Efficient and Evidence-Based: A New Look at the BIOS-Home

We developed the Bilingual Input–Output Survey–(BIOS-Home & School) as a quick caregiver and teacher interview for SLPs to estimate how much Spanish and English a bilingual child hears (input) and uses (output) during a typical week. One reason we wanted to do this rather than to directly test each language is to use as a part of the BESA battery to determine language ability. If we directly test children with a focus on proficiency, we don’t know if low scores are a result of lack of exposure to a language or a lack of ability. This way we could set expectations for different levels of exposure to help us determine DLD.

Although the BIOS only takes about 10–15 minutes, it can feel time intensive during already tight evaluation timelines and overall available time to interview parents and teachers. The BIOS asks caregivers to report language exposure hour by hour, for a typical weekday and a typical weekend. But, is it possible to reduce the number of questions so that we can take less than 5 minutes? Work by Calandruccio and colleagues suggested that it could be shortened. In a recent study, we replicated their study with a larger group of children in a narrower age range. We also extended the study to understand if expected associations between direct language measures and the long BIOS and shorter BIOS still help up.

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BILINGUAL SUPPORT WHEN YOU ONLY SPEAK ONE LANGUAGE


What if I only speak English? How can I do intervention with bilingual children?

As SLPs, we have to provide services to all persons that are on our caseloads. I think everyone is well aware that bilingual children need to develop skills in both of their languages not just the language of the school (in the US, English). There are good reasons for this. All children need to be able to communicate with those around them. For bilingual children this means they need to be able to communicate in both of their languages. For children with DLD (and other disabilities) in particular, providing them supports in both languages means that they will have opportunities to talk with more of the people in their lives. In turn, this means that they will gain more practice speaking, listening, and interacting with an expanding circle of people. This will help provide them language models across their languages further expanding their language skills.

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Word Types Matter: How Bilingual Children Build Vocabulary

Vocabulary development in young bilingual children is critical for social development and for academic success. But, how does vocabulary develop in a bilingual context? What words do they need to know? And in what language(s)? We know that bilingual children don’t have translation equivalents for all words across their two languages. We have also learned that some words are more likely to be known in the home vs. school language and these are related age at which they first heard these words.

In a recent paper, we looked at how specific word characteristics influence vocabulary development in typically developing Spanish–English bilingual children ages 5–12. Rather than only asking how many words children know, the study asked which kinds of words are learned more easily and why.

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Can we do language intervention in TWO languages?

This is a question that comes up a lot and the answer is yes. But, clinicians, teachers, principals, and parents alike want explanations and reassurance. In a recent study, we profiled bilingual children with and without DLD and found a lot of variability. You can read that paper here, and read a summary here. What are the implications of having exposure and access to two languages? And how can this be navigated:

1. Therapy in two languages is helpful—not harmful

Supporting both Spanish and English does not confuse children. In fact, helping children build skills in both languages supports communication at home, at school, and in the community.

2. Therapy focuses on how language works, not just vocabulary

While learning new words is important, therapy often focuses on helping children:

  • Put words together into complete sentences
  • Use correct verb and noun forms and grammar
  • Understand and express ideas clearly

These skills help children succeed across both languages.

3. A child can be bilingual and have a language disorder

A language disorder is not caused by bilingualism. Some bilingual children need extra support with language, just like some monolingual children do. The goal of therapy is to help children use their languages more effectively and confidently.

4. Strong skills in one language support the other

When children improve grammar and sentence skills in one language, those skills often help the other language too. This is why bilingual intervention can be especially powerful.


What should parents expect from bilingual intervention?

Your child’s speech-language pathologist may:

  • Use Spanish, English, or both, depending on your child’s needs
  • Build on the language used at home
  • Focus on grammar, sentence structure, and meaning—not just pronunciation
  • Help your child communicate more successfully with family, teachers, and peers

The goal is not to replace a home language, but to strengthen your child’s ability to communicate across settings.

We need to communicate this information to families! Bilingualism is good for you, even if a child has DLD.

Every bilingual child has a unique language profile. Differences across languages are normal. What matters most is that your child receives support that:

  • Respects their cultural and linguistic background
  • Strengthens their ability to express their ideas completely
  • Helps them succeed socially and academically

Bilingualism is a gift—and with the right support, children with language difficulties can thrive in both languages.

I’m often asked by families, clinicians and teachers about whether the home language should be continued and whether children with DLD will be confused. Here are some FAQs around this topic:

Should we stop using Spanish at home if my child has a language disorder (DLD)?

No. You should not stop using Spanish at home.

Using Spanish at home does not cause language difficulties, and stopping it will not fix a language disorder. Children with DLD have difficulty learning language in any language they use, not because they are bilingual.

Why is continuing Spanish important?

  • Spanish is how your child connects with family.
    Using the home language supports emotional bonds, cultural identity, and confidence.
  • Children learn language best in the language they hear most naturally.
    Parents communicate more clearly, richly, and naturally in their strongest language.
  • Strong Spanish supports English learning.
    Skills such as grammar, sentence structure, and storytelling can transfer from Spanish to English over time.

