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Review of  Clinical Sociolinguistics

Reviewer: Michael Dean
Book Title: Clinical Sociolinguistics
Book Author: Martin J. Ball
Publisher: Wiley
Linguistic Field(s): Applied Linguistics
Subject Language(s): English
Issue Number: 18.364

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EDITOR: Ball, Martin J.
TITLE: Clinical Sociolinguistics
SERIES: Language in Society
PUBLISHER: Blackwell
YEAR: 2005

Michael P. Dean, Regional Neurological Rehabilitation Unit, Homerton
University Hospital NHS Trust, London, UK

This volume, edited by Martin Ball, contains 21 contributions, organised
into two sections. Part One contains chapters that review primary trends
within sociolinguistics, and Part Two the application of these paradigms to
clinical situations. Each chapter has a list of recommended further
reading. The volume as a whole contains references, and author and subject
indices. The aim of the book is to promote, from both sides, the further
development of a clinical sociolinguistics.



In Chapter 1, Britain and Matsumoto discuss the different kinds of
relationships between people that have been used to characterise
communities, namely common evaluation of norms, social networks, and shared
enterprise. The relative merits of these concepts are examined with
reference to studies of New York accents and of Italian migrants in
Germany, and other examples. The authors consider the role of group and
individual identity in linguistic variation.

In Chapter 2, Maclagan describes how topographic region and social
variables (class, gender, ethnic background, education, and the context of
the communication) can influence variation in phonology, morphology, syntax
and lexis. She uses examples to illustrate a complex pattern, with some
aspects of language use being affected by some variables more than others.

Guendouzi expands on language and gender, considering how behaviours such
as interruption, turn-taking, topic management, cooperativity,
self-disclosure, and advice giving may reflect sex differences or power
dominance. Understanding the development of these differences, whether
innate or through socialisation, is important to clinical practice as
larger numbers of male children are diagnosed with a range of communication
disorders. Differences in diagnoses could themselves reflect gender
stereotyping. Guendouzi also discusses gender differences and expert vs.
cooperative styles that may apply in therapeutic situations.

In Chapter 4, Edwards introduces bi- and multilingualism, dealing with
definitions of competence, additive and subtractive bilingualism, primary
and secondary bilingualism, and transitional vs. stable collective
bilingualism. He introduces behaviours such as transference, borrowing,
interference and code-switching that can occur at different levels of
linguistic analysis, and the use of which interact with social attitudes
towards the speaker. He discusses response to the communication
difficulties posed by multilingualism, such as the expansion of individual
repertoires, the acceptance of shared link languages and translation, and
resistance to change due to language use's role in establishing group
identity and maintaining relative status.

Chapter 5 is 'Code-switching and diglossia' by Muller and Ball. They
discuss the terminology for a family of related behaviours. There are
systematic patterns to code-switching; it can be analysed in terms of the
text - the points where switches occur, the kinds of element that are
switched, and the linguistic relationships between the two languages at
those points -, and in terms of speaker and listener characteristics, the
situation, and transactional motivation. Diglossia is often defined as the
situation pertaining with a High standard form and a related Low vernacular
form. This definition, however, can be extended to include unrelated
languages, to overlap with definitions of bilingualism. The High and Low
distinction breaks down in some cases, as the status of forms may differ
between different groups of users, and there may be shifts in status over time.

Damico, Simmons-Mackie and Hawley discuss the relationship between language
and power in Chapter 6. Power in interaction is socially constructed, with
operational characteristics of complexity, multidimensionality, and its
differing manifestations between cultures, settings and particular
interactants. It is collaboratively constructed, emerging as the
interaction proceeds. Example manifestations are discussed, including
forms of address, control of speaking turn, topic selection and
maintenance, asking questions (their form and purpose), and the use of
evaluative statements. In clinical contexts, asymmetries of power exist
and may be deemed necessary to achieve the goals of the interaction. If
recognised and controlled, this adds to the arsenal of the clinician.

