Wow. I'm not going to lie...suddenly I feel slightly ill-equipped to write this next portion of the series- assessment. My world just got rocked by these videos by Dr. Cate Crowley on second language acquisition and factors influencing bilingual language development. So before you continue reading this post, I highly suggest you check out both of these videos.
Now, why do I say these videos have me questioning whether I'm well-equipped to handle this topic? Mostly because she denounced essentially the main point of this post, and that is the idea that typically a child can be correctly identified as having a language disorder based on delays in L1 and L2.
At least that's what I was taught in grad school. These videos mentioned several aspects of second language acquisition such "silent periods", formulaic utterances, and the fact that many sequential bilingual children demonstrate attrition of L1 when L2 is introduced with large exposure. Now, that is not to say that all of our assumptions regarding simultaneous delays in L1 and L2 and language disorders are incorrect; however, I believe the point is that we need to be looking at multiple factors beyond black- and-white syntax and vocabulary deficits to correct identify these children, and in turn, not over-identify them.
That being said, my tips for this post regarding assessment are a little less intense in nature in regards to the above disclaimer. These are just some things that have assisted me in my evaluations as a bilingual therapist and I hope will give some of you just starting out in this endeavor more confidence.
If You Are a Monolingual SLP...
I know it is nearly impossible to avoid, but it is my general opinion that only bilingual therapists should be attempting bilingual evaluations and treatment due to the fact that correct identification of the presence of disorders is hard enough without calling into play the fact that you are unfamiliar with the language of the child you are working with. This makes writing appropriate goals for language AND speech development very difficult, and treatment even more impossible as typically interpreters are not available in realms outside of home health.
If a child is Spanish-speaking only and you are asked to administer services in English, we all know this is a direct violation of ethics. Printing out Spanish verb pictures or articulation pages from the Internet may sometimes be the only choice you have as a monolingual therapist, but is not always the most ethical route nor will it be the most effective. In terms of preschool therapy, much of the session is based on spontaneous language and play interaction, something very hard to do through an interpreter. If you have the ability as a monolingual SLP to recommend transferring Spanish-only or bilingual clients to a bilingual therapist or other bilingual intervention resource, I recommend doing so, not only for the sake of the child but for your professional ethics. Otherwise, do your best to gather reputable resources and use an interpreter to communicate with the family how they can support you in your efforts with a great Home Exercise Program (HEP).
General Strategies for Bilingual Assessment:
1) Pre-determine the child's general language dominance before you attempt the evaluation by talking to the parent.
You might need to do a little re-con in terms of asking specific questions such as:
a) What language does your child hear majority of the day?
b) In what language does your child attempt to communicate primarily?
c) Can your child follow directions in Language A/B or identify common objects?
d) Does your child attempt to use both Language A and B in the home?
You're looking for what language the child has both the most exposure to and demonstrates the strongest receptive/expressive language abilities at this time. On several occasions you will prompt items in both languages, but it is good to know if the child may be a bilingual language learner or whether they are only exposed to one.
2) When in doubt, bring the test that is NOT in English.
By this I mean, bring the PLS-5 Spanish. The items are there for you translated in Spanish, and you are familiar enough with the test to prompt items in English should the need arise. If you only bring the PLS-5 English, you will not have the Spanish prompts if you need them.
3) If a child misses an item in their L1, recast in L2.
Give a child a chance to demonstrate whether they possess a skill in either language. If it is present in one or at least L1, chances are it is not delay but rather a matter of language acquisition.
4) If you are using an interpreter, remind them to not prompt beyond what is called for.
Majority of interpreters, while highly skilled in what they do, are not SLPs and do not realize that just by adding a word or two they may be prompting Little Johnny enough to score a 1 when he really scored a 0 on a receptive language item. Speak with your interpreters ahead of time as well as parents to remind them what is necessary to ensure a valid and reliable assessment.
5) Keep in mind that many children will have alternate, more colloquial terms for test-based items.
In terms of an articulation test, you may have to prompt the requested word using hand-covered mouth or delayed production approach to get all of your scores. It's always a good idea to write these colloquial terms down also for future reference.
5) In interpretation of scores, score the test based on the "dominant" language being assessed, but in goal writing, keep in mind where the most functional deficits lie.
In writing my goals, I often assign them to be mastered in both languages if the child is a simultaneous bilingual language learner.
These are only a few of the things I consider when administering a bilingual speech and language evaluation. Have any of you encountered any particular issues or questions during a bilingual eval that I did not touch on? Let me know in the comments.
Coming up- Part 3: Treatment!
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