TERMINOLOGY

Families may refer to themselves with a variety of different terms.  They may identify as Black, African-American, Afro-Caribbean, Afro-Latino/a/x, People of Color, BIPOC (Black, Indigenous and other People of Color), or by their country of origin.  Early intervention providers should not automatically assume that a specific term is accepted as the identity of the individual/family.

 

HISTORY OF AFRICAN AMERICANS WITHIN THE UNITED STATES

Early intervention providers should become familiar with the history of Black African Americans in the United States.  Though the majority of people who identify as Black are descendants of slaves, some families may be recent immigrants/refugees.  Other families may have immigrated to the United States because of war, poverty, or disaster in their countries of origin.  Their personal history and generations in the United States will  contribute to their values, culture, and beliefs about disability, education and health services.

The immigration history of African Americans is unique to the culture.  Many African American ancestors were forcibly taken from their African villages and sold as slaves during the European settlement of America, making this specific American culture unique in many aspects. 

DESCENDANTS OF SLAVERY:

SMITHSONIAN MAGAZINE:

https://www.smithsonianmag.com/history/158-resources-understanding-systemic-racism-america-180975029/

HISTORY.COM:

https://www.history.com/topics/black-history/black-history-milestones

 1619 PROJECT:

https://www.nytimes.com/interactive/2019/08/14/magazine/1619-america-slavery.html

IMMIGRATION IN RECENT YEARS:

• The Black African immigrant population grew 246%, from roughly 600,000 to 2.0 million from 2000-2019. People of African origin now make up 42% of the overall foreign-born Black population, a substantial increase from 2000 when that share was 23%.

• The Caribbean remains the most common region of birth for Black immigrants. Just under half of the foreign-born Black population were born in this region (46%). Jamaica (16%) and Haiti (15%) are the two largest origin countries.

• Early intervention providers should refer to information for Families/Parents and Providers under language in the home for more information.

HISTORY OF DEAF BLACK AMERICANS

• African American Deaf people are a minority group within a minority group (Hairston & Smith, 1983). This population may experience discrimination by the majority White culture (and other cultures), as well as biases within the African American community as a result of assumptions regarding deafness.  The Deaf community is not void of prejudice.  The larger society has an influence on every sub-culture within that society.  

 https://dcmp.org/learn/366-black-deaf-culture-through-the-lens-of-history

DEAF CULTURE WITHIN BLACK CULTURE:

https://www.verywellhealth.com/multicultural-deaf-and-african-american-1046096

 THE HISTORY OF BLACK DEAF SCHOOLS:  

https://www.youtube.com/watch?v=grpyswPABa8

BLACK DEAF HISTORY MONTH:

https://www.nbda.org/content/black-deaf-history-month

DEAF CULTURAL IDENTITY

• • As a whole, the Black Deaf community is more flexible in its definition of members into the African American Deaf community, as compared to the general Deaf community. 

  • (Schmitt & Leigh, (2015) reported changes in Deaf cultural identity development for Black Deaf people that involves intersections and interactions of myriad variables as compared to the Aramburo study.  

  • Deaf African Americans are considered a minority within a minority (Hairston & Smith, 1983). 

The majority of deaf African Americans identify with being African American first, Deaf second (Hairston & Smith, 1983).
Aramburo (1992) found that Black Deaf people who had Deaf parents were more likely to identify with Deaf culture first and being black second. 

HEARING LIKE ME:  A BRIEF HISTORY OF BLACK DEAF PEOPLE IN AMERICA

https://www.hearinglikeme.com/a-brief-history-of-black-deaf-people-in-america/

GALLAUDET UNIVERSITY DEPARTMENT OF DEAF STUDIES:

https://www.gallaudet.edu/department-of-deaf-studies/past-events/multicultural-annotated-bibliography/african-american/black/

SIGNS OF SOLIDARITY FOR DEAF BLACK PEOPLE:

https://www.youtube.com/watch?v=TXI_B-AuO3A

DEAF BLACK LEADERS AND ROLE MODELS: 

NATIONAL BLACK DEAF ADVOCATES:

https://www.nbda.org/

BLACK DEAF CENTER: 

https://www.blackdeafcenter.com/

https://www.blackdeafcenter.com/about

 BLACK DEAF PRESENTERS FOR WORKSHOPS:

https://www.blackdeafcenter.com/workshop

FAMOUS BLACK DEAF PEOPLE YOU SHOULD KNOW ABOUT:

https://www.hearinglikeme.com/famous-deaf-black-people-to-know/Hard of Hearing people in the United States.

