Cross-Cohort Evidence of Disparities in Service Receipt for Speech

https://doi.org/10.1177/0014402917718341

Exceptional Children

2017, Vol. 84(1) 27 –41

DOI: 10.1177/0014402917718341

journals.sagepub.com/home/ecx

Article

Speech or language impairments (SLIs)

increase young children’s risk for atypical

development, including lower cognitive,

behavioral, and school functioning (Bornstein,

Hahn, & Suwalsky, 2013; Petersen et al., 2013;

U.S. Preventive Services Task Force, 2006).

Elementary school–age children with SLIs are

at increased risk of having reading (Catts, Fey,

Tomblin, & Zhang, 2002; Snowling, Bishop,

& Stothard, 2000) and behavioral (Yew &

O’Kearney, 2013) disabilities and often expe-

rience greater bullying and feelings of isola-

tion (Harrison, McLeod, Berthelsen, & Walker,

2009; McCormack, Harrison, McLeod, &

McAllister, 2011; Morgan, Farkas, & Wu,

2011). As they age, children with SLIs are less

likely to complete high school; are more

frequently unemployed; and, if employed,

hold lower-paying positions (Elbro, Dalby, &

Maarbjerg, 2011; Felsenfeld, Broen, & McGue,

1994; Johnson, Beitchman, & Brownlie, 2010;

Muir, O’Callaghan, Bor, Najman, & Williams,

2011). Prevalence estimates among preschool

children vary, ranging from 5% to 8% for com-

bined speech and language delays and 2% to

19% for language delays, with persistence

rates of 40% to 60% for untreated speech

and language delays (Nelson, Nygren, Walker,

& Panoscha, 2006). Although SLIs may

constitute a chronic condition (Silva,

Williams, & McGee, 1987; Snowling et al.,

2000; Tomblin, Zhang, Buckwalter, &

O’Brien, 2003), children appropriately identi-

fied and provided with interventions and ser-

vices by kindergarten display substantially

improved speech and language capabilities

(Beitchman, Wilson, Brownlie, Walters, &

Lancee, 1996; Boyle, McCartney, O’Hare, &

Forbes, 2009; Hebbeler et al., 2007; Law,

718341ECX

XXX10.1177/0014402917718341Exceptional ChildrenMorgan et al.

research-article2017

Pennsylvania State University

University of California, Irvine

Corresponding Author:

Paul L. Morgan, Department of Education Policy Studies,

310E Rackley Building, University Park, PA, 16802.

E-mail: [email protected]

Cross-Cohort Evidence of

Disparities in Service Receipt for

Speech or Language Impairments

Paul L. Morgan

, George Farkas

, Marianne M. Hillemeier

Hui Li

, Wik Hung Pun

, and Michael Cook

Abstract

We examined the extent to which disparities in the receipt of special education services

for speech or language impairments (SLIs) on the basis of race, ethnicity, or language use by

kindergarten—when the delivery of these services might be expected to be most effective—

have changed over a 12-year period in the United States. Logistic regression modeling of 2

nationally representative cohorts (N = 16,800 and 12,080) indicated that children who are

Black (covariate-adjusted odds ratios = 0.39 and 0.54) or from non-English-speaking households

(covariate-adjusted odds ratios = 0.57 and 0.50) continue to be less likely to receive services

for SLIs. Hispanic children are now less likely to receive these services (covariate adjusted

odds ratio = 0.54) than otherwise similar non-Hispanic White children. Disparities in special

education service receipt for SLIs attributable to race, ethnicity, and language presently occur in

the United States and are not explained by many potential confounds.

28 Exceptional Children 84(1)

Garrett, & Nye, 2004; Nelson et al., 2006;

Roberts & Kaiser, 2011; Wilcox, Gray, Guimond,

& Lafferty, 2011).

Disparities in SLI

Identification and Service

Receipt by Race, Ethnicity,

and Language Use

Although young children should be regularly

evaluated for possible speech or language delays

(Hagan, Shaw, & Duncan, 2008), fewer than

50% of those who need treatment for SLIs

receive it (Skeat et al., 2014). Racial, ethnic, and

language minorities are a large and rapidly

growing segment of the U.S. child population

(Colby & Ortman, 2014). Although they are at

greater risk for SLI symptoms (Harrison &

McLeod, 2010; Morgan, Farkas, Hillemeier, &

Maczuga, 2012; Pruitt, Oetting, & Hegarty,

2011), minority children with SLIs may be espe-

cially unlikely to be identified and so receive

treatment, including through special education

(Harrison & McLeod, 2010; Morgan et al.,

2012; Morgan et al., 2016). Because of their

unmet treatment needs, minority children there-

fore may be disproportionately likely to grow to

experience the sequela of untreated SLIs (e.g.,

reading or behavioral disabilities, bullying,

unemployment). For example, White children’s

behavioral struggles are more likely to be medi-

calized and those of minority more likely to be

criminalized―and so ineffectively managed

(Ramey, 2015). Minority children’s greater like-

lihood of having unidentified and so untreated

disabilities has been hypothesized to at least

partly explain achievement gaps in the United

States (Basch, 2011).

