Academic journal article Exceptional Children

Cross-Cohort Evidence of Disparities in Service Receipt for Speech or Language Impairments

Academic journal article Exceptional Children

Cross-Cohort Evidence of Disparities in Service Receipt for Speech or Language Impairments

Article excerpt

Abstract

We examined the extent to which disparities in the receipt of special education services for speech or language impairments (SLIs) on the basis of race, ethnicity, or language use by kindergarten--when the delivery of these services might be expected to be most effective--have changed over a 12-year period in the United States. Logistic regression modeling of 2 nationally representative cohorts (N = 16,800 and 12,080) indicated that children who are Black (covariate-adjusted odds ratios = 0.39 and 0.54) or from non-English-speaking households (covariate-adjusted odds ratios = 0.57 and 0.50) continue to be less likely to receive services for SLIs. Hispanic children are now less likely to receive these services (covariate adjusted odds ratio = 0.54) than otherwise similar non-Hispanic White children. Disparities in special education service receipt for SLIs attributable to race, ethnicity, and language presently occur in the United States and are not explained by many potential confounds.

Speech or language impairments (SLIs) increase young children's risk for atypical development, including lower cognitive, behavioral, and school functioning (Bornstein, Hahn, & Suwalsky, 2013; Petersen et al, 2013; U.S. Preventive Services Task Force, 2006). Elementary school-age children with SLIs are at increased risk of having reading (Catts, Fey, Tomblin, & Zhang, 2002; Snowling, Bishop, & Stothard, 2000) and behavioral (Yew & O'Kearney, 2013) disabilities and often experience greater bullying and feelings of isolation (Harrison, McLeod, Berthelsen, & Walker, 2009; McCormack, Harrison, McLeod, & McAllister, 2011; Morgan, Farkas, & Wu, 2011). As they age, children with SLIs are less likely to complete high school; are more frequently unemployed; and, if employed, hold lower-paying positions (Elbro, Dalby, & Maarbjerg, 2011; Felsenfeld, Broen, & McGue, 1994; Johnson, Beitchman, & Brownlie, 2010; Muir, O'Callaghan, Bor, Najman, & Williams, 2011). Prevalence estimates among preschool children vary, ranging from 5% to 8% for combined speech and language delays and 2% to 19% for language delays, with persistence rates of 40% to 60% for untreated speech and language delays (Nelson, Nygren, Walker, & Panoscha, 2006). Although SLIs may constitute a chronic condition (Silva, Williams, & McGee, 1987; Snowling et al, 2000; Tomblin, Zhang, Buckwalter, & O'Brien, 2003), children appropriately identified and provided with interventions and services by kindergarten display substantially improved speech and language capabilities (Beitchman, Wilson, Brownlie, Walters, & Lancee, 1996; Boyle, McCartney, O'Hare, & Forbes, 2009; Hebbeler et al., 2007; Law, Garrett, & Nye, 2004; Nelson et al, 2006; Roberts & Kaiser, 2011; Wilcox, Gray, Guimond, &Lafferty,2011).

Disparities in SLI Identification and Service Receipt by Race, Ethnicity, and Language Use

Although young children should be regularly evaluated for possible speech or language delays (Hagan, Shaw, & Duncan, 2008), fewer than 50% of those who need treatment for SLIs receive it (Skeat et al., 2014). Racial, ethnic, and language minorities are a large and rapidly growing segment of the U.S. child population (Colby & Ortman, 2014). Although they are at greater risk for SLI symptoms (Harrison & McLeod, 2010; Morgan, Farkas, Hillemeier, & Maczuga, 2012; Pruitt, Oetting, & Hegarty, 2011), minority children with SLIs may be especially unlikely to be identified and so receive treatment, including through special education (Harrison & McLeod, 2010; Morgan et al., 2012; Morgan et al., 2016). Because of their unmet treatment needs, minority children therefore may be disproportionately likely to grow to experience the sequela of untreated SLIs (e.g., reading or behavioral disabilities, bullying, unemployment). For example, White children's behavioral struggles are more likely to be medicalized and those of minority more likely to be criminalized--and so ineffectively managed (Ramey, 2015). …

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