Case History Form
Assessment Framework 3-5Yrs
Assessment Framework 5-9Yrs
Assessing Phonology

·    Why do we need a thorough assessment?
·    What are the aims of assessment?
·    How do we assess?
·    Formal Assessment
·    Informal assessment
·    What do we assess?
·    Identification of a language difficulty
·    Who assesses the needs of a bilingual child?
·    What practical limitations can we face?
To diagnose between a language acquisition problem affecting all language learning and a problem affecting the acquisition of an additional language (AL).
A child who has limited AL proficiency should not be considered to have a speech or language disorder if the communication pattern reflects the child’s limited exposure in using the AL.

The assessment needs of a bilingual child are essentially the same as those of a monolingual child, regardless of the languages spoken by the child. The aim of an assessment of communication abilities and needs remain the same. The reasons for assessment are as follows:

  • To investigate the child’s communication abilities and needs in one or more specified areas of language across both/all the languages the child is exposed to, i.e. attention/listening, play, comprehension, expression, speech, social skills.
  • To describe the child’s speech and language skills in terms of their linguistic ability taking into consideration any medical, cognitive, psychological factors and socio-economic status, providing clear aims and objectives for appropriate management.
  • To diagnose between a language acquisition problem affecting all language learning and a problem affecting the acquisition of an AL.
  • To help decide whether speech and language therapy intervention is required and/or a referral is needed to other agencies.
  • If SLT is appropriate, to provide a baseline for therapy.
  • To identify the child’s education/social needs in relation to communicative abilities, so that the necessary resources can be organised to support the child in school/home and in the community.

Review, Interview, Observe and Test: ‘Based on the assumption that every individual is an inseparable part of a social system and that one’s behaviour cannot be understood without considering its context’ (McCormick 1997, from Martin D. 2009, Language Disabilities in Cultural and Linguistic Diversity)

Assess both/all languages
: The bilingual child’s language proficiency is not like that of a monolingual speaker – as both languages integrate to some extent. We are therefore not looking at 2 individual languages – we are looking at the skills across both languages. Need to look at all areas – attention, listening, play, social skills, comprehension, expression and speech including functional communication skills.

·    Ensure you spend time interviewing the parent/carer
·    As far as is possible, try and observe the child in multiple environments with child interacting with different people. 
·    Also, try and get as many samples of natural communication as possible (home, school) in order to accurately establish the child’s level of expressive language.
·    Gain a baseline and ascertain language levels in both/all languages

: Look at the whole development of the child – not just speech and language skills. Consider cognitive, psychological, social, emotional, environmental, educational, medical, physical aspects of child’s development.  Review all pertinent documents from other professionals that are involved.
Differential diagnosis: Apply your theoretical knowledge and consider the features of second language acquisition.  Specific Language Impairment vs. Additional Language Development, Selective mutism vs. silent period, non specific vocabulary vs. word finding difficulties, Global developmental delay.  See differential diagnosis checklist.
Identify needs and plan next steps: Does the case warrant further SLT involvement? Is there another organisation better suited to meet this child’s needs? Is SLT a priority concern for this child’s family?  
Be dynamic: ‘With dynamic assessment the practitioner can determine not only the child’s current level of functioning, but also the best means to facilitate further learning. ‘
Ref: Martin, D. 2009, Language Disabilities in culture and linguistic diversity Page 171
In dynamic assessment, assessment and teaching/learning co-occur.  Not just a snap shot static assessment – but assessment over time.


Formal assessments/checklists used by Speech and Language Therapists, Educational Psychologists and Teachers that are standardised on monolingual L1 speaking children (e.g. English in the UK) should not be used in the prescribed way for assessing bi/multilingual children learning the majority language as an AL and/or are from diverse cultural backgrounds. 
If such an assessment is used to assess an AL child’s language skills, one should not give standard scores or percentiles. Instead, describe the child’s performance in a qualitative manner in the child’s notes, report, whilst remembering to state that the assessment was normed on a monolingual L1 speaking population.
• Standardising a language developmental test on first language L1 speakers (e.g. English in the UK) means that the norms for language development cannot extend AL speakers/learners.
• Linguistic Mismatches -Translating formal English assessments into other languages is inappropriate and inaccurate because the linguistic term in English may translate into a different linguistic form in the other language. This may emerge developmentally at a different stage in that language.
• Culture Mismatches – E.g. the cultural references of the English tests reflect the lifestyle of the “white middle class” majority in the UK, e.g. asking a child to “put the spoon in the cup” (Reynell Developmental Language Scales 3). This is an obvious association for a child from the ‘white’ majority culture but a more obscure association for a child from a different culture background where teaspoons are not associated with teacups.
• However, take care not to make assumptions and stereotype e.g. do not assume that just because the eating of pork is forbidden in Islamic culture, that you may not use pigs in the language assessment of a Muslim child. Ask first!
• Children from some cultures may not be used to testing situations and will vary in their familiarity with a test situation. This could influence their performance.