Children appropriately identified and

provided with interventions and

services by kindergarten display

substantially improved speech and

language capabilities.

Possible mechanisms for racial, ethnic, and

language use disparities in special education

service receipt for SLIs include socioeco-

nomic, language, and cultural factors that

reduce access and receptivity to SLI screening

and treatment by minority families (E. Flores,

Tschann, Dimas, Pasch, & de Groat, 2010;

Peña & Fiestas, 2009; Zuckerman, Mattox,

Sinche, Blaschke, & Bethell, 2014); a lack of

diagnostic protocols designed and validated

for use with cultural and language minority

populations (Figueroa & Newsome, 2006;

Kohnert, Yim, Nett, Kan, & Duran, 2005;

Linan-Thompson, 2010; Zuckerman et al.,

2013); and a reluctance by practitioners to

identify minority children for fear of being

considered racially biased (possibly by misat-

tributing a speech or language dialectal differ-

ence to SLIs; Hibel, Farkas, & Morgan, 2010;

Skiba et al., 2006). Practitioners may be com-

paratively less likely to solicit developmental

concerns from minority families (Guerrero,

Rodriguez, & Flores, 2011; Zuckerman,

Sinche, et al., 2014; Zuckerman, Boudreau,

Lipstein, Kuhlthau, & Perrin, 2009).

Extant Work’s Limitations

There are major limitations in the field’s

knowledge base about which children in the

United States are receiving special education

services for SLIs, including the extent to which

disparities based on race, ethnicity, and lan-

guage use currently occur. Overall, researchers

and practitioners currently have “little infor-

mation” (U.S. Preventive Services Task Force,

2014) about the risk factors for SLIs to guide

early screening and intervention efforts. This

is despite repeated calls by the U.S. Preventive

Services Task Force for epidemiological stud-

ies that better inform SLI screening, evalua-

tion, and service delivery for this especially

vulnerable population of children (Nelson

et al., 2006; U.S. Preventive Services Task

Force, 2006, 2014). Existing studies investi-

gating disparities based on race, ethnicity, or

language use have mostly used convenience

samples or have not accounted for likely con-

founding factors, including family socioeco-

nomic status, maternal age and marital status,

health insurance coverage, prematurity, birth

weight, academic functioning, and behavioral

self-regulation (Morrier & Gallagher, 2010;

Singer et al., 2001). Such factors are important

Morgan et al. 29

to control for, as they otherwise explain dis-

parities initially attributable to children’s race,

ethnicity, or language use (Morgan et al.,

2015). For example, minority children are

more likely to experience low birthweight

(Clay & Andrade, 2016), which may itself

increase the risk for SLIs (Yliherva, Olsen,

Maki-Torkko, Koiranen, & Jarvelin, 2001).

Available studies analyzing population-based

data have mostly used non-U.S. samples

(Harrison & McLeod, 2010; Reilly et al.,

2010; Zubrick, Taylor, Rice, & Slegers, 2007)

and so may not generalize to the increasingly

diverse U.S. school-aged population. The few

population-based studies based on U.S. sam-

ples have reported conflicting findings regard-

ing whether racial, ethnic, and language

minority children are less likely to receive

special education services for SLIs (Hibel

et al., 2010; Morgan et al., 2012; Morgan et al.,

2015; Sullivan & Bal, 2013), possibly because

the disparities have sometimes been investi-

gated with samples of children attending upper

elementary grades (Hibel et al., 2010; Sullivan

& Bal, 2013). Instead, these disparities may be

most likely to occur early in children’s school

careers because children in the United States

are most likely to be identified as having

SLIs by kindergarten (Morgan et al., 2015).

Consistent with this, Morgan and colleagues’

(2016) recent analyses of a nationally repre-

sentative data set of children born in the United

States indicated that Black children were less

likely than otherwise similar White children to

receive services for SLIs prior to or by kinder-

garten entry. Disparities attributable to chil-

dren’s race, ethnicity, and language use were

also evident at the end of kindergarten in an

older, nationally representative data set of

U.S. children entering kindergarten in 1998 or

1999 (Morgan et al., 2015). However, whether

and to what extent these disparities continue

to occur in the United States, as well as the

extent to which they may have changed over

the preceding 12-year period as the nation

has grown increasingly diverse, is currently

unclear (Morgan et al., 2016).

