INT J LANG COMMUN DISORD, NOVEMBERDECEMBER VOL.

2011,

46, NO. 6, 613627

Review Evaluation of speech and language assessment approaches with bilingual children
Caroline De Lamo White and Lixian Jin
Speech and Language Therapy, Leicester Partnership Trust, Leicester, UK Speech and Language Therapy, De Montfort University, Leicester, UK

(Received 8 June 2010; accepted 4 December 2010) Abstract

Background: British society is multicultural and multilingual, thus for many children English is not their main or only language. Speech and language therapists are required to assess accurately the speech and language skills of bilingual children if they are suspected of having a disorder. Cultural and linguistic diversity means that a more complex assessment procedure is needed and research suggests that bilingual children are at risk of misdiagnosis. Clinicians have identied a lack of suitable assessment instruments for use with this client group. Aims: This paper highlights the challenges of assessing bilingual children and reviews available speech and language assessment procedures and approaches for use with this client group. It evaluates different approaches for assessing bilingual children to identify approaches that may be more appropriate for carrying out assessments effectively. Methods & Procedures: This review discusses and evaluates the efcacy of norm-referenced standardized measures, criterion-referenced measures, language-processing measures, dynamic assessment and a sociocultural approach. Outcomes & Results: When all named procedures and approaches are compared, the sociocultural approach appears to hold the most promise for accurate assessment of bilingual children. Research suggests that language-processing measures are not effective indicators for identifying speech and language disorders in bilingual children, but further research is warranted. The sociocultural approach encompasses some of the other approaches discussed, including norm-referenced measures, criterion-referenced measures and dynamic assessment. Conclusions & Implications: The sociocultural approach enables the clinician to interpret results in the light of the childs linguistic and cultural background. In addition, combining approaches mitigates the weaknesses inherent in each approach. Keywords: speech and language assessment approaches, bilingual children, sociocultural approach

What this paper adds What is already known on this subject Many procedures and approaches for assessing bilingual clients have been trialled within different clinical studies, however clinicians may not have the time or the opportunity to become familiar with all procedures and approaches available to themlet alone make a decision about which approaches should be employed with their bilingual clients. What this study adds This study reviews major approaches used for assessing the speech and language needs of bilingual children with the aim of informing clinical practice. It evaluates these procedures and approaches with examples and evidence to present arguments for using a sociocultural approach as a more appropriate method, whilst incorporating the strengths of other approaches. This study makes a case for the provision of training to equip students and speech and language therapists with the knowledge and skills to use these approaches with bilingual children.

Address correspondence to: Dr. Lixian Jin, Speech & Language Therapy, De Montfort University, H0.19b Hawthorn Building, Leicester, LE1 9BH, UK; e-mail: jin@dmu.ac.uk
International Journal of Language & Communication Disorders ISSN 1368-2822 print/ISSN 1460-6984 online c 2011 Royal College of Speech and Language Therapists DOI: 10.1111/j.1460-6984.2011.00049.x

614 Introduction Accurate assessment of a childs communicative ability plays an essential role in diagnosis and informs therapy so that intervention strategies meet the childs needs. The Royal College of Speech and Language Therapists (RCSLT) (1996: 268) denes bilingualism as people who acquire communicative skills in more than one language. Bilingualism does not cause language disorders and is seen by the RCSLT as a distinct communicative advantage. The sociocultural and linguistic differences associated with bilingualism result in a more complex assessment procedure. This, combined with a perceived lack of appropriate assessment tools (Roseberry-McKibbin et al. 2005), has placed bilingual children at risk of misdiagnosis (Crutchley et al. 1997). Bilingual children are consequently under and over-represented on the caseloads of speech and language therapy (SLT) services in the UK (Winter 1999, 2001). Although this paper does not focus on bilingualism per se, it is important to position the context within the key concepts of bilingualism and different types of bilinguals to set up a theoretical framework to review speech and language assessment approaches with bilingual children. Current concepts of bilingualism recognize its diversity and complexity, thus the term bilingualism has various connotations (Martin 2009). For some people the term implies complete oral uency in two languages; for others it refers to any degree of competence in two languages. Baker (2006) has presented the complexity of dening bilingualism by giving different dimensions of bilingualism, rather than dening bilingualism in one sentence or even a paragraph. Li (2007: 7) presents 37 types of bilinguals, covering many social, economic and linguistic dimensions and the degrees of competence of a bilingual person. However, the RCSLT (1996) denes bilingualism as an ability to communicate in two or more languages, in a variety of modalities and to varying levels of prociency. Currently, bilingualism generally refers to people who use more than one language for interaction on a day-to-day basis (Martin 2009). Further, the papers pertinent to this review use a variety of terminology to describe their target populations including: minority children, culturally and linguistically diverse (CLD) children, English language learners (ELL), secondlanguage learners and bilingual or bicultural children. Aspinall (2002) acknowledges the ambiguous nature of terminology surrounding minority ethnic populations. For clarity, this review denes bilingual children as those who speak or are regularly exposed to two or more languages. The term minority ethnic (Multiverse 2004) is used in all other instances. Biculturalism is commonly

