Recently I have had several discussions with colleagues concerning language disorders and bilingualism. It has come to my attention that sometimes children who are bilingual with a true language disorder do not receive services due to claims that they have a language difference. Assessing individuals who are bilingual poses many concerns because we do not want to over-identify (children do not have a disorder but were given services and miss time from their regular education) or to under-identify (children with true disorders do not receive services) bilingual children with language disorders.

ESL identification and Language disorders

Lately, I have come across cases where bilingual children with true disorders do not receive the language services that they require. Children who come from Hispanic families are sometimes placed in English second language learning classrooms even though their dominant language at home is English and not Spanish. I am unsure how children are sorted into regular and English second language (ESL) learning classes in the school system. However, I assume their English skills must be a little lower to be placed in ESL classes. What we must try to understand is whether those children’s English language skills are lower because they have not been exposed to English at all or little time (other spoken language at home) or if they have a language disorder. If the child is put in an ESL class and English is the only language that they speak but they come from a different culture then I would be concerned. As a parent, if my child was placed in an ESL classroom I would make sure to try and understand how that was decided and what they used to assess my child’s language skills.

It is up to you as parents to advocate for your child’s rights. You must inform yourself as to why they may have been placed or not placed in an ESL class. If you are concerned about your child’s speech and language then ensure a proper assessment is conducted for your bilingual child.

It is up to Speech-Language Pathologists (SLPs) to perform a thorough assessment for our bilingual clients to ensure that we provide correct recommendations and support you, the families. That is why this post will discuss the difference between a language disorder and a language difference and provide some information regarding speech and language assessments for bilingual individuals.

Bilingualism and Language disorders

As previously mentioned in my bilingualism post, bilingual/multilingual individuals will vary among language dominance and proficiency. A child’s dominant language at home may be Spanish and their proficiency for Spanish and English may be the same or different. Therefore, when we decide that the child has a language difference and not a disorder that means that their language skills are average in at least one of the spoken languages (most likely the most proficient one). If the child has a language disorder then their language skills are considered to be below average for each spoken language. A multilingual child with a language disorder will also most likely have different proficiencies across spoken languages.

Cummins (1984) distinguished between two types of language proficiencies:

Basic interpersonal skills (BICS) are the context-embedded, everyday language that occurs between conversational partners, typically requiring 2 years under ideal conditions to acquire proficiency.

Cognitive academic language proficiency (CALP) is the context-reduced language of academics, typically requiring 5 to 7 years under ideal conditions to develop a level commensurate with native speakers.

An individual may be fluent in conversational communication, yet continue to have difficulties with communication needs in an academic arena. That is why observing an individual’s language skills in both areas is essential to develop a comprehensive understanding of his/her language abilities.

According to a study by Kohnert (2012), the identification of a communication disorder in a multilingual individual requires the consideration of the vast factors influencing communication abilities. A true communication disorder is evident in all languages used by an individual and a skilled clinician must take into account language development, language loss, language dominance fluctuation, dual language acquisition and use to differentiate between a difference and a disorder.

According to ASHA (1993), “a language disorder is an impairment in comprehension and/or use of a spoken, written, and/or other communication symbol system (e.g., American Sign Language). The disorder may involve the form of language (phonology, morphology, syntax), the content of language (semantics), and/or the function of language in communication (pragmatics) in any combination.”

Language domains and deficits

Here is a brief description of each language domain:

Phonology: distribution and pattern of speech sounds in a language. Speech sounds can be organized into systems. Children with phonological disorders have difficulty distinguishing the difference between sounds. For instance, a child might have a phonological disorder where he still uses the incorrect pattern of fronting sounds (e.g. he uses /t,d/ for /k,g/ sounds and says “dut” for “duck”). This child would also be unable to discriminate between words that only differ by one sound (i.e. minimal pairs – “cap/tap”). Therefore, were you to show him/her a picture of a “cap” and a “tap” and asked to point to “cap”, the child would point to “tap”, unable to differentiate the two sounds.

Morphology: the structure of words and part of words, how they are formed and their relationship to other words. For instance, in English when we want to make words plural we may add –s at the end of the word (e.g. cat-s, dog-s, pencil-s) or add –ed for the past regular tense (e.g. jump-ed, fold-ed, collect-ed). Of course, there are exceptions where we use irregular forms for plural (e.g. mice) and past tense (e.g. ate). Children with morphological deficits will demonstrate difficulty in forming correct word patterns. For example they might overgeneralize the use of past tense –ed to all verbs in the past (e.g. go-ed, eat-ed, hit-ed) or omit –s for plurals (e.g. two cat).

Syntax: set of rules, principles and processes that influence the structure of sentences in a language. In simpler terms, the way we combine words in a sentence. For instance, in some languages the pattern used is subject verb object (e.g. sally kicked the ball) but in other languages the pattern might be different. If a child has poor syntax then they will not form sentences in accordance with the language rules. For example, a child may ask “what you do today?” vs. “what did you do today?”