Understanding whether racial, ethnic, and

language use disparities in SLI identification

are continuing to occur by kindergarten in the

United States is especially timely, including

for policy, research, and practice. Despite

some studies finding that―among children

displaying similar clinical needs―racial, eth-

nic, and language minority children are less

likely to receive school-based services for

SLIs (Morgan et al., 2012; Morgan et al.,

2015; Morgan et al., 2016), federal policy

makers have expanded efforts to reduce what

is considered to be disproportionate overrep-

resentation in special education due to wide-

spread misidentification based on children’s

race or ethnicity (U.S. Department of

Education, 2016a). This includes for SLIs

(U.S. Department of Education, 2016b).

Establishing that underidentification and ser-

vice receipt for SLIs currently occur or are

possibly increasing in the United States on the

basis of race, ethnicity, and language use—

particularly during kindergarten, when these

services may be most effective—should better

inform federal policy making as well as edu-

cational research and practice. This includes

policies designed to bring greater equity to

special education by ensuring that all children

with disabilities are being appropriately

recognized and provided with the services to

which they have a civil right. More generally,

and by identifying factors that are repeatedly

associated with an increased likelihood of SLI

identification, cross-cohort analyses of two

nationally representative samples should

better inform empirically based efforts to

appropriately screen, monitor, and possibly

evaluate children who may be at risk for these

impairments and their sequela.

Purpose

Our study had two purposes. The first was to

estimate to what extent disparities on the basis

of race, ethnicity, and language use in the

receipt of special education services for SLIs

by kindergarten continue to occur or possibly

may be increasing in the United States. We

did so by conducting cross-cohort analyses of

two nationally representative data sets over a

12-year period. Because the disparity esti-

mates are adjusted for many confounding fac-

tors, they should provide for less ambiguous

30 Exceptional Children 84(1)

inferences about whether the disparities are

attributable to children’s status as racial,

ethnic, or language minorities. This in turn

should help inform federal policy, including

newly announced regulations (U.S. Department

of Education, 2016a). The second purpose

was to identify which factors—across a range

of gestational and birth, sociodemographic,

and other child and family characteristics—

are most strongly and consistently associated

with receiving special education services for

SLIs during kindergarten. By replicating these

estimates through cross-cohort analyses of

two nationally representative samples of U.S.

kindergarteners, these results should help

inform efforts to identify and provide services

to children with SLIs as they are beginning

formal schooling.

Method

Data and Samples

Data from two Early Childhood Longitudinal

Study (Pollack, Atkins-Burnett, Rock, &

Weiss, 2005) cohorts were analyzed: the kin-

dergarten class of 1998–1999 (ECLS-K:

1999; N = 16,800) and the kindergarten class

of 2010–2011 (ECLS-K: 2011; N = 12,080).

Both of these nationally representative data

sets are maintained by the National Center for

Education Statistics, U.S. Department of

Education (https://nces.ed.gov/ecls/index.asp).

Table 1 displays descriptive statistics of the

two samples. The racial and ethnic distribu-

tion was similar for the two cohorts, with non-

Hispanic White children composing a little

more than half the sample. Children who are

Black, Hispanic, and of another race or eth-

nicity constituted 13%–14%, 17%–22%, and

10%–12% of the samples, respectively. Simi-

lar proportions of the two cohorts were born at

low birth weight (7%–9%) or prematurely

(17%–20%). Family characteristics were also

similar between the groups, including mater-

nal age at first birth, marital status, health

insurance coverage, and English language

usage at home. Nearly equivalent proportions

of the two samples were reported to have

communication problems (7%–8%), were

evaluated by professionals for a communica-

tion problem (10%–11%), or had a school

record of having SLIs (3%–4%).

Measures

Special Education Services for SLIs. Special edu-

cation service receipt for SLIs was reported in

each cohort by the children’s special educa-

tion teachers. These teachers were responsible

for coordinating delivery of the children’s

school-based special education services.

Sociodemographic Characteristics. Children’s

race or ethnicity was classified as being

non-Hispanic White, non-Hispanic Black,

Hispanic, or other race/ethnicity. The inci-

dence of SLIs may vary by other demo-

graphic characteristics, including region of

residence (Northeast, Midwest, South, West)

and family’s socioeconomic status, which

were included as covariates in the analyses

(Morgan et al., 2012). A composite continu-

ous variable measuring a family’s socioeco-

nomic status was constructed by the National

Center for Education Statistics based on

multivariate information from parent ques-

tionnaires about the family’s household

income and each parent’s education level

and occupation. This variable has been used

in prior studies analyzing the ECLS-K data

(McCormack et al., 2011). Parents reported

in the spring of kindergarten on their marital

status, which was also included in the analy-

ses to control for family composition.