Caroline De Lamo White and Lixian Jin associated with bilingualism; it implies participation in two or more cultures (Martin 2009), but biculturalism is not necessarily a given result of being bilingual or vice versa. Britain is a multicultural and multilingual society and in principle each person is perceived to have the same rights and access to services. SLTs frequently come into contact with clients who speak more than one language and increasingly with those whose primary language is not English. The UK Ofce of National Statistics (2001) states that the minority ethnic population accounts for 7.9% of the total British population (in a city like Leicester it is over 45%), while minority ethnic groups account for 73% of Britains overall population growth (Kings Fund 2006). This ethnic diversity implies bilingualism in practice though not necessarily for some communities. School pupils in London between them speak well over 300 different languages, plus many more dialects (Baker and Eversley 2000) and about 30% of Londons children use English as an Additional Language (EAL). In some schools, over 90% of pupils are considered to be within the EAL group. As this diversity looks set to increase through migration and minority ethnic birth rates, clinicians will more frequently come into contact with bilingual children. Despite the fact that the majority of children nationally are monolingual English speakers, Winter (1999) estimates that 59% of therapists will encounter at least one bilingual child and that 11% work with a minimum of 20 bilingual children; however, as the gures cited above show, these percentages will be far higher in some cities. Clinicians have an ethical, legal and professional duty (RCSLT 1996) to meet the needs of these children. Professional standards (Health Professionals Council 2007, RCSLT 1996) require clinicians to offer a nondiscriminatory service and to be competent in carrying out appropriate and sensitive assessment procedures. It is imperative that the profession addresses any inequality of care being provided to bilingual children. Consequently, the purpose of this paper is to answer the following questions. What assessment techniques are available to clinicians for use with bilingual children? Which assessment techniques are the most appropriate and effective at diagnosing language impairments in bilingual children? This review will start with the examination of assessment challenges; it then moves to identify assessment techniques discussed in research literature. It will systematically evaluate the scope and efcacy of each technique so that clinicians are better informed about

SLT assessment approaches with bilingual children assessment options for use with bilingual children. It will make recommendations for improving future practice and identify areas for further research in the hope of reducing occurrences of misdiagnosis and inequalities in client care. Assessment challenges Bilingual children present SLTs with a unique challenge; the clinician must differentiate between a fundamental speech and language disorder and perceived difculties resulting from speech and language differences. Differences may be expressed in sentence structure, speech sound production, vocabulary and pragmatics (Roseberry-McKibbin 2002). For bilinguals who are learning English there may be a linguistic inuence or interference on any of these language levels from a rst language onto the second (Odlin 1989) or from a second language to the rst (Cook 2003). In the case of specic languages, such inuences often have predictable effects on a bilinguals use of English as a second language (Swan and Smith 2001), which means that SLTs can ascertain some inuences. As Hamayan and Damico (1991) point out, these phenomena are supercially similar to those exhibited by children who have a fundamental speech and language disorder. The following short discussion highlights other features that make assessment of bilingual children particularly complex. An important part of assessment is knowledge of the familys culture and language use, including dialectal variation (Laing and Kamhi 2003). Figure 1 is one model of cultural identity (London SIG Bilingualism 2007a) which takes clients socio-cultural factors into consideration while assessing them. The four boxes loosely represent the components of cultural identity which include: ethnicity, culture, race and nationality, along with relevant sub-factors (London SIG Bilingualism 2009). Without considering these factors, a clinician

615 runs the risk of carrying out a culturally and linguistically biased assessment procedure and is unlikely to obtain a genuine prole of the childs communicative competence. Further, a socio-cultural approach should be seen as the essential approach underpinning other assessment methods for assessing bilingual clients; rather than simply being an alternative to other approaches, it should be seen as the core context for them. Yet, the socio-cultural approach may not in itself solve the totality of problems associated with other approaches. However, Mennen and Stanseld (2006) comment that many SLTs lack knowledge about languages and cultures other than their own. The majority of SLTs in the UK are white, middle-class and women (Cortazzi and Jin 2004). One possible solution would be to encourage more people from minority groups and speakers of minority languages into the profession. However, Papoutsis Kritikos (2003) points out that SLTs who speak minority languages will inevitably come into contact with children who speak yet other languages and are from unfamiliar cultures. It is unrealistic to suggest that recruitment would be a solution in itself. S anchez (2006) proposes that another of the challenges facing clinicians is the variability of language prociency amongst bilingual children. Language prociency is dependent upon a number of factors including the childs age and intensity of exposure to a language, as well as the opportunity and motivation which the child has to use that language. Similar variability applies to cultural factors (Cheng 1997). To a large extent, the childs cultural identity will be determined by the values and beliefs held by their carers, and as argued by Jin and Cortazzi (1993: 84), these may be inexplicit: Culture is necessarily subjective and involves assumptions, ideas and beliefs which are often not articulated. The challenge is that the clinician must fully consider the childs language history and cultural background in order to make an informed diagnosis but clients and their families cannot always be expected to make explicit the relevant linguistic and cultural information Chavda et al. (2003) stress that insufcient knowledge on the part of health and educational professionals about language acquisition in bilingual children often results in misdiagnosis. The clinician must be aware of developmental processes and patterns of language use which are used by bilingual individuals. These include language mixing, code switching, interference, language loss, fossilization and a silent period (Hamayan and Damico 1991, Nicoladis and Genesee 1997, Roseberry-McKibbin 2002). Well-intentioned professionals unfamiliar with these processes may erroneously refer bilingual children for SLT when it is not required.

Values & Beliefs Traditions Language Religion Country of Origin Physical Appearance / Features Gender Age Sexuality Disability

Diet Dress Lifestyle Family Dynamics Class Socioeconomic Status Political Climate Education Employment Experience

Figure 1. Factors that constitute cultural identity (London SIG Bilingualism 2007b).

