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This Practice Portal page focuses on audiology and speech-language pathology services for multilingual people across the life span. Visit Multilingual Service Providers for more information about audiologists, speech-language pathologists (SLPs), and assistants who use more than one language in service delivery.
Multilingualism is hard to define because of the differences among the people who understand and use more than one language. Differences can include the ages of acquisition, contexts for use, and levels of competence (Valds, n.d.). As a result, terminology is evolving to describe a multilingual person and the languages they use. Some examples are as follows:
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There is an increasing prevalence of multilingual people. The U.S. Department of Health and Human Services (HHS) created the National Culturally and Linguistically Appropriate Services Standards to improve the quality of care and promote health equity. The principal standard urges health care organizations to be responsive to diverse cultural health beliefs, languages used, healthy literacy, and additional communication needs.
The ASHA Code of Ethics (ASHA, 2023b) indicates that audiologists and SLPs shall engage in only those aspects of the profession that are within their scope of professional practice and competence, considering their level of education, training, and experience. See the next section below for additional ethical considerations.
Circumstances may call for the clinician to work with an interpreter to ensure that clinical services are provided in the language that is most appropriate for the patient and family. For additional information related to working with interpreters in spoken and manually coded languages, please see the Practice Portal page on Collaborating With Interpreters, Transliterators, and Translators.
It is the legal and ethical responsibility of the facility and its providers to offer reasonable and appropriate accommodations to facilitate access to clinical services. See the State and Federal Legislation section below for additional legal considerations.
The ASHA Code of Ethics (ASHA, 2023b) and the Issues in Ethics statement on Cultural and Linguistic Competence (ASHA, 2017) clarify the principles related to providing services to multilingual people. These principles include
Several state and federal regulations have implications for the provision of audiology and speech-language pathology services to multilingual clients, patients, or students. Differences in state regulations may be reflected in several requirements, including education. See the ASHA State-by-State advocacy page for a summary of state requirements.
According to the Office for Civil Rights, all providers who work for any agency funded by the HHS are required to provide language access services to patients who use languages besides spoken English.
Health entities must also take reasonable steps to provide meaningful access to people who use languages besides spoken English. Covered health programs or activities are also required to post taglines in at least the top 15 languages in their state. Taglines are brief messages in documents and websites that explain how people can obtain a translation of the document or request an interpreter to explain the document for them in their heritage language(s).
IDEA was enacted to ensure that everyone, including children with disabilities, receives a free and appropriate public education. IDEA 2006, Part B, Final Regulations, supports nondiscriminatory service delivery by establishing the following:
Federal regulations clearly define steps that states must take to address the problem of disproportionality in special education. Children who are ELLs and who are suspected of having a disability must be evaluated in a timely manner (Office for Civil Rights, 2015). The Office for Civil Rights (2015) clarified that ELLs with disabilities are entitled to a free and appropriate public education. This means that school districts are obligated to provide language assistance (e.g., English as a second language [ESL] services) and disability-related services (i.e., IEP, 504 plan).
ESSA, Public Law 114-95, reauthorized the Elementary and Secondary Education Act and its long-standing commitment to equal opportunity for all students. ESSA, which replaced the No Child Left Behind Act, provides greater flexibility to state and local governments to create their own accountability systems, academic goals, reporting, and other requirements when implementing programs. ESSA ensures that all students are prepared for college and careers.
ESSA requires that states (a) include English language development/proficiency in their accountability frameworks, alongside statewide math and language arts assessments, and (b) report English proficiency progress by a growth measure for up to 4 years.
Understanding the typical processes and occurrences of acquiring additional language(s) after learning any first language(s) ensures accurate speech and language assessment of multilingual clients. The experience of learning a second language is unique to each person, but common experiences during the second-language acquisition process are listed below. See additional resources and information to share with families on Learning More Than One Language.
Influence or transfer occurs when the structure of a primary language (L1) directly influences an utterance made in a second language (L2). For example, children who are sequential ELLs may manifest influence or transfer from their first language (L1) to English (L2). In children who are simultaneous bilinguals, influence or transfer may occur between the two languages. Patterns that are the result of influence or transfer are not indicative of a disorder.
A silent period may occur during the initial phase of second-language acquisition while an individual focuses on listening and comprehending the new language (Elizalde-Utnick, 2007, as cited in Mayworm et al., 2015). The main characteristic of this developmental stage is that, after some initial exposure to the language, the learner can understand much more than they can produce.
Code-switching involves changing dialects or languages within utterances (known as intra-utterances) and across utterances (known as inter-utterances) based on the linguistic context and community around them (Roseberry-McKibbin, 2014). Many fluent multilingual speakers code-switch. In individuals who are simultaneous bilinguals, code-switching does not occur randomly. It is grammatically and socioculturally constrained.
Code-switching may be a cognitive strategy for multilingual people to easily access all the languages they know in order to provide alternate ways to convey meaning (Beatty-Martnez et al., 2020). Adolescents and adults who are developing proficiency in a second language may substitute grammatical structures and words from the first language for forms that they have not learned yet in the second language; however, this is not necessarily indicative of a language disorder (Roseberry-McKibbin, 2014).
Variation from typical code-switching constraints in adolescents and adults who are fluent in multiple languages may indicate cognitive and/or communication disorders. These errors are often noted due to deficits in executive function and decreased inhibition of the nontarget language, dementia, aphasia, and other language disorders (Ansaldo & Marcotte, 2007).
Translanguaging proposes that multilingual speakers have a unified linguistic repertoire consisting of all of the linguistic features that a speaker uses based on different contexts without focusing on a single language (Otheguy et al., 2015). The notion of translanguaging challenges the hierarchical nature of socially constructed languages as well as the suppression of minoritized languages and peoples (Otheguy et al., 2015).
In children, the order of acquisition in one language may influence phoneme acquisition in another language. Additionally, accent may affect phoneme use and substitutions in each language. Dialect may influence the development of morphosyntax, syntax, and semantics as influence/transfer may appear across the languages that the child is learning (Yavas, 2007).
In an adult population, an accent may continue to influence phonetic patterns. Learning the appropriate phonetic patterns of a second language may become more difficult with age, and the influence of a first language on speech in a second language may be more evident. The clinician considers if the phonetic patterns observed are consistent with second-language acquisition and with the baseline for the individual or if they are the result of a communication disorder (Bell-Berti, 2007).
The clinician also considers the nature of language demands in a given interaction and the effects that contextual support, or lack thereof, may play in language proficiency. Cummins (1984) distinguished between two types of language proficiencies:
For more information about care of multilingual people with specific disorders or conditions (e.g., aphasia, dysphagia, spoken language disorders), visit the Clinical Topics page on the Practice Portal.
In some settings, such as schools, a speech-language and hearing screening may be conducted to determine whether there is a need for further assessment. Screening activities do not result in diagnosis. Screening multilingual individuals may include the following:
A comprehensive assessment of communication skills is culturally relevant and functional. It involves the collaborative efforts of families/care partners, cultural brokers, interpreters, and other professionals as needed.
Parent surveys for young bilingual children can be an effective way to gather information about early language development (Thal et al., 2000). Parent surveys used during a preliminary screening of a bilingual child have the potential to yield valid and reliable information (Guiberson & Rodrguez, 2010).
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