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Red flags to identify if a bilingual child is at risk to develop a language disorder

Posted on
June 29, 2022
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ASHA certified Speech and Language Pathologist, Johanna Pino Grisales, dives into the red flags to identify if a bilingual child is at risk to develop a language disorder. Johanna is a bilingual swallowing specialist and currently resides in Barcelona, Spain.  

It remains unclear the exact number of languages spoken around the world. According to an article in the Linguistic Society of America, by 2009, it was estimated that there was a total of 6,909 distinct languages. This number can potentially be a lot higher, considering the fact that certain areas around the world have not been studied yet. Therefore, we can assume that at some point in our lives, and depending on our geographical location, we have or will be exposed to another language. For example, people living in areas of the world such as Europe and North America, grow up in environments where two languages coexist.

Throughout the article we will be talking about Michael and use him as an imaginary example:

Michael, a 5-year-old English speaking boy, will soon be moving from Michigan, USA to Barcelona, Spain. Michael has been exposed to English his entire life, except for a couple of Spanish classes he took during the summer in preparation for the trip. His dad speaks some Spanish, but he never uses it at home. Michael struggles a lot in school. He has difficulties following instructions, needs repetitions of tasks, and experiences difficulties producing complete sentences in English. Michael barely interacts with other children and prefers to play by himself. Now that the family is moving to a country where the dominant language is Spanish, Michael’s parents are scared about “confusing” their child with another language…

What is bilingualism?

“Bilingualism refers to the ability to use two languages in everyday life. Bilingualism is common and is on the rise in many parts of the world, with perhaps one in three people being bilingual or multilingual” (Wei, 2000). Some key variables should be considered when defining a bilingual person including:

  • Age and manner of acquisition
  • Proficiency levels in specific languages
  • Domains of language use
  • Self-identification and attitude

Let’s consider two main categories of bilingualism:

  • Simultaneous Bilingualism: It refers to someone who is equally exposed to two or more languages from birth
  • Sequential Bilingualism: It refers to someone who acquired one or more languages after having learned the first one

What type of bilingual will Michael become?

Despite the prevalence of bilinguals around the world, there are still many misconceptions around the topic. Research is still evolving in this young field, and some time needs to pass until we can get more accurate answers. However, research has already helped us as providers and caregivers to understand how to differentiate myths from evidence-based information.

Before moving to Spain, Michael’s parents took him to his last appointment with the pediatrician. They shared with him their concerns about Michael’s language delays and even expressed their worries about exposing him to a second language. The pediatrician increased their concern, as he suggested that exposing Michael to another language will most likely “confuse” him, exacerbating his problem. He recommended following up with a speech and language pathologist to decide whether he would be a good candidate for therapy. Based on the pediatrician’s remarks, Michael’s parents decided to minimise his exposure to Spanish while in Spain. To do so, finding a monolingual school and making sure that they only continued speaking in English at home.

Let’s dive into some facts about a bilingual child!  

“Speaking two languages to a child may cause a speech or language disorder”

Fact: If a bilingual child has a speech or language problem, it will show up in BOTH languages. However, these problems are not caused by learning two languages.


“Learning two languages will confuse your child”

  • Fact: Some bilingual children may mix grammar rules from time to time, or they might use words from both languages in the same sentence (i.e., "quiero mas juice" [I want more juice]). This is a normal part of bilingual language development and does not mean that the child is confused. They will ultimately learn to separate both languages correctly.


“Children with speech or language processing disorders can have more difficulty learning a second language”

  • Fact: Children with speech and language disorders may have more difficulty learning a second language but research shows many can do so successfully.


“Bilingual children will have academic problems once they start school”

  • Fact: The school setting that best suits bilingual children depends on the age of the child. If a child mainly speaks Spanish, immersion in an English language-speaking classroom might be the best approach for a younger child but might be less effective for an older student. Research shows many academic advantages of being bilingual. Including superior problem solving and multitasking skills, as well as increased cognitive flexibility.


“If a child does not learn a second language when he or she is very young, he or she will never be fluent”

  • Fact: Although the ideal language-learning window is during the first few years of life, the most rapid period of brain development. Older children and adults can still become fluent in a second language.


“If a child is not equally fluent in both languages, he/she is not truly bilingual”

  • Fact: Many people who are bilingual have a dominant language, which can change over time, depending on how often the language is used. Just because someone is not equally fluent in both languages does not mean he or she is not bilingual. Regular use and practice of verbal communication, along with writing and reading, will help children (and adults) retain their second language long-term.


So far, we have covered the definition of bilingualism, two of the main categories and some common misconceptions around the topic. Now, let’s cover some common red flags to identify if your child needs a comprehensive evaluation by a speech and language pathologist.

