Multilingual Service Delivery in Audiology and Speech-Language Pathology

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.

Visit the Cultural Responsiveness and Collaborating With Interpreters, Transliterators, and Translators Practice Portal pages for more information about cultural and linguistic considerations.

See the Cultural and Linguistic Diversity (CLD) Evidence Map for summaries of the available research on this topic.

For information about assessment and treatment of specific communication, hearing, or swallowing disorders, refer to the relevant Clinical Topics in the Practice Portal