616 Given the complex interplay between the above variables, it is unsurprising that clinicians report nding it difcult to make sound clinical judgements about the communicative competence of bilingual children (Crutchley et al. 1997, Winter 2001). Many clinicians do not believe that they have the necessary skills or training to do so (Papoutsis Kritikos 2003). Despite language differences, any battery of speech and language assessments used must accurately differentiate between children with genuine language impairment (LI) and children with normally developing language (LN)or languages. Assessment proceduresrelevant research There is an emerging body of research into the assessment of bilingual children (Rodekohr and Haynes 2001, Irvine Saenz and Blake Huer 2003, Stokes et al. 2006, Gould 2008). There is a variety of assessment approaches discussed, which mainly include ve types: norm-referenced standardized measures, criterion-referenced (CR) measures, languageprocessing measures, dynamic assessment (DA) and a sociocultural approach. Table 1 provides an overview of each type of assessment measure. These approaches will be discussed in the order outlined in Table 1. The research will be presented and evaluated for each approach before considering the implications for practice and drawing conclusions. Norm-referenced standardized measures Norm-referenced, standardized speech and language assessments have been described as the tools of the profession (Stow and Dodd 2003: 363), and the cornerstone of diagnosis in the eld (Pe na and Spaulding 2006: 247.) This is perhaps because they

Caroline De Lamo White and Lixian Jin are perceived as an efcient testing method which provides a good indication of a childs position amongst his/her peers in terms of a percentile rank. It is a description which many other professionals understand. However, Caesar and Kohler (2007) comment that norm-referenced assessments have proven to be an inadequate diagnostic tool for bilingual children. This inadequacy is attributed to content bias, linguistic bias and a disproportionately small representation of bilingual children in normative samples (Laing and Kamhi 2003, Stow and Dodd 2003, Martin 2009). Content bias Whilst norm-referenced testing enables clinicians to evaluate a childs existing knowledge base and compare it with normally developing children of the same age, it works on the assumption that all children have been through similar life experiences and have knowledge of the same concepts and vocabulary. However, this can be an erroneous assumption when it does not take into account the differences in experience associated with cultural diversity. For example, S anchez (2006) found that the use of traditional reading and writing tasks for evaluating Peruvian childrens language prociency placed bilingual children from rural communities at a distinct disadvantage, partly because of the predominance of oral communication over written forms within their home communities. Some languages even today do not have a written form (Stow and Dodd 2003) and in others with different scriptssuch as Chinese or Japanesethe nature of literacy can be different. Signicantly, the assessments in Peru were carried out predominantly in Spanish, thus discounting the childrens prociency in their home language. S anchez (2006) found that the pictures used for assessment needed to reect the childrens own rural environment in

Table 1. Assessment measures summarized Assessment approach Norm-referenced standardized measures What it measures A measure of a childs performance determined by direct comparison with the performance of a specied population A measure of a childs level of performance on a specic skill, e.g. grammatical structure A measure of a childs ability to process language An evaluation of a childs language-learning potential and the mechanisms by which they learn A holistic evaluation of a childs communicative abilities within their wider environment Example Published formal assessment, e.g. Pre-School CELF (Wiig et al. 2006) in which a standard score and percentile rank is derived Language sampling for linguistic analysis, e.g. Using mean length of utterance to evaluate the individuals functional ability Memory tasks such as non-word repetition (NWR) and competing language processing tasks (CLPT) Mediation. Testteachretest. Graduated prompting Ethnographic assessment such as RIOT (review, interview, observe, test) approach

Criterion-referenced measures Language-processing measures Dynamic assessment Sociocultural approach

SLT assessment approaches with bilingual children order for them to make accurate interpretation. Other cross-cultural researchers have found that interpreting pictures is culturally specic and closely linked to the use of picture books for story-telling. For example, Carter et al. (2005) found that Kenyan children had difculties interpreting picture stimuli; children were found to have difculty with perspective; particularly when interpreting pictorial representations of prepositions. They confused items of a similar shape, or had no experience of the item depicted. This is to be expected in a multicultural context, given that many items used on a regular basis by one community may never be used by another (e.g. cooking utensils and food items). Cultural identity also subsumes differences in beliefs and everyday practices, in religious celebrations and, less obviously, in culture-specic language styles of, say, storytelling (Cortazzi 1993, Minami 2002), which could affect language assessments using narratives. Many formal language tests require children to label pictures of objects; however, Lidz and Pe na (1996) raise the crucial point that in different cultures parents use different strategies to direct their childs attention. They cite research in which Puerto Rican and African American mothers were found to comment predominantly on object function rather than object labelling. Consequently, for cultural reasons, some children from diverse backgrounds may not perform well on object labelling in tests of vocabulary, thus providing a negative view of their linguistic competence. Linguistic bias The strict marking criteria of many standard assessments do not make allowances for linguistic or dialectal variation. Cheng (1997) maintains that linguistic variation can affect all parameters including phonology, syntax and pragmatics. Laing and Kamhi (2003) suggest that this can be made worse as a result of disparity between the language of the clinician and the child. Perceived poor performance may be the result of linguistic difference rather than impairment; conversely, the clinician may wrongly attribute genuine errors to linguistic variation and over estimate the childs competence. Disproportionate representation in normative data Pring (2005) notes that standardized tests allow clinicians to compare a childs score with a specied population. If a test has been standardized among white, monolingual children living in England, then comparisons with children from other culturally or linguistically diverse backgrounds will not yield scores which can be reliably compared. London SIG Bilingualism (2007a) guidelines recommend that children should