TEN ONLINE COMMUNITIES OF BLACK DEAF FOLK:

https://www.csd.org/stories/online-black-deaf-communities/

 DEMOGRAPHIC INFORMATION

https://www.pewresearch.org/social-trends/2021/03/25/the-growing-diversity-of-black-america/

https://www.pewresearch.org/social-trends/fact-sheet/facts-about-the-us-black-population/

POPULATION OF AFRICAN AMERICANS IN THE UNITED STATES:

• In 2020, there were about 44.78 million African Americans in the U.S., accounting for 14.1% of the total U.S. population (U.S. Census Bureau, 2020).

AVERAGE AGE OF AFRICAN AMERICANS IN THE UNITED STATES (2020):

• The median age of the Black population in the United States is 32 years.

• The median age of the Black Hispanic population in the United States is 22 years.

• The median age of Multi-racial Black population is 16 years.

PROPORTION OF AFRICAN AMERICANS IN THE UNITED STATES WHO ARE IMMIGRANTS:

• 1 in 10 African American are foreign born (2016)

• 6 in 10 foreign-born are US citizens.  Black immigrants, 5 and older, are more likely to be proficient in English (74% to 51% in the general immigrant population).

• 17% are from Jamaica, 17% from Haiti, 8% Nigeria, 6% Ethiopia, 4% Trinidad, Tobago, 48% from 148 other countries

GEOGRAPHIC LOCATION OF AFRICAN AMERICANS LIVING IN THE UNITED STATES:

• The majority of African Americans live in the South (58.7%) while the fewest live in the West (8.9%) (U.S. Census Bureau, 2001).

  • https://www.census.gov/newsroom/releases/archives/census_2000/cb01cn176.html#:~:text=Of%20all%20the%20people%20who,percent%20lived%20in%20the%20West.

EMPLOYMENT STATUS, INCOME LEVEL, HOUSING NEEDS OF AFRICAN AMERICANS IN THE UNITED STATES:

https://www.census.gov/library/stories/2020/09/poverty-rates-for-blacks-and-hispanics-reached-historic-lows-in-2019.html

https://www.census.gov/content/dam/Census/library/publications/2020/demo/p60-270.pdf

https://www.jec.senate.gov/public/_cache/files/ccf4dbe2-810a-44f8-b3e7-14f7e5143ba6/economic-state-of-black-america-2020.pdf

• Almost twice as many African Americans are unemployed and live below the poverty level compared to the general population.  In 2021, 7.9% of African Americans were unemployed. As compared to 6.9% in 2000. 

• In 2019, 18% of African Americans were at the poverty level compared to 7.3% of the White/Caucasian U.S. population. 

• 1 of every 2 African American children live in poverty

• Housing is frequently inadequate due to poverty

HEALTH ISSUES OF AFRICAN AMERICAN CHILDREN AND FAMILIES:

• Frequently inadequate due to poverty

• Lack of access to health insurance

• Lack of accessibility of health care

• Poorer nutrition

  • Nutritional Issues caused by poverty are 10 times greater for African American children than the general population

• Transportation and child care issues due to poverty

• 1 out of every 6 African American children have elevated levels of lead in the blood

• 1 in 700 African American children have cleft lip or palate.

• Projected life expectancy is lower than general population

LEVEL OF EDUCATION OF AFRICAN AMERICANS IN THE UNITED STATES

• • In 2019, 88% of non-Hispanic Blacks over the age of 25 had a high school diploma. 26% Bachelor’s degree and 8.6%  had an advanced degree.  Educational attainment of high school is comparable to the general population through age 70.  through bachelor’s degree is about 10% lower than the overall U.S. population, while advanced degree is about 50% lower than the total U.S. population (Baughman & Graf, 2003).

  • The highest level of education completed for elderly African Americans (age 60 and older) is lower than for the general African American population.

  • 32% have completed less than junior high, 43% have completed high school, 17% have completed college, and 7% have a postgraduate degree (Pugh & Crandell, 2002). 

 INFANT MORTALITY OF AFRICAN AMERICAN INFANTS:

• African Americans have a high rate of infant mortality (14.6 per 1,000 births in 1999 compared to 5.8 per 1,000 Caucasian births) (U.S. Department of Health and Human Services, 2002) that has been steadily decreasing.

• In 2018, the infant mortality rate was 10.5 per 1000 (African American) compared to 4.6 (White) and 5.7 (All races).  This rate is over twice as high as the White/Caucasian population. 

PREMATURITY AND BIRTH WEIGHT OF AFRICAN AMERICAN INFANTS:

• In 2020 African Americans had a 14.4% rate of premature births and 13.3% for low birth weight, 50% higher than the general population.  Prematurity and low birth rate increases the risk of hearing loss (Scott, 2005).

PREVALENCE OF HEARING LOSS

Approximately 2 million African Americans have a serious enough hearing loss to need medical and educational attention.  Of these 2 million, approximately 22,000 are estimated to be profoundly deaf (Hairston & Smith, 1983).

