Wednesday 7 December 2011

Providing clinical services to bilingual children: Stop Doing That!
=Guest post=

by Brian A. Goldstein

“A long habit of not thinking a thing wrong gives it a superficial appearance of being right.” (Thomas Paine)

In most countries, bilingualism is well-established. That is not the case in the United States. However, because of demographic changes, bilingualism in the United States is slowly but surely becoming the default condition… the underlying representation… the new normal (Goldstein, 2012). In the U.S., it is estimated that 10.9 million (21%) 5- to 17-year-olds speak a language other than English at home, and 2.7 million (5%) speak English with difficulty (Language Use, U.S. Bureau of the Census, 2007). At the same time, the amount of research related to bilingual children has increased significantly. Much of that research is translational in that it aids practitioners in providing reliable and valid clinical services to bilingual children.

Despite the rapid increase in research related to bilinguals, clinical practice has not always changed as a necessary and important by-product of that research (Kritikos, 2003). I witnessed this disconnect recently while attending the annual convention of the American Speech-Language-Hearing Association (ASHA), in November this year. At the convention, I witnessed clinicians questioning clinical advice that has been current for 20 years. It was clear to me that these individuals did not seem to have received these messages. Here are some messages that I believe need to be delivered.

  • Stop telling bilingual parents to speak only one language to their children. There is no evidence that speaking only one language or practicing the one parent-one language dichotomy improves language skills or staves off a speech and language disorder. Even parents who report that they use the one parent-one language rule do not do so in practice (Lanza 2004).
  • Stop believing that being bilingual causes and/or exacerbates a speech or language disorder. As Kohnert says, “A disorder in bilinguals is not caused by bilingualism or cured by monolingualism” (Kohnert, 2007, p. 105). It is now reasonable to conclude that in the acquisition of two languages, bilingual children do not appear to be “remarkably delayed nor remarkably advanced” relative to monolingual children (Nicoladis and Genesee, 1997, p. 264).
  • Stop using family members as interpreters/translators (Langdon and Cheng, 2002). Family members are not trained in this area and are clearly biased when it comes to their own family members. It also places them in a precarious position in which they are not likely to be comfortable.
  • Stop trying to calculate an omnibus measure of language dominance. The notion of dominance has been criticized on both theoretical and methodological grounds (e.g., MacSwan and Rolstad, 2006). Moreover, its utility relative to speech and language skills is equivocal. Ball, Müller, and Munro (2001) found that Welsh-dominant children (aged 2;6-5;0) acquired the Welsh trill earlier than their peers who were English-dominant. However, Law and So (2006) found that both Cantonese-dominant and Putonghua-dominant children (2;6-4;11) acquired Cantonese phonology first. This is not to say that variables such as language history, language use, and language proficiency are not important variables to consider. They are. What should be dismissed, however, is determining language dominance based on a standardized test and then triaging clinical services based on its results.
  • Stop assessing speech and language skills in only one language. The bilingual’s languages are not mirror images of each other. Skills are often distributed across the two languages. The same language skills can be easy in one language but difficult in the other (Peña, Bedore, and Rappazzo, 2003). The distributed nature of language skills in bilinguals necessitates examining speech and language skills in each of the child’s languages.
  • Stop waiting 2-3 years before assessing a bilingual child for a possible speech and language disorder. The belief by many practitioners is that a child needs to have years of experience in the second language before even thinking about assessing their speech and language skills bilingually. That viewpoint runs counter to the mounting evidence that such children acquire their language skills fairly quickly. For example, Paradis (2007) found that after 21 months of exposure to English, sequential bilinguals exhibited skills within the normal range of monolinguals in the areas of morphology (40%), receptive vocabulary (65%), and story grammar (90%). In a seminar titled English Phonological Skills of English Language Learners, presented at the ASHA convention in New Orleans in November 2009, Gilhool, Goldstein, Burrows, and Paradis found that after an average of 8 months of exposure to English, sequential bilinguals (ages 4;6-6;9) averaged consonant accuracy of 90%.
  • Stop comparing the speech and language skills of bilinguals to those of monolinguals. Bilinguals are not two monolinguals in one (Grosjean, 1989). Thus, although their skills will be similar to monolinguals, they will not be identical. Further, in a seminar titled Lifelong Bilingualism: Linguistic Costs, Cognitive Benefits, and Long-Term Consequences, presented at the ASHA convention in Philadelphia in November 2010, Bialystok indicated that both languages of bilinguals are active when using one of them, even in strongly monolingual contexts. What this means is that bilinguals do not sublimate the other language, even if the speaking community is exclusively or largely monolingual. Both languages are always active to one degree or another. Thus, from a clinical perspective, this view argues for comparing monolinguals to monolinguals and bilinguals to bilinguals.
  • Stop treating those with speech or language disorders in only one language. To again quote Kohnert (2007, pp. 143-144), “Being ‘monolingual’ in a bilingual family or community exacerbates a weakness, turning a disability into a handicap.” If, as practitioners, our focus is to develop a bilingual speaker, then services for those with speech and language disorders necessarily have to be conducted in both languages. Intervention in only one language is not an option.

Finally, “Stop thinking in terms of limitations and start thinking in terms of possibilities.” (Terry Josephson)

Brian A. Goldstein is Dean of the School of Nursing and Health Sciences and Professor of Speech-Language-Hearing Sciences at La Salle University, Philadelphia, PA, USA.

