Difference or Disorder?

Researchers develop tool to identify bilingual children with true language disorders

Sept. 27, 2010

According to the 2000 census, nearly one-third of Texans ages 5 years and older speak Spanish at home. Add the under-5 population and the percentage is even higher. Due to continued immigration and globalism, the bilingual population will continue to grow in Texas.

Five to 8 percent of preschoolers experience a speech-language disorder, one of the most common childhood disabilities, but also one of the most treatable when identified early. Speech disorders include difficulty pronouncing sounds, articulation problems and stuttering, while language disorders involve difficulty expressing ideas and understanding what is heard. Because language is the foundation of communication, untreated speech-language disorders can lead to struggles with reading, school absenteeism, behavioral issues and academic failure.

Elizabeth Peña
Elizabeth Peña, professor in the Department of Communication Sciences and Disorders, researches how children from diverse linguistic backgrounds learn new language skills and how they lexicalize their conceptual knowledge across two languages.

School-based speech pathologists work with children to identify speech-language disorders and provide the treatment they need. Bilingual children, with emerging language skills in two languages, add another layer to the complexity.

With one of the few bilingual speech-language disorder programs in the country, The University of Texas at Austin is in many ways setting the standard for how bilingual children are evaluated and treated.

Elizabeth Peña, professor of communication sciences and disorders, and Lisa Bedore, associate professor of communication sciences and disorders, in the College of Communication, have spent the past decade developing an assessment test that school-based speech-language pathologists can use to identify children with a true speech-language disorder so that those children may get them the treatment they need.

Disorder or Difference?

Many bilingual children are first exposed to English instruction through a pre-kindergarten program, such as Head Start, or when they enter kindergarten.

Standardized speech-language evaluations used in school screenings are based on typical child language development in English. The majority of educators and school-based speech-language pathologists are accordingly unfamiliar with the process young children go through in learning a second language. These staff often encounter trouble distinguishing typical second-language differences from true disorders.

In the early stages of bilingualism, children's language skills are in flux, so there's a huge range of proficiency in their second-language performance. Children from a linguistically diverse background are often over- or under-identified with a language disorder. Dr. Elizabeth Peña

According to Peña, at this stage in their language development, bilingual children are likely to score in the at-risk range on standardized language tests in their weaker language.

“In the early stages of bilingualism, children’s language skills are in flux, so there’s a huge range of proficiency in their second-language performance, which makes it difficult to distinguish between typical second-language differences and genuine language impairment,” she explained. “The result is that children from a linguistically diverse background are often over- or under-identified with a language disorder.”

For example, as a child’s second language skills become more complex, their first language may undergo delays. Many educators and healthcare professionals will diagnose such a child with a speech disorder and prescribe therapy. According to Peña and Bedore’s research, however, this is typical and will work itself out without therapy.

On the other hand, some speech-language patterns are symptoms of a more serious, language-based disorder and may be related to other childhood conditions. Some educators and healthcare professionals may overlook a language disorder, thinking they are giving a child the benefit of more time to learn the second language, when in fact they are delaying much-needed therapy.

Peña and Bedore determined they needed to create a better, more precise language assessment test to screen for speech-language disorders; one that would take into account the fact that children with emerging language skills are trying to navigate two languages at once while accounting for cultural differences, as well.

The researchers tested an entire spectrum of 1,200 bilingual 4- and 5-year-olds — from those with severe to mild to no speech-language disorders — to identify the diagnostic markers of language impairment in bilingual children. Based on their research, the pair created a diagnostic language test with a dual-language approach to identify and distinguish between children who truly need speech therapy from those who are merely grappling with acquiring two languages simultaneously and experiencing typical development.

Lisa Bedore
Lisa Bedore, associate professor in the Department of Communication Sciences and Disorders, researches child language and phonological development and disorders with a special interest in Spanish-English bilingual children.

The test, an experimental version of the Bilingual English Spanish Assessment (BESA), is being used by Peña and Bedore in three NIH-funded research projects. Other research groups are using the BESA, or a screener based on the BESA, in their research on bilingual language development. M.A. students in the Communication Sciences and Disorders Department have learned to use the test and the principles used to develop it.