617 be assessed in all the languages which they use. Translation might seem a solution, however experts strongly advise against simply translating tests into other languages due to notable differences in semantics, syntax and phonology (Roseberry-McKibbin 2002, London SIG Bilingualism 2007a, Bedore and Pe na 2008, Martin 2009). Bedore and Pe na (2008: 17) point out that children speaking other languages do not necessarily follow the same developmental trajectories as English. The majority of language assessments which have been comprehensively and appropriately adapted from English to another language are also normed on monolingual groups (Bedore and Pe na 2008). Yet tests designed for use with monolingual children are unlikely to provide an accurate picture of a bilingual childs communicative competence; at best they provide a reasonable estimation. Research shows that normally developing bilingual children tend to perform lower on norm-referenced tests than their monolingual peers even when one or both languages are assessed independently (Thordatottir et al. 2006). It is this which can lead to over-identication of speech and language disorders in bilingual children. Grosjean (1989) emphasizes that a bilingual speaker is not the sum of two monolinguals, but an individual with a unique, integrated, linguistic prole: a bilinguals linguistic repertoire generally has a unique prole of the uses of languages across domains and topics with particular speakers in specic contexts. Removing biasevaluating some solutions Modifying assessment content and format So is it possible to remove the bias from standardized assessments? Irvine Saenz and Blake Huer (2003) conducted an investigation into the effects of test modication using the CELF-3 (Semel et al. 1995). First an unmodied version, then a modied version of the test was administered to 25 LN bilingual Latino children. Test modications included rewording or expanding instructions, providing additional response time, providing credit for the use of dialect and using real items and objects if the participants lacked experience of books and pictures. Although the modications did improve raw test scores, the difference between the unmodied and modied scores was not statistically signicant. On both versions the participants performed below the mean. In contrast, they are reported as performing within the standard range on familiar academic tests. Test performance has been shown to be affected by experience and task familiarity (Pe na and Quinn 1997). Irvine Saenz and Blake Huer (2003) observed that despite the lack of statistical signicance, repeated testing provided students with the opportunity to develop strategies which improved their raw scores.

618 They concluded that there might be a case for use of DA which includes a test, teach, retest format (discussed below). Re-standardization and inclusion of minority groups Attempts have been made to re-standardize assessments by modifying the sample population to include a larger number of children from ethnic minority backgrounds. Washington and Craig (1992) issued the Peabody Picture Vocabulary TestRevised (PPVT-R; Dunn and Dunn 1981) to African American preschool children but found that even with scoring allowances the test was racially biased, indicated by a lack of performance spread, with 91% performing signicantly below the mean. A third version of the PPVT was developed (PPVT-III; Dunn and Dunn 1997) with modied assessment questions following a pilot with three major American groups (African American, Hispanic and Native American). These ethnic groups were then included within the normative sample in line with their percentage representation amongst the total population. Washington and Craig (1999) examined the performance of 59 African American preschool children on the PPVT-III and found that that they performed within normal limits: there was no statistical difference from the normal standard distribution. They concluded that modifying the questions and restandardizing the test resulted in a less biased assessment. However, Stockman (2000) points out that reduced bias for some groups may have come at the expense of being able to make clinical judgements about others. In a re-examination, Stockman found that the raw scores resulted in much higher standard scores in the PPVTIII than the PPVT-R suggesting that the modied test content resulted in the PPVT-III being easier. She argues that this could result in failure to identify correctly LI in children from other ethnic groups, particularly Caucasian ones. Stockman concludes that test bias would need to be investigated for all major groups of children. Critical evaluationnorm-referenced measures Given the ethnic diversity in Britain and many other countries, one could speculate whether it would be possible to devise a one-size-ts-all norm-referenced standardized assessment. Mennen and Stanselds (2006) study of SLT service delivery in three UK cities identied in excess of 60 languages spoken in the smallest city. Whilst some minority populations may be relatively static (such as Native American populations within the USA), the UK is undergoing massive shifts in its social diversity as a result of immigration (Kings Fund 2006). Re-standardizing any assessment to take account

Caroline De Lamo White and Lixian Jin of all multiethnic variation could pose an insurmountable challenge. Nevertheless, in areas where there is a high proportion of people from one particular ethnic group with a similar linguistic and cultural background, it is worth re-standardizing an assessment on that specic population. Chavda and Jin (2003) have redeveloped and re-standardized the STASS (South Tyneside Assessment of Syntactic Structures; Armstrong and Ainley 1988) for use with Gujarati-speaking children living in the UK. However, Irvine Saenz and Blake Huer (2003) comment that test renorming requires signicant time and resource and that tests which have been modied and/or renormed should have their reliability and validity evaluated. Moreover, to focus on bilingual children, norm-referenced measures require a relatively homogenous group: yet almost by denition, a bilingual population embraces diversity and extensive heterogeneity (Thordatottir et al. 2006: 4). Second language acquisition is by its very dynamic nature, with children learning at different times and rates. Even if children from the same ethnic origin were placed into one group, these children may be at different stages of language acquisition as a result of differing life experiences. This also raises the question of whether the nature and dimensions of bilingualism should be considered (e.g. sequential or simultaneous), but this crucial aspect was not mentioned in any of the above test-modication research papers. Mattes and Omark (1984) argue that the development of a standardized test suitable for all bilingual children is unrealistic due to the heterogeneity of the client group. Criterion-referenced (CR) measures CR measures also evaluate a childs existing knowledge base, but within a specic domain. In contrast to normreferenced tests which are interpreted in relation to the performance of others, CR measures are interpreted in relation to predetermined performance criteria; that is, a set of behaviours deemed to constitute an acceptable response (Terrell et al. 1992). For the purpose of identifying speech and language disorders, these may be standards of performance based on developmental data or language descriptions. McCauley (1996) suggests that CR measures can be used when normreferenced measures are unavailable or inappropriate, which as shown is often the case for bilingual children. The advantage of using CR measures is that the clinician can use materials and interaction patterns which will be familiar to the child and thus try to reduce cultural/linguistic bias. Therefore, this assessment tends to be informal and includes techniques such as language sampling and probing. In the absence of a suitable standardized test for a NigerianAmerican child exposed to English and Ibo

