Bilinguismo

Article published online: 2022-07-07
THIEME
Original Article e33
Assessing Language Skills in Bilingual Children:

Current Trends in Research and Practice
Max R. Freeman1 Scott R. Schroeder2
1 Department of Communication Sciences and Disorders, St. John’s Address for correspondence Max R. Freeman, PhD, CCC-SLP,
University, Jamaica, New York, United States Department of Communication Sciences and Disorders, St. John’s
2 Department of Speech-Language-Hearing Sciences, Hofstra University, St. John Hall 344, 8000 Utopia Parkway, Jamaica, NY
University, Hempstead, New York, United States 11439, United States (e-mail: [email protected]).
J Child Sci 2022;12:e33–e46.
Abstract A continuously challenging issue in the field of speech–language pathology is

accurately identifying and diagnosing a language disorder in school-aged (pre-kinder-
garten through 5th grade) bilingual children, as bilingual children are disproportion-
ately under- and overidentified with a language disorder. The current review focuses on
the assessment of bilingual children in pre-kindergarten through fifth grade, aimed to
inform teachers, pediatricians, parents, and other relevant professionals of issues
surrounding assessment of these dual-language learners. We examine the barriers to
assessing bilingual children for language disorders, such as the lack of availability of
bilingual tests, underinformative current best practice guidelines, lack of speech–
language pathologist (SLP) training/knowledge of bilingualism, and use of interpreters.
We discuss the necessary considerations when SLPs use norm-referenced tests with
Keywords bilingual children, such as norming samples, accurate identification of a language
► language assessment disorder, reliability and validity, test administration, and potential solutions to using
► bilingual otherwise poorly suited norm-referenced tests. We also consider research on several
► children alternative measures to norm-referenced assessments, including dynamic assessment,
► developmental nonword repetition, language sampling, nonlinguistic cognition, and parent report.
language disorder We conclude by synthesizing the information in this review to offer six principles of best
► language impairment practices for bilingual assessment.
Introduction child’s native language(s), despite otherwise having gener-

ally typical cognitive and neurological function. Geared
One of the roles of a speech–language pathologist (SLP) is to toward teachers, families, pediatricians, and other relevant
determine whether a bilingual child (i.e., a child developing professionals, this review considers the current trends in
two languages) presents with typical language abilities, a evidence-based practice for the assessment of bilingual
delay in language development, or has a language disorder. children.
The purpose of this article is to review the literature on There are a few high-quality and useful reviews that
how to successfully identify and diagnose a language cover DLD in bilingual children.1–6 Bedore and Peña’s6
disorder, specifically, developmental language disorder review laid out a clinical framework for assessing bilingual
(DLD) in bilingual children in the pre-kindergarten through children. De Lamo White and Jin’s4 review suggested that
5th grade age range. DLD is an impairment in acquiring the clinicians take a holistic approach to assessing bilingual
words (i.e., lexicon) and rules (i.e., morphosyntax) of the children for DLD, including evaluating a child’s language
received DOI https://doi.org/ © 2022. The Author(s).

December 26, 2021 10.1055/s-0042-1743575. This is an open access article published by Thieme under the terms of the
accepted ISSN 2474-5871. Creative Commons Attribution License, permitting unrestricted use,
January 5, 2022 distribution, and reproduction so long as the original work is properly cited.
(https://creativecommons.org/licenses/by/4.0/)
Georg Thieme Verlag KG, Rüdigerstraße 14, 70469 Stuttgart,
Germany
e34 Assessment of Bilingual Children Freeman, Schroeder
abilities within the context of their environment. Castilla- Availability and Use of Norm-Referenced Tests
Earls et al’s3 review suggested that clinicians look for The first barrier to assessing the bilingual child is the
converging evidence from multiple sources when assessing availability of norm-referenced bilingual assessments. In
bilingual children. Kay-Raining Bird et al’s2 review dis- the school setting, special education administrators often
cussed bilingual children with developmental disorders require the use of norm-referenced tests when assessing
more broadly and identified important differences between children, even if there is not a test available in the child’s
simultaneous and sequential bilinguals. Ebert and Koh- most proficient or dominant language.3,10–12 In practice,
nert’s5 review provided a detailed discussion of diagnosis SLPs use norm-referenced tests more often than alternative
and treatment of bilingual children. Kohnert’s1 review measures (e.g., language samples and dynamic assessment)
discussed normal language development in bilinguals as in the school setting with bilingual children.10 Overuse of
well as how language disorder manifests in bilingual norm-referenced assessments results in overdiagnosis of
children. DLD,10,13–16 often due to the tests being normed, or stan-
The current review differs from these previous reviews in dardized among a larger group, with English monolingual
several ways. First, the current review is designed to inform children.17–19 An SLP might be tempted to translate a test or
teachers, families, pediatricians, and other relevant profes- specific test items; however, this practice is also not recom-
sionals, rather than having SLPs as the sole audience. Second, mended because, for example, vocabulary items that are
some of the highly influential reviews were published more present within the child in one language may not be present
than a decade ago, and since then, much has changed: new in the other language, also falsely indicating the presence of a
norm-referenced tests have been introduced, the field has language disorder.6
advanced to provide additional, alternative approaches to An alternative to norm-referenced testing involves
norm-referenced tests and even the diagnostic label has gaining a comprehensive profile on the child’s strengths and
largely changed, from specific language impairment to weaknesses in language domains, while also considering
DLD. Third, we offer six principles to assess bilingual children the sociocultural and familial factors that contribute to
for DLD, which are aimed to enhance knowledge for teachers, the child’s “clinical” presentation.4 To do so, Saenz and
families, pediatricians, and other relevant professionals on Huer20 and Caesar and Kohler10 discuss several alternative
the assessment process. approaches to norm-referenced assessment with bilingual
The importance of reviewing the state-of-the-art meth- children, including dynamic assessment, parent interviews,
ods for assessing bilingual children is underscored by the questionnaires/checklists, observation of the child across mul-
evidence that bilingual children are prone to both overiden- tiple communicative contexts (e.g., during recess and in the
tification7,8 and underidentification9 of language disorder. In classroom), and language samples. Additional detail on many
this article, we discuss the (1) barriers to assessing bilingual of these alternatives is offered in the “Alternative Measures”
children, (2) norm-referenced measures and (3) alternatives section. Dynamic assessment, for example, reliably identifies
to norm-referenced measures that can be used to assess such language disorders within bilingual children.21 Dynamic as-
children, and then we close with (4) six principles of best sessment involves assessing a child at two time points with an
practice for bilingual assessment. intervention or teaching phase in between. If the child makes
significant progress in response to teaching, it is likely that they
are within the typical range of language development. If the
Barriers to Assessing Bilingual Children for
child does not make significant progress, it is likely that they
Language Disorder
have some type of language disorder. Language sampling may
In contrast to the monolingual child, there are several also be effective with software, such as the Systematic Analysis
barriers to assessing a same-aged bilingual child for DLD. of Language Transcripts (SALT),22 since comparison data now
The first barrier is the lack of norm-referenced tests for use exist for bilingual children in SALT’s databases. However, aside
with bilingual children. Norm-referenced tests make com- from language sampling software, there are no comparison
parisons to a normative database or sample of the intended data for these alternative assessments, and thus a bilingual
population. Second, the American Speech-Language-Hearing child’s performance cannot be compared with his or her peers,
Association (ASHA) and the Individuals with Disabilities which explains why school administrators prefer SLPs to use
Education Act (IDEA) provide best practice guidelines for norm-referenced measures. In addition, Dollaghan and
SLPs on assessing bilingual children; however, these recom- Horner23 conducted a meta-analysis to identify diagnostic
mendations are not consistent with each other or with the accuracy of language disorder with alternative language as-
literature on best practices. Third, it is difficult to identify a sessment measures and found that a combination of norm-
language disorder when SLPs do not have training or knowl- referenced and alternative measures is necessary to ensure
edge on how to assess bilingual children or are not familiar proper diagnosis.
with the language and/or culture of a child being assessed.
Fourth, the use of interpreters to assist with assessment is ASHA and IDEA Guidelines
often problematic. We provide detail as to how all of these In 2004, the ASHA issued guidelines for SLPs. In the same
concerns result in obstacles to assessing bilingual children, year, the IDEA was released, which provided practice guide-
while also offering evidence-based strategies on how to lines for individuals (e.g., teachers and SLPs) working in a
overcome them. school setting. Therefore, it is expected that school-based
Journal of Child Science Vol. 12 No. 1/2022 © 2022. The Author(s).

