When to Refer a Bilingual or Multilingual Child for Speech-Language Therapy

Author: Lisa “Luna” DeCurtis, M.A., CCC-SLP


Babies born to bilingual households often develop speech and language more slowly than children born to households speaking only one language.  Usually, this delay is natural, no cause for concern and the when the child does speak, it is bilingually.  However, there are times when a child’s delay in speech and language development is due to more than just spoken to in two languages.  When is it time to refer a bi or multi lingual child for speech therapy?  How to pay for speech therapy? Get health insurance for children now.

This is the 3rd part of the series on bilingual/multilingual language development.

Today’s focus is on when to refer a bilingual/multilingual child for speech-language evaluation and determine if therapy is needed.

An important key is first assessing the amount and type of exposure the child has to each language, and by whom, as well as the amount of opportunity to speak that language with both adults and peers in various social contexts. This will give a fair baseline for what the child would be expected to know and do based on exposure and experience.  Read more about typical language development for ages 0 to 18 months,  and typical language development for ages 18 months to 3 years.

After the background information is gathered, it is most important that any concern about a potential delay in a child’s communication is noticed in both or all languages, and not just in one language. For example, it would be necessary to see challenges in the child’s communication in both English and Chinese, and not just when speaking in English, before referring the child for a full evaluation.

Specifically, if a parent or teacher reports that a child’s speech is unclear or his “level of intelligibility” is poor, in a true speech disorder it is expected that his speech would be unintelligible regardless of the language spoken. It would be rare to hear a child with a true speech disorder speak clearly in one language and very poorly in the other, even though each language has its own set of phonemic (sound) inventories and phonological rules.

Regarding the receptive and expressive language skills of children, the child with a disorder may have difficulty processing language for following directions or answering questions, or may not use the correct grammar or syntax, exhibit a low vocabulary, or may have trouble finding the right word. These typical patterns may be characteristics of a language disorder but would be evident in both or all languages that the child is exposed to and using to be a true disorder.

Socially speaking, the child who shows difficulty with social skills seen across all settings, whether he was at a park or a playground or a birthday party, and with either language being spoken would be a sign of a true social-pragmatic disorder. However, if the child is comfortable when he is with his French-speaking friends at a play date but very shy or quiet when at a play date with his English-speaking friends, it is probably not a true social-pragmatic disorder.  Health insurance agents in California can help you pick family health insurance plans to meet your child’s needs.

It is the same for voice and fluency concerns. That is, the child would exhibit a voice disorder when speaking in both or all languages and would exhibit dysfluencies, such as stuttering, in all languages. When concerns are noted in only one language or only in certain contexts, recommendations can be made to support improving bilingual development but the child may not be formal speech-language therapy.

When you’re assessing a bilingual or multilingual child, it is important to compare the child to other children who are bilingual or multilingual to gain a more fair representation of what is expected at that age. Although there are not easily accessible and readily available formal and norm-referenced assessments to use, it is important to seek out a speech-language pathologist (SLP) who speaks those languages to help determine the true nature of the delay or disorder, as well as compare the child to similar children in their linguistic community.

It is important to remember that the bilingual child is NOT expected to have the same skills and strengths in both languages (e.g., he may tell better narratives (stories) in one language, yet may feel more comfortable socializing with peers in another language) but the bilingual child with a true disorder IS expected to have similar communication challenges across contexts regardless of the language spoken.

Once a child is appropriately compared and results of the formal and informal assessment are determined to be true representations of that child’s communication strengths and challenges, that will help focus on the type of intervention and speech-language therapy that he or she will receive to maximize improvement in both or all languages in the child’s life.

Please note, it is not prudent or accurate to advise a parent or family to stop using one or any of the languages as children with developmental delays and disorders can continue to communicate bilingually, albeit at a slower rate. But “removing” a language may inadvertently “remove” skills that a child has in that language that have not transferred over. In speech-language therapy, the therapist, or SLP, can work with the families to ensure the communication skills and concepts are being learned and practiced in both or all languages so that transfer of skills across languages can occur.

Review HSA plans for ideas on helping your child’s speech and language development.  And, get medical insurance quotes for low cost individual medical insurance plans, and health insurance for children now.

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