Child Characteristics. Parents identified their

children’s gender, which was included as a

covariate because of its associations with

speech or language delays and SLI service

receipt (Harrison & McLeod, 2010). The

child’s age (in months) was recorded at the

date of the interview in spring of kindergar-

ten for both cohorts and was included in the

analyses to control for variation in age at the

time of testing. Variables were also included

to indicate whether the child was born with

low birth weight (<5.5 lb) or prematurely (>2

weeks before due date), as they are associ-

ated with increased risk of atypical language

Morgan et al. 31

development (e.g., Vohr, 2014). Whether the

child was covered by health insurance was

also included as a covariate because insur-

ance has been associated with greater access

to health care providers who could refer for

eligibility and service receipt for SLIs prior

to school entry (G. Flores & the Committee

on Pediatric Research, 2010). In the fall of

kindergarten, interviewed parents reported

the biological mother’s age when she gave

birth to her first child. Because differences in

health risks, including those for SLIs, have

been associated with whether children are

born to young or older mothers (Harrison &

Table 1. Descriptive Statistics.

ECLS-K: 1999

(N = 16,800)

ECLS-K: 2011

(N = 12,080)

Variable Percentage Mean (SD) Percentage Mean (SD)

Race/ethnicity

White 58 54

Black 14 13

Hispanic 17 22

Other race/ethnicity 10 12

Socioeconomic status 0.04 (0.79) –0.01 (0.8)

Child characteristics

Male 51 51

Child age, fall of kindergarten 68.47 (4.44) 68.45 (4.5)

Low birth weight 7 9

Born more than 2 weeks before due 17 20

Biological mother gave her first birth at

age <18

12 11

Biological mother gave her first birth at

age ≥38

1 2

Covered by health insurance, spring of

kindergarten

91 95

Parents were married, spring of

kindergarten

68 71

Language primarily spoken at home is

not English

12 13

Region

Northeast 19 15

Midwest 25 23

South 32 38

West 23 23

Academic achievement

Reading test, spring of kindergarten 32.4 (10.4) 49.99 (11.78)

Mathematics test, spring of kindergarten 28 (8.83) 42.63 (11.1)

Behavioral functioning

Behavioral self-regulation 3.11 (0.67) 3.11 (0.68)

Externalizing problem behaviors 1.67 (0.64) 1.64 (0.62)

Internalizing problem behaviors 1.57 (0.51) 1.51 (0.48)

School record of speech or language

impairment

3 4

Note. ECLS-K = Early Childhood Longitudinal Study–Kindergarten.

Special education teacher report

32 Exceptional Children 84(1)

McLeod, 2010), these factors were captured

by maternal age dummy variables in the

analyses. Because non-English-speaking

families may have reduced interactions with

health care providers and school personnel,

we included a variable indicating whether

English or another language was primarily

spoken at home (Morgan et al., 2016). We

did so to examine whether disparities in SLI

service receipt were also occurring based on

language use, as well as possibly based on

race or ethnicity.

Academic Achievement. Children’s academic

achievement is strongly associated with the

likelihood for disability identification, includ-

ing that for SLIs (Morgan et al., 2015), and so

was included here as an additional explanatory

factor. For both cohorts, grade-appropriate,

item response theory-scaled psychometrically

validated measures of reading and mathemat-

ics achievement were individually adminis-

tered in kindergarten. These adaptive

assessments included some items that were

specifically created for the ECLS-K studies,

some that were adapted from commercial

assessments with copyright permission, and

some that were developed for other studies

fielded by the National Center for Education

Statistics. The reading assessment includes

questions measuring basic skills, such as print

familiarity, letter recognition, beginning and

ending sounds, word recognition, and vocabu-

lary knowledge. The mathematics assessment

includes questions on number sense, proper-

ties, and operations. The conceptual basis and

psychometric processes used to derive the

assessments were highly similar in the two

ECLS-K cohorts, although the measures were

not identical. Theta reliabilities for the reading

and mathematics achievement measures in

kindergarten were in the mid-.90s (Pollack

et al., 2005). We used children’s spring-of-

kindergarten scores on the reading and mathe-

matics achievement measures from both

cohorts as covariates.

In each cohort, English language profi-

ciency was assessed prior to administration of

the achievement assessments. Spanish speak-

ers who were not sufficiently fluent in English

received Spanish forms of the achievement

assessments. Children who did not speak

either English or Spanish did not participate

in the achievement assessments.