Assessment of Bilingual Children Freeman, Schroeder e35
SLPs use the guidelines set forth by the ASHA and IDEA to The SLP is not Familiar with the Language and/or has
ensure best practice. ASHA24 states: not Received Training on How to Assess Bilingual
Children for Language Disorder
“Speech-language assessment for individuals who are bi- Aside from the lack of norm-referenced tests for bilingual
lingual and/or learning English as an additional language children and ambiguity on best practices from ASHA and
(i.e., “English Language Learners, ELL”) comprises services to IDEA, two additional, related barriers to bilingual assessment
assess speech-language and communication functioning are (1) if the SLP is not proficient in one or more of the child’s
(strengths and weaknesses) in an individual’s first language languages29,30 and (2) if the SLP does not possess adequate
(L1) or a second language (L2). Bilingual assessment ser- knowledge on how to assess the bilingual child.31 These
vices include identification of language use (i.e., the lan- barriers dramatically affect the accurate interpretation of
guage the individual speaks or is exposed to most of the evaluation results. At the end of 2019, ASHA reported that
time) and language proficiency (i.e., degree of ability in each out of all certified SLPs, only 6.5% were bilingual service
language). In addition, assessment addresses potential providers.32 Spanish is the most commonly spoken language,
impairments, associated activity and participation limita- comprising of 4.4% of all SLPs. The situation is more alarming in
tions, and context barriers and facilitators.” elementary schools, where only 17% of all bilingual service
providers work. For perspective, as of 2007, approximately 20%
IDEA25 states: of the U.S. population speaks a language other than English at
home,33 a number that is projected to increase. Given the
“Assessments and other evaluation materials used to increased cultural and linguistic diversity in the U.S., the
assess a child under this part— necessity is growing for more bilingual service providers
(i) Are selected and administered so as not to be discrimi- who possess adequate proficiency in another language and
natory on a racial or cultural basis; (ii) Are provided and knowledge on how to assess bilingual children. Moreover,
administered in the child’s native language or other mode of Kritikos31 identified in a survey of 811 SLPs that 64% did not
communication and in the form most likely to yield accurate speak the language necessary to assess the child, and impor-
information on what the child knows and can do academically, tantly, around 60% did not possess adequate knowledge on
developmentally, and functionally, unless it is clearly not bilingual assessment. When referring to knowledge, this
feasible to provide or administer; (iii) Are used for the purposes includes course training on language disorders versus
for which the assessments or measures are valid and reliable; differences, second language acquisition, clinical experience
(iv) Are administered by trained and knowledgeable person- with bilingual clients, knowledge of or experience working
nel; and (v) Are administered in accordance with any instruc- with children from nonmainstream cultures, and differential
tions provided by the producer of the assessments.” assessment practices for bilingual and monolingual children.
While training programs have evolved since the publication of
The major issue stemming from the current ASHA and this study, many clinicians enter the field without the requisite
IDEA practice guidelines is that bilingual assessment is not knowledge of working with bilingual children.
directly indicated; specifically, assessment should occur in If the SLP is not proficient in the language in which the
either the native (L1) or second (L2) language. In addition, child needs to be assessed, or is unfamiliar with the child’s
ASHA specifies that language assessment should include a culture, it is important that the SLP consults with teachers,
profile of language use and proficiency, which helps deter- families, and other related service providers to gain more
mine which language to assess in, while IDEA does not. More information and knowledge about bilingual language devel-
recently, ASHA26 stated that SLPs should use culturally and opment. Bilinguals do not exist in a vacuum, with variations
linguistically equivalent adapted tests to assess bilingual in cultural and linguistic profiles. Bilingual children’s lan-
children across both languages when possible. However, guage development in many cases follows a different trajec-
there are few, if any, of those tests. Therefore, the SLP faces tory in each language.34 Therefore, it is not appropriate to
conflicting advice: assess according to practice guidelines in compare a bilingual child’s linguistic milestones to those of a
the first or second language, or assess bilingually, with few to monolingual child.27 A child, whether monolingual or bilin-
no tests available. Even if SLPs were to assess the child across gual, may present with language difficulties in the domains
both languages, the amount of time required to do so is a of vocabulary and/or grammar. Vocabulary includes seman-
barrier in the fast-paced environments of schools.27 tics, or meaning of words, and vocabulary size, or repertoire.
IDEA25 also states that the assessments must be adminis- Grammar includes morphology, or word structure, and
tered according to the instructions of the test maker. However, syntax, or sentence structure. Moreover, deficits within
in practice, many SLPs use norm-referenced tests in an infor- the child could stem from understanding (receptive)
mal manner, such as translating test items, reducing their and/or producing (expressive) aspects of language. Bilingual
ability to accurately and reliably make diagnostic decisions.28 children with a language disorder may present with deficits
Despite the lack of clarity for which language to assess in and in one or more of these linguistic domains. Importantly, the
the use of norm-referenced tests in an informal way, SLPs specific deficits may or may not exist across both languages.
should use ASHA and IDEA as guides within their practice, Furthermore, differences in morphosyntactic rules across
while being aware that these recommendations will not be languages may result in distinct rates or orders of acquisition
applicable to all situations and children. in monolinguals versus bilinguals.6 Importantly, typical

