New assessment could reduce learning disorder misdiagnoses among bilingual children

As a San Francisco-based speech-language consultant in the mid-1980s, Elizabeth Peña noticed a discouraging trend. At one elementary school, speech-language pathologists had diagnosed every English-Spanish bilingual kindergartner with a language learning disability.

Doubting that every child had a learning disability, Peña—now a communication sciences and disorders professor at The University of Texas at Austin Moody College of Communication—made it her mission to reduce learning disorder misdiagnoses among English-Spanish bilingual children.

Peña and other researchers have introduced the Bilingual English-Spanish Assessment (BESA), which will help speech-language pathologists differentiate limited exposure to English from underlying language impairments among children ages 4 to 6 years, 11 months.

Conducted through Moody College's Human Abilities in Bilingual Language Acquisition Lab, research was funded by the National Institute for Deafness and Other Communication Disorders. Other researchers included Moody College Professor Lisa Bedore, San Diego State University Professor Vera Gutiérrez-Clellen, Temple University Professor Aquiles Iglesias, and La Salle University School of Nursing and Health Sciences Dean Brian Goldstein.

"Most standardized language assessments are developed for English speakers, and the assessments that are developed for Spanish speakers are focused on students who are monolingual or who mostly speak Spanish," Peña said. "But if students have a fairly balanced understanding of each language, which assessment do you give? That's why we developed the BESA."

Since the BESA's December publication, speech-language pathologists in private practice, schools and clinical settings across the U.S. have placed orders, according to AR-Clinical Publications owner Nancy Martin. A subsidiary of San Rafael, Calif.-based AbigSys Research, AR-Clinical Publications was formed to publish bilingual assessment materials.

The BESA is designed specifically for bilingual speakers and focuses on the features of Spanish and English that are most associated with language impairment. In Spanish, for example, children with language impairments tend to make more mistakes with articles that mark number and gender. In English, children with language impairments tend to have difficulties learning past tenses.

Unlike other assessments, the BESA also provides guidance for combining test scores from English and Spanish versions to reach a diagnostic decision.

In research presented at the 2013 American Speech-Language-Hearing Association Convention, recent University of Cincinnati Ph.D. graduate Rochel Lazewnik found the BESA to be the most highly discriminating of five standardized tests for predicting language impairment among bilingual children.

The BESA's key strengths are that it includes English and Spanish subtests and items based on the linguistic characteristics and cultural practices of bilingual English-Spanish children, Lazewnik said.

Kai Greene, who earned his Ph.D. in communication sciences and disorders from the Moody College in 2012 and has worked for more than 10 years as a bilingual certified speech-language pathologist in Texas and California, said the BESA is a huge step in the right direction for speech-language pathologists, educators, administrators and parents.

"Sadly, much work still needs to be done in terms of educating school administrators, teachers and parents about many of the unique factors that revolve around bilingual language learning," said Greene, now an assistant professor at California State University, East Bay. "The issue of overdiagnosis persists in that bilingual children's language differences are mistaken as disorders."

Casey Taliancich, a communication sciences and disorders doctoral candidate, said such a test would help her in her position as a speech-language pathologist in Dallas.

"With the assessment we've been using, it's difficult to get a comprehensive picture of language needs," Taliancich said. "I'm confident that this new assessment will be an efficient tool for speech- pathologists."

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