Nonword Repetition in Bilingual Assessment: A Guide to Clinical Application

Purpose: Nonword repetition (NWR) is a useful tool in the identification of language impairment in bilingual children. As a method of alternative assessment, the task is less biased than many traditional forms of assessment. Despite its potential utility, the use of NWR in language assessment is limited. The goal of this tutorial is to provide speech-language pathologists with the information needed to use NWR as a diagnostic tool in bilingual assessment by describing research into its diagnostic accuracy and considerations for clinical application. Conclusions: NWR is a useful diagnostic tool in bilingual language assessment when used as part of an assessment battery. Although its diagnostic accuracy limits its ability to be used in the absence of other tools, it can provide valuable information that can be used to strengthen clinical impressions. When using NWR measures, clinicians should take several important aspects in account, including the language and age for which it was intended, the type of stimuli included, and the scoring procedures. Clinicians who work with bilingual children should consider including NWR in their diagnostic toolkits, as a less biased method of assessment.

C-14 Socially Responsible Neuropsychology (SRN) in Action: Assessment of a Highly Educated Bilingual Latina Older Adult

Objective Early identification of cognitive symptoms pathognomonic of Alzheimer’s disease (AD) in highly educated bilingual adults remains challenging. We present a clinical case illustrating the application of an SRN model in a 70-year-old highly educated, balanced bilingual Latina eventually diagnosed with moderate-severe stages of AD following an event of severe confusion and disorientation. Method An SRN model was applied to promote equitable care through evidence-based consideration of cognitive aging-reserve and its putative manifestation in neurodegenerative disorders. The patient underwent a neuropsychological assessment and structural/functional neuroimaging. Her educational background, linguistic proficiencies, acculturation level, social/behavioral comportment, and limitations in available neuropsychological tools/norms were integrated to reflect the complexity in conducting a reliable bilingual assessment and formulating differential diagnoses. Results The SRN model guided clinical decision-making to determine the appropriate target language for bilingual assessment, and to identify reliable normative anchors of impairment relative to premorbid estimates, resulting in incorporation of validated Spanish measures/norms. Neuroimaging revealed bilateral parietal-temporal hypometabolism, which was generally consistent with neuropsychological findings, and the patient was diagnosed with major neurocognitive disorder due to AD. Conclusions Given the advanced nature of this patient’s cognitive decline by the time of assessment, it was hypothesized that the combination of bilingualism and high education further masked the precipitous decline atypically observed in AD individuals with high cognitive reserve. Cognitive reserve theories, nonetheless, continue to be anchored strictly within a monocultural-monolingual framework. This complex case, therefore, highlights the urgent need to incorporate bilingualism in current models of cognitive reserve to boost sensitivity in detecting early expression of bilingual AD.

Synthesizing Information From Language Samples and Standardized Tests in School-Age Bilingual Assessment

Purpose Although language samples and standardized tests are regularly used in assessment, few studies provide clinical guidance on how to synthesize information from these testing tools. This study extends previous work on the relations between tests and language samples to a new population—school-age bilingual speakers with primary language impairment—and considers the clinical implications for bilingual assessment. Method Fifty-one bilingual children with primary language impairment completed narrative language samples and standardized language tests in English and Spanish. Children were separated into younger (ages 5;6 [years;months]–8;11) and older (ages 9;0–11;2) groups. Analysis included correlations with age and partial correlations between language sample measures and test scores in each language. Results Within the younger group, positive correlations with large effect sizes indicated convergence between test scores and microstructural language sample measures in both Spanish and English. There were minimal correlations in the older group for either language. Age related to English but not Spanish measures. Conclusions Tests and language samples complement each other in assessment. Wordless picture-book narratives may be more appropriate for ages 5–8 than for older children. We discuss clinical implications, including a case example of a bilingual child with primary language impairment, to illustrate how to synthesize information from these tools in assessment.

Self-ratings of spoken language dominance: A Multilingual Naming Test (MINT) and preliminary norms for young and aging Spanish–English bilinguals

This study investigated correspondence between different measures of bilingual language proficiency contrasting self-report, proficiency interview, and picture naming skills. Fifty-two young (Experiment 1) and 20 aging (Experiment 2) Spanish–English bilinguals provided self-ratings of proficiency level, were interviewed for spoken proficiency, and named pictures in a Multilingual Naming Test (MINT); in Experiment 1, the Boston Naming Test (BNT) was also used. Self-ratings, proficiency interview, and the MINT did not differ significantly in classifying bilinguals into language-dominance groups, but naming tests (especially the BNT) classified bilinguals as more English-dominant than other measures. Strong correlations were observed between measures of proficiency in each language and language-dominance, but not degree of balanced bilingualism (index scores). Depending on the measure, up to 60% of bilinguals scored best in their self-reported non-dominant language. The BNT distorted bilingual assessment by underestimating ability in Spanish. These results illustrate what self-ratings can and cannot provide, illustrate the pitfalls of testing bilinguals with measures designed for monolinguals, and invite a multi-measure goal-driven approach to classifying bilinguals into dominance groups.