vocabulary, morphosyntactic, and narrative errors that bi- nology about speech and language norms across both
lingual children make relative to monolingual children may languages, is proficient in both languages, understands
not indicate a language disorder but may viewed as such by why testing is indicated, and maintains confidentiali-
an underinformed SLP. ty.11,12,29,30,36 This collaboration ensures best practice and,
Aside from the knowledge SLPs, teachers, families, pedia- most importantly, that the child is appropriately assessed.
tricians, and other related service providers should have on Although this ideal scenario may take time and education,
language development in bilingual versus monolingual chil- assessment can be accomplished by working with those who
dren, what characteristics do bilingual children demonstrate interact with the child most frequently (e.g., a teacher,
that indicate a true language disorder? A strong indicator of a parent, or cultural broker).
language disorder is if the bilingual child presents with
difficulties across both languages, although the specific
Norm-Referenced Measures for Assessing
deficits within each language will be distinct.6,34 For exam-
Bilingual Children
ple, Bedore and Peña6 noted that language disorder in
English-speaking children often involves difficulties with Norm-referenced tests are highly utilized as effective assess-
the past tense (e.g., walk/walked). Spanish-speaking children ment tools,38,39 although they can also serve as a barrier to
with language disorder often struggle with direct object the assessment process. Norm-referenced tests are one of the
clitics (e.g., lo/la) and articles (e.g., el/la). Another indicator methods that SLPs can use to tease apart whether a bilingual
of language disorder is if the child has difficulty learning new child has a language disorder (e.g., DLD) or if the child’s
linguistic structures, independent of the languages he or she profile represents a language difference (e.g., lack of ade-
speaks, highlighting the necessity for dynamic assessment to quate dual-language exposure).3 The advantages include
tap into the child’s learning abilities. In addition, to further ease and consistency of administration, objectivity, and the
identify language disorder versus difference, conceptual ability to compare a child’s performance to a sample of many
knowledge should be assessed, whether the child knows a same-aged children.40 Norm-referenced tests provide a mea-
linguistic structure (e.g., vocabulary item) in one language, sure of a constellation of language skills and an accessible
the other, or both35 which is discussed further in the “Norm- way for other educational and health professionals to inter-
Referenced Assessment” section. Therefore, it is important to pret performance.38 However, one barrier is that few assess-
be aware that (1) there are differences in deficits that ments are available in languages other than English.10,15
indicate a language disorder across bilingual children’s lan- While used by clinicians (i.e., SLPs), our goal is to provide
guages, and (2) lack of knowledge does not indicate a teachers, parents, pediatricians, and other related service
language disorder, while lack of ability does. providers with an in-depth understanding as to why norm-
If there is a need for a bilingual child to be assessed in a referenced measures are used in the assessment of children
non-English language, ASHA24 and IDEA25 support the use of for DLD and the issues that arise when these measures are
interpreters to assist with the assessment process, however, used with bilingual children. Several factors must be consid-
there are additional concerns with interpreters as well, ered when assessing bilingual children with norm-refer-
which are identified next. enced tests, including representative norming samples,
accurate identification of language disorder, validity and
The Use of Interpreters for Assessing the Bilingual reliability, and administration and interpretation. We also
Child offer potential solutions to the identified concerns with
Given the majority of SLPs in the U.S. are monolingual, an norm-referenced testing.
option is to work with interpreters to assess bilingual
children directly and/or communicate with families.30 While Bilingual Tests with Representative Norming Samples
research has revealed that collaboration between monolin- Importantly, norm-referenced tests are indeed norm-refer-
gual SLPs and interpreters is necessary to ensure best prac- enced, that is, prior to their release, researchers recruit a
tice and service delivery for bilingual clients,12,24,25,36 there large sample of the population (i.e., 1,000 þ ) of a particular
are often obstacles when working with interpreters when demographic (e.g., bilingual children across a certain age
they are not professionally trained (e.g., family members). range) to ensure that the norming sample is reflective of the
The interpreter might not be proficient in both languages population. A child’s performance on a test is compared with
(e.g., Spanish-dominant), resulting in poor quality of inter- the norming sample, which provides information as to
pretation; there are no clear guidelines for training bilingual whether the child falls within the average range based on
interpreters, specifically for speech and language assess- their age or grade level.41 While many assessment batteries
ments; interpreters may lack knowledge in the field of are available and normed for English monolingual children,
speech–language pathology; and it is sometimes difficult there is a dearth of tests for bilingual children, especially
for interpreters to remain neutral, confidential, and honest ones that include bilinguals in the norming sample.
during the assessment process, therefore family members See ►Table 1.
should be avoided.11,12,30,36,37 Thus, SLPs, teachers, families, In fact, only five assessments are available to SLPs with
and other clinicians must collaborate with an interpreter “adequate” norming samples containing bilingual children. If
who is professionally trained, familiar with the child’s lin- the bilingual child is older than 7, only receptive and
guistic and cultural profile, possesses knowledge and termi- expressive vocabulary can be assessed bilingually. Language

Table 1 Tests and screeners that are available to assess Spanish-English bilingual children
Test Domain Age