Taylor and Mendoza-Denton discuss language and culture in Chapter 7. They
introduce the concept of linguistic co-construction of meaning. The
interaction between verbal and nonverbal communication and the social and
physical environment is illustrated by instances in very different cultural
contexts of the use of gesture and speech to refer to place. The authors
then discuss the use of discourse markers or 'filler words' to modulate
disagreement and take stance within discussion, and to indicate group

In Chapter 8, Wolfram describes accounts of the origins and early
development of African American English (AAE), and the establishment of a
social grouping with language norms that support a distinct cultural
identity. He details phonological, grammatical and unique lexical features
AAE. There are implications for the use of clinical assessments that have
been standardised on other, or non-inclusive, populations, with the
potential to impact on, e.g., educational provision. Assessments can be
developed, not only to recognise 'alternative correct' responses, but to
focus on levels of language organisation shared across varieties. Wolfram
notes that speech-language pathologists are uniquely placed to educate
students and colleagues on the orderly nature of sociolinguistic diversity.

Watt and Smith introduce concepts and methodologies in the study of
language change over time. Changes can be substantial and rapid and are
often most evident in children's language, where innovations may be
regarded by adults as evidence of individual laziness or wider spread
language decay. Difficulties arise clinically when innovative changes are
in the direction of features associated with delayed or disordered speech
and language. An example is given of recent changes in the vowels patterns
of West Yorkshire English; in that they deviate from standard forms, these
have been described as disordered in at least one study. A second example
relates the language use of children in a region of Scotland, with
inflectional and lexical syntactic features that are also associated with
specific language impairment.

Language planning refers to the strategies that societies use to change (or
stop change) in their use of language and is discussed by Tonkin in Chapter
10. Planning occurs, for example, through the action of governments,
companies, education systems, and within families, and can affect content
(corpus planning) or pattern of use within society (status planning).
Planned actions can be minor adjustments, or can be wholesale adoptions or
the instigation of language death. Plans necessarily favour one group of
speakers over another. Tonkin gives many examples where language planning
has been a telling component in a nation's political history.

Preston and Robinson describe how the stereotyping of characteristics of
groups extends to their use of speech and language. These attitudes can
pervade education and clinical practice. Speakers of a standard form tend
to be judged high in competence, whereas non-standard forms invite high
ratings of integrity and attractiveness. Attitudes can be based on
identifying that the speaker belongs to a particular social group, or be
reactions to particular linguistic features themselves. Investigating such
factors can cast light on folk theories of language. The authors detail
their studies of university students' maps of speech regions and ratings of
evaluative characteristics. Rather than simply rating their own region
most positively, speakers have different investment in 'correctness' or


Roberts describes the acquisition of sociolinguistic variation, noting that
this variation is orderly, and that acquiring it is integral to competence
within a speech community. This includes considerations of the language
acquisition environment, different socialization processes, and dialect
related features of child directed speech. The few studies that there have
been of dialect production in children reveal that they acquire patterns of
variation early.

Bi- and multilingual language acquisition is reviewed by Zhu Hua and Li Wei
in Chapter 13. People become bilingual in different ways, for example,
whether planned or unplanned, whether languages are acquired simultaneously
or successively, and in different contexts (e.g. at home or in formal
education). Parents may have different language use to each other, they
may apply specific strategies (e.g. one parent speaks one language to the
child, the other the other), and the wider community exercises a pattern of
language use. The authors cite studies and evidence for various
standpoints in the debates surrounding the plurality of language processing
systems in bilingual speakers, whether bi- and monolingual acquisition
occur via the same or different processes, and whether there are specific
considerations associated with multi- vs. bilingual acquisition.

