Providing Culturally and Linguistically Responsive Services

Cultural Diversity

Recognizing that we all have and represent a culture is a critical component of clinical practice. . It's important to be aware of the many cultural variables that can impact assessment and intervention. The professional organizations of the NJC have produced a variety of statements and guidelines concerning cultural and linguistic diversity (AAIDD, 2017; ASHA, 2014, 2017, 2020).

Some of the cultural variables that may influence the perceptions and behaviors of both individuals and clinicians are age, disability, gender, occupation, religious beliefs, race, sexual orientation, socioeconomic status, and ethnicity.

Rules for verbal and nonverbal communication may vary across cultures. For example, gestures and their meaning may vary from culture to culture. A gesture viewed as indicating a positive behavior for one culture, such as a "thumbs up," may be viewed as inappropriate in another culture. The communication roles that partners play also may vary with cultural expectations. For example, helping a child to initiate communication more often may not be valued by some cultures. Silence may be perceived as a sign of respect for a communication partner, rather than a failure to respond or understand. Service providers should be as knowledgeable as possible about individuals' cultural backgrounds.

Linguistic Diversity

The linguistic diversity of individuals may affect aspects of communication, such as vocabulary, dialect, and  literacy. Family preferences regarding linguistic priorities should be reflected in service provision (ASHA, 2014, 2017, 2020). In addition to respecting cultural and linguistic heritage in all communication services, inclusion of parental perspectives on language use is also critical (Rhodes & Washington, 2016; Yu, 2013).

Research shows that individuals with severe disabilities can learn more than one language (Kay Raining-Bird, Lamond, & Holden, 2012; Kay Raining-Bird, Cleave, Trudeau, Thordardottr Sutton, & Thorpe, 2005). Although guidelines suggest that instruction in an individual’s first language helps build a strong base for further language instruction, including AAC, there is limited research supporting the specific strategies involved in teaching AAC (Harrison-Harris, 2002) to individuals from multilingual backgrounds. Therefore, we recommend working closely with the family and other members of the team to provide the individual with opportunities to communicate both at home and at school or other community locations in the language that will be most effective within those contexts. This may mean using different systems or a different set of vocabulary across settings at some time during the course of instruction. Careful data collection will help guide the team regarding the use of multiple systems. For example, if an individual using AAC is using symbols and text in his or her first language, data are needed to evaluate how well school personnel respond to the individual's first language. Similarly, if two different AAC systems are used, the team may consider whether the individual responds less often in one versus another (perhaps due to confusion). The clinician and team members will need to create their own data set to make decisions that are best for the individual.

Bottom Line:

With an increasingly diverse population, it is necessary that individuals providing for the communication needs of persons with severe disabilities become sensitive to cultural influences (Rhodes & Washington, 2016). For persons who live with families that speak another language, multiple factors need to be taken into consideration. The individual must have access to opportunities to communicate both at home and in the communityin the language or languages that will be most effective within those contexts.


American Association on Intellectual and Developmental Disabilities (2017). Position statement in Support of Diversity and Inclusion. Retrieved from

American Speech-Language-Hearing Association. (2017). Issues in ethics: Cultural and linguistic competence. Retrieved from

American Speech-Language-Hearing Association. (2022). Cultural responsiveness. Available from

American Speech-Language-Hearing Association. (2020). Multicultural Affairs and Resources. Available from:

Harrison-Harris, O. L. (2002, November 5). AAC, literacy and bilingualism. The ASHA Leader, pp. 4–5, 16–17.

Huer, M. B. (2008). Toward and understanding of the interplay between culture, language, and augmentative and alternative communication . Perspectives of the ASHA Special Interest Groups, 17(3), 113-119.

Kay Raining-Bird, E., Lamond, E., & Holden, J., (2012). Survey of bilingualism in autism spectrum disorders.  International Journal of Language and Communication Disorders, 47. 52-64. 10.1111/j.1460-6984.2011.00071.x..

Kay Raining-Bird, E., Cleave, P., Trudeau, N, Thordardottr, E., Sutton, A., & Thorpe, A., (2005). The language abilities of bilingual children with Down syndrome. American Journal of Speech Language Pathology, 14, 187-199.

Kulkarni, S. S., & Parmar, J. (2017). Culturally and linguistically diverse student and family perspectives of AAC. Augmentative and Alternative Communication, 33, 170-180.

McNamara, E. (2018). Bilingualism, Augmentative and Alternative Communication, and Equity: Making a Case for People With Complex Communication Needs. Perspectives of the ASHA Special Interest Groups, 3(12), 138–145.

Rhodes, K., & Washington, J. (2016). The role of cultural, ethnic and linguistic diversity. In R. Sevcik, & M. A., Romski (Eds.) Communication interventions for individuals with severe Brookes Publishing.

Yu, B. (2013). Issues in bilingualism and heritage language maintenance: Perspectives of minority-language mothers of children with autism spectrum disorders. American Journal of Speech-Language Pathology, 22, 10–24. doi:10.1044/1058-0360.


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