Bilingual English-Spanish Assessment42 Morphosyntax, semantics, phonology, pragmatics 4 through 6
43
Ortiz Picture Vocabulary Acquisition Test Receptive vocabulary 2.5 through 22
Receptive One Word Picture Vocabulary Test-4: Receptive vocabulary 2 through 80þ
Spanish-Bilingual Edition44
Expressive One Word Picture Vocabulary Test- Expressive vocabulary 2 through 80þ
4: Spanish-Bilingual Edition45
Preschool Language Scale-5 Spanish46 Receptive and expressive language 0 through 7
Screenera Domain Age
47
Quick Interactive Language Screener Vocabulary grammar (product and process) 3 through 5
Bilingual English-Spanish Oral Screener48 Morphosyntax and semantics 4 through 6
a
Screeners are not used to make diagnostic decisions, but rather to identify if there are any language concerns. Screeners can be used to make a
referral for a full speech and language evaluation.
disorders, especially in older children, exist in domains other Identifying Language Disorder in Norming Samples:
than vocabulary as well, such as morphosyntax and narrative Considerations for Bilinguals versus Monolinguals
abilities (i.e., telling stories and conversational dialogue).6,41 In addition to a representative norming sample and the lack
Another important consideration when choosing a bilin- of availability of tests across different language pairings, it is
gual test is the diversity of bilinguals within the norming also necessary to identify the test’s sensitivity and specifici-
sample and throughout the population of bilingual children ty. Sensitivity refers to a test or construct’s ability to correctly
being assessed. This variation is due to bilingualism existing identify those with an impairment (e.g., DLD), while speci-
on a continuum of proficiency, dominance, and age of ficity is defined as a test or construct’s accurate identification
acquisition,13,49–51 along with cultural and linguistic differ- of those without an impairment. Often, SLPs use English
ences. Bilinguals in one country or geographic area (e.g., monolingual tests with bilingual children when the sensitiv-
Spain) may differ from bilinguals in a different region (e.g., ity and specificity of these tests are based on norming
Puerto Rico) in terms of dialect, vocabulary, accent, and samples with English monolingual children. Therefore, using
syntax. Bilinguals also represent a variety of socioeconomic English monolingual tests can result in typically developing
backgrounds, many below the poverty line, which could lead bilingual children appearing to have similar clinical presen-
to differential performance on norm-referenced language tations as monolingual children with a language disorder.
assessments.20 Therefore, to adequately capture the diversity These similar profiles can be seen, for example, when there is
that encompasses bilinguals, norming samples reflective of a gap in children’s receptive (i.e., comprehension of lan-
the entire bilingual population must contain participants guage) versus expressive (i.e., production of language) lan-
representative of a variety of socioeconomic and cultural guage. Typically developing bilingual children may present
backgrounds. Currently, the only bilingual test that recruited with a similar receptive-expressive gap to monolingual
a diverse sample of bilingual children is the Bilingual English- children with language disorder on norm-referenced tests,
Spanish Assessment (BESA). The BESA’s norming sample where comprehension skills are greater than expression
included 4- through 6-year-old Spanish-English bilinguals skills in one or both languages.53–55 An important distinction
throughout the United States and who spoke 17 distinct here is that bilingual children with a large difference in
dialects of Spanish.42 Perhaps the age range can be expanded scores on receptive versus expressive language subtests in
to older, school-aged bilingual children in future versions of one language only most likely do not have a language disor-
this test. der, such as DLD, as this receptive-expressive gap represents
An additional concern with currently available norm- a language difference of knowledge due to dual language
referenced tests is the variety of languages. The assessments exposure. Therefore, using norm-referenced test criteria (i.e.,
listed in ►Table 1 are normed for Spanish-English bilin- sensitivity and specificity) with bilingual children can lead
guals. The majority of bilinguals in the United States are overidentification/misdiagnosis of language disorder.
speakers of Spanish and English; therefore, the focus has
been to create tests for these language pairings.13 Arias52 Understanding Validity and Reliability when
explains that there is a dearth of norm-referenced tests in Assessing Bilingual Children
languages other than English, resulting in clinicians using Norming samples reflective of bilingual populations are
norm-referenced tests with bilingual children, but intended critical to norm-referenced tests, along with high sensitivity
for English-only speakers. At the time of this publication, and specificity; however, so too are the reliability and other
there are no bilingual assessments available for other aspects of the validity of the tests. Paul56 provides definitions
language pairings. for validity and reliability. A test’s validity refers to its ability