SLT assessment approaches with bilingual children (a Nigerian language), Terrell et al. (1992) used the fathers responses as the basis for evaluating the childs responses. They termed this method of assessment ParentChild Comparative Analysis (PCCA) (Terrell et al. (1992: 34). Essentially this involved administering the same standardized speech and language tests to both the parent and the child and obtaining spontaneous speech samples. When the childs response deviated from Standard English it was compared with the parental responses and compared with developmental norms for the childs age. Any child response failing to match that of the parent and falling outside the scope of normal (monolingual) language development was deemed disordered. Further research provides evidence that CR measures may provide an alternative method of assessment. Restrepo (1998) found that SLTs using a combination of language sampling (analysing the mean length and number of errors per T-unit) combined with a parental report and family history were able to discriminate between bilingual children with and without LI with a high level of accuracy (> 90%). However, a recent study (Paradis 2005) found that analysis of morphosyntax in isolation did not accurately differentiate between children with and without LI. Critical evaluationcriterion-referenced measures Whilst research provides evidence that CR measures can be used to identify LI in bilingual children, studies (Restrepo 1998) suggest that language analysis needs to be supplemented by obtaining background information from family/carers in order to differentiate reliably between children with and without LI. This provides evidence that the sociocultural approach should underpin this assessment procedure. Laing and Kamhi (2003) note that CR measures are only as good as the data on which they are based. CR measures may seek to draw upon developmental data regarding the process of language acquisition. Progress is being made within this eld, but Thordatottir (2005) suggests that research into patterns of language acquisition in languages other than English is comparatively lacking. Whilst Martin (2009) acknowledges that difculties with morphology are symptomatic of LI, language acquisition patterns and syntax have been found to differ across languages. For example, Thordatottir (2005) found that Frenchspeaking children had a higher mean length of utterance but smaller vocabulary size than English-speaking children. This asymmetry makes comparing a childs language skills across two or more languages additionally complex. One advantage of using CR measures is that their application within a specied domain enables the

619 clinician to test denite clinical hypotheses and in this way dene the exact nature of the difculty. Another advantage of using an informal assessment technique is that cultural differences can be embraced. However Terrell et al. (1992) suggest that CR measures can be just as biased as standardized measures if the clinician lacks knowledge and awareness about the clients culture. One way to overcome this is to involve a bicultural co-worker and for clinicians to become familiar with the clients languages and cultures through additional reading and research. Terrell et al. (1992) describe a single case study of ParentChild Comparative Analysis. No further research appears to have been carried out into the validity of using this particular technique, which weakens the reliability of its application with other bilingual children. Language-processing measures In contrast to norm-referenced and CR measures, language-processing tasks are independent of the childs existing knowledge base so are considered to be a less biased, potential alternative to the traditional knowledge dependent tests discussed. Languageprocessing tasks (LPTs) indirectly assess a childs underlying processing functions and include memory tasks such as non-word repetition (NWR; Gathercole et al. 1994); competing language processing tasks (CLPT; Gaulin and Campbell 1994); and perceptual tasks such as the Revised Token Test (RTT; McNeil and Prescott 1978). LPTs are therefore said to be processing dependent. Gathercole and Baddeley (1990) found that children with specic language impairment (SLI) had poor language-processing abilities and performed substantially below their age-matched controls in NWR tasks. With this in mind, Campbell et al. (1997) compared the performance of Caucasian and minority ethnic children on three LPTs (NWR, CLPT, RTT) and one norm-referenced assessment. They found that the minority ethnic children scored signicantly lower on the standardized test but did not differ on the LPTs. Further research by Dollaghan and Campbell (1998) provided evidence that using a NWR task had a high degree of accuracy in distinguishing between children with and without LI independent of ethnicity. Rodekohr and Haynes (2001) research supports these ndings: they found that language-processing measures were able to differentiate between LI and LN for both Caucasian and African American groups. However, children from minority ethnic groups may not be necessarily bilingual, though their language repertoires may well include culturally diverse features. Kohnert et al. (2006) conducted research to determine

620 whether NWR and CLPT could be used to differentiate between LN monolingual, LI monolingual and LN bilingual children. The bilingual children are described as procient SpanishEnglish speakers. The researchers hypothesized that if language-processing measures were without sociolinguistic bias and sensitive enough to detect LI, then bilingual and monolingual LN children would perform similarly. In contrast, the LI children would be expected to perform signicantly below the other two groups. However, results showed that the LN monolingual children performed best, the bilingual children performed signicantly below their monolingual peers, and the LI children performed signicantly below both the other two groups. Whilst there was signicant differentiation between the groups, the researchers (Kohnert et al. 2006) suggest that NWR and CLPT are not independent of previous language experience and so cannot be considered to be free from linguistic bias. Children who were less procient bilinguals than those in their study may not be expected to perform as well. They concluded that NWR and CLPT would not be good indicators of LI in bilingual children. By extension, Stokes et al. (2006) found that NWR was unable to distinguish between groups of LI and LN monolingual Cantonese children as there was no signicant difference between their performances. They concluded that NWR is affected by existing language knowledge and that the underlying processes required to carry out this task are not impaired in Cantonese-speaking children with LI. On the other hand, these researchers also tested sentence repetition (SR) and found that there was a signicant difference in performance between the LI and LN Cantonesespeakers, which suggests that this may be an avenue for further investigation.