Research in the Real World

Jennifer Garcia, who works as a speech-language pathologist in McAllen, conducts evaluations and treatment with bilingual children experiencing language delays and disorders. A former student, she uses Bedore and Peña’s assessment approach in her evaluation and treatment protocol.

Through this approach, she conducts an informal assessment, asking children simple questions in their dominant language, such as “Tell me what you did today.” She will then try to engage a child through play in that language.

“At the initial evaluation session, I determine what languages the child is exposed to in their environment. For example, while many of my patients’ parents speak English, these preschool-age children may spend their days at home with grandma who is speaking Spanish, watching Spanish-language television and listening to Spanish-language music,” said Garcia.

Spanish speakers acquire different parts of grammar at different times relative to English-speaking children. So what's typical for a Spanish speaking child is very different from the English-language norm. Dr. Lisa Bedore

After an initial parent interview and evaluation, a child’s speech-language skills in both languages are evaluated, according to bilingual speech pathologist and alumna Debbie Joyner, who works with Dell Children’s Medical Center of Central Texas and Connect Care Therapy for Kids, a home health therapy company in Austin.

“I’ll spend a 30-minute session showing a child pictures and asking them to identify colors or common objects,” said Joyner, who earned a bachelor’s degree in Spanish as well as communication sciences and disorders.

Compared to standardized tests, which assess what children already know, the BESA developed by Peña and Bedore allows children to respond in Spanish, English — or both — and accepts responses that reflect cultural knowledge.

“This BESA focuses on the distinctive characteristics of each and reduces cultural bias setting up tasks so that children can demonstrate what they know,” said Bedore, who worked at Universidad de las Americas, in Mexico City. “Working as a speech-language pathologist in Mexico City, it became clear to me that the pattern of language problems children experience in Spanish differs from that observed in English. This sparked my interest in studying language development and impairment in Spanish-speaking children.

“Spanish speakers acquire different parts of grammar at different times relative to English-speaking children. So what’s typical for a Spanish-speaking child is very different from the English-language norm,” explained Bedore.

Code mixing — mixing elements of different languages into the same sentence — is common among children in the early stages of bilingualism. Until recently, this was perceived by many as a red flag for a speech-language disorder.

“When learning two languages, it is common to code mix the languages, but there’s a correct way and an incorrect way to do so,” said Austin-based speech pathologist, Lisa Rukovena, who is fluent in Spanish and is the coordinator of bilingual speech-language services at Austin Independent School District. “An experienced speech pathologist can determine whether a child is mixing languages appropriately or whether their method of mixing is inappropriate — for instance, the grammar has to be compatible.”

It’s not unusual for the structure, syntax and pronunciation of a child’s first language to affect their emerging language.

Take vowel and consonant sounds: English has 13 vowel sounds while Spanish has five, English has 26 consonant sounds while Spanish has 18. In Spanish, the letters “b” and “v” represent the same sound, so a child whose first language is Spanish, might pronounce the word “vase” as “base.”

“It’s common for an emerging bilingual child to mix their Spanish and English pronouns. In English, you need the pronoun: ‘He fell down.’ But in Spanish, you can complete the sentence without a pronoun: ‘Se cayó’ or ‘fell down,’” said Garcia.

“Languages are constantly interacting and changing for a child, so I would not diagnose this child with a disorder — perhaps a delay if other significant linguistic differences were noted that would impact academic or functional communication skills — but not a disorder, said Garcia.

While the BESA test more accurately measures a bilingual child’s language skills it also saves money and time. Fewer children are mistakenly prescribed speech-language therapy and speech-pathologists can more quickly determine where a child falls in the proficiency range.

“These assessment tests, which have been normed on bilingual children, complement my informal language evaluation so I can know immediately if the child is in a typical range or not,” said Joyner. “When I conducted evaluations earlier in my career, I had to do a language sample, conduct the evaluation and look at the norms because there wasn’t a Spanish-English language test — and I only had one hour to spend on each patient.”

Thanks to Peña and Bedore’s research into language in children from diverse linguistic backgrounds, the speech-language pathology field is adopting new approaches to assessing bilingual children’s language skills: testing the ability to learn new language skills rather than what children already know.