to adequately measure a content area (i.e., language domain), suggested in Principle 4, SLPs should assess in both languages
its inclusion of items that are representative of the content whenever possible, consult with those who are closest to the
area, and its alignment with other tests that measure the child for language background information (i.e., parents and
same content area. A test’s reliability ensures that the scores teachers), and be aware that bilingualism exists on a contin-
are the same over time (repeated administration), with uum of multiple factors, including proficiency, dominance,
different test administrators and scorers, and whether spe- and age of acquisition.13,49–51
cific items within the test capture the content area that the Before administering the assessment(s), the clinician
test measures as a whole. must decide which subtests or domains to focus on based
It would be invalid and inappropriate to rely on a Spanish on the language concerns with which the child presents,
and/or English monolingual test to assess a Spanish-English based on observation, family, and teacher report. For exam-
bilingual child4,57 for several reasons. Bilingual children’s ple, a norm-referenced test measuring receptive vocabulary
vocabulary and/or syntax may be distributed across the two will contain a list of words (i.e., nouns and verbs) that vary in
languages.6,40 That is, a vocabulary item or sentence struc- difficulty, starting with the easiest and ending with the
ture may be known in one language but not the other. As a hardest items. The child views an array of 3 to 4 pictures
result of bilingualism, children will hear and use words in and must select one after hearing it. In a test measuring
both languages less frequently than their monolingual expressive vocabulary, the child names the picture placed in
peers.41,58 Therefore, norm-referenced tests may underesti- front of them. Tests that measure other aspects of language,
mate total (conceptual) linguistic knowledge if only one including morphology and syntax might focus on children’s
language is assessed or accepted as a correct response to a understanding of wh-questions (e.g., “who,” “what,” and
prompt. However, altering the test in any way to capture a “where”) or ask children to produce certain grammatical
bilingual child’s conceptual knowledge, for example, would forms with open-ended prompts (e.g., picture of a girl and
render it invalid. boy playing tag: “the girl is the boy,” target is “chasing”). As
Invalidating a norm-referenced test also occurs when SLPs already discussed in identifying DLD in norming samples, a
translate the test or specific test items into a different bilingual child with typical language skills may achieve a
language in which the test was not normed.6,40 Translating similar test score to a monolingual child with a DLD.16 In
tests also reduces reliability, since words across languages other words, considering the heterogeneity in typically
may have multiple translations and even different mean- developing bilingual children’s exposure and proficiency in
ings.59 It must not be assumed that children of different their languages,1 they often perform lower on norm-refer-
linguistic backgrounds acquire specific language structures enced tests in one or both languages relative to typically
along the same timeline, achieving the same milestones developing monolingual peers.13,16,27 Parents, teachers, and
within each language, as monolingual children.6 Translated other clinicians should therefore interpret speech and lan-
tests also do not consider what the typical indicators are for guage evaluations of bilingual children with caution if scores
language disorder in each language.6 For example, a hallmark are slightly below the average range in comparison to the
for DLD in English is difficulties with past tense (e.g., bilingual child’s same-aged (or grade) peers. As a side note,
go/went), whereas in Spanish, children with a language Thordardottir61 proposed that SLPs should change score
disorder are challenged by direct object clitics (e.g., lo/la) thresholds (i.e., cutoff criteria for typically developing versus
and articles (e.g., el/la). If test creators analyzed each item on language impaired) for bilingual children to reflect the
the test to examine children’s performance across languages, amount of exposure in the more proficient or weaker lan-
then clinicians might be inclined to use translated tests.52 guage, depending on the language(s) tested.
Parents, teachers, and other related service providers should
therefore interpret a bilingual child’s performance on a test Potential Solutions to Using Norm-Referenced Tests
with caution if the items were translated. with Bilingual Children
If an SLP uses a norm-referenced test normed with a mono-
Test Administration and Interpretation with Bilingual lingual population to assess bilingual child, a potential solu-
Children tion is to not report the scored results (quantitative
Once the test is deemed valid and reliable, the SLP perform- performance) and discuss how the child performed in terms
ing the evaluation should assess a bilingual child in both of observations during the assessment (qualitative perfor-
languages whenever possible. However, previous and erro- mance). The SLP may describe the child’s general language
neous guidance to bilingual assessment would emphasize abilities based on the tests administered,4 the amount of
assessing the child in his or her more dominant language.24 prompting required for the child to understand the
Language dominance measures the knowledge within one task/subtest, the child’s overall disposition during the test,
language relative to the other.40 Dominance can be deter- and any of the child’s behaviors worth noting during the
mined from questionnaires completed by parents and/or assessment. Another solution to norm-referenced testing
teachers, or through behavioral measures (e.g., verbal fluen- with bilingual children is to use conceptual scoring. The
cy task: name as many fruits one knows). Relying on language SLP readministers the item missed in the target language in
dominance alone to make a decision on which language to the child’s other language, and if the child answers correctly,
test in can result in an underestimation of a child’s knowl- the item is counted as correct. Conceptual scoring demon-
edge across both languages (conceptual knowledge).40,60 As strates that the child knows the item conceptually but does

not penalize them for not knowing it in one lan- have less experience than a monolingual child in using a
guage.35,41,62,63 Lowering score thresholds, discussing qual- given language, and that reduced experience will result in
itative performance, and conceptual scoring on a less knowledge of the language.41,58 This lower knowledge
monolingual test are considered informal measurements of can place the bilingual child in the atypical range on a static
the child’s language skills. Moreover, conceptual scoring assessment, leading the child to be misdiagnosed as a having
works well with vocabulary, but not with morphosyntax.40 DLD when, in reality, the child was lacking experience with
We propose in Principle 3 that a combination of norm- the language (and thus knowledge). Dynamic assessment
referenced and alternative measures should be used to gain downplays the child’s current knowledge or lack thereof and
insight into a child’s linguistic profile. instead focuses on how much the child can learn when
To summarize, on norm-referenced tests are heavily provided with a short intervention.
utilized to assess monolingual children for DLD. However, Dynamic assessment has been used to assess several
with bilingual children, norm-referenced tests often do not domains of language, including lexical, morphosyntactic,
contain appropriate norming samples, are nonexistent, lack and narrative skills. As an example of a recent study exam-
diversity in language pairings, and are inappropriately used ining lexical skills, Petersen et al21 used a test-teach-test
in invalid and unreliable ways (e.g., monolingual tests used dynamic assessment of word learning to classify Spanish-
with bilingual children and translating test items). In the English bilingual kindergarteners, first graders, second
next section, we expand upon the alternative measures, graders, and third graders as language impaired or typically
other than norm-referenced tests, that can be used to assess developing. As part of the pretest, children listened to a story
bilingual children. that contained a novel word. For example, a sentence in the
story was: “Then Juan decided to go inside and tell his mom
that his clothes needed to be punuped because they were
Alternative Measures for Assessing Bilingual
dirty.” The children were tested on the meaning of the novel
Children
word; i.e., they were asked, what does punup mean? Next, as
In addition to norm-referenced measures that can potential- part the teaching phase, a new story with a new novel word
ly be used to evaluate the bilingual child for DLD, there are was read to the child, and the examiner taught the child
also several alternative measures available. Alternative strategies for determining the meaning. For example, the
measures are sometimes preferred over the available examiner told the child to look for nearby words that might
norm-referenced measures with bilingual children due to help them learn the meaning of the novel word. During this
their high diagnostic accuracy and lack of cultural and teaching phase, the examiner completed a modifiability scale
linguistic discrimination that is associated with current that rated the child’s potential to learn word meanings.
norm-referenced measures. This section covers dynamic Lastly, as part of posttest, the children were told yet another
assessment, nonword repetition, language sampling, nonlin- story with a novel word, and they were tasked with learning
guistic cognition, and parent report. the meaning of the novel word. The results indicated that the
children with a language disorder had lower modifiability
Dynamic Assessment scores, as well as lower posttest scores, relative to typically
Whereas all other assessments used to assess bilingual developing children. The dynamic assessment was more
children are static, in that they evaluate the child at one successful in classifying children as typical or disordered
point in time and compare them to a normative sample or than static assessments that were conducted in both of the
criterion, dynamic assessment is nonstatic. One example of child’s languages. With sensitivity in the 90 to 100% range
dynamic assessment includes assessing the child at two and specificity in the 90.5 to 95.2% range, the dynamic
points in time, with an intervening teaching phase, and assessment was a highly effective diagnostic tool for identi-
then determining whether the child sufficiently improves fying language disorder.
in response to the teaching. If the bilingual child demon- The positive results from Petersen et al21 are consistent
strates significant progress, it is likely that their ability to with those of a meta-analysis conducted a year prior.65 In the
learn is intact and that they are typically developing. Con- meta-analysis, 7 dynamic assessment studies of bilingual
versely, if the bilingual child does not make progress, their children aged 3 to 8 were analyzed. The results indicated
ability to learn may be deficient, and the child may have a that examiner modifiability scores were effective in differen-
language disorder, such as DLD. tial diagnosis of children with and without language disorder,
Dynamic assessment derives from Vygotskij’s sociocultur- though gain scores from pretest to posttest were not effective,
al theory.64 Vygotskij emphasized the level of learning that and that almost all of the studies had specificity and sensitivity
can be ascended to when assisted by others, relative to the values that were close to or above 80%. Based on the positive
unassisted level of learning. If this relative difference, called results, the authors suggest that “it may be beneficial for
the zone of proximal development, is large, then it would clinicians to use [dynamic assessment] in their practices.”65
indicate a healthy learning ability. If small, then a deficient
learning ability would be suspected. Nonword Repetition
Dynamic assessment has advantages over static assess- Aside from dynamic assessment, nonword repetition tests
ment. The major advantage is that it reduces the knowledge may also be used to capture a bilingual child’s linguistic
and experience variables.21 In many cases, a bilingual will skills. Nonword repetition tasks are processing-based. That