Will using Spanish confuse my child?

No. Research shows that children—even those with DLD—are capable of learning two languages. Children are not confused by hearing or using Spanish and English. In fact, reducing language input can limit opportunities to practice communication.

What if English is the language of school?

It is okay—and beneficial—for:

  • Spanish to be the language of the home, and
  • English to be supported at school and in therapy

Speech-language therapy helps children build skills that work across languages, especially grammar and sentence structure.

What happens if we stop using Spanish?

Stopping Spanish can:

  • Reduce the amount of language your child hears and uses
  • Limit communication with family members
  • Create stress or frustration for your child
  • Remove an important cultural and emotional support system

For children with DLD, less language input means fewer chances to practice, not faster improvement.

What is the best thing we can do at home?

✔ Speak to your child in the language you are most comfortable using
✔ Talk often, read together, and tell stories in Spanish
✔ Encourage your child to express ideas—mistakes are okay
✔ Work with your speech-language pathologist as a team

Bottom line for families

Bilingualism does not cause language disorders.
Spanish is an asset, not a barrier.
Your child deserves support that strengthens communication without asking families to give up their language or culture.

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Language Profiles of Bilingual Children with and without DLD

Many children grow up using two languages, such as Spanish and English. Learning two languages is a strength—but it can also look different from one child to another. This is especially true for children who have developmental language disorder (DLD), a condition that makes learning language harder, even when children are smart, motivated, and well supported.

Understanding bilingual profiles is important for making clinical and educational decisions about bilingual children. In a recent study, we examined how Spanish–English bilingual children (ages 5–10) differed in their language profiles across two languages (Spanish, English) and two domains (morphosyntax, semantics). In a recent study, we were interested in how these profiles related to developmental language disorder (DLD). We used a person-centered statistical approach to better understand naturally occurring profiles rather than assuming a single or predominant “typical” bilingual pattern.

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BESA & BESA-ME Compared: Spanish Morphosyntax

Last post I compared the BESA English morphosyntax for 4-6;11 year olds with the upward extension, the BESA-ME, that is designed for children 7 to 11;11. This time, let’s compare BESA-ME Spanish morphosyntax to BESA. Many people have asked why we couldn’t just use the BESA with older kids and just extend the norms. The answer in short is that many of the items on the BESA are just too easy for older kids with DLD. So, those items would not do a good job of differentiating between bilingual children with and without DLD. When we test children for diagnostic purposes, we want tests that help us make decisions of whether or not the child has the disorder that we are testing for. In this case, developmental language disorder.

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BESA & BESA-ME Comparison: English Morphosyntax

Yes, the BESA-ME is coming! And we are so happy to be able to give you all a timeframe for getting it into the hands of SLPs who serve bilingual children. The BESA-ME is the Bilingual English Spanish Assessment-Middle Elementary (or is it Middle Extension? I can’t remember what we ended up with but, still BESA-ME). It will be published by Brookes Publishing. They say it will be available summer of 2026, so pretty soon. We did turn in everything last summer, but there are steps to finish, clean up drawings, do the protocol layout, the picture books, and edits for the whole thing.

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How Bilingual Kids’ Language Environments Change as They Grow

When we think about how bilingual children learn language, we often imagine their home environment as something steady—Spanish at home, English at school, maybe some mix in between. But in a new study by Albudoor and colleagues (2024) we show that a child’s language environment is far from fixed. In fact, it changes a lot as kids grow, especially between ages 4 and 12.

In this research, we followed 280 of Spanish–English bilingual children over several years and looked closely at when, where, and with whom children used each language. We hope these findings can help families, teachers, and speech-language pathologists better understand bilingual development—and find ways to better support it.

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BILD: Bilingual Innovation in Language Diagnosis (Sharing Nomogram and Decision Tree Handout at ASHA)

We presented the clinical use of the nomogram and decision tree models at this year’s ASHA convention (Handout here). These tools aim to help us identify bilinguals with DLD efficiently and accurately.

Why should we use nomogram and decision tree models in clinical practice?

Traditional MethodTool #1: Nomogram of BESATool #2: Decision tree on multiple evidence
Different subtests rated equallyAdjust subtests weighting(Aims to maximize sensitivity and specificity)Provide the order of assessment based on the nodes
Collect different assessment data(Time-consuming)Considering multiple subtestsProvide the order of assessment tasks(Efficiency)
Making a diagnostic decision based on multiple evidenceProvide the decision based on the tasks
Easy to use
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Mediated Learning Observation: Validity & Possible Uses

Observation of mediated learning—that is learning in the moment is critical component of dynamic assessment. These observations of learning during a very short intervention is a strong indicator of developmental language disorder (DLD).

In a 2024 study, we explored whether the Mediated Learning Observation (MLO)—a tool used during the teaching phase of dynamic assessment (DA)—was a valid and reliable way to rate children between kindergarten through 2nd grade. In previous studies, we have found that this tool works well for bilingual kindergarten age children and for monolingual first and second graders. In this study, we were interested in whether the items on the MLO instrument conformed to the theorized structure.

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