New to this topic? Start with our companion article: Bilingual Language Learning and Disability: What Brisbane Families Need to Know
Our companion article made the case that bilingualism and multilingualism don't cause or worsen language difficulties in children with disabilities. That's half the picture. The other half — the clinical half — is what to actually do in assessment and therapy when a child is both multilingual and has a developmental disability. That's what this article is about: the practical decisions that change when we're supporting a child across every language in their life, not just English.
Getting Assessment Right
Assessment is where things can go wrong most easily for bilingual and multilingual children with disabilities. If we only assess in English, we risk two types of errors:
- Over-identification — deciding a child has a language difficulty when they're actually just still developing their English. Their home language skills might be age-appropriate, but we'd never know if we didn't ask.
- Under-identification — assuming a child's difficulties are just because English is their second language, when actually they have genuine communication difficulties across both languages that need support. This is one of the persistent myths families often come across.
Both of these errors have real consequences for children and families. This is why good assessment in this space tends to look different from a single English-only session.
Looking at all of a child's languages
The gold standard is to gather information about a child's communication skills in all of their languages. In practice, this isn't always possible — assessment tools in many languages are limited, and most Australian speech pathologists don't speak every home language they encounter. What speech pathologists often do instead is combine detailed parent and caregiver interviews about the child's home language, video recordings of the child communicating at home, and interpreter support where it's available. Best-practice guidance is clear that communication difficulties should never be diagnosed on the basis of English-only assessment (McLeod, Verdon et al., 2017). This is one of the main reasons a bilingual child with a disability benefits from a speech pathologist who's done this kind of work before.Use dynamic assessment
Dynamic assessment is a particularly useful approach for bilingual children. Instead of just testing what a child already knows (which is heavily influenced by their language exposure), dynamic assessment looks at how a child learns when given support.The therapist teaches the child something new during the assessment — a new word, a new sentence structure, a new concept — and observes how quickly and easily the child picks it up. Children who are typically developing but just need more English exposure tend to learn quickly with support. Children with genuine language difficulties tend to find it harder, regardless of which language is being used.
Peña and colleagues (2014) demonstrated that dynamic assessment of narrative ability can accurately identify language impairment in children who are learning English as an additional language — avoiding the bias inherent in static tests.
Consider the disability and bilingualism separately
This sounds straightforward, but it requires careful thinking. We need to ask:- Which communication features are related to the child's disability? (For example, the social communication differences seen in autism, or the speech patterns associated with Down syndrome)
- Which features are related to typical bilingual development? (For example, mixing languages, having a smaller vocabulary in each language compared to monolinguals, or transferring sounds from one language to another)
- Which features might indicate a language difficulty on top of the disability?
Teasing these apart takes skill and experience — and a willingness to gather information from multiple sources, not just a single test.
Therapy Approaches That Support Both Languages
Once there's a clear picture of a child's strengths and needs, therapy is designed to support communication in all of the child's languages, not just English. This is the kind of work that needs a plan built for the specific child — but there are a few threads that tend to run through it.
Many communication goals aren't language-specific — things like using more words, combining two words together, taking turns, or requesting and commenting can all be worked on in any language. When goals are set this way, families can reinforce them in the home language while the therapist focuses on English, and progress in one language supports progress in the other. Speech pathologists often draw on bridging therapy and its practical applications to do this — pre-teaching concepts in the home language, using visual supports that work across languages, and encouraging parents to keep being active language models in the language they speak most naturally.
For children who use AAC — picture boards, communication apps, or sign — the same principle applies. Soto and Yu (2014) found that bilingual children using AAC benefited from vocabulary in both languages, and that this did not slow their communication development. When I've worked with bilingual children using AAC, the children have taught me very quickly that their device needs to speak the same languages their family does — otherwise half their world is missing from the page. The core aim, especially for children with more significant disabilities, is functional communication — getting a message across in whatever way works, in the child's home environment, with their family, in their home language. This is rarely something that can be worked out from a blog article; it's the kind of thing that a speech pathologist and family work through together.
Working with Families to Maintain the Home Language
Families are the most important part of this equation. Speech pathologists who work well with bilingual families tend to offer clear, confident reassurance that the home language is beneficial and should be continued (many families have been told the opposite), design activities that can be practised in whatever language the family uses at home, and involve parents, grandparents, and extended family in setting goals that actually reflect the child's day-to-day life. The home language is treated as a strength, not an obstacle to work around.
Cultural Considerations in Therapy
Good speech pathology for bilingual children with disabilities isn't just about language — it's also about culture. Culture influences:
- How families understand disability. Different cultures have different frameworks for understanding why a child has a disability and what should be done about it. A speech pathologist should listen to and respect the family's perspective.
- What communication goals matter most. In some cultures, eye contact and direct speech are valued; in others, they're not. Goals should reflect what's meaningful and appropriate for the child and their family.
- How families interact with professionals. Some families are comfortable asking questions and challenging recommendations; others come from cultures where professionals are treated as authorities. A good speech pathologist will create space for families to share their views in whatever way feels comfortable.
- Who is involved in the child's care. In many cultures, grandparents, aunties, uncles, and older siblings play a significant role in child-rearing. This is particularly true in many Aboriginal and Torres Strait Islander families, where extended kinship networks are central to how children are raised and how language is shared across generations. Therapy plans should reflect the reality of who is supporting the child day to day.
Cultural competence is widely recognised as essential for all speech pathologists, and services should be adapted to meet the cultural and linguistic needs of each family (Verdon, McLeod & Wong, 2015).
Putting It All Together
Supporting bilingual children with disabilities well requires us to hold two things at once: a thorough understanding of the child's disability and communication needs, and genuine respect for their linguistic and cultural identity. Neither should be sacrificed for the other.
The evidence tells us that bilingual children with disabilities can and should continue to develop both languages. Our job as speech pathologists is to make sure therapy supports that — practically, respectfully, and effectively.
Alexandra Bouwmeester is a Senior Speech Pathologist (MSPA, CPSP) with experience supporting children with complex communication needs across culturally diverse communities. She offers mobile speech pathology to families across Brisbane's south side and Logan, with a whole-child, whole-family focus.
Every child deserves therapy that respects all of who they are — including every language they speak. If you'd like to discuss how we can support your bilingual child with a disability, Speaking Speech Pathology is here to help.
References
- Kay-Raining Bird, E., Genesee, F., & Verhoeven, L. (2016). Bilingualism in children with developmental disorders: A narrative review. Journal of Communication Disorders, 63, 1–14.
- Soto, G., & Yu, B. (2014). Considerations for the provision of services to bilingual children who use augmentative and alternative communication. Augmentative and Alternative Communication, 30(1), 83–92.
- McLeod, S., Verdon, S., & International Expert Panel on Multilingual Children's Speech. (2017). Tutorial: Speech assessment for multilingual children who do not speak the same language(s) as the speech-language pathologist. American Journal of Speech-Language Pathology, 26(3), 691–708.
