in education, social development, language and communication skills, and future life outcomes (e.g., Drager et al., 2010; Romski et al., 2015).”

What the sources say

• Not checked yetcites Drager et al., 2010
• Not checked yetcites Romski et al., 2015

In the paper

“which may result in more punitive measures for Black children and other children of color, leading to less access to instruction (Gregory et al., 2010; Morris & Perry, 2016), greater communication challenges, and a vicious cycle of inequity.”

What the sources say

• Not checked yetcites Gregory et al., 2010
• Not checked yetcites Morris & Perry, 2016

In the paper

“These types of initiatives offer avenues of system change to address disparities in education and speech-language pathology services, including AAC services specifically.”

In the paper

“Information regarding these types of factors was not available within this sample, and thus, the impact of these (or other) variables on the observed disparity in amount of AAC intervention per week could not be investigated.”

In the paper

“The original data set is dated (data at study initiation are from 2007) and may not reflect current practices within either these schools and school districts or the United States at large.”

In the paper

“Local initiatives can increase their power, impact, and longevity by extending collaborations as broadly as possible (Hayes-Greene & Love, 2018).”

What the sources say

• Not checked yetcites Hayes-Greene & Love, 2018

In the paper

“However, though the number of participants lost varied by group, the percentage was similar and did not appear to differentially impact either gender or diagnostic categories.”

In the paper

“Unfortunately, data on these child-level characteristics are not comprehensive, and data on partner-level factors are minimal.”

In the paper

“The sample in this study also only included children from English-speaking homes, neglecting issues of language and culture in AAC intervention.”

In the paper

“Nonetheless, children may have differed on unreported, relevant factors (length of time since AAC provision, AAC proficiency, type of AAC system, etc.).”

In the paper

“The ratio of white children as compared to Black children in this sample is notably unbalanced, though this ratio does represent the demographics of Topeka and Wichita per the 2010 Census (U.S. Census Bureau, n.d.).”

What the sources say

• Not checked yetcites U.S. Census Bureau, n.d.

In the paper

“Additionally, both Black and white participant groups experienced attrition from study initiation to study completion.”

In the paper

“For example, evidence suggests that developing family peer advocate relationships (i.e., when families with similar needs, such as supporting a child with ASD, provide knowledge and support to one another) can increase knowledge about relevant services, as well as empower families to access those services successfully (Jamison et al., 2017).”

What the sources say

• Not checked yetcites Jamison et al., 2017

In the paper

“However, it is important to note that all participants in the present data set already had access to AAC systems and services as a part of their teaching plans, as a prerequisite for study enrollment, minimizing the impact of initial access to AAC systems and services on amount of intervention reported.”

In the paper

“This lack of representation in research populations may mask issues of inequity in access to appropriate services or even aggravate the problem further, by failing to address the efficacy of interventions across culturally and linguistically diverse populations.”

In the paper

“The small sample of Black children limits not only the statistical power of the results but also the generalizability of these data.”

In the paper

“Importantly, only the quantity of AAC instruction was measured, without addressing the quality of the AAC intervention provided.”

In the paper

“The definition of “direct” AAC intervention provided to teachers by Brady (2016) could have also impacted estimates of the amount of intervention per week, if teachers misunderstood or interpreted “direct” intervention differently.”

What the sources say

• Not checked yetcites Brady (2016)

In the paper

“The measurement scale relied on estimated reports from teachers, which could have differed from the actual, measurable amount of AAC intervention each participant received per week.”

• Also stated in: § Acknowledgments · plain

  “It is important to note that this measure of AAC intervention per week reflects teacher report on an ordinal scale and thus does not directly represent the exact amount of time participants actually received AAC intervention in the classroom.”

In the paper

“For example, it is unclear whether any participants may have attended the same schools, been in the same classrooms, and/or had the same SLPs overseeing their AAC intervention services.”

In the paper

“Additionally, classrooms that were larger or understaffed may have had a higher frequency of group-based activities, which teachers were told to disregard in their estimations if the activities did not directly target AAC intervention for the participating child.”

In the paper

“However, what teachers considered carryover “instruction” within their classrooms may have differed.”

In the paper

“The evidence from health care and education suggests that large-scale change is needed to effectively address issues of racial inequality long term, given the pervasive, dynamic, mutually reinforcing nature of structural racism (Hayes-Greene & Love, 2018; Reskin, 2012; Williams & Cooper, 2019).”

What the sources say

• Not checked yetcites Hayes-Greene & Love, 2018
• Not checked yetcites Reskin, 2012
• Not checked yetcites Williams & Cooper, 2019