The most representative language samples are obtained in a variety of natural settings, e.g. home, playgroup and with at least two different “communicative partners”, e.g. parents/carers, nursery key workers, siblings.  
• Use informal/natural communication. 
• Use picture books/toys. 
• Observe parent-child interaction.


Case History
Please see additional case history. If this form is used or adapted in any way please ensure the original source is referenced.
·    Language map – who speaks what and with whom, when and in what context
·    Establish aetiological factors
·    Establish if there are any environmental factors that maybe influencing the communication environment
·    Obtain information about the constraints of variables, e.g. a family can speak a different language but cannot read it. That will need to be adjusted to, for effective and efficient support and intervention, e.g. leaflets
Attention and Listening and Behaviour
·    Remember to ascertain skills in a variety of contexts
·    The child may have greater difficulty in listening to an unfamiliar language. 
·    Are you using the correct name/pronunciation to get the child’s attention? Check what name the child is usually called at home
·    Consider that there maybe cultural variations in the expectations of the child to sit and attend.  Could this be reflected in actual attention and listening abilities?
Non-verbal skills
·    ‘Good enough draw a man’ test
·    Copying shapes (norms give you some idea of child’s level of cognitive functioning)
·    Refer to Mary Sheridan, 2009 From Birth to Five Years for developmental stages e.g. building brick tower
·    Portage checklists
·    N.B. cultural appropriate/familiarity of materials used
·    Questions to ask: who plays with the child? what do they play with? how often do they play?
·    Think about your play materials – familiarity, gender differences
·    Beware of using formal assessments e.g. symbolic play test - not culturally sensitive e.g. in some Asian cultures, knife and fork would be unfamiliar – to a child who eats with his fingers – tractor/chequered table cloth would be unfamiliar to some of our monolingual English speakers too!
·    Determine what sort of toys/games/materials child plays with at home
·    Determine how and with whom child plays with
·    If appropriate observe parent/carer playing with child (note parent/child interaction styles).  May be more appropriate to observe siblings play together
Social Skills
·    Be aware that if the child is reported to not initiate as much as you would expect for their age, perhaps it is less appropriate in their culture.
·    Important to establish what is considered appropriate and inappropriate in child’s culture e.g. in some Somali cultures eye contact with elders is considered disrespectful
·    N.B. Assessing pragmatic and conversational skills build up a child’s profile of activities and performance, strengths and weaknesses, e.g. a child’s ability to seek clarification in school/home, ability to take turns in a conversation or in a game, following the routine of the school day.
·    Check language exposed to and dialect.
·    Beware of standardised, formal assessments and remember not to give age equivalents without qualifying that the norms are based on the performances of monolingual L1 speaking peers.
·    Do not give quantitative scores.  Instead use the assessment as a guide and give qualitative information. 

  • When using standardised assessments, compare child against

themselves over a given time period taking into account progress made developmentally.
·    Check cultural appropriateness of materials used in assessments.
·    Be aware that the linguistic structure of other languages may differ from those used in the standardised assessments.
·    If using an interpreter be aware that the translated questions may differ in terms
·    Informal screen using culturally sensitive materials
·    Check concept knowledge; understanding of grammar etc.
·    Consider what strategies aid the child’s comprehension? Repetition, cueing, chunking, visuals etc.

