American Speech-Language-Hearing Association

Communication Facts: Focus on Culturally and Linguistically Diverse Populations - 2008 Edition

Scholars from a variety of disciplines describe communication and generate models of communication that portend to show how people communicate, how they interact verbally and nonverbally with one another, and what happens when communication breaks down. Particular attention is given to issues pertaining to communication disorders or differences as a possible function of cultural, linguistic and/or social variables, including those that may be linked with race (1). The relationship between communication and culture is reciprocal: culture and communication influence each other (2). Diversity, multiculturalism, and individual differences are concepts that are becoming of greater interest to speech-language pathologists, audiologists, and speech, language, and hearing scientists as they strive to make clinical management more functional and meaningful for all clients (3).

General Demographics

The following are projection figures from the U.S. Bureau on racial and ethnic groups (4):

Ethnic and/or Racial Group Census 2000 Population Projection: 2010 Population Projection: 2020
African American 36.4 million 40.4 million 39.5 million
American Indian/Alaskan Native 2.5 million Projections for American Indian/Alaska Native are not provided.
Asian American 11.9 million 14.2 million 17.9 million
Hispanic/Latino 35.3 million 47.7 million 59.7 million
Native Hawaiian/Pacific Islander 874,414 Projections for Native Hawaiian/Pacific Islanders are not provided.

There are few reliable data on the general incidence or prevalence of communication disorders among culturally and linguistically diverse populations in the United States. Estimates are based on projections from data founded on the mainstream population (5). A review of the medical and allied health literature reveals a number of studies focusing on particular aspects of communication disorders in select ethnic and/or racial groups (5-9).

Provided that the prevalence of communication disorders among racial and ethnic minorities is consistent with that of the general population, it is estimated that 6.2 million culturally and linguistically diverse Americans have a communication disorder (5).

Speech and Language Disorders

  • Few qualitative studies have been conducted with people who stutter of historically disadvantaged race-ethnic groups (10).
  • Early studies on stuttering focused on Native American tribes, and were indicative of the nature of early research in the field of stuttering among minority groups. Such studies lacked quantitative data and relied upon interviews collected with the help of a translator (11, 12).
  • One study suggests that bilingual ability influences frequency, distribution, and nature of disfluencies (13).

Voice Disorders

  • One study reports that Blacks have a generally higher incidence of laryngeal cancers than do Whites (14).
  • A study of bilingual Cantonese/English and Russian/English speakers by Altenberg indicates negative attributes/perceptions to individuals as severity of the voice disorder within their group increases (15).
  • Research conducted by Dobres and colleagues suggests that the incidence of abnormality of the laryngeal cartilage was higher among White males than females; however, the reverse is true among Blacks (16).

Hearing Loss

  • Among populations inhabiting the Canadian North, the Inuit appear to be at higher risk for conductive hearing loss than other ethnic groups (17, 18).
  • Twenty percent of non-Hispanic White adults experienced some hearing trouble compared with 9% of non-Hispanic black adults and Hispanic adults (19).
  • Cholesteatoma, which can be a result of recurrent otitis media, is more prevalent among Native Americans and Alaskan Natives than other racial groups (20).
  • The incidence of otosclerosis is estimated to be at 5%-10% among Whites. It is less frequent among African Americans (21).
  • There is evidence of peripheral and central auditory dysfunction in minority children with sickle cell disorder. Permanent peripheral dysfunction is most likely to manifest itself as a high-frequency sensorineural hearing loss (5).


  1. Taylor, O.L. (Ed.). (1986). Treatment of communication disorders in culturally and linguistically diverse populations. Austin, TX: Pro-Ed.
  2. Keesling, R. (1974). Theories of culture. Annual Review of Anthropology, 3, 73-97.
  3. Wallace, G.L. (1999). An inclusive management approach for individuals with right hemisphere deficits. Seminars in Speech and Language, 20 (4): 343-354.
  4. U.S. Census Bureau. (2004). U.S. Interim Projections by Age, Sex, Race, & Hispanic Origin <Accessed, August 27, 2007>.
  5. Battle, D.E. (2002). Communication disorders in multicultural populations (3rd ed). Boston: Butterworth-Heinemann.
  6. Hollifield, M. Geppert, C., Johnson, Y., & Fryer, C. (2003, September). A Vietnamese man with selective mutism: The relevance of multiple interacting "cultures" in clinical psychiatry. Transcultural Psychiatry, 40 (3): 329-341.
  7. Kobayashi, Y., et. al. (2006, April). Linguistic features of Japanese twins at 3 or 4 years of age evaluated by Illinois test of psycholinguistic abilities. Twin Research and Human Genetics, 9 (2): 272-278.
  8. Law, Z.W., & So, L.K. (2006, December). Phonological abilities of hearing-impaired Cantonese-speaking children with cochlear implants or hearing aids. Journal of Speech & Hearing Research, 49 (6): 1342-1353.
  9. Seymour, H.N., & Pearson, B.Z. (2004, February). Steps in designing and implementing an innovative assessment instrument. Seminars in Speech and Language, 25 (1): 27-31.
  10. Daniels, D.E., Hagstrom, F., & Gabel, R.M. (2006). A qualitative study of how African-American men who stutter attribute meaning to identity and life choices. Journal of Fluency Disorders, 31 (3): 200-215.
  11. Snidecor, J.C. (1947). Why the Indian does not stutter. Quarterly Journal of Speech, 33, 493.
  12. Stewart, J.L. (1960). The problem of stuttering in certain North American Indian societies [monograph]. Journal of Speech and Hearing Disorders, 6, 1.
  13. Jankelowitz, D.L., & Bortz, M.A. (1996, May-June). The interaction of bilingualism and stuttering in an adult. Journal of Communication Disorders, 29 (3): 223-234.
  14. Miller, B.A., Kolonel, L.N., Bernstein, L., et. al. (1996). Racial/ethnic patterns of cancer in the United States, 1988-1992. Washington, DC: National Cancer Institute (NIH Pub. No. 96-4104).
  15. Altenberg, E.P., & Ferrand, C.T. (2006, August). Perception of individuals with voice disorders by monolingual English, bilingual Catonese/English, and bilingual Russion/English women. Journal of Speech, Language, and Hearing Research, 49 (4): 879-887.
  16. Dobres, R., Lee, L., Stemple, J.C., et. al. (1990). Description of laryngeal pathologies in children evaluated by otolaryngologists. Journal of Speech and Hearing Disorders, 55 (3): 526-532.
  17. Moore, J.A. (1999, December). Comparison of risk of conductive hearing loss among three ethnic groups of Arctic audiology patients. Journal of Speech, Language, and Hearing Research, 42 (6): 1311-1322.
  18. Ayukawa, H., et. al. (2004). Otitis media and hearing loss among 12-16 year-old Inuit of Inukjuak, Quebec, Canada. International Journal of Circumpolar Health, 63 (suppl. 2): 312-314.
  19. Pleis, J.R., & Coles, R. (2002). Summary health statistics for U.S. adults: National Health Interview Survey, 1998. National Center for Health Statistics. Vital Health Stat 10(209).
  20. Seymour, C.M., & Nober, E.H. (1998). Introduction to communication disorders: A multicultural approach. Boston, MA: Butterworth-Heinemann.
  21. Canalis, R.F., & Lambert, P.R. (2000). The ear: Comprehensive otology. Philadelphia, PA: Lippincott Williams & Williams.

Compiled by Andrea Castrogiovanni * American Speech-Language-Hearing Association * 2200 Research Boulevard, Rockville, MD 20850 *

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