PREVALENCE OF HEARING LOSS IN CHILDREN 6-19 YEARS:

• • Prevalence of hearing loss in African American children from EHDI programs had a higher incidence of delayed identification as a result of loss to follow-up.

  • Poverty is a significant predictor of hearing loss in infancy (Lantos et al., 2020).

  • The prevalence of hearing loss in African American children ages 6-19 is estimated at 17 in 1,000 (Lee, Gomez-Marin, & Lee, 1996).

PREVALENCE OF MODERATE OR GREATER HEARING LOSS:

• • The prevalence of moderate or greater hearing loss is about twice as high for African Americans compared to Caucasians (7.6 per 1,000 and 3.7 per 1,000, respectively) (Lee, Gomez-Marin, & Lee, 1996).

PROPORTION OF DEAF AND HARD OF HEARING YOUTH WHO ARE DEAF OR HARD OF HEARING:

• • The 2006-2007 Annual Survey of Deaf and Hard of Hearing Youth reported that 15.1% of all deaf or hard of hearing youth were African American (Gallaudet Research Institute, 2007).

PREVALENCE OF HEARING LOSS IN ELDERLY AFRICAN AMERICANS. 

• • The prevalence of hearing loss in elderly African Americans has been estimated at 26% (Bazargan, Baker, & Bazargan, 2001).

POST-SECONDARY OUTCOMES OF BLACK DEAF IN THE UNITED STATES:

https://www.nationaldeafcenter.org/sites/default/files/Postsecondary%20Achievement%20of%20Black%20Deaf%20People%20in%20the%20United%20States_%202019%20(7.23.19)(ENGLISH)(WEB).pdf

ETIOLOGIES OF HEARING LOSS

CYTOMEGALIC VIRUS AND AFRICAN AMERICANS

• Cytomegalovirus (CMV) is a virus found around the world. It is related to the viruses that cause chickenpox and infectious mononucleosis (mono) (Lantos et al., 2015)

• CMV is spread through close contact with body fluids. ). Between 50% and 80% of adults in the United States have had a CMV infection by age 40. Once CMV is in a person’s body, it stays there for life. Most people with CMV don’t get sick and don’t know that they’ve been infected.

• The infection with the virus can be serious in babies and people with weak immune systems. If a woman gets CMV when she is pregnant, she can pass it on to her baby. Usually the babies do not have health problems. But some babies can develop lifelong disabilities.

• A blood test can tell whether a person has ever been infected with CMV

• Cytomegalovirus seropositivity was significantly more common among African Americans (73% vs 42%; odds ratio, 3.31; 95% confidence interval, 2.7–4.1), and this disparity persisted across the life span.

• Clusters of high CMV odds were found in communities with high proportions of African Americans.

• African American communities have high prevalence rates of CMV infection, and there may be a disparate burden of CMV-associated morbidity in these communities.

• Significantly more children with CMV–related hearing loss were born to mothers younger than 20 years of age (88%) compared with only 47% of the children with normal hearing. More children in the hearing loss group (56%) had symptomatic congenital CMV infection than those with normal hearing (13%, P < 0.001). 

• There is a higher incidence of CMV among those with lower socio-economic status

OTITIS MEDIA AND AFRICAN AMERICAN CHILDREN:

• African American children have the lowest rates of otitis media in the general population, regardless of socio-economic status (Van Keulen, Weddington, & DeBose, 1998).

SICKLE CELL ANEMIA:

• African Americans have a higher incidence of hearing loss related to sickle cell anemia and HIV/AIDS than Caucasians.  Due the high number of African Americans living in poverty and lack of access to medical care, the incidence of hearing loss related to CMV and meningitis is also higher among African Americans (Scott, 2005).

• Sickle cell anemia is a genetic disorder that is characterized by abnormally shaped red blood cells (sickle cells).  The sickle cells occlude the vascular system, creating a variety of associated problems, including organ damage (Burch-Sims & Matlock, 2005).

• Sickle cell anemia is the most common genetic disorder in the United States.  1 in 400 African Americans have sickle cell anemia; 1 in 10 African American carry the sickle cell trait (Burch-Sims & Matlock, 2005). One in every 375 African Americans is born with Sickle Cell Anemia, and one in ever 12 is born with the trait that causes the disease (Lonergan, Cline, & Abbondanzo, 2001).  SCD affects black people world-wide and is associated with cumulative hearing loss and other speech and language deficits.

