IDENTIFICATION AND TREATMENT OF CHILDHOOD LANGUAGE IMPAIRMENT INMULTICULTURAL POPULATIONS NIH GUIDE, Volume 21, Number 38, October 23, 1992 PA NUMBER: PA-93-011 P.T. 34, AA Keywords: Language Acquisition & Development Learning Disabled Education National Institute on Deafness and Other Communication Disorders PURPOSE Many children who are members of multicultural populations, such as African-, Asian-, and Hispanic-Americans, are often incorrectly identified as language impaired because culturally appropriate language assessment instruments are largely unavailable. In addition, those multicultural children with genuine language disorders in need of remediation may go unrecognized. The need for culturally sensitive assessment tools to evaluate the language of multicultural children has long been recognized, yet progress in this area is lacking. The National Institute on Deafness and Other Communication Disorders (NIDCD) encourages applications to develop or expand upon currently available diagnostic, as well as treatment procedures, for language-impaired children from multicultural environments. HEALTHY PEOPLE 2000 The Public Health Service (PHS) is committed to achieving the health promotion and disease prevention objectives of "Healthy People 2000," a PHS-led national activity for setting priority areas. This Program Announcement (PA), Identification and Treatment of Childhood Language Impairment in Multicultural Populations, is related to the priority areas of diabetes and chronic disabling conditions and special population objectives. Potential applicants may obtain a copy of "Healthy People 2000" (Full Report: Stock No. 017-001-11474-0 or Summary Report: Stock No. 017-001-11473-1) through the Superintendent of Documents, Government Printing Office, Washington, DC 20402-9325 (telephone 202-783-3238). ELIGIBILITY REQUIREMENTS Applications may be submitted by domestic and foreign, for-profit and non-profit organizations, public and private, such as universities, colleges, hospitals, laboratories, units of State and local governments, and eligible agencies of the Federal government. Applications from minority individuals and women are encouraged. Foreign institutions are not eligible for the First Independent Research Support and Transition (FIRST) (R29) Award or the Small Business Innovation Research (SBIR) (R43) Awards. MECHANISM OF SUPPORT The support mechanisms for grants in this area will be the investigator-initiated research grant (R01), the FIRST (R29) award, and the SBIR (R43) award. RESEARCH OBJECTIVES The United States has a culturally diverse population, with the rate of increase in the minority population accelerating in recent years. According to recent census figures, 23 million people over the age of five speak a language other than Standard English in the home. Almost half of these individuals reportedly do not speak English at all or do not speak it proficiently. A disproportionate number of children from these environments are identified as language impaired. Dialectal varieties of English are not considered a disorder or a pathological form of speech or language, although dialect speakers may have language disorders within the dialect. To make accurate diagnoses of language impairment, it is important to distinguish between those aspects of linguistic variation that represent a difference or diversity from those that represent a disorder. In recent years, researchers and clinicians have questioned the validity of most speech and language assessment measures for multicultural children. Because of these children's diverse cultural, economic, and linguistic backgrounds, these procedures and instruments, by their content and design, often discriminate against children whose native language is not Standard English. Thus, high proportions of these children are incorrectly identified as language disordered and are subsequently placed into special education or communication disorders programs. Appropriate assessment of language skills and proper academic placement are critical if multicultural children are to achieve their potential. Nonetheless, few standardized tests address the issues of cultural and linguistic diversity in their construction. In addition, most available instruments have not been standardized on children from different cultural, economic, or linguistic backgrounds. These problems make appropriate diagnosis and treatment difficult. Examples of issues to be addressed in applications submitted in response to this PA include, but are not limited to, the following: Language Impairment o Definition and characteristics of impaired language in specific cultures at varying ages (including phonology, syntax, semantics, pragmatics) o Bilingual proficiency and language disorders, including factors such as type of exposure to English, age of acquisition of English, and code switching Assessment o Means of differentiating between language differences and disorders across cultural groups (that is, procedures for differentiating disordered language from normal language differences due to a nonstandard dialect of English, or to the acquisition of English as a second language) o Development of evaluative measures that are culturally fair, or modifications/adaptations of existing measures that would make them more culturally sensitive o Establishment of cultural norms for determining presence or absence of communication disorders o Development of language sampling procedures or observational techniques that are valid within specific cultures o Differing assessment models (e.g., natural context, questionnaire) and their validity o Factors that influence assessment process, such as the effect of ethnic group membership of the examiner on test scores; the test environment; examiner's fluency in the child's language Treatment o Factors that impede efficacy of treatment in the clinical management of children from multicultural environments o Impact of cognitive factors, interpersonal and ecological factors, preferred learning style, and cultural systems of belief on response to treatment o Development of effective, innovative intervention strategies or models of service delivery, and frameworks for treatment within specific cultures o Factors related to effective language intervention, including effects of using only the first language, both the first and second languages, or English-only treatment; language skills of speech-language pathologist in both languages; effects of communication events within clinical setting on the level of linguistic performance STUDY POPULATIONS SPECIAL INSTRUCTIONS TO APPLICANTS REGARDING IMPLEMENTATION OF NIH POLICIES CONCERNING INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH STUDY POPULATIONS NIH policy is that applicants for NIH clinical research grants and cooperative agreements are required to include minorities and women in study populations so that research findings can be of benefit to all persons at risk of the disease, disorder or condition under study; special emphasis must be placed on the need for inclusion of minorities and women in studies of diseases, disorders and conditions which disproportionately affect them. This policy is intended to apply to males and females of all ages. If women or minorities are excluded or inadequately represented in clinical research, particularly in proposed population-based studies, a clear compelling rationale must be provided. The composition of the proposed study population must be described in terms of gender and racial/ethnic group. In addition, gender and racial/ethnic issues must be addressed in developing a research design and sample size appropriate for the scientific objectives of the study. This information must be included in the form PHS 398 in Sections 1-4 of the Research Plan AND summarized in Section 5, Human Subjects. Applicants are urged to assess carefully the feasibility of including the broadest possible representation of minority groups. However, the NIH recognizes that it may not be feasible or appropriate in all research projects to include representation of the full array of United States racial/ethnic minority populations (i.e., Native Americans [including American Indians or Alaskan Natives], Asian/Pacific Islanders,African-Americans, Hispanics). The rationale for studies on single minority population groups should be provided. For the purpose of this policy, clinical research is defined as human biomedical and behavioral studies of etiology, epidemiology, prevention (and preventive strategies), diagnosis, or treatment of diseases, disorders or conditions, including but not limited to clinical trials. The usual NIH policies concerning research on human subjects also apply. Basic research or clinical studies in which human tissues cannot be identified or linked to individuals are excluded. However, every effort should be made to include human tissues from women and racial/ethnic minorities when it is important to apply the results of the study broadly, and this should be addressed by applicants. For foreign awards, the policy on inclusion of women applies fully; since the definition of minority differs in other countries, the applicant must discuss the relevance of research involving foreign population groups to the United States' populations, including minorities. If the required information is not contained within the application, the application will be returned. Peer reviewers will address specifically whether the research plan in the application conforms to these policies. If the representation of women or minorities in a study design is inadequate to answer the scientific question(s) addressed AND the justification for the selected study population is inadequate, it will be considered a scientific weakness or deficiency in the study design and reflected in assigning the priority score to the application. All applications for clinical research submitted to the NIH are required to address these policies. NIH funding components will not award grants or cooperative agreements that do not comply with these policies. APPLICATION PROCEDURES Applications for R01 and FIRST (R29) awards are to be submitted on the grant application form PHS 398 (rev. 9/91) and will be accepted at the standard application deadlines as indicated in the application kit. Applications for SBIR (R43) awards are to be submitted on the grant application form PHS 6246-1 (rev. 1/92) and will be accepted at the SBIR application deadlines as indicated in the application kit. These kits are available from most institutional offices of sponsored research, the NIDCD Program Administrator cited below, and the Office of Grants Inquiries, Division of Research Grants, National Institutes of Health, Westwood Building, Room 449, Bethesda, MD 20892, telephone (301) 496-7441. The title and number of the announcement must be typed in Section 2a on the face page of the application. FIRST (R29) award applications must include at least three sealed letters of reference attached to the face page of the original application. First (R29) award applications submitted without the required number of reference letters will be considered incomplete and will be returned to the applicant without review. The completed original application and five legible copies of the PHS 398, or two copies of the PHS 6246-1, must be sent or delivered to: Division of Research Grants National Institutes of Health Westwood Building, Room 240 Bethesda, MD 20892** REVIEW CONSIDERATIONS Applications will be reviewed for scientific and technical merit by an appropriate Initial Review Group within the Division of Research Grants, NIH, in accordance with the standard NIH peer review procedures. Following scientific-technical review, the applications will receive a second-level review by the appropriate National Advisory Council. AWARD CRITERIA Applications will compete for available funds with all other applications. The following will be considered in when funding decisions: o Quality of the proposed project as determined by peer review o Availability of funds o Program balance among research areas of the announcement INQUIRIES Written and telephone inquiries concerning this PA are encouraged. The opportunity to clarify any issues or questions from potential applicants is welcome. Direct inquiries regarding programmatic issues to: Judith A. Cooper, Ph.D. Deputy Director, Division of Communication Sciences and Disorders National Institute on Deafness and Other Communication Disorders Executive Plaza South, Room 400-B 6120 Executive Boulevard Rockville, MD 20892 Telephone: (301) 496-5061 FAX: (301) 402-6251 Direct inquiries regarding fiscal matters to: Sharon Hunt Grants Management Officer National Institute on Deafness and Other Communication Disorders Executive Plaza South, Room 400-B 6120 Executive Boulevard Rockville, MD 20892 Telephone: (301) 402-0909 AUTHORITY AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance No. 93.173. Awards are made under authorization of the Public Health Service Act, Title IV, Part A (Public Law 78-410, as amended by Public Law 99-158, 42 USC 241 and 285) and administered under PHS grants policies and Federal Regulations 42 CFR 52 and 45 CFR Part 74. This program is not subject to the intergovernmental review requirements of Executive Order 12372 or Health Systems Agency review. .
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