Red Flags for Speech

Normally, caregivers or people in the immediate environment notice when a bilingual child is struggling in this area. Here, we have a child that is unable to produce specific sounds in the any language and that cannot be understood by unfamiliar listeners. They rely on other means of communication such as pointing or using nonspecific vocalizations. Some of these children might experience increased frustration levels as they cannot identify the specific sounds involved in the production of a word in the target language.

Understanding speech development is a key factor to determine the presence of a speech disorder in a bilingual child. Each language follows a set of milestones that develop over time. If suspecting a speech delay in a bilingual child, it is recommended to consider the child’s age and the development of his/her speech milestones in his dominant language(s). If a therapeutic intervention is guaranteed, this can help in determining the specific set of goals.

Red Flags for Language

Just as speech development, language also follows a set of similar guidelines. That means that certain milestones need to be met first, for others to develop later. A bilingual child at risk to develop a language disorder, exhibits difficulties in BOTH languages. Observing very little or no language development over an extended period in BOTH languages can be considered one of the main red flags. Some of other red flags include:

  • Difficulties following directions
  • Difficulties understanding questions and/or comments in a conversation requiring repetitions
  • Little to no desire to engage in communication interactions with others.
  • Difficulties organizing words into syntactically correct sentences to ask a question
  • Preference for one-word utterances (e.g., “milk” instead of “I want milk”)
  • Difficulties retelling events that happen to him/her
  • Difficulties sequencing events
  • Prolonged pauses in between a comment and/or question and their answer.

For older children we also see:

  • Difficulties with reading, writing, math
  • Difficulties understanding figurative language (e.g., It’s raining cats and dogs)
  • Difficulties making inferences or predictions.
  • Difficulties with social interactions


When considering these red flags, keep the previously mentioned categories of bilingualism in mind (i.e., simultaneous & sequential bilingualism). In the case of simultaneous bilinguals, where the child was exposed both languages since birth, it is important to identify a bilingual provider. In the case of sequential bilinguals, it is important that the provider establishes the dominant language. You can do this by administering a questionnaire (Language Experience and Proficiency Questionnaire LEAP for a set of specific questions in different languages) to determine the dominant language at home, and conduct testing first in this language. It would be unfair for a sequential bilingual to be classified as having a speech and language disorder, when in fact he/she is only exhibiting difficulties acquiring another language. In fact, it has been well documented that bilingual children are often over-diagnosed with a speech and language disorder. As they score lower in standardised tests that are not sensitive enough to identify difficulties acquiring a second language.  

Following Michael’s pediatrician’s advice, his parents decided to get him evaluated by a speech and language pathologist in Michigan. Recap on some of Michael’s red flags:

- Difficulties following instructions
- Need for repetitions
- Limited verbal output in dominant language (English)
- Limited social interactions with other students

Results from the comprehensive evaluation, revealed that Michael exhibited below average receptive and expressive language skills in comparison to monolingual children his age. Impacting his academic performance and social interactions. When reviewing the results, the speech and language pathologist explained the social and cognitive advantages of exposing Michael to a second language and encouraged them to support him in the acquisition of Spanish. She suggested finding a provider in Barcelona that could target goals in Michael’s dominant language - while encouraging the incorporation of a second language. Michael’s parents felt more at ease with the recommendations and decided to stay in touch with the provider to get tele-consultations at least once a month.

If you'd like an initial online assessment, feel free to book via Noala Hub - assessing receptive and expressive language

References

Byers-Heinlein, K., & Lew-Williams, C. (2013). Bilingualism in the early years: What the science says. LEARNing landscapes, 7(1), 95-112. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6168212/

García EE, McLaughlin B, Spodek B, Saracho ON. Yearbook in early childhood education. Vol. 6: Meeting the challenge of linguistic and cultural diversity in early childhood education. New York: Teachers College Press; 1995

How many languages are there in the world? | Linguistic Society of America. (s. f.). https://www.linguisticsociety.org/content/how-many-languages-are-there-world

lbreiseth. (2016, noviembre 22). At-risk learners and bilingualism: Is it a good idea? [Text]. Colorín Colorado. https://www.colorincolorado.org/article/risk-learners-and-bilingualism-it-good-idea

Leap-questionnaire « bilingualism and psycholinguistics research group. (s. f.). https://bilingualism.northwestern.edu/leapq/

Prath, S. (2016). Red Flags for Speech-Language Impairment in Bilingual Children: Differentiate disability from disorder by understanding common developmental milestones. The ASHA Leader, 21(11), 32-33. https://doi.org/10.1044/leader.SCM.21112016.32

Wei L. Dimensions of bilingualism. In: Wei L, editor. The bilingualism reader. New York: Routledge; 2000. pp. 3–25.

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