·    Remember the features of additional language acquisition e.g.
o     silent period – this can last up to 6-8 months after being exposed to the new/additional language
o      interference - be aware that errors in English therefore may reflect differences in:  sentence structure, grammatical differences, and developmental acquisition of the child’s home language.
o     empty/non specific vocabulary use - if the child is using a lot of gesture/fillers/non specific language it is important to distinguish whether this is a word finding difficulty or that the child does not know the word in the AL.
·    Make sure you distinguish whether the child is using the home language or jargon. 
·    Grammar/linguistic rules for each language child is exposed to will be different – and expressed differently. Bear in mind that in some languages a short sentence may equate to a longer one in another language.  Therefore if a child uses a short mean length of utterance in the AL this does not mean that they necessarily have limited expressive skills in their home language.
·    Informal: action picture cards, conversation, narrative.
·    Obtain Video/Audio sample of child in a variety of natural settings
·    If using formal assessments, use them qualitatively comparing the child against himself over a given time period – taking into account progress made developmentally.
·    Consider functional communication skills: How effective is child in getting his message across in order to initiate, request, refuse, comment, describe etc

Oral examination
·     As you would a monolingual

·     The sounds in the English sound system may differ from the child’s home language.
·     If possible try to determine whether speech sound errors in English are in fact normal in the home language, for example in Arabic [p] does not exist.   This sound is therefore realised as a [b].
·     DEAP is normed on bilingual children.
·     Informal: picture books, form boards/inset puzzles, bag of objects
·     Remember – articulation vs. phonology problems. 
·     Articulation problems – affecting the motor aspects of speech production can be present in both languages so problems and therefore therapy in one language can impact on the other language (as long as that sound is present in both languages). 
·     Phonology problems – affecting the child’s system of speech sounds at a linguistic level – will differ for each language – so problems in one language will not necessarily be present in the other language and therapy targeting a process in one language may not necessarily rectify or impact an affected process in the other language (if it is present in the first instance)


·     As you would a monolingual
·     Breathing posture, tension, contributing and maintaining factors


·     As you would a monolingual
·     Breathing, phonation, quality, contributing factors


For children learning English as an additional language (EAL)
Some possible symptoms of a potential language disorder in EAL children (Wei, Miller and Dodd 1998):
If the EAL child is unable to do one or more of the following, when compared to children of similar age, no matter which language is being used, the problem may be a language disorder:

  • produce common speech sounds N.B. sounds in home language vs. English
  • understand familiar words
  • say words commonly found in children’s vocabulary
  • remember pronunciation of new words
  • express themselves in grammatical sentences
  • use appropriate non-verbal communication N.B. cultural differences

Do not assume if a child is not speaking, that they can speak in home language – you need to ask the parents about their home language skills. 
Be aware of children who are speaking some English – but are not adding to their repertoire.
If you cannot understand what a child is saying, do not assume they are words in mother tongue - as they may be jargon which do not have a meaning in any language.

Signs related to ‘less than perfect learning’ of the additional language rather than potential language disorder:
(Wei, Miller and Dodd 1998 p.4):
·    Knows many more words in one language than in the other
·    Some words always said in one language and not in the other
·     Pronunciation errors in one language but can produce the same/similar speech sounds in the other language
·    Interested in learning new words in one language but not in the other
·    Can use grammatical sentences in one language but not in the other
·    Is fluent in one language only
·    Chooses to use the ‘wrong’ language with other speakers
It is important to work with other professionals and parents/carers in order to meet the needs of the bilingual child with SLT difficulties. 
·     SLT
·     Parents/Carers
·     Education – SENCo, Teachers, Learning Support staff
·     Education Psychologists
·     Paediatricians

  • Occupational therapists, Physiotherapists

·     Health Visitors
·     Social workers
·     Bilingual Co-Workers/Interpreters
•     Lack of developmental norms for some languages. 
•     Lack of knowledge about how AL learners learn the majority language of the country (e.g. English in the UK).  Uniqueness of each child’s “bilingual” language ability.
•     Lack of knowledge about target language/speech sound system
•     Lack of standardised assessments in each of the target languages
•     Insufficient cultural information on family relationships, attitudes to ‘disability’, attitudes towards discourse, language functions and literacy.
•     Lack of culturally appropriate material and resources (e.g. observation checklists, resources)
•     Differences between practitioner & child/family (attitudes, knowledge, culture, religion, language & gender)
•     Different dialects of interpreter/support staff
•     Lack of sufficiently trained bilingual support staff
•     Financial and time limitations e.g. interpreting services can be costly
•     Lack of access to and knowledge of available services
•     Generalisation of language/skills from school to home setting and vice versa
•     Difficulties understanding written correspondence
•     Terminology interpretations (rehabilitation & autism)
•     Medical versus cultural models of “cure”
•     Lack of parental concern