Chapter 14, by Oetting, concerns the assessment of language in children who
speak a non-mainstream variety of English, stressing the need to
distinguish between language differences and weaknesses. She provides
information on tools that are of direct use in clinical practice, noting
that further work on including non-mainstream speech communities is needed.
The few measures that have been designed for non-mainstream varieties
adopt different approaches, e.g. standardised tests normed on appropriate
populations, tests that assess skills other than existing knowledge of
forms (e.g. learning new forms, the non-word repetition task), and analyses
of language samples (with the relatively good performance of MLU–mean
length of utterance; DSS–developmental sentence score' and IPSyn–index of
productive syntax, across varieties in identifying language impairment).

In Chapter 15, Li Wei, Miller, Dodd and Zhu Hua expand on the features of
language development in bilingual children that differ from monolinguals.
Bilingual children may produce error forms that would be considered delayed
or disordered in normally developing monolingual children, they may
demonstrate error forms in one language and not the other, and they may
demonstrate different interaction skills, such as use of silence and
signaling of turns. The authors list possible evidence for communication
disorders in bilingual children. Clinicians need to recognise that an
assessment session is one particular social context, and which can be
enriched with natural elicitation procedures, by considering community
definitions of pathology, and from community corroboration of test and
natural data.

Speech perception, hearing impairment and linguistic variation are reviewed
by Clopper and Pisoni in Chapter 16. The speech signal carries 'indexical'
information about the talker such as gender, age, identity, dialect and
emotional state. In the normal hearing population, these are readily
perceived under degraded conditions and are readily learned. In deafened
adults with cochlear implants, talker discrimination is a more difficult
task. A single case of dialect identification within the normal range is
described. Pre-linguistically deaf cochlear implant users have reduced
talker identification (correlating with lexical identification skills) but
good gender discrimination skills. The authors conclude that those with
hearing impairment are able to process indexical information and use it in
normal processes of attitude formation.

Gitterman discusses aphasia in multilingual populations, including
hypotheses that there are different anatomical bases for languages acquired
through explicit strategies and implicitly, and a greater role for the
right hemisphere in processing a second language due to a greater role for
pragmatic processing, or reflecting processing of visuo-spatial information
in sign languages, pitch in tone language, or of characters in ideographic
systems of writing. In terms of assessments, an overview of the Bilingual
Aphasia Test is given - a battery of tasks given in both languages, plus
translation tasks. Gitterman cites evidence that treatment in one language
improves skills in the other, with structural similarity between languages
a factor in the extent to which this generalization occurs.

Chapter 18 is 'Designing assessments for multilingual children', by
Patterson and Rodriguez. As social context is a significant factor in
language use and hence learning experience, Patterson and Rodriguez believe
it should be an organising element in assessment. A case history should
include the family's language-related history, and assessment should
include their concerns. Assessment should be in all languages spoken, and
not assume that a 'dominant' language will encompass all skills of a
'weaker' one. Assessment should occur in contexts congruent with
experience, and can proceed through observation, sampling, standardised
instruments, and dynamic means (e.g. how does the child respond to the
scaffolding provided by others in acquiring new skills?). Analyses should
include explanation in terms of language use and inter-language influence,
as well as disorder.

In 'Literacy as a sociolinguistic process for clinical purposes' (Chapter
19), Damico, Nelson and Bryan discuss a view that stresses dynamic and
functional qualities of literacy skills. Examples include that literacy is
often acquired in a social context of modeled and joint reading with a
parent, and that definitions of (il-) literacy have changed over time.
Literacy skills are used with purpose within specific contexts -
essentially, what are the texts about? - and so literacy work has the
potential to motivate and empower students. Individuals and communities
make many adaptations to meet the literacy demands of society (e.g. making
use of skilled others, using substitute technologies) and so the
relationship between an individual's literacy skills and the ability to
participate in literacy activities is not straightforward.