• A meta-analysis of studies examining hearing loss in patients with sickle cell anemia reported a prevalence of SNHL between 0 and 66% (Burch-Sims & Matlock, 2005; Schreibstein, MacDonald, Cox, McMahon, & Bloom, 1997). 66% of subjects 15-56 with SCD had significant hearing loss.  High incidence of HF HL  9%.  58% of SCD had mild hearing loss as compared to 78% of control (Onakoye et al 2002).  More hearing loss with increasing age. 

• Sickle cell anemia may produce sudden SNHL.  The degree and pattern of hearing loss is variable, ranging from mild to moderate unilateral to profound bilateral and may affect only the high frequencies.  The hearing loss can be temporary or permanent, depending on whether the cause is a temporary blockage or a hemorrhage of the stria vascularis (Burch-Sims & Matlock, 2005). 

• Not all African Americans with sickle cell anemia are aware that they have the disease, especially if they have a milder version.  The audiologist should refer any African American patient with a sudden SNHL to a physician.  An MRI is used to confirm vascular hemorrhage in the cochlear labyrinth (Schreibstein et al., 1997).

HIV/AIDS:

• In 2002, the CDC reported 886,575 cases of AIDS in the United States.  Of these, 39% of patients were African American (Centers for Disease Control and Prevention, 2003).

• Several etiologies of hearing loss are related to HIV/AIDS exist, including: chronic otitis media, cholesteatomas, Eustachian tube dysfunction, recurrent bacterial and viral infections of the ear, and sensorineural hearing loss (Madriz & Herrera, 1995). 

• Abnormal P300 latencies have confirmed hearing loss due to central pathology in some cases, so the audiologist may want to add this test to the audiological assessment battery when testing a patient with HIV/AIDS (Madriz & Herrera, 1995).

PRESBYCUSIS, OTOSCLEROSIS AND NOISE-INDUCED HEARING LOSS OF AFRICAN AMERICANS:

• African Americans have a lower incidence of presbycusis, otosclerosis, and noise-induced hearing loss than Caucasians.

PERSPECTIVES ON MEDICAL CARE, DISABILITY AND HEARING LOSS:

• Perspectives are dependent upon acculturation, and generations within the United States.

• African Americans may prefer natural holistic treatments, such as herbal remedies, teas, mentholated petroleum jelly, dried fruit, roots, and vinegar as an alternative to traditional medicine.  This is most common in the rural south (Willis, 2004).

•  The patient may prefer to try alternative remedies to “cure” the hearing loss instead of hearing aids and aural rehabilitation.  The audiologist should counsel the patient about the benefits of hearing aids and rehabilitation.  If the patient is insistent on trying the natural holistic treatments, he/she should be encouraged to try hearing aids and aural rehabilitation in combination with the holistic treatments.

• Many African Americans have inadequate access to medical care.  Lack of money, lack of knowledge about health care and disease, and lack of motivational resources to seek treatment are the primary reasons.  African Americans that lack the financial resources to seek health care are often more motivated to seek care for their children than themselves, even if they find the process of applying for outside assistance frustrating and offensive (Willis, 2004).

• African Americans’ perspectives about disability are closely related to their religious beliefs.  The majority of African Americans are Protestant Christian (80%); 55% of the Protestants are Baptists and 13% are Methodist (Willis, 2004).

• Disability may be viewed as a punishment for disobeying God, work of the Devil or evil spirits, misfortune or bad luck, and “sins of the fathers” (Willis, 2004).

• If a particular family member is blamed for the hearing loss, the audiologist may need to refer the family to counseling services.

PERSPECTIVE ON DEAFNESS/HEARING LOSS:

• Due to being a minority within a minority, the potential for isolation is very high in deaf and hard of hearing African American children.  Therefore, it is important to find deaf and hard of hearing African American role-models for these children (Hairston & Smith, 1983).

NATIONAL BLACK DEAF ADVOCATES:

• • The National Black Deaf Advocates (NBDA) organization provides support to African Americans who are deaf or hard of hearing, parents of deaf/hard of hearing African American children, and professionals that work with this population.  NBDA is the leading black deaf advocacy in the United States.

  • https://www.nbda.org/

FAMILY SYSTEMS

• Family systems in African American culture are perceived in high regards.  Many families acknowledge their distinct heritage and take pride in those differences.  Elders are given a great deal of respect (Willis, 1992). 

• An authoritative approach to child-rearing is often the norm, with an emphasis on family loyalty (Willis, 1992).  Extended family is viewed with importance and knowledge of extended family members is the custom.  Teen pregnancy and single-parent families are common within the Black community.  In 1990, it was estimated that about 51% of African American children in the United States lived with their mothers’ only (Horton & Smith, 1993). 

LANGUAGE AND COMMUNICATION

 African American English (AAE)

•  AAE has been in the United States for over 400 years.  AAE developed during the slavery period when slaves were not allowed to speak to each other in their native African language.  Since African Americans were not allowed to use their native language, they instead chose to incorporate syntactical rules found in their native languages into English, thereby creating AAE (Willis, 2004).