Behavioral Functioning. Children’s behavior,

including their self-regulation and internaliz-

ing problem behaviors, is associated with the

incidence of language delays and SLI service

use (Harrison & McLeod, 2010) and so was

included as an explanatory factor. In the spring

of kindergarten, children’s behaviors were

rated by their general education teachers

using items from the Social Rating Scale

(Pollack et al., 2005), a psychometrically

validated behavioral measure (e.g., split-half

reliabilities ranging from .76 to .91; Pollack

et al., 2005). We controlled for three types of

behavioral functioning. The Approaches to

Learning Scale measures self-regulatory

behaviors, including the frequency with which

the child pays attention, keeps belongings

organized, works independently, shows eager-

ness to learn new things, easily adapts to

changes in routine, and persists in completing

tasks. The Externalizing Problem Behaviors

Scale measures acting-out behaviors, includ-

ing the frequency with which a child argues,

fights, becomes angry, acts impulsively, and

disturbs ongoing classroom activities. The

Internalizing Problem Behaviors Scale mea-

sures how often the child seems anxious,

lonely, or sad, or displays low self-esteem.

Missing Data

Each cohort sample was initially captured in

the fall of kindergarten. There was a small

amount of missing data in spring when we

measured whether children were receiving

special education services for SLIs. However,

and by controlling for variables included in

the data associated with missingness (e.g.,

socioeconomic status, race/ethnicity, aca-

demic achievement), we reasonably assumed

that the data were missing at random. We then

used multiple imputation procedures to

impute missing independent variable data,

resulting in the largest possible number of

cases in our analyses. The missingness of the

Morgan et al. 33

predictors in the study ranged from 0% to

8.3% for ECLS-K: 1999 and from 0% to

19.3% for ECLS-K: 2011. We imputed miss-

ing data for each cohort five times to create

five data sets for each, which enabled us to

estimate five sets of model parameters. We

then used standard formulas to combine these

five sets of estimates into those reported here.

Analytical Methods

Separate logistic regression equations predict-

ing special education service receipt for SLIs

were estimated for each period, and the differ-

ence in coefficients for race, ethnicity, and

language use was tested for statistical signifi-

cance. Because the data were collected by

first sampling kindergarten classrooms and

then sampling children within these class-

rooms, we used multilevel modeling (children

nested in kindergarten classrooms) to estimate

the regression equations. Doing so adjusted

the standard errors for the clustering of obser-

vations within schools. We standardized fam-

ily socioeconomic status, child age, academic

achievement scores, and teacher ratings of

behavior with M = 0 and SD = 1 for each

cohort. Doing so made the data from these

two cohorts more comparable (with continu-

ous predictors now measured in standard

deviation units). We obtained Institutional

Review Board approval.

Results

Table 2 shows the coefficient estimates for the

multilevel multiple logistic regressions pre-

dicting whether children were receiving spe-

cial education services for SLIs for each

U.S. cohort. All factors were simultaneously

entered into each cohort’s regression model. In

1999, the covariate-adjusted odds ratio coeffi-

cient for Black children was a statistically sig-

nificant 0.39. This odds ratio indicates that the

odds that Black children were receiving ser-

vices for SLIs were 61% lower (calculated as 1

minus the odds ratio of .39) than the odds for

otherwise similar White children. Twelve

years later, in 2011, the same covariate-

adjusted odds ratio was .54, indicating that

Black children’s odds of service receipt were

46% lower than for otherwise similar White

children (1 – .54). Black children in the United

States therefore continued to be less likely

than otherwise similar White children to be

receiving services for SLIs by kindergarten.

The estimated magnitude of this disparity in

2011 was not statistically significantly differ-

ent from the disparity in 1999.

In 1999, the covariate-adjusted odds ratio

for Hispanic children was .86, which was not

statistically significant. However, by 2011,

this same ethnic disparity had increased and

become statistically significant. This odds

ratio for Hispanic children was .54 at the more

recent time point, indicating that the odds that

they were receiving services were now 46%

(1 – .54) lower than for otherwise similar

non-Hispanic White children.

For children from non-English-speaking

homes, their odds of receiving services for

SLIs were 43% (1 – .57) and 50% (1 – .50)

lower than those from English-speaking homes

in 1999 and 2011, respectively. Both these dis-

parity estimates were statistically significant,

but they are not significantly different from

each other. Taken together, the results indi-

cated that children from non-English-speaking

homes continued to be less likely to receive

services for SLIs than otherwise similar chil-

dren from English-speaking homes.

Children from non-English-speaking

homes continued to be less likely to

receive services for SLIs than

otherwise similar children from

English-speaking homes.

Covariates that were statistically signifi-

cant at both periods for increased risk of SLI

service delivery included being male, being

older at the time of assessment, having lower

reading as well as mathematics achievement,

and displaying less frequent behavioral self-

regulation. Residing in the Western region of

the United States was consistently associated

with a lower likelihood of service receipt. A

number of other predictors achieved signifi-

cance at one but not the other period.