Lucas, Bayley and Kelly consider the sociolinguistics of sign languages in
Chapter 20. They provide a historical review and discuss major themes in
the relationship between the spoken language of the wider community and the
signed language of the Deaf community, and whether frameworks developed in
the investigation of spoken languages necessarily apply. They discuss the
unique historical social contexts of sign language learning.
Sociolinguistic variation in sign languages is considered, with an
illustrative study of systematic variation in the sign DEAF, determined by
discourse factors and signer characteristics. A second example is of
Tactile American Sign Language used by Deaf-Blind people, with deviation
from the visual form determined in part by the physical contact between
signer and receiver.

The final chapter is 'Managing linguistic diversity in the clinic:
interpreters in speech-language pathology' by Isaac. Interpreters can play
a role in language translation and also the interpretation of a speaker's
intent, given their specific cultural background. It is therefore
important to consider whether they are 'bicultural' as well as bilingual.
There are many barriers to effective interpreter-mediated interaction;
Isaac summarises these under interacting categories of: inadequate
preparation, inadequate communication; issues of independence, and
assumptions, with examples from post-session reflection by speech-language
pathologists and interpreters. She offers specific suggestions for
maximising success, including collaborative partnership and increased
awareness of the interpreter's skills and role.


This volume achieves its aim of introducing the concerns, accounts and
lessons of sociolinguistic research to clinical practice with people with
communication disorders. It hence contributes to the development of a
clinical sociolinguistics. The individual contributions, while differing
in scope, provide excellent overviews of their topic areas, are clearly
written without exception, and contain reference to a further literature
where this exists.

The collecting together of individual contributions means that commonly
occurring themes become evident, as do omissions. The latter are expected
in what must be considered a fledging discipline. The most fully developed
themes are of multilingualism, dialect variation and, clinically, the
assessment of children's speech and language skills in the context of these
factors (chapters 4, 5, 8, 9, 12, 13, 14, 15 and 18). This emphasis
reflects the agenda of academics in addressing the social exclusion of many
minority ethnic and other marginalised groups, through access to education.
Of course, as the authors here often reiterate, multilingualism and use of
non-standard forms are in fact the norm for the majority of the world's
communicators. To assess them appropriately, it is not a matter of
'translating' materials developed for a monolingual population of standard
form speakers, but rather of recognising that they possess different and
additional skills (skills perhaps not possessed by the majority of the
world's healthcare commissioners and curriculum setters).

While the major theme emerging concerns the clinician's ability to
distinguish between difference and disorder, there is less research to date
and less here on the IMPACT of speech and language impairments as
understood within a sociolinguistic framework. For example, how about the
impact of pragmatic disorders on social networks, code-switching in
bilinguals as a skill to address in therapy, the ability to shift dialect
when using alternative communication technologies, listener attitudes to
speakers with dysarthria, or the different disabling effects of a literacy
impairment depending upon a community's normal practice. This is not an
error of omission, but rather reflects the developing nature of the
discipline. This book therefore succeeds in provoking the reader into
thinking about how sociolinguistic frameworks can be applied elsewhere (and
it is exciting to be provoked so).

Not all of the authors in Part One of the book explicitly consider clinical
application. I think this is an opportunity missed, as it is not
transparent how all aspects of the sociolinguistics presented here have
relevance. The most frequently made link to clinical application is that
clinicians need to understand the language use of the communities they
serve, and therefore need an understanding of sociolinguistics. This is a
simple statement, though undeniably true; the point is not, in every case,
fleshed out. The chapters by Guendouzi, and Damico, Simmons-Mackie and
Hawley are examples where the authors do more fully develop their ideas
with the book's remit in mind. Overall, this volume makes a valuable
contribution, in giving an introduction to research that is underway and
setting some foundation stones, indicating space for neighbours.

Michael Dean, Ph.D. is a speech and language therapist working with brain
injured adults, in a post-acute neurological rehabilitation unit within the
National Health Service. The unit is located in a culturally and
linguistically diverse part of London. He has research interests in
aphasia and cognitive neuropsychology.

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