• AAE is a dialect of Standard American English (SAE); therefore, AAE is considered a language difference, not a language disorder (Van Keulen, Weddington, DeBose, 1998).

• African American English is a rule-governed linguistic system that is spoken by many, but not all, African Americans or individuals exposed to African American culture.  The linguistic structures affected by AAE, in comparison to SAE include the morphology, syntax, and phonology. 

• Primarily, African Americans with a lower SES speak AAE (Van Keulen, Weddington, & DeBose).

• However, a study examining lower and middle SES African American children found that 93.75% chose to speak AAE over SAE when asked to read a passage out loud (Craig, Thompson, Washington, & Potter, 2003).

• Many African Americans will code switch between AAE and SAE depending on the social context (Willis, 2004).

LANGNET AAVE:

https://www.hawaii.edu/satocenter/langnet/definitions/aave.html

BILINGUISTICS: 

https://bilinguistics.com/african-american-english-articulation-differences-and-language-characteristics/?utm_source=ActiveCampaign&utm_medium=email&utm_content=New+SLP+Blog+Post%3A++RSS%3AITEM%3ATITLE&utm_campaign=Weekly+Blog+Post

• Phonemic and morphosyntactical features of AAE that were observed in the Craig et al. (2003) 

  • Postvocalic consonant reduction – Deletions of consonant singles following vowels

    • “mouth” – /maU/ for /maUT/

  • “g” dropping & Substitutions of /n/ for /N/ in final word positions

    • • “waiting” – /wetIn/ for /wetIN/

  • Substitutions for /T/ and /D/ – /t/ and /d/ substitute for /T/ and /D/ in prevocalic positions, /f/, /t/, and /v/ substitute for /T/ and /D/ in intervocalic positions and in postvocalic positions

    • •  “this” – /dIs/ for /DIs/   

      • “birthday” – /bFfde/ for /bFTde/

      • both,” “with” – /bof/ for /boT/ , /wIt/ for /wIT/

  • Devoicing final consonants – Voiceless consonants substitute for voiced following the vowel

    • • “his” – /hIs/ for /hIz/

  • Consonant cluster reduction – Deletion of phonemes from consonant clusters

    • • “world” – /wFl/ for /wFld/

  • Consonant cluster movement – Reversal of phonemes within a cluster, with or without consonant reduplication

    • “escape” – /Ekskep/ for /Eskep/

  • Syllable deletion – Reduction of an (unstressed) syllable in a multisyllabic word

    • “became” – /kem/ for /bikem/

  • Syllable addition – Addition of a syllable to a word, usually as a hypercorrection

    • “forests” – /forIstsIz/ for /forIsts/

  • Monophthongization of diphthongs- Neutralization of diphthong

    • “our” – /ar/ for /aUr/

Morphosyntactical features and examples of AAE (from Craig et al., 2003).

• Ain’t

  • Ain’t used as a negative auxiliary in have+not, do+not, are+not, and is+not constructions

  • “you ain’t know that?”

• Appositive pronoun

  • Both a pronoun and a noun, or two pronouns, used to signify the same referent

  • “and the other people they wasn’t”

• Completive done

  • Done is used to emphasize a recently completed action

  • “done set the fire”

• Double marking

  • Multiple agreement markers for regular nouns and verbs, and hypercorrection of irregulars

    • “he tries to kills him”

    • “two people felled”

• Double copula/auxiliary/modal

  • • “I’m is the boy”

• Existential it

  • • It is used in place of there to indicate the existence of a referent without adding meaning

    • “I think it’s a girl or a boy is yelling”

• Fitna/sposeta/bouta

  • Abbreviated forms coding imminent action

    • “he fitna be ten”

    • “he bouta fall”

• Preterite had

  • Had appears before simple past verbs

    • “he flew with a strong stick in his claws while the turtle had held the stick fast in her mouth”

• Indefinite article

  • A is used regardless of the vowel context

    • “one day she met a eagle traveling to a far-away lands across the sea”

•  Invariant be

  • Infinitival be coding habitual actions or states

    • “and they be cold”

• Multiple negation

  • Two or more negatives used in a clause

    • “it not raining no more”

• Regularized reflexive pronoun

  • Hisself, thyself, theirselves replace reflexive pronouns

    • “bouta fall and trying to hold hisself back up”

• Remote past been

  • Been coding action in the remote past

    • “I been knew how to swim”

• Subject-verb agreement

  • Subjects and verbs differ in marking of number

    • “Our cat Mimi like  to sit on the roof”

• Undifferentiated pronoun case

  • Pronoun cases used interchangeably

    • “her fell”