Semantics: meaning of words, phrases, sentences and the relationships between them. If we want to define “apple” we could say it is a fruit, it is round, can eat it and can be red, green, or yellow. The words “apple” and “orange” are linked under the category “fruits”. Children with semantic deficits may have reduced vocabulary, word finding difficulties, oral and reading comprehension issues, reduced semantic mapping (categorizing) skills and more. For example, a child would be unable to name at least 10 animals when asked to do so or tell you that a cow is a farm animal.

Pragmatics: social use of language or using language appropriately in social contexts. For instance, having a conversation that is appropriate to the partner (e.g. peer, teacher, and parent), taking turns and maintaining the topic. Children with pragmatic language deficits are unable to alter the way they speak whether they are talking to a baby, peer, parent or teacher and they struggle with turn taking, asking appropriate questions, making comments in a conversation, maintaining the topic of discussion, storytelling and more. They may also have difficulty taking perspective of others, interpreting situations and making appropriate inferences therefore they tend to not be in tune with others. For example, a child may give you a convoluted and confusing answer to your question but will not be able to reiterate what they said in a way that you can understand when you tell them that you are confused.

Assessing speech and language in bilingual children

The following information is targeted more toward SLPs who may be conducting the assessment. However, it is also valuable information for parents to know because you can better understand how your child’s language and speech are evaluated in relation to their bilingualism. Also, once you receive your child’s report, if you are reasonably unsatisfied with the decision then you may request additional testing if deemed necessary.

When assessing a monolingual child for a language disorder we will assess all language domains in their single language. Similarly, when assessing a bilingual child we should also assess each language domain within each spoken language in different contexts. Of course, one of the issues that we come across is that not all SLPs are bilingual and may not be able to assess the child in their specific languages. Therefore we must rely on the help of families and/or interpreters to make our best clinical judgment.

Bilingualism and the Assessment process as proposed by ASHA

1) Case history

age and manner of acquisition of the language(s),
dialect of the language used,
language(s) used at home and at school/work,
language(s) used within the family,
length of exposure to each language,
language of choice with peers,
progress in receiving English as a second language (ESL) services or adult English language learning classes,
contact with native speakers of L1 (primary language),
language of academic instruction,
academic performance in each language,
age of immigration.

It is very important to get a descriptive language history. A client interview is often included in patient intake and case history.

2) Questionnaires

Parent surveys for bilingual children are an effective way of gathering information about early language development and can be used during a preliminary screening of a bilingual child to gain reliable and valid information. You may have to adapt your English parent survey to the parent’s native language or have an interpreter translate it for you. Some English-Spanish parent surveys can be found on teachers pay teachers.

3) Oral-Peripheral Examination

It is always good practice to perform an OME to ensure the child’s oral structural mechanism appears normal and functions normally. If the child does not speak your language then it may be beneficial to provide a visual model of the task to facilitate comprehension of oral motor taks (e.g. sticking out your tongue). Cultural and individual differences may influence how clients perceive tasks, such as a sticking out their tongues; therefore, it may be necessary to explain the reason for requested activities.

4) Assessment Tools

Criterion-referenced assessment tools can be used to identify and evaluate a client’s strengths and weaknesses, as opposed to norm-referenced testing, which assesses an individual relative to a group.

It is important note that standardized test scores are not valid for an individual who is not reflected in the normative sample for a given assessment. However, these assessments may still provide valuable descriptive information about a client’s abilities and limitations in the language of the test (i.e., a test given in English will speak to a child’s ability in English; a test given in Spanish will speak to a child’s ability in Spanish). For example, the CELF-5, PPVT, and EOWPVT can be administered in English or Spanish.

Also, it is not appropriate to translate standardized assessments to reach a standard score. If you decide to use a formal standardized test of language then you must ensure that it is already written in the spoken language you are assessing.

5) Speech and Language Sample

Speech and language samples are an essential component to assessing a bilingual individual. It allows us to examine communication skills as they are functionally used and may provide more insight than the typical standardized or criterion-referenced test.

Both single-word and connected speech (conversation or narrative) samples should be obtained in all languages spoken by the client. If possible samples should also be taken in different communicative environments. Using these language samples, an in-depth assessment of the individual’s morphological, syntactic, phonological, and lexical systems can be provided.

Tricky but possible!

As you can see, nothing is straight forward in the assessment of a language disorder in a bilingual individual. Bilingualism is a spectrum, bilingual individuals cannot be compared to each other or to monolinguals so it is tricky to pinpoint what the average language skills of a bilingual speaker should resemble. However, if the bilingual child has clear language difficulties speaking any of their languages then that should indicate that there may be more than just a language difference. Always follow your parental gut or if you are a teacher and have concerns then please refer your child to get their speech and language assessed. We always want our children to thrive to their fullest potential and can help them by being their best advocate.

This blog post was more technical then my previous ones. If you have questions about any of this information or did not fully understand the information then please feel free to contact me and I will be more than happy to explain in more detail or in a different language (if I can speak it).

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