Caroline De Lamo White and Lixian Jin The work of Stokes et al. (2006) provides compelling evidence against the assumption that NWR is independent of language experience. Existing research into the efcacy of NWR does not provide sufcient evidence to warrant its use as an assessment tool for use with bilingual children. On the other hand, LI affected Cantonese childrens performance on the SR task, which suggests that more research is needed to determine the value of this task as a diagnostic tool. Research to evaluate the diagnostic value of SR for children who speak languages other than Cantonese is warranted; the diagnostic value of SR for use with bilingual children needs to be established. Martin (2009) concedes that language-processing measures have yet to realize their full potential. Kohnert et al. (2006) suggest that more research is needed into the underlying cognitive systems involved in language-processing. Dynamic assessment (DA) Similar to languageprocessing measures, DA does not rely solely upon a childs existing knowledge or life experience, instead it attempts to measure their potential for learning (Hasson 2009). DA is based on the work of Vygotsky (1978, cited in Guti errezClellen and Pe na 2001: 212) and the zone of proximal development (ibid), which encapsulates how a childs cognitive development takes place as a result of social interactions with others, especially within tasks which a child is as yet unable to perform aloneadult supported learning in this zone is also known as mediation and scaffolding. DA commonly follows a testteachretest format and in doing so, provides information about current levels of performance, the effect of intervention upon performance and highlights the best strategies for supporting further learning. Evaluation is also made about a childs learning behaviour during the mediation phase. The term modiability describes to what extent a child is capable of change in response to intervention (Lidz and Pe na 1996: 368). A modiability score is based on the level of examiners effort required, the childs responsiveness/motivation and demonstration of a transfer of learning. This technique can be described as diagnostic therapy because assessment and therapy occur simultaneously. Other DA methods discussed in the literature include task/stimulus variability and graduated prompting. However, there was less attention given to these techniques in the literature reviewed, so they are not discussed in detail here. Testteachretest Pe na et al. (1992) carried out research into the effectiveness of using testteachretest for assessing the language abilities of 50 bilingual children (African American and

Critical evaluationlanguage-processing measures Whilst NWR is reported as easy and quick to administer (Laing and Kamhi 2003), it cannot be used alone for diagnostic assessment. NWR and CLPT do not inform the clinician about the precise nature of the underlying difculty, they simply aim to differentiate between children with and without LI. NWR may hold promise for distinguishing between LN and LI minority ethnic English-speaking children, but research results from Kohnert et al. (2006) showed that NWR and CLPT were not able to distinguish between LN and LI bilingual children. This raises a question of whether NWR can be truly free from linguistic bias or independent of previous language experience given that all the worlds languages are subject to language specic phonotactic rules (Roach 2000).

SLT assessment approaches with bilingual children Puerto Rican children exposed to Spanish and English teaching environments on a daily basis). The children were split into two groups, LN and LI, and tested using two formal standardized assessments; a test of vocabulary (object labelling) and a test of comprehension (object description) in order to obtain baseline scores. Both groups of children performed signicantly better on the test of comprehension. So for 6 weeks both groups of children were taught about object labelling. During this phase the childrens performance was also rated in relation to their learning behaviour or modiability. The children were nally retested. Whilst all of the childrens raw scores improved upon retest, the LN children performed signicantly better on the vocabulary retest and had higher modiability scores than the LI children. The LI childrens modiability scores indicated that they required a higher level of examiner effort, were less responsive to input and did not readily transfer their learning. Therefore the testteach retest format, combined with the modiability rating was shown to be effective at differentiating between the children with and without LI, irrespective of cultural identity or language experience. Research by Ukrainetz et al. (2000) supports that of Pe na et al. (1992). They undertook a testteach retest research study with Native American children and divided the children into two groups; stronger and weaker language-learners. The testteachretest assessment method reliably differentiated between the two groups. Lidz and Pe na (1996) undertook a small case study with two bilingual Latino American preschool children, A and B, who were performing signicantly below the mean on a standardized vocabulary test. The testteach retest approach was used to evaluate their language ability. B responded well in mediated sessions and achieved a high modiability score, whereas A needed high levels of examiner effort and had difculty learning the new concepts. B achieved a signicantly higher retest score following mediation; A showed very little improvement. B was diagnosed as LN with language differences, while A was diagnosed as LI. The clinician was able to provide the class teacher with an insight into the nature of As difculties. Critical evaluationdynamic assessment Research provides evidence that DA is effective at identifying LI in bilingual children. Cheng (1997) comments that a distinct advantage of DA, is that it allows the clinician to assess a child over time thereby providing opportunities to monitor the childs performance and outcomes of intervention at regular intervals. The dual, diagnostic and therapeutic components of DA enable the clinician to adjust

621 intervention plans and mediational strategies to meet the needs of the child. The mediation phase provides opportunity to identify strategies that facilitate the greatest change and enables the clinician to give recommendations to others involved with the child. Mediation can be used to predict a childs responsiveness to intervention (Hasson and Joffe 2007). However, Isaac (2002) argues that clinicians must consider the childs cultural background before making judgements about the childs responsiveness to mediation. Carter et al. (2005) discuss the inuence of culture upon performance and note that culture can inuence variables such as eye contact and turn-taking. Ukrainetz et al. (2000) concede that DA is most reliable when a child is compared with several others from the same cultural group, so the clinician may want to assess others to obtain a frame of reference. When this is not feasible, ethnographic information could be used to bridge the knowledge gap. Ethnographic assessment is discussed in more detail in the section entitled sociocultural approach. Diagnostic therapy is used informally by many SLTs, but DA is not currently used as part of routine evaluation (Caesar and Kohler 2007). DA is very time consuming and requires intensive contact, particularly during the mediation phase. Bray et al. (1999) recognize that in a climate of stretched resources clinicians may have less available direct contact time for their clients. Another issue with DA is inter-rater reliability (Hasson and Joffe 2007) clinicians are free to modify their mediation and assessment procedures to suit the child, but cannot be sure of their validity or reliability unless they have access to other clinicians DA with the same clients, which is unlikely. Sociocultural approach The sociocultural approach is a technique advocated by various experts (Westby et al. 1990, Cheng 1990, 1997, Isaac 2002, Roseberry-McKibbin 2002, Martin 2009) and is based on the assumption that an individuals language use is inseparable from the inuence of their social and cultural environment. Martin (2009) refers to Bronfenbrenners model, the ecology of human development, in which the child is at the centre of their ecosystem. In contrast to other methods of assessment that attempt to decontextualize the assessment procedure in a bid to reduce the inuence of external factors on performance; the sociocultural approach takes a holistic view of the childs developing speech and language skills within the context of their social and cultural environment. Figure 2, taken from Anderson and Van der Gaag (2005: 91), shows the inuence of each social subsystem upon the next, and how jointly they shape the childs