• Zero article

  • Articles are variably included

    • “this cake is (the) best present of all”

• Zero copula/auxiliary

  • Copula and auxiliary forms of the verb to be are variably included

    • “but she always comes down when it (is) time to eat”

    • “then you’(ll) have to wear the brown ones instead

• Zero –ing

  • Present progressive –ing is variably included

    • “It was go(ing) to be a good birthday”

• Zero modal auxiliary

  • Will, can, do, and have are variably included as modal auxiliaries

    • “he might     been in the car”

• Zero past tense

  • -ed markers are variably included on regular past verbs and present forms of irregulars are used

    • “as soon as she open(ed) her mouth, she fall straight into the ocean below”

• Zero plural

  • -s is variably included to mark number

    • “Father went out to buy some pretty flower “

• Zero possessive

  • Possession coded by word order so –s is deleted or the case of possessive pronouns is changed

    • “The boy’(s) grandmother showed him how to put worms on the hook”

• Zero preposition

  • Prepositions are variably included

    • “she sits and looks (at) birds”

• Zero to

  • Infinitival to is variably included

    • “that man right there getting ready    slip on his one foot”

BLACK SIGN LANGUAGE

BLACK AMERICAN SIGN LANGUAGE:

https://www.nytimes.com/2021/01/23/us/black-american-sign-language-tiktok.html

SIGNING BLACK IN AMERICA: 

https://www.youtube.com/watch?v=oiLltM1tJ9M

 BLACK ASL:  HISTORY, CULTURE AND LANGUAGE DR JOSEPH HILL

https://www.youtube.com/watch?v=kxj6qhMJaL8

 HIDDEN TREASURE OF BLACK ASL:  CHAPTER 1

https://www.youtube.com/watch?v=gjjktL2oOM0

HIDDEN TREASURE OF BLACK ASL CHAPTER 2:  SOCIAL AND HISTORICAL BACKGROUND

https://www.youtube.com/watch?v=OI0NsvzErLk

HIDDEN TREASURE OF BLACK ASL CHAPTER 3:  HOW WE DID THE STUDY

https://www.youtube.com/watch?v=bNFnyGfZXIk

HIDDEN TREASURE OF BLACK ASL CHAPTER 4:  PERCEPTIONS

https://www.youtube.com/watch?v=Q–bh84vxLw

HIDDEN TREASURE OF BLACK ASL CHAPTER 5:  PHONOLOGICAL VARIATION

https://www.youtube.com/watch?v=ayyjje3r1bY

HIDDEN TREASURE OF BLACK ASL CHAPTER 6:  VARIATION IN SYNTAX AND DISCOURSE

https://www.youtube.com/watch?v=t5yhx7PNPQk

HIDDEN TREASURE OF BLACK ASL CHAPTER 7:  THE EFFECTS OF LANGUAGE CONTACT

https://www.youtube.com/watch?v=aYjZPqoHlYU

HIDDEN TREASURE OF BLACK ASL CHAPTER 8:  LEXICAL VARIATION

 https://www.youtube.com/watch?v=gkmzZI3DI3Y

 HIDDEN TREASURE OF BLACK ASL CHAPTER 9:  CONCLUSION

https://www.youtube.com/watch?v=4wSNgY5QQhU

 CHILDREN’S BOOKS FOR AFRICAN AMERICAN CHILDREN

https://www.pinterest.com/brownbabyreads/african-american-board-books-for-toddlers-infants/

https://coloursofus.com/multicultural-childrens-books-lists/african-ethnicity/african-multicultural-childrens-books-babies-toddlers/

https://www.eyeseeme.com/collections/collection-for-0-5/african-american-children-books

https://aalbc.com/books/children.php

https://www.penguin.co.uk/articles/children/2019/jun/childrens-books-with-black-characters.html

https://thebrownbookshelf.com/2021/01/03/african-american-childrens-book-projects-best-picture-books-of-2020/

https://matermea.com/where-to-find-multicultural-and-black-childrens-books/

https://coloursofus.com/multicultural-childrens-books-lists/african-ethnicity/african-multicultural-childrens-books-elementary-school/

CHILDREN’S SONGS FOR AFRICAN AMERICAN CHILDREN

https://www.mamalisa.com/?t=el&lang=Historical+Black+American+English

https://matermea.com/black-childrens-music/

https://www.youtube.com/watch?v=3nUrliO9tTE

https://www.youtube.com/watch?v=3nUrliO9tTE&t=18s

https://www.youtube.com/watch?v=flO4zMrhG6g

https://www.youtube.com/watch?v=vsZIhKTJWrw

 

CULTURAL ATTITUDES AND ISSUES APPLIED TO AUDIOLOGY PRACTICE

Waiting Room/Telephone “Hold” Music:

• • Many African Americans feel out of place and uncomfortable when typical waiting room/telephone “hold” music is played (classical and easy-listening) (Terrell, Battle, & Grantham, 1998).

