Can it be too late?

Usually, my applied work focuses on limiting OVER-identification (false positives) of language impairment in children who speak English as a second language. But, there’s another side to this too and that’s UNDER-identification of language impairment in this same population. I see these patterns in some of the national schools data. From year to year sometimes it looks like preschool English language learners (ELLs) are less likely than average to be identified with language impairment while school-age ELL children are more likely to be diagnosed with language impairment.

How can this be? What’s the average anyway? And what are the outcomes?

Epidemiological studies demonstrate that language impairment occurs in about 7% of the population. That doesn’t include children with other disabilities that affect language (such as cerebral palsy, mental retardation, hearing loss). Boys seem to be slightly more affected than girls, but the differences are pretty small about 1.1 to 1. This is different from identified or enrolled ratios. On school-based SLP loads, boys are about twice as likely to be identified with language impairment compared to girls. Sharon Vaughn tells me that these differences between caseload enrollment vs. prospective epi studies is similar to what’s been found in reading. I know I’m getting slightly off-topic, but I wanted to give you a feel for what this population of kids should look like.

So, to go back– how can over- and under-identification can occur in the ELL population? I think it’s based on a number of factors. At preschool the two I think are most critical are: waiting and waiting. I list waiting twice because it’s done for different (related) reasons. I think one reason that diagnosis is delayed in young ELL children is to give them more time to learn English. I will never forget the 3-year-old Spanish-speaking child I worked with in a Head Start program. He had about a 10-12 word expressive vocabulary, well below what’s expected for a child that age. But, when I tried to get him services in the public schools I was told their policy was to wait for ELLs to learn English and THEN test for language impairment. I know this is an extreme example, hopefully this wouldn’t happen today (I hate to admit that this was about 25 years ago), but I think a more subtle version of this happens today.

The other kind of “wait” is waiting to see how children will do; how they’ll settle into preschool or kindergarten. Related to this is the fact that there are few instruments that can be used to reliably identify langauge impairment in ELL children. If they are in an all-English setting at school, their home language development may stall a bit, so tests developed for the home language may not be appropriate. So, we wait. Wait till their language use is more stable; wait till they learn school routines; and so on.

The over-identification of ELLs comes later. Often this coincides with shifting from learning to read to reading to learn (about 3rd or 4th grade). The expectations in school are ramped up, and some kids may still be in the process of learning their second language, learning to read in that language, and learing the subtleties of the language. This is a time that ELLs can be over-referred or over-identified with language impairment. After all, it can’t be that after all this time ELLs still aren’t “caught up” with their monolingual peers (sarcasm alert in case you missed that). But, while they may be caught up in some areas, they may not be completely caught up in others. 

Today, the focus is on under-identification though, so what happens with these kids? Some might be identified later, others though I suspect are never identified (especially if their difficulties are subtle). I think that some of these kids get passed along from one year to the next.

So, can their language impairments be identified later? Can it make a difference? I don’t know. I think it is possible to identify kids with language impairment in middle and high school. And, I think it is possible to provide interventions that will help them to improve communication and language effectiveness. What I worry about is that these kids may have been seen as lazy rather than as having communication impairments for a long time. At the same time, I think that these kids can benefit from intervention.

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