© Brian A. Goldstein 2011

Next post: Language geniuses and language dunces. Wednesday 14th December 2011.


  1. Hi i love this post and just placed a link on my blog to this. i believe so many clinicians and parents can benefit from this very easy to read yet researched-cited post.
    i have a question to the point that said "don't wait 2-3 years to assess a bilingual child" - so is there any waiting period? surely a child who just arrives from another country should not be so quickly assessed for a speech and language disorder? or should they be assessed in their first language? and if so, what if that language is a relatively obscure one to the more common second languages present in the country?

    i also love the point that the same language skills could be easy in one language but difficult in another. but this also calls for a more in-depth study by SLPs into the child's native language and again if it's one less known to the clinician, this could potentially take quite a bit more time and resources that may not always be available.

  2. Dear Speechiespeaks: Thank you for the kid words; I greatly appreciate it.

    I will do my best to respond to each of your questions:
    *Waiting period: You are correct that some waiting period is often warranted if the child has not been previously diagnosed with a speech or language problem. The precise time period depends, of course, on the child. I have head many SLPs indicate that they wait, or are directed to wait, 2-3 years before even assessing a bilingual child who is suspected of having language difficulties. In my opinion, that is too long. If there is a suspicion, SLPs should initiate at least a "watch and see" perspective as soon as it is feasible to do so. Once the clinician assesses, she should attempt to do so in both/all languages. Even if the child has lesser expressive skills than receptive ones, all areas should be examined.

    *Obscure languages. Many bilingual children are acquiring "obscure" languages(i.e., low incidence languages in their country of residence). In those cases, the SLP will need to engage the services of a community broker and/or interpreter and/or translator and/or trained(!) support personnel. I have done so myself to assess Vietnamese and Amharic speaking children.

    You are right that we need more study (don't we always). It is my hope that more clinicians will go into PhD programs and/or partner with researchers to help answer our many questions.

    Thank you for your time to respond to the post!



  3. I think, that for those of us "in the trenches," things are further complicated by the issues of low SES and low maternal levels of education ... factors correlated with low levels of academic achievement. I would love to know more about the background of students in Paradis' study.

    1. I agree with you about the effect of SES. There is no doubt that there is such a relationship. Here's a little about the children in Paradis' Study: 19 English Language Learners living in Canada between the ages of 4;2 and 6;9 (mean = 5;4) the children had between 2 and 18 months of English exposure; the average age of arrival was 40.32 months (standard deviation = 26.79), and the average age of exposure was 54.59 months (standard deviation = 10.91). All of the children attended preschool or school in an English majority city in Canada. Reportedly, all had typical speech and language skills.

      Hope this helps.


  4. Thank you for your response. The population in Paradis' study had the advantage of attending preschool, which is typically not the case for the sequential bilingual children who enter kindergarten in the school in which I teach. For these students, there are so many brand-new demands upon entering the formal school environment that it just seems logical that we might see delays in certain areas. Despite all the research available, it continues to be a challenge to determine which children truly have a disability versus a lack of background knowledge/instruction and/or exposure to English (and therefore should not be identified as having a disability). I think this might be one reason therapists/districts have a tendency to wait at least a year or two before identifying students as having a disability. I know that I am always reluctant to classify a student who has only been in school for one year ... the social, academic, and emotional impact of classification is long-lasting. Let's hope that RtI provides us a way to be more accurate in making these determinations.

    1. I agree that determining difference from disorder is a challenge. Intuitively, I also understand the philosophy of waiting. That said, I don't think it's necessary to wait a year or two make a differential diagnosis. By examining both of the child's languages and incorporating assessment approaches such as dynamic assessment, a reliable and valid diagnosis can occur well before two years. Approaches such as RtI are also useful. Thanks again for your comments.

  5. Hi, what would be the preferred option for translation in cases of uncommon languages (certain African dialects, for example)? Should these kids not be evaluated at all or should we place the concerned parents in the uncomfortable position.

  6. The same principle applies in that the children should be evaluated in both languages, even if the home/native language is uncommon (meaning relative to the common language(s) spoken in the current country of residence). Parents/family members should *not* be used as interpreters. I would suggest recruiting and training a volunteer from the community center at which that language is spoken. There are often such individuals who like to participate in these kinds of activities. I was able to do that for Vietnamese speakers in the US. It is time-consuming but can be reliable and valid. I would suggest looking at:

    Langdon, H., & Cheng, LRL. (2002). Collaborating with Interpreters and Translators. Eau Claire, WI: Thinking Publications.

    All the best.


  7. Hi Brian,

    I am not a SLP, but I am almost bilingual. After read your blog, I was wondering what is the principal objective of a bilingual Speech Language Pathologist? About my experience, when I arrived to USA it was difficult adapt me to USA accent, specially, I did not recognize words with similar sounds. This factor of not recognition the sounds put me to do not pronounce some sounds. As regards with Intervention Period, I am in complete disagree. I think that an early intervention will obtain good results.

  8. Anonymous: for the objectives guiding multilingual awareness among clinicians, this excerpt of Kathryn Kohnert’s book, Language Disorders in Bilingual Children and Adults, referred in the post, may be of use: Supporting Two Languages in Bilingual Children with Primary Developmental Language Disorders.

    If you’re wondering whether a particular speech-language behaviour reflects a disorder or a developmental matter (including adult linguistic development!), these two articles might also help:

    Language therapy or language tuition?

    Multilingual typicality vs. speech-language disorder



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