  • Since the waiting room and contact via telephone are typically the first impressions the patient will have of the audiology practice, it is important to ensure that the patient feels comfortable prior to the appointment.

  • African American patients may feel more comfortable if jazz or blues music is played in the waiting room/on the telephone as an alternative to classical or easy-listening. However, the audiologist should ensure that the jazz/blues artists featured are African American.  Some African Americans find it offensive if the jazz or blues artists are not African American, since these music genres originated in African American culture (Terrell, Battle, & Grantham, 1998).

 Family-centered Practice:

• The audiologist will see a variety of family structures among African American patients. The extended family is valued in African American culture and is often has as much familial influence as the nuclear structure (Willis, 2004; Terrell, Battle, & Grantham, 1998).

• Since the extended family is often extensively involved in the child rearing, their input about the child’s hearing may be invaluable (Willis, 2004).

• The clinician should involve any extended family in aural rehabilitation therapy that wish to participate, since they may be providing a lot of care for the child (Willis, 2004).

 Establishing Rapport:

• • African American patients may be distrusting of white people or white institutions (including healthcare settings), since previous interactions may have resulted in discrimination, humiliation, and frustration (Levy, 1985).

  • The audiologist should strive to establish a rapport with the patient to help reduce and hopefully eliminate feelings of distrust. This may include having an open discussion about the feelings of distrust.  If distrust does not improve, the patient may need to be referred to an audiologist that he/she feels more comfortable with.

• • Formality and good manners will help establish rapport. Many African Americans dislike the use of first names or nicknames because it is considered disrespectful.  The audiologist should address the patient by his/her proper title and last name (Mr., Mrs., etc.) until the patient gives permission to call him/her by something else (Terrell, Battle, & Grantham, 1998).

 Financial and Emotional Considerations:

• • Due to the economic and social hardships that some African Americans have faced, they may have developed a sense of hopelessness, frustration, and despair which may have an impact on audiological services, including missed appointments, non-compliance with treatments, and not fully expressing concerns about the hearing loss to the audiologist (Levy, 1985).

  • If the patient misses an appointment or is not following the treatment plan, it is important for the audiologist to express disappointment without conveying guilt. Making the patient feel guilty when he/she may already be overwhelmed in other areas of life will only contribute to feelings of despair or passiveness (Levy, 1985).

  • Several African American children may come from single parent households that are economically disadvantaged. Be considerate of the family’s level of financial and emotional resources.  When deciding on a treatment plan with the patient, make sure that the treatment is something that the patient has the appropriate amount of energy resources and coping skills to successfully undertake.  If the proposed treatment is unrealistic for the family’s circumstances, the patient may give up on treatment altogether (Levy, 1985).

Communication Strategies

 Eye Contact:

• • African American patients may not make eye contact with the audiologist, because eye contact is considered disrespectful (Terrell, Battle, & Grantham, 1998; Willis, 2004).

• • When providing aural rehabilitation therapy, the therapist may need to stress the importance of eye contact for visual information during therapy.

 “Silent Code”:

• • African American patients have developed a communication strategy of a silent code, which is to reveal as little as possible about themselves. The silent code is used when the patient is unsure how the information collected will be used, and relates to the distrust of white institutions (Terrell, Battle, & Grantham, 1998).

• • The audiologist should explain the importance of the case history to the patient and how the information will be used to assist with diagnosis and treatment.

• • The silent code can also affect diagnostic testing. Audiological results may not reflect the patients’ true capabilities if the silent code is being utilized.

• • Establishing rapport is the most effective method for overcoming the silent code.

• Shutdown of Communication:

  • African Americans will use a number of verbal and non-verbal communication strategies to demonstrate a shutdown of communication.

  • African Americans are heavily reliant on non-verbal communication. This is a remnant of the slavery period when African Americans would communicate non-verbally with each other in the presence of the slave owner in order to have privacy (Terrell, Battle, & Grantham, 1998).

  • Several verbal and nonverbal behaviors can be used to demonstrate a shutdown of communication. These behaviors may be reflexive or purposeful (Willis, 2004).

  • Verbal behaviors include: giving incorrect responses, refusing to respond, and answering impulsively (Willis, 2004; Terrell, Battle, & Grantham, 1998)

  • Nonverbal behaviors include: an expressionless, blank face, arms folded across the chest, eye-rolling, exhalations of air, and looking upward (as if wishing for divine intervention) (Willis, 2004; Terrell, Battle, & Grantham, 1998)

  • The audiologist should pay attention to these behaviors and try to determine why a behavior is occurring so that the breakdown in communication can be repaired quickly.