34 Exceptional Children 84(1)

Discussion

This study provides covariate-adjusted esti-

mates of disparities in special education ser-

vice delivery for SLIs attributable to

kindergarten children’s status as racial, ethnic,

and language minorities. Similar disparities

have been found in some studies (Morgan

et al., 2016; Morrier & Gallagher, 2010) but

not others (Campbell et al., 2003; Sullivan &

Bal, 2013), possibly because of sampling lim-

itations. Our analyses of two nationally repre-

sentative, individual-level data sets based on

extensive covariate adjustment indicate that

children in the United States who are racial,

ethnic, and language minorities are less likely

than otherwise similar White and/or English-

speaking children to receive services for

identified SLIs during kindergarten―when

delivery of these school-based services might

Table 2. Multilevel Multivariate Logistic Regression Models of Teacher-Reported SLIs, Spring

Kindergarten: Estimated for ECLS-K 1998–1999 and ECLS-K 2010–2011 Data.

Odds ratio coefficients

[95% confidence intervals]

Variables

ECLS-K: 1999

N = 16,800

ECLS-K: 2011

N = 12,080

Race/ethnicity

Black 0.39

***

[0.28, 0.55] 0.54

***

[0.39, 0.75]

Hispanic 0.86 [0.62, 1.2] 0.54

***

[0.38, 0.75]

Other race/ethnicity 1 [0.68, 1.46] 0.83 [0.58, 1.19]

Socioeconomic status 0.89 [0.79, 1.01] 0.87 [0.76, 1]

Child characteristics

Language primarily spoken at home is not English 0.57

[0.37, 0.88] 0.5

[0.33, 0.78]

Male 1.75

***

[1.41, 2.18] 1.71

***

[1.37, 2.14]

Child age, fall of kindergarten 1.49

***

[1.37, 1.63] 1.43

***

[1.31, 1.57]

Low birth weight 1.27 [0.9, 1.79] 1.21 [0.86, 1.69]

Born more than 2 weeks before due 1.4

[1.08, 1.82] 1.18 [0.91, 1.53]

Biological mother gave her first birth at age <18 0.96 [0.71, 1.29] 0.85 [0.61, 1.17]

Biological mother gave her first birth at age ≥38 1.7 [0.67, 4.3] 2.38

[1.27, 4.44]

Covered by health insurance, spring of kindergarten 1.55

[1.02, 2.36] 1.66 [0.85, 3.23]

Parents were married, spring of kindergarten 1.07 [0.85, 1.34] 0.99 [0.76, 1.3]

Region

Midwest 0.31

***

[0.23, 0.42] 1.02 [0.75, 1.39]

South 0.79 [0.62, 1.01] 0.8 [0.6, 1.08]

West 0.24

***

[0.17, 0.35] 0.5

***

[0.35, 0.73]

Academic achievement

Reading test, spring of kindergarten 0.73

[0.6, 0.89] 0.76

[0.65, 0.9]

Mathematics test, spring of kindergarten 0.63

***

[0.53, 0.76] 0.52

***

[0.44, 0.61]

Behavioral functioning

Behavioral self-regulation 0.83

[0.73, 0.95] 0.76

***

[0.67, 0.88]

Externalizing problem behaviors 0.91 [0.82, 1.02] 0.94 [0.84, 1.05]

Internalizing problem behaviors 1.19

***

[1.08, 1.31] 0.99 [0.9, 1.09]

Note. Socioeconomic status, child age, academic achievement test scores and teacher ratings of child’s behaviors

standardized with M = 0 and SD = 1. Odds ratios >1 indicate a positive relation between the variable and the

outcome. Odds ratios <1 indicate a negative relation between the variable and the outcome. For example, the .39

coefficient for children who are Black indicates that their odds of being identified with SLIs are .39 that of otherwise

similar children who are White. That is, these odds are 61% (1 – .39) lower for Black than for White children. SLIs =

speech or language impairments; ECLS-K = Early Childhood Longitudinal Study–Kindergarten.

*p ≤ .05. **p ≤ .01. ***p ≤ .001.

Morgan et al. 35

be expected to be most effective due to the

children’s young age. These disparities occur

despite racial, ethnic, and language minority

children’s previously reported greater risk of

SLI symptoms (Harrison & McLeod, 2010;

Morgan et al., 2012), suggesting that minority

children in the United States may be dispro-

portionately more likely to experience the

many adversities associated with untreated

SLIs, including lower academic achievement,

bullying, school dropout, unemployment, and

psychiatric disorders (Elbro et al., 2011;

Felsenfeld et al., 1994; Harrison et al., 2009;

Johnson et al., 2010; McCormack et al., 2011;

Morgan et al., 2011; Muir et al., 2011). These

disparities are not explained by a wide variety

of potential confounds, including gestational,

birth, and sociodemographic characteristics,

as well as children’s own academic achieve-

ment or behavioral functioning. It is important

to note that we found no evidence indicating

that the disparities for children who are Black

and those from non-English-speaking homes

have appreciably lessened in the United

States. Instead, racial, ethnic, and language

use disparities in SLI service receipt have

been generally stable across a 12-year period.