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Figure 2. Bronfenbrenners ecology of human development after Bronfenbrenners model (cited in Anderson and Van der Gaag 2005: 91).

experiences and development. The microsystem is the childs immediate environment and includes those who interact directly with the child. The mesosystem denotes the interplay between the components of the microsystem: signicantly, when health professionals work alongside the parents and each other for the good of the child. Components of the exosystem and macrosystem tend to have a more indirectbut signicant impact upon the child. For example, governmental decisions may affect the amount of support a child is able to receive in school. The key to the left illustrates the components of each system. Cheng (1997) contends that the rationale for using a sociocultural approach is that by collecting data and viewing it through the perspective of the target culture, the clinician is able to make a less biased and more valid interpretation of ndings: thus the clinician is less likely to draw conclusions which lead to misdiagnosis. In the course of any SLT assessment, the clinician would take a case history, speak with parents and carers and carry out observations of the child. However, ethnographic assessment involves a more comprehensive procedure. It is worth mentioning that ethnographic interviewing has a long history of use within SLT, e.g. getting information from family members and understanding clients from the perspective of families (Hammer 1998). Its use is advocated with all client

groups, monolingual and bilingual alike. Westby et al. (1990) suggest that ethnographic interviewing enables the clinician to see the world from the clients perspective and in doing so places them at the heart of intervention goals and strategies. They argue that this client-centred perspective makes therapeutic intervention more effective. Cheng (1990) outlines the procedure as follows: Observing the child in multiple settings with a variety of different people to understand with whom the child interacts and how, what they talk about and what activities they enjoy. Observation should include a setting which facilitates a low level of anxiety and a high level of motivation to give the child opportunity to demonstrate their full communicative potential. Interviewing members of the family to learn about family dynamics, interactions, attitudes and cultural differences, and about the childs language history to nd out if the child is a simultaneous or sequential bilingual. Westby et al. (1990: 102) outline the type of questions that should be used to elicit ethnographic data and the principles which should be adopted to gain an extended and unambiguous response. This includes asking

SLT assessment approaches with bilingual children descriptive, open-ended questions such as Tell me about a typical day and limiting the use of closed and leading questions. Engaging in a childclinician session to learn about the childs interests, conversational strategies (maintenance, breakdown and repair) and interaction style (pragmatic skills). Consultation with teachers and teaching assistants to understand their observations and perspective. The clinician is recommended to reect on their own cultural perspectives, world views and biases. Increased awareness of self and others helps to reduce barriers and promote good cross-cultural communication. Cheng (1990: 115) argues that the comprehensive and detailed nature of ethnographic assessment increases the representativeness, reliability and validity of [collected] data. This approach also helps to create a language prole for the child: which languages are spoken in each setting and the means, reasons and opportunities for communicating in each language. For example, the child may speak English at school with teachers and peers and with siblings at home, but use Gujarati at home with parents and grandparents. RIOT procedure Cheng (1997) is also an advocate of the review, interview, observe and test (RIOT) procedure as a part of the sociocultural approach. This procedure draws upon other techniques discussed above, but modies them within the clinicians understanding of childs sociocultural context and environment, culture and subsequent development. Analysing all collected data in the light of ethnographic data will contribute to the decisionmaking process and reduce the chance of misdiagnosis. Cheng (1997) describes the components of the RIOT procedure as follows: Review all documentation, client records, clinical history and educational records. Interviewconduct an ethnographic interview with parents, carers, teachers and relevant others to nd out more about the childs language history, family dynamics, interactions, attitudes and cultural differences. For example, it would be useful to build a prole of which languages are spoken with each member of the family and which languages are used at school. Observe the child in multiple settings with a variety of different people. This could include observations at home with the immediate family (parents and siblings) or with wider family members (such as grandparents, cousins, etc.). In conducting an ethnographic study, Komulainen

623 (2005) made contrastive observations in a nursery and in a clinical setting (such as a therapy room). She observed the childs interactions with peers and adults (care staff and health professionals) during individual and group activities and at mealtimes. This meant observing interactions on different days and at different times. In addition to observing verbal communication, Komulainen (2005) made a note of the situational context and non-verbal interaction in order to interpret holistically a childs communicative ability. Westby et al. (1990: 103) comment that every social situation has multiple dimensions including the people involved, places used, activities, routines, objects, goals, time and feelings. Test all languages which the child speaks using (modied) formal assessments, informal assessments including language sampling, and alternative testing procedures such as DA. In conducting research into bilingual childrens oral prociency, S anchez (2006) developed a sociolinguistic questionnaire to determine patterns of language use amongst children. She was able to identify shifting patterns of language use within different communities and consider the effect of language use upon test data. The research carried out by Restrepo (1998) which combined language sampling with parental report also provides evidence that using the sociocultural approach (in this instance the use of parental interview) increases the accuracy of differentiating between bilingual children with and without LI, which could not be achieved by language sampling alone. Critical evaluationsociocultural approach The sociocultural approach is comprehensive and encompasses aspects of the other approaches which have been found to be effective indicators of LI in bilingual children. The weaknesses inherent to each approach are supplemented by ethnographic data which jointly aids their implementation and interpretation. By learning more about the childs cultural background, the SLT can plan activities which are language and culture specic. Cheng (1990, 1997) contends that only a sociocultural approach truly accounts for differences in cultural and linguistic background. Arguably, it gives bilingual children opportunities to demonstrate their full communicative competence because they are observed in a variety of settings and their sociolinguistic circumstances are better understood by the assessor. However, the approach is not without its disadvantages: it is an intensive, time-consuming and costly procedure. It will often involve employing bilingual coworkers/translators in order to be undertaken properly.