is, nonword repetition tests assess the child’s language- nication for the number of different words that they used, for
processing mechanisms, rather than language knowledge, the grammatical correctness of their sentences, for the
by having the child repeat back nonwords, such as versa- length and complexity of their sentences, etc. Although
trionist and stoppagrattic. These tests—which test some of Language Sample Analysis can be labor-intensive and it often
the cognitive foundations of language learning, such as lacks the psychometric properties of most norm-referenced
phonological processing and short-term memory—have tests (e.g., sensitivity and specificity), it has some major
been found to have mostly adequate diagnostic accuracy in benefits. Foremost is its ecological validity, capturing real-
the assessment of DLD in monolingual children.66,67 Given world language use. Additionally, Language Sample Analysis
that these tests have validity in monolingual children, and is highly flexible, in that it can be used to measure many
that they seem less likely to disadvantage bilingual children different aspects of language, across different settings, age
who have less experience with and knowledge of a given groups, and languages. For these reasons, along with the
language (relative to monolingual peers), nonword repeti- view that it is less culturally and linguistically biased than
tion tests have been extensively studied as a possible diag- many norm-referenced tests, Language Sample Analysis has
nostic tool for assessing language disorders in bilingual been deemed to be the gold standard of language assessment
children.68–77 for bilingual children.82
The studies of nonword repetition tests in bilingual However, Language Sample Analysis does to some extent
children have examined diagnostic accuracy when both have the same major limitation as many norm-referenced
language-specific versions and language-general versions tests, in that it can disadvantage bilinguals relative to mono-
are given. Language-specific refers to nonword repetition linguals. That is, on certain measures, such as grammaticality
tests whose nonwords conform to the phonotactic rules (i.e., in a language sample, typically developing bilingual children
rules for combining speech sounds) of a given language, perform worse than typically developing monolingual chil-
whereas language-general refers to nonword repetition tests dren.83–85 If typically developing bilinguals perform worse,
whose nonwords are meant to be phonotactically compatible they are at risk for being falsely diagnosed as having a
with most languages. While language-specific tests some- language disorder. Nevertheless, Language Sample Analysis
times demonstrated adequate sensitivity and specificity, has shown utility in assessing bilingual children, especially
language-general tests, though much less studied, appear when bilingual children are compared with a database of
to have higher sensitivity and specificity. other bilingual children rather than monolingual children,22
If administered a language-specific nonword repetition though often sensitivity and specificity analyses have not
test, bilingual children are prone to be misdiagnosed, be- been included in these studies.86
cause bilingual children often perform worse than monolin- As an illustrative example of a study that examined the
gual children on such tests.68–70,78–80 This finding suggests effectiveness of Language Sample Analysis, 4- and 5-year-old
that nonword repetition tests, particularly language-specific Spanish-English bilingual children were asked to retell a
versions, are not in fact knowledge-free. Indeed, when lower wordless picture story, among other assessments that
vocabulary in bilinguals is taken into account, bilinguals’ were taken.87 Two measures, grammaticality (i.e., grammat-
lower performance on the language-specific nonword repe- ical errors per communication unit) and D (i.e., a measure of
tition test disappears.79,80 Nevertheless, some studies have lexical diversity), accurately classified children as typical or
found success in using language-specific versions to diagnose disordered, with 90% sensitivity and 85% specificity.
language disorders in bilingual children,71–73 and this may While some combination of measures derived from Lan-
be especially the case when language-specific versions are guage Sample Analysis are likely to be effective during
given in both of a bilingual’s languages.74,75 assessment, which specific measures are most useful
In contrast to language-specific versions, early research remains to be identified. As in the study described above,
on language-general versions is more promising. In particu- measures of grammaticality have emerged as promising
lar, preliminary positive results have been observed with the differentiators of typical and atypical language develop-
Cross-Linguistic Nonword Repetition Test.71,76,77 This test ment.86,88–90 Measures of lexical diversity, as in the above
was designed to be “maximally compatible with different study, may be useful, though more evidence is needed.84,90,91
languages.”76,77 It consists of vowels and consonants that are Measures of utterance length, such as mean length of utter-
common to many languages, and all syllables are of the ance in words and morphemes, may be helpful but are
common CV structure. Though merely preliminary, this generally less helpful than other measures.86–89,92,93 Lan-
language-general version has demonstrated high specificity guage Sample Analysis has shown promise in the assessment
and sensitivity in L2 learners of Dutch with a variety of L1s of bilingual children, but more studies are needed to deter-
(e.g., Chinese and Russian).76 mine which measures to use and how accurate these meas-
ures are at diagnosing DLD in bilinguals.
Language Sample Analysis
Language Sample Analysis involves the elicitation, recording, Nonlinguistic Cognition
coding, and analysis of a child’s speech in a naturalistic Although very few studies have considered the possible use
context. For example, as part of an assessment, the child of nonlinguistic cognitive assessments, for example, assess-
might retell a narrative, such as the “Frog, Where are You?”81 ments of nonverbal working memory, to diagnose language
story, and then the clinician will assess the child’s commu- disorders in bilingual children or even monolingual children,