The disparities increased in estimated magni-

tude for Hispanic children in the United States

and now have become statistically as well as

practically significant (i.e., a difference of

46% in respective odds).

We found no evidence indicating that

the disparities for children who are

Black and those from non-English-

speaking homes have appreciably

lessened in the United States.

Our analyses extend the currently limited

and inconsistent knowledge base by identify-

ing a general set of factors associated with an

increased or decreased likelihood of receiving

services for SLIs, thereby helping to inform

screening, monitoring, and intervention efforts

by the beginning of formal schooling. Factors

associated with a greater likelihood of special

education service receipt for SLIs include

being male, being older, and displaying lower

academic achievement as well as behavioral

self-regulation (e.g., off task, inattentive, dis-

organized). Residence in the Western region of

the United States is associated with a signifi-

cantly decreased likelihood of SLI service

receipt. This suggests differences in SLI iden-

tification and service use depending on where

children and their families live in the United

States. Further research is needed to identify

factors that may account for this geographic

variation.

Limitations

The present study is limited to estimates of dis-

parities in service receipt for SLIs during chil-

dren’s kindergarten year. Due to data

limitations, we were unable to independently

verify whether children reported by their teach-

ers met formal diagnostic criteria for SLIs.

Children identified as having SLIs may be

quite heterogeneous in regard to their specific

types of speech or language delays and disor-

ders. We were unable to distinguish among

types of SLIs because of how special education

teachers were surveyed about SLIs in the ECLS

data sets, which might be particularly impor-

tant in regard to identification of speech versus

language impairments for children who are

English language learners. The two ECLS-K

databases do not include independently admin-

istered measures of children’s speech produc-

tion, expressive or receptive vocabulary, or

other indicators of SLI symptoms, although

such variables would likely correlate with chil-

dren’s academic achievement and behavioral

functioning as well as other controls included

in our analyses. Despite extensive statistical

control for many potential confounding factors,

it is possible that characteristics not measured

in the study may contribute to the disparities

inferred to children’s status as racial, ethnic, or

language minorities. Consistent with prior

work on health disparities (Cheng & Goodman,

2015; E. Flores et al., 2010; Morgan, Staff,

Hillemeier, Farkas, & Maczuga, 2013), we

interpret the directionality of the disparities as

indicating that minority children are dispropor-

tionately underidentified as having SLIs and so

36 Exceptional Children 84(1)

less likely to receive services for SLIs. It may

be instead that White children are dispropor-

tionately overidentified and so more likely to

receive these services. Recent work suggests

that minority underidentification may be the

more likely explanation (Coker et al., 2016).

Because the data analyzed for each cohort were

cross sectional, it is not possible to clearly dis-

tinguish whether those with lower academic

and behavioral functioning are more likely to

be identified for SLI services or, instead,

whether SLI impairments are more likely to

result in impaired academic and behavioral

functioning. Analyses of longitudinal data,

including from the ECLS-K: 2011, would pro-

vide helpful insights in this regard.

Study’s Contributions and

Implications for Policy and Practice

Our study adds to an expanding literature

indicating that racial, ethnic and language

minority children in the United States may be

less likely to receive additional supports and

services to which they may be legally entitled

due to disabling conditions (E. Flores et al.,

2010; Hibel et al., 2010; Morgan, Hillemeier,

Farkas, & Maczuga, 2014; Zuckerman et al.,

2013). Disparities in special education ser-

vice receipt for SLIs may be contributing to

minority children’s well-documented lower

educational attainment including in both

reading and mathematics, greater likelihood

of experiencing harsh or punitive discipline

in school, more frequent experiences of eco-

nomic adversity, and comparatively fewer

societal opportunities over the life course

(Basch, 2011; Braveman & Barclay, 2009;

National Assessment of Educational Progress,

2013; Ramey, 2015). Our findings indicate

that these disparities, which continue to occur

for children who are Black as well as those

who are language minorities, now occur for

children who are Hispanic. These findings

suggest that policies designed to address

overrepresentation in special education for

SLIs based on race or ethnicity, although well

intentioned, may be misdirected and instead

risk exacerbating already occurring dispari-

ties in service receipt. Instead, our findings

suggest that such policies should attempt to

ensure that Child Find procedures are used

throughout the United States that result in

children with SLIs, including those who are

racial, ethnic, or language minorities, being

appropriately recognized and provided the

special education services to which they have

a civil right. Our results provide further evi-

dence indicating that underidentification for

disabilities based on race or ethnicity in the

United States may be widespread as well as

long-standing (Hibel et al., 2010; Morgan

et al., 2012; Morgan et al., 2015), as indicated

by contrasts among similarly situated chil-

dren (U.S. Department of Education Office of

Civil Rights, 2016).