624 Nevertheless, these limitations must be balanced by signicant benets and the obligation to provide an equitable and diagnostically accurate service. The sociocultural approach may hold the key to reducing occurrences of misdiagnosis amongst bilingual children, thusin the long termit reduces costs by avoiding inappropriate spending. Implications for assessment and the profession Isaac (2002) contends that standardized assessments can be used to gain a qualitative (descriptive) measure of a childs linguistic competence, and that clinicians should not attempt to score the assessment for comparison with normative data. She comments that clinicians should use the test to analyse what skills the child has (in the broadest sense) and consider ethnographic variables which could explain poor performance. Cheng (1997) and Isaac (2002) maintain that standardized tests can be used as a component within a broader ethnographic approach. Many researchers cited here used standardized tests as the tool for implementing other approaches such as CR measures and DA. In these instances the researchers adapted the scoring procedures and interpreted them differently. McCauley (1996: 124) concurs with this view when she concludes that norm and criterion-referencing are probably best considered as modes of interpretation rather than mutually exclusive categories of tests. Caesar and Kohler (2007) suggest that improvements to practice will only be brought about when undergraduate programmes have a greater focus on alternative assessment procedures for bilingual children. Roseberry-McKibbin et al. (2005) found that SLTs whose undergraduate courses had a greater element of assessment of bilingual children perceived a greater lack of appropriate assessment procedures; at least this raised awareness of the difculties in assessing this client group. SLTs are unlikely to modify practice (in line with Health Professionals Council 2007: 2c.1) if they are unaware of the need to do so. However, awareness raising alone is unlikely to facilitate change. Caesar and Kohler (2007) conducted a survey to investigate the type and frequency of assessment approaches used by SLTs working with bilingual children. Of the 400 plus SLTs who responded, the majority stated that they used formal standardized testing most frequently, thus providing evidence that SLTs are over-reliant on standardized norm-referenced measures. Reportedly, DA was not mentioned by any of the clinicians responding to the survey. This implies that undergraduate or postgraduate training needs to give students opportunity to learn about and gain practical experience of using alternative methods of assessment within the context of the sociocultural approach. Clearly, the full range of cultural and linguis-

Caroline De Lamo White and Lixian Jin tic diversity that exists amongst bilingual clients cannot be represented in training courses, but carefully chosen representative examples can be given, so that SLTs are aware of the dimensions, scale and manner of variability as well as the range of cultural contexts, linguistic repertoires and cultural language styles. This should be supplemented with opportunity to sample a good range of assessment procedures and gain an understanding of the associated difculties. Continuous professional training in this aspect is also a way forward to develop the SLTs knowledge and competence in assessing bilingual clients. Conclusion In conclusion, no single approach to identify language impairment (LI) in bilingual children is effective on its own. Criterion-referenced (CR) measures and dynamic assessment (DA) have been found to be the most effective identiers of LI in bilingual children when integrated within the sociocultural approach. Norm-referenced, standardized measures can be used to provide descriptive measures of a bilingual childs language ability, but should not be formally scored and compared with the monolingual norms. Interpretation of assessments should be made in light of ethnographic information. A bilingual child should be assessed in all the languages they use and within each of their interaction environments, involving a bilingual co-worker where necessary. Figure 3 recommends that CR and DA

Figure 3. Suggested framework for using a sociocultural approach with bilingual clients.

SLT assessment approaches with bilingual children contribute to a sociocultural approach; but this practice with bilingual clients needs to be supported by updated training programmes offered to speech and language therapy (SLT) students and professionals. Language-processing measures have not been found to be good indicators of LI in bilingual children but further research should be undertaken to determine the diagnostic potential of sentence-repetition tasks. Most of the relevant research has been carried out in North America and it is important that studies are carried out upon minority ethnic and bilingual populations living in other countries where to be bilingual is normal. More research is recommended to analyse the inter-rater reliability and validity of DA techniques so that clinicians have increased condence and understanding of their application. Currently there may be an over-reliance on Western standardized assessments (Gladstone et al. 2009) among which more culturally appropriate assessment tools are lacking in local multilingual and multicultural contexts. This might explain the misrepresentation of bilingual children on caseloads. However, with the constant updating and improvement of SLT curricula and more recently published research ndings and outcomes on bilingual assessments and SLI, e.g. over 50 papers have been published or are in press since 2009 from one European Union project, it is recommended that SLT training and staff-development programmes should contain updated elements on the assessment of bilingual children and implementation of alternative assessment procedures with the sociocultural approach, produced within and outside Western countries, to enhance the condence of SLTs working with bilingual clients (Harnett and OToole 2009). Such programmes should include specic examples of linguistic and cultural differences to equip SLTs with the knowledge and skills to assess bilingual clients. They should encompass relevant aspects of intercultural communication and cultures of learning (Cortazzi and Jin 2002) to assist SLTs in communicating with bilingual clients and their carers within the sociocultural approach underpinning their assessments. As a result, it is hoped that bilingual children will receive a diagnostically accurate assessment which is linguistically and culturally sensitive and hence will only receive intervention when it is actually merited.

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