For more information, contact: Erin Geisler, KUT Radio, Moody College of Communication, (512) 475-8071;
Photos of Elizabeth Peña and Lisa Bedore: Christina Murrey

8 Comments to "Researchers develop tool to identify bilingual children with true language disorders"

1.  Lizze Norlander said on Aug. 24, 2011

Hi –

I work for a clinic in Tyler and approximately 50% of our patients are bilingual. I have been following the research on the BESA for a couple years now and was wondering if it would be avbailable for use. We currently assess children separately in English and Spanish, but would be very interested in a bilingual assessment, since it would provide a more much more accurate assessment.

Any information you have would be greatly appreciated!


Lizze Norlander

2.  Cheri Fry said on Feb. 23, 2012

I am an SLP in child Search; had an eval. with a bilingual child whose parent is concerned with articulation development in both languages. What are best procedures to use for articulaiton testing for an ESL child?

3.  Sarah-Maye Miller said on Feb. 23, 2012

I am a Speech-Language Pathologist in Napa, CA and I work with a large population of Spanish speakers. I was curious as to how the development of the BESA/BESOS was coming and if there was a possible publication date for the future.

4.  Denise Milligan said on March 4, 2012

Is the BESA available for purcahse at this time? I have been anxiously awaiting this assessment tool. Thanks!

5.  Liz Pena said on March 5, 2012

I just today got a note that we had some comments on the story.
Re: the BESA, we hope to have it published by fall.
Re: articulation intervention, Brian Goldstein from Temple University has written a column on this.
thanks for your questions and comments!

6.  Rosario G. Gould said on March 6, 2012

Very interesting and the test is a must. What is the age range?

I do Early Intervention – Westchester County, New York.

I am concerned about the misinterpretation of the statement “this is typical and will work itself out without therapy”. I frequently hear educator and therapist using this statement to encourage parents to speak to the child English when they only know basic English. Therefore, they speak using incorrect English when interacting with the child. On the other hand I frequently encounter professionals that only know basic Spanish using incorrect Spanish when interacting with the child. As an audiologist / speech therapist, I know the implications of listening to sounds during the early years of life in language / speech development. If a parent speaks English utilizing only 5 vowels and approximations to English consonants (i.e tree for three, cat for cut), this child would be receiving the incorrect input of the language.

I also strongly agreed with your statement “Code mixing — mixing elements of different languages into the same sentence — is common among children in the early stages of bilingualism.” This is clearly a stage of development and the child should feel acceptance to his oral communication. However, many individuals misinterpret this fact. It is a common belief that it is O.K for the adult to code mix when speaking to the child to make it easier for him. I strongly believe that it is not O.K. for the adult to code mix – particularly speech sound – when talking to the child. I addition, I believe that this strategy makes it even more difficult for the children that have speech / language problems to overcome the difficulties the child might have (i.e. Central Auditory Processing Difficulties).

I am doing a presentation for NYSABE next Saturday and I would like to know your opinion on this subject.

Is it O.K. for the adult to use incorrect English / Spanish – Code mixing while interacting / communicating with the child during his early years?

7.  Norma said on March 13, 2012


I am a bilingual speech/language pathologist and I am looking for better ways to test my bilingual children. I came across an article based on the assessment that is being developed and I would like to know if the assessment has been published or when will it be out in the market?

8.  Rosie Gunning said on April 21, 2012

Help. I am an English-speaking Australian living in Greece, that (right or wrong) speak very little Greek. I am married to a Greek who speaks no English. I have a five year old child who is bilingual without problems. I have a three year old who is not speaking at all – maybe three or four unclear words. Mum is even a struggle. At home my husband speaks only Greek to the child ren and I speak only English to the children. Most of the time the children are with me. The watch television, sometimes in English, sometimes Greek.

I have visited the hospital in Greece seeking help for my three(and four month) child who is not talking. They talk me the reason is I speak to fast, and I speak like an English woman, and that I must only speak Greek at home with the child and not English at all. I find this very difficult because my level of Greek is extremely low, and my level of English is University level. In Australia I was a Registered Nurse.

My three year old has not yet had a hearing test, and they have booked him in to therapy at a centre with children with special needs (all in Greek). Even if I wanted to I couldn’t speak all day in a language that I barely know myself.

What should I do. I have booked him in to hearing test myself.