One practical implication of our findings

is the importance of school-based practitio-

ners soliciting developmental concerns from

racial, ethnic, and language minority parents

to better identify possible delays or impair-

ments in speech or language production.

Parental report of developmental concerns

strongly predicts SLI identification and ser-

vice receipt (Skeat, Eadie, Ukoumunne, &

Reilly, 2010). Unfortunately, some studies

have also found practitioners to be less

likely to solicit developmental concerns from

minority families (Guerrero et al., 2011;

Zuckerman, Sinche, et al., 2014), even when

their children are at high risk for develop-

mental disorders (Zuckerman et al., 2009).

Strategies that can be implemented to better

solicit a parent’s concerns include universal

use of a structured and standardized screening

measure (e.g., Ages & Stages Question-

naires; Squires, Bricker, & Potter, 1997), as

well as utilizing effective interviewing tech-

niques such as eliciting parental information

on children’s speech and language abilities in

comparison to siblings, cousins, or same-

aged peers and in the parent’s preferred lan-

guage (Kummerer & Lopez-Reyna, 2009).

Doing so should help account for family and

peer norms that vary across racial, ethnic, and

spoken-language groups. Identifying SLIs in

children who are language minorities may

require special care and additional assess-

ments, including the use of bilingual peer-

based comparisons that may be more sensitive

to SLIs than comparisons with monolingual

peers (Kohnert, 2010). Universal screening

Morgan et al. 37

based on structured protocols has been found

to help address disparities in medical care as

well as in gifted education service receipt

(Card & Giuliano, 2015; Payne & Puumala,

2013) and so may be helpful in reducing dis-

parities in special education service receipt

(Morgan et al., 2015).

Another practical implication of our study is

that school-based practitioners should ensure

that their screening and monitoring efforts are

sensitive to the needs of cultural and language

minorities. Although some minority parents

have reported that practitioners were instru-

mental in identifying their children’s SLIs

(Kummerer & Lopez-Reyna, 2009), others

have reported practitioners being dismissive of

their concerns (Zuckerman, Mattox, et al.,

2014) or culturally insensitive or indifferent

(Shapiro, Monzó, Rueda, Gomez, & Blacher,

2004). For example, Gillborn, Rollock,

Vincent, and Ball’s (2016) qualitative study

involving 77 interviews of Black middle-class

parents of children with identified disabilities

indicated that the families felt that they encoun-

tered school professionals who were resistant

to their concerns “at virtually every stage” and

who “reacted with little interest, ranging from

slow responses to open antagonism and refusal”

(p. 53). Actively engaging parents during chil-

dren’s SLI evaluation (e.g., asking open-ended

follow-up questions over concerns about lan-

guage development and then restating the par-

ent’s response to ensure proper interpretation),

doing so in the parent’s preferred language, and

working collaboratively to introduce and coor-

dinate interventions and services that are sensi-

tive to diverse cultural beliefs may lessen

disparities in SLI identification and service

delivery (Kummerer, 2012; Thordardottir, 2010;

Toomey, Chien, Elliott, Ratner, & Schuster,

2013; Westby, 2009). More generally, research

on culturally and language sensitive care

has highlighted the importance of engaged

and personal practitioner–parent relationships

(DeCamp et al., 2013; Guerrero et al., 2011),

including conscious efforts to understand

the family’s perspective (Langdon, 2008).

Additional relevant interventions could

include public awareness campaigns, commu-

nity- and school-based Child Find programs,

and targeted screenings of minority children

at elevated risk (e.g., older boys who are per-

sistently experiencing academic difficulties

during kindergarten). A combination of these

efforts involving speech or language patholo-

gists, special education teachers, parents, and

schools and community organizations may be

needed to reduce widespread and continuing

disparities in service delivery for SLIs that are

disproportionately experienced by racial, eth-

nic, and language minority children. Such

efforts may be needed to ensure that minority

children are not disproportionately experienc-

ing the sequela of untreated SLIs (e.g., reading

or behavioral disabilities, bullying, unemploy-

ment), especially as they begin formal school-

ing in the United States.

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Authors’ Note

Funding for this study was provided by the National

Center for Special Education Research, Institute of

Education Science, U.S. Department of Education

(R324A120046) and the Spencer Foundation.

Infrastructure support was provided by Penn

State’s Population Research Institute through

funding from the National Institute of Child Health

and Human Development, National Institutes of

Health (P2CHD041025). These funders had no

direct involvement in the study.

Manuscript received October 2016; accepted

January 2017.