  • Shutdown in communication may be due to a variety of factors, including disagreement about treatment recommendations, confusion about instructions, and feeling overwhelmed by the amount of treatment options and information being presented (Willis, 2004).

  • Culturally, communication styles within African American culture are similar to that of White Americans.

  • Some differences include the reluctance of some African American students to make eye contact with adults and they may rely on gestures to accompany narratives (Willis, 1992).

  • The development of social interactions is highly regarded and often viewed as more important than the acquisition of a large vocabulary (Anderson & Battle, 1993).

  • Conversations, competitive in nature, are common among African Americans, and may be viewed by White Americans as hostile and overbearing.

  • Communication is a multidimensional process, with different styles and codes being used according to the environment and context of the interaction.

  • Cultural competence ameliorates communication breakdown and misinterpretations during evaluation and habilitation of African American with hearing loss.

Counseling Considerations for the Audiologist

• Do not stereotype:

  • There is much heterogeneity in African-American culture, regardless of socioeconomic status (Levy, 1985; Willis, 2004).

• • Poverty does not always equal dysfunction. Many African American families living in poverty are able to provide quality, nurturing care for their children (Willis, 2004).

• • Stereotyping could lead to the audiologist assuming that he/she knows what the best treatment for the patient is and not presenting all options to the patient.

• Patient-Physician Relationship:

• • Partnership in the patient-physician relationship as a function of race was examined. Results indicated that African American patients had a less participatory relationship with white physicians than African American physicians, regardless of socioeconomic status and patient educational level (Cooper-Patrick, Gallo, Gonzales, Vu, Powe, Nelson, et al., 1999). 

  • While research has not examined the patient-audiologist partnership between African American patients and white audiologists, results are likely similar. Improving the partnership between African American patients and audiologists may result in better adherence to treatment plans, higher level of patient care, and better treatment outcomes. 

  • Audiologists should make sure that the patient is actively involved in the decision-making process about treatment options. Audiologists can improve their partnership with African American patients by recognizing unconscious racial biases that may contribute to the relationship being less participatory, gaining a better understanding of African American culture’s perspective about hearing loss, and recognizing that the patient’s objectives for visiting an audiologist may be different than the audiologists’ goals.

• Knowledge about Noise-Induced Hearing Loss:

  • African American students were less likely than Caucasian college students to respond that NIHL could not be cured (75% compared to 95%). Eleven percent said that hearing loss could be cured by bed rest, 8% by medication, and 6% by a doctor (Lee, Gomez-Marin, & Lee, 2004).

  • African American students were less able to identify symptoms of NIHL than Caucasian students (Lee, Gomez-Marin, & Lee, 2004).

Diagnostic Testing and Aural Rehabilitation Considerations

 Diagnostic Testing:

• High-technology medical devices can be associated with trauma since there is a high incidence of violence, accidental death, and premature births in the African American population (Willis, 2004).

• The audiologist should thoroughly explain each diagnostic test and the equipment prior to testing to ensure that the patient understands there is no trauma involved.

• Phonemic features of AAE may make interpretation of speech and word recognition testing challenging, since it may be difficult to distinguish whether the patient’s response is due to hearing loss or the language difference.

• The audiologist may consider closed-set word recognition testing to overcome this issue, if age-appropriate.

Aural Rehabilitation:

• • The clinician providing aural rehabilitation therapy should be familiar with AAE and sensitive to maintaining the values of the family and patient. The clinician should ensure that aural rehabilitation therapy preserves the patient’s use of AAE (Terrell, Battle, & Grantham, 1998).

  • The audiologist and aural rehabilitation therapist should consider the patient’s preferred learning style when developing an aural rehabilitation treatment plan. Both African American adults and children may prefer group therapy over individual therapy.  Research has demonstrated that group therapy can help reduce distrust of the clinician, while individual therapy may lower self-esteem and increase feelings of isolation in African American patients.  Additionally, African Americans value social, interpersonal interactions and group cooperation (Terrell, Battle, & Grantham, 1998).

 Language Assessments:

• When administering and interpreting language assessments, it is important to consider the validity of the assessment. The clinician should examine the normative data to determine whether African Americans were included in the sampling.  If separate norms exist for AAE speakers, these may be helpful in interpreting the language assessment.  If there are no norms for AAE speakers, the clinician may wish to establish local normative data (Terrell, Battle, & Grantham, 1998).

• Dialectal variations due to AAE should also be considered when administering a language assessment. The clinician may wish to analyze each question for possible AAE responses based on the phonemic and morphosyntactical features (see tables 1 and 2) prior to administering the test and score the assessment according to accepted SAE and AAE responses (Terrell, Battle, & Grantham, 1998).