these assessments have significant promise. Despite the grammatical proficiency, and comprehension proficiency.
classic definition of DLD as children who are neurotypical Parent report is valued because parents have considerably
in their nonlinguistic cognitive abilities but atypical in their more experience with their child’s language than clinicians
linguistic abilities, it is now clear that such children have do, and because parent report is often correlated with
minor, subclinical deficits (i.e., not deficient enough to be objective measures of language.102–105 Further, parent re-
diagnosed with an impairment) in several areas of nonlin- port may be especially valuable when norm-referenced tests
guistic cognition, including processing speed,94 working are not available. However, parent report is subject to bias, as
memory,95 attention and inhibition,96 and procedural mem- parents might over- or underestimate their child’s ability,
ory.97 These nonlinguistic deficits demonstrate that it might potentially leading to misdiagnosis.106,107
be possible to successfully identify language disorder in Research on the use of parent report in bilingual assess-
children by using tests that are devoid of language. ment is sparse, but some of the studies have demonstrated
Because language-based tests can disadvantage bilin- success,108,109 but see Pua et al.110 For example, in a recent
guals, the use of nonlinguistic cognitive assessments is study,111 the Alberta Language and Development Question-
particularly appealing in the case of bilingual assessment. naire (ALDeQ)109 was administered to parents. The ALDeQ is
However, for these assessments to be effective, the nonlin- a questionnaire that collects data on the child’s L1, with
guistic cognitive domains in question need to be unaffected questions about the child’s age of first word, age of first word
by experience with two languages, which might not always combinations, among many other aspects of language. Points
be so, given some evidence for bilingual advantages. In other are assigned to every question, leading to a quantifiable
words, there is some evidence for bilingual advantages in score. In this study, children who were, on average, 5 years
nonlinguistics domains, such as working memory98 and and 10 months old, with an average of 2 years and 9 months
attention and inhibition.99 Thus, bilingual children with of English exposure, were successfully identified as having a
DLD might perform in the normal or above normal range language disorder by the questionnaire. In fact, the ques-
on these tests, leading to underidentification and low sensi- tionnaire had 100% sensitivity and 95.2% specificity. These
tivity. Yet, many studies that have examined monolingual results are promising, and parent report is likely to be a
and bilingual children with and without DLD on such meas- useful component of language assessment, but more data are
ures have failed to find a bilingual advantage,100 rescuing the needed before parent report can be fully recommended as a
possibility of using nonlinguistic tests for bilingual language stand-alone assessment.
diagnostics.
As an example of a recent study that used nonlinguistic
Synthesis and Summary: Six Principles for
tests for bilingual diagnostics, Ebert and Pham101 employed
Assessing Bilingual Children
three nonlinguistics tests—tests of processing speed, work-
ing memory, and attention/inhibition—in attempt to detect To synthesize and summarize the information covered in this
language disorder in 6- to 10-year-old English monolinguals article, as well as to provide guidance for teachers, pedia-
and Spanish-English bilinguals. The processing speed task tricians, families, and other related professionals, we offer
involved quickly pressing the corresponding button when- six, evidence-based principles for best practice to assess
ever the child saw a red or a blue circle. The working memory bilingual children in the elementary grades, pre-kindergar-
test involved determining whether two auditory tones were ten through fifth grade (►Table 2). If applied, these six
the same or different. The attention/inhibition test was a principles may remove the ambiguity and confusion sur-
flanker test in which a central fish was flanked by surround- rounding bilingual assessment, as well as serve as a resource
ing fish that sometimes pointed in the opposite direction of to those involved in the assessment process.
the central fish, and the participants had to indicate the
direction in which the central fish was pointing. The results Principle 1: Bilingual and Monolingual Children should
indicated fair to good sensitivity or specificity in many cases, not be Assessed in the Same Manner
suggesting that there is promise for nonlinguistic tests but What makes the bilingual experience unique is that bilin-
that these tests need to be improved before clinical use. In the guals have more than one way to express their thoughts and
near future, DLD might be accurately diagnosed in both feelings. Bilingual children may also be bicultural as a result
bilinguals and monolinguals by utilizing a language-free of their language repertoire and background. Within lan-
assessment. guage assessment, SLPs must account for this increased
diversity and ensure that this variability does not negatively
Parent Report impact the child’s overall evaluation. Knowing an L2 alone
Assessments of bilingual (and monolingual) children often does not negatively impact overall academic perfor-
include information from the parent of the child being mance112; however, children from nonmainstream cultures
evaluated. For example, as part of the BESA,42 there are might perform worse on language assessments than children
parent interviews, called the Instrument to Assess Language from mainstream cultures (monolinguals) if the same meas-
Knowledge and the Bilingual Input-Output Survey, in which ures are used across both groups.15 Lower performance
parents are queried about their child’s history of exposure to occurs because most language assessments are designed
the two languages and their child’s ability in both languages for mainstream-culture monolinguals. Therefore, bilingual
in regards to vocabulary, intelligibility, utterance length, and monolingual children should not be assessed for a

