Clinical Guidelines on Speech, Language and Communication Disorders in a Bilingualism Context

These are provided to illustrate that guidance on bilingualism and home language assessment and intervention are not new. The Royal College of Speech and Language Therapists has had such guidance in place for over 30 years.

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Communicating Quality 3

The Royal College of Speech and Language Therapists (RCSLT) issued Clinical guidelines in book format (and as a PDF document). The third edition including the following guidelines on working with bilingual people.

Stow, C. J. (2006). Chapter 8. Service Provision: Part 3, Working with Specific Client Groups, 8.5 Bilingualism. In The Royal College of Speech and Language Therapists, Communicating Quality 3: RCSLT's guidance on best practice in service organisation and provision (3rd Ed., pp. 268-271). RCSLT: London. ISBN: 0-947589-55-4

8.5 Bilingualism
This information is designed to support speech and language therapy services undertaking reviews of service organisation and provision. Therapists seeking detailed clinical guidance are referred to the RCSLT Clinical Guidelines (2005), position papers and Reference Framework: Underpinning Competence to Practise (2003), available on the RCSLT website:


Individuals or groups of people who acquire communicative skills in more than one language. They acquire these skills with varying degrees of proficiency, in oral and/or written forms, in order to interact with speakers of one or more languages at home and in society.
An individual should be regarded as bilingual regardless of the relative proficiency of the languages understood or used.
Any of the conditions listed within this chapter may occur in the context of bilingualism. Cross-referencing with all chapter 8 client group sections is therefore recommended.

National guidance and sources of further information
RCSLT SIG Bilingualism Good Practice Guidelines. RCSLT (to be revised, 2005).
Race Relations (Amendment) Act, 2000.
Sure Start planning pack: Sure Start for all: Guidance on involving minority ethnic children and families. Department for Education and Employment, 1999.
Quality protects: Black and ethnic minority children and their families. Department of Health, 1998.
The NHS Plan: A plan for investment, a plan for reform, Department of Health, 2000. Disability Discrimination Act,1995.
Human Rights Act, 2000.

Bilingualism is not a disorder and it is not therefore appropriate to be considered as a condition with measurable prevalence. There are few reliable official statistics on the number of bilingual individuals in Britain and there is virtually no data available on language use in Britain.
The UK Census 2001 indicates that 7.9% of the population is from a minority ethic background and, although caution should be exercised in equating a minority ethnic background with bilingualism, the links between language, ethnicity and culture are widely acknowledged (Battle, 1998; Schott & Henley, 1996).
There are over 300 languages spoken by children in London schools (Literacy Trust, 2000). Winter (1999) reports that 59% of SLTs working with a paediatric caseload in England have at least one bilingual child on their caseload, with 11% of these having 20 or more bilingual children on their caseload.
As bilingualism does not cause communication disorders, there is no reason why bilingual children should have a different rate of speech and language problems from a monolingual population (Crutchley, 1999; Crutchley et al, 1997a, 1997b; Duncan & Gibbs, 1989; Winter 2001).

Speech and language therapy value
Assessment of the individual’s communication skills in all the languages to which they are exposed. This detailed assessment will facilitate the SLT to reach a differential diagnosis and establish if there is a primary communication difficulty that does not arise as a result of acquiring English as an additional language.
Providing intervention in the individual’s mother tongue and support the family in their use of mother tongue when necessary/appropriate, ie when it is the individual’s preferred/ dominant language. Language choice should be discussed and agreed with families. With regard to children, the evidence base demonstrates both the need for mother tongue therapy in cases of speech disorder (Holm & Dodd, 2001; Holm et al, 1999) and the efficacy of therapeutic intervention in the individual’s mother tongue in language delay and disorder (Guttierrez-Clellen, 1999).
Ensuring equal access and equal quality of care for all members of the local population regardless of ethnic or linguistic background. The use of trained bilingual SLTAs/ bilingual co-workers and expertise in working with interpreters will ensure that bilingual individuals have access to all care pathways.
Ensuring a clear, culturally appropriate explanation is provided in the most appropriate language for individuals with dysphagia and their families in order to minimise the risk of aspiration, chest infections and malnutrition. Guidelines should be provided in the most appropriate medium and language as well as demonstrated and reviewed until fully understood.

Vulnerability: risk issues
Specific language impairment is under-identified within bilingual children in the UK. These children are therefore not accessing speech and language therapy services (Crutchley et al, 1997a, 1997b; Winter, 2001).
Similarly there is evidence emerging that bilingual children with speech disorders are not being identified by referral agents and are therefore under represented on speech and language therapy caseloads (Stow & Dodd, 2005). Bilingual individuals may be vulnerable to well-meaning, but ill- informed, professionals who advise the abandonment of mother tongue in order to facilitate the development of skills in English. SLTs should not advise individuals and their carers to abandon their mother tongue to facilitate progress in English. The RCSLT recognises that bilingualism in an adult or child is an advantage and does not cause communication disorders. With regard to assessment and differential diagnosis, bilingual individuals are vulnerable to misdiagnosis if linguistically and/or culturally inappropriate assessment tools are used to reach a diagnosis. An incomplete picture of their skills will emerge if only one language is assessed. There is also risk if normative data that has been developed with monolingual populations is applied to bilingual individuals. SLTs should strive to assess an individual in all the languages to which they are exposed. When reaching a differential diagnosis, or writing reports, SLTs should highlight any areas where lack of appropriate assessment tools have prevented a full investigation of an individual’s skills.
Lack of therapy material or written information translated into other languages may mean that individuals are not able to access AAC systems and families are not able to fully partake in intervention. As a result, compliance may be reduced.
Understanding the aetiology of a condition may be difficult, if language barriers exist and bilingual co-workers are not present at consultations.

Royal College of Speech and Language Therapists' Special Interest Group in Bilingualism

RCSLT's Special Interest Groups (SIGs) were the forerunners of the current Clinical Excellence Networks (CENs). These consisted of Speech and Language Therapists and sometimes other members of the multi-disciplinary team meeting to develop best practice.

The RCSLT SIG Bilingualism developed the document 'Good practice for Speech and Language Therapists working with clients from linguistic minority communities: Guidelines of the Royal College of Speech and Language Therapists (2007).

Prior to this, Deirdre M. Duncan edited Working with Bilingual LAnguage Disability, published under the Therapy in Practice banner. This was a project of the SIG Bilingualism. Duncan, D.M. (Ed.), (1989). Working with Bilingual Language Disability. Chapman and Hall: London. ISBN 0-412-33940-4

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