Profiling Bilingual Children: Using Monolingual Assessment to Inform Diagnosis

Purpose: Diagnostic tools developed for monolinguals are frequently used for bilingual linguistic assessment. The absence of evaluation criteria for using monolingual norms for bilinguals contributes to inconsistent diagnostic proce-dures, impacting research and clinical practice. This study considers the reliance on monolingual tools to assess the heritage language to identify bilingual atypical language development (ALD) even when bilingual norms are available for the societal language. Method: One hundred thirty-one English–Hebrew bilingual children aged 5;6– 5;11 (years;months) were assessed using diagnostic tools. Bilingual standards are available for the societal language but not for the heritage language. Fifteen English–Hebrew bilingual children were suspected of ALD. They were individually compared with 116 typically developing bilingual peers. The Core Language Score and seven subtest standardized scores of the Clinical Evaluation of Language Fundamentals Preschool–Second Edition were analyzed in the heritage language, English. Results: Results revealed that a composite score used for differential diagnosis in monolingual children cannot be relied upon for bilingual children. Measure-ments vary in their diagnostic accuracy, with Concepts and Following Directions (comprehension of instructions), Receptive and Expressive Word Classes (lexi-con), and Sentence Repetition (syntax) being the most promising for identifying ALD in bilingual children. Lastly, bilingual children’s age of onset of bilingualism must be considered in the analysis of linguistic outcomes. Conclusions: Findings elucidate that monolingual assessments for heritage speakers must consider bilingual models of development to ensure a reliable and informative diagnosis. Interacting factors, such as reliance on language-specific knowledge and the recruitment of other nonlinguistic processing skills, may influence a measurement’s sensitivity. The findings are pertinent to the practice of speech-language pathologists, informing evidence-based assessment procedures for bilingual children. A group study to determine whether the suggested bilingual standards can identify ALD with acceptable specificity and sensitivity is now recommended.