Table 2 Six principles of bilingual assessment
Principle 1 Bilingual and monolingual children should not be assessed in the same manner
Principle 2 No two bilingual children are the same
Principle 3 Use a combination of norm-referenced and alternative measures for assessment
Principle 4 Assess in both languages whenever possible
Principle 5 Determine if there is a language disorder or a language difference
Principle 6 Collaborate with SLPs, families, teachers, interpreters, and other professionals
Abbreviation: SLP, speech–language pathologist.
language disorder in the same manner, using the same tools. norm-referenced and alternative assessments with bilingual
Otherwise, bilingual children would be at greater risk for children and elucidated the advantages and challenges of
overidentification of DLD. Different language assessment each. For example, there is a lack of norm-referenced tests
techniques have been developed for use with bilingual that are available for use with bilingual children.15,30 There-
children from nonmainstream cultures, such as a holistic fore, tests designed for English monolingual children are
approach,4 including dynamic assessment, nonword repeti- often used with bilingual children, which can result in
tion, language sampling, nonlinguistic tests, and parent overidentification of DLD.6 One solution is to not report
report. norm-referenced scores and discuss the child’s qualitative
performance.4 Another is to change, or lower, the norm-
Principle 2: No Two Bilingual Children are the Same referenced score thresholds that indicate a language disor-
Given the linguistic and cultural diversity among bilinguals, der.61 However, these methods indicate a norm-referenced
it is also important to highlight that no two bilingual test is being used in an informal way. Therefore, alternative
children present with the same linguistic profile. Bilingualism methods, such as (but not limited to) dynamic assessment,
exists on a continuum of proficiency, dominance, and age of nonword repetition tasks, and language samples should be
acquisition.13,49–51 Within this continuum comes much varia- considered for use in conjunction with formal measures to
tion. For example, there are two English-Spanish speaking ensure diagnostic accuracy. Although using multiple meth-
children that are the same age and in the same classroom. One ods of assessment can be time consuming, SLPs can advocate
child speaks only Spanish at home, along with English and to request additional time to ensure fair assessment and best
Spanish in school, while the other child speaks both languages practice.
at home and at school. The former child first started learning
English upon school entry, while the latter child learned Principle 4: Assess in Both Languages whenever
English and Spanish from birth. Both children present with Possible
an expressive language delay across both languages. These Related to using multiple forms of assessment, the bilingual
children, although bilingual speakers of English and Spanish, child should be assessed in both languages whenever possible.
differ in proficiency, dominance, and age of acquisition. This ASHA26 and research10,27,71,113 suggest that dual-language
case scenario highlights the heterogeneity within the bilingual assessment is best practice with bilingual children. However,
population, even within the same classroom. Moreover, these bilingual assessment may not always be feasible. The SLP often
factors are important in estimating the children’s overall does not speak both languages proficiently and/or possess
linguistic ability and will impact assessment decisions (e.g., adequate knowledge of the bilingual assessment process, and
what linguistic information is needed from the family, which bilingual tests are not available to adequately capture a child’s
language(s) to assess in, which measures to use). Although it is linguistic profile. There are solutions to overcome these
unclear at this point how proficiency, dominance, and age of obstacles. The SLP can work with a trained interpreter
acquisition impact language development,16 these factors and/or a cultural broker who is knowledgeable about speech
must be determined to examine their relative contributions and language development, neutral, and remains confidential
to the child’s linguistic profile and to ensure best practice for throughout the process. The SLP can also use a combination of
bilingual assessment.24 norm-referenced and alternative measures across languages
that allow him or her to gain insight into the child’s holistic
Principle 3: Use a Combination of Norm-Referenced linguistic profile, including strengths and weaknesses. These
and Alternative Measures for Assessment solutions are especially critical as the majority of SLPs in
As there is a great deal of heterogeneity in the bilingual the U.S. are monolingual.10,32
population, it is important to take a holistic view of the child
during assessment. Current trends in research and practice Principle 5: Determine if There is a Language Disorder
demonstrate that a combination of norm-referenced and or a Language Difference
alternative measures must be used to assess a bilingual Whether the child is monolingual or bilingual, the SLP’s
child’s linguistic strengths and weaknesses and to ensure primary role for assessment in the school setting is to
diagnostic accuracy.23,28,40 This article discussed the use of determine if there is a language disorder that negatively

impacts social and academic performance.24,25 With bilin- Conclusion

gual children, teasing apart language disorder versus differ-
ence becomes challenging for several reasons. Oetting This article discussed current trends in research and practice
et al114 argue that a false dichotomy occurs between dialect, for assessing the bilingual child, including barriers to assess-
or in the current case, language difference, and disorder. The ment, norm-referenced testing, and alternative measures.
statement of language difference versus disorder suggests We summarized aspects within each domain by offering six,
that there might be some similarities between these two evidence-based principles for bilingual assessment. We
concepts, which is untrue. This dichotomy also minimizes aimed to provide information about the bilingual assessment
the emphasis on identifying the nature and impact of DLD process and to assist with overcoming barriers, applicable to
and puts more emphasis on describing the differences that families, teachers, pediatricians, and other related profes-
exist between two languages. Moreover, relying solely on sionals. With an eye toward the future, Caesar and Kohler10
norm-referenced measures, bilingual children with typical describe that to advance our field and ensure evidence-based
language skills often present with a similar profile to assessment of bilingual children, it will take a combination of
monolingual children with a language disorder. In other external forces, including school administrators allowing
words, bilingual children perform worse on norm-refer- extra time for assessment, more tools to assess bilingual
enced tests of language than monolingual chil- children, and graduate program education, with intrinsic
dren.10,14–16,71 This is often due to norm-referenced tests’ motivation within clinicians, including professional devel-
norming samples, which include English monolingual chil- opment and literature searches, to effect change.
dren only. If language deficits are present only in one
language, then this indicates a language difference. There- Conflict of Interest
fore, using alternative measures to norm-referenced tests None declared.
may assist in identifying whether a bilingual child presents
with a true language disorder or if their profile represents a
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Article published online: 2022-07-07

Assessing Language Skills in Bilingual Children:

J Child Sci 2022;12:e33–e46.

Abstract A continuously challenging issue in the ﬁeld of speech–language pathology is

Introduction child’s native language(s), despite otherwise having gener-

received DOI https://doi.org/ © 2022. The Author(s).

Journal of Child Science Vol. 12 No. 1/2022 © 2022. The Author(s).

Journal of Child Science Vol. 12 No. 1/2022 © 2022. The Author(s).

Journal of Child Science Vol. 12 No. 1/2022 © 2022. The Author(s).

Test Domain Age

Journal of Child Science Vol. 12 No. 1/2022 © 2022. The Author(s).

Journal of Child Science Vol. 12 No. 1/2022 © 2022. The Author(s).

Journal of Child Science Vol. 12 No. 1/2022 © 2022. The Author(s).

Journal of Child Science Vol. 12 No. 1/2022 © 2022. The Author(s).

Journal of Child Science Vol. 12 No. 1/2022 © 2022. The Author(s).

Table 2 Six principles of bilingual assessment

Abbreviation: SLP, speech–language pathologist.

Journal of Child Science Vol. 12 No. 1/2022 © 2022. The Author(s).

impacts social and academic performance.24,25 With bilin- Conclusion

Journal of Child Science Vol. 12 No. 1/2022 © 2022. The Author(s).

Journal of Child Science Vol. 12 No. 1/2022 © 2022. The Author(s).

Journal of Child Science Vol. 12 No. 1/2022 © 2022. The Author(s).

Journal of Child Science Vol. 12 No. 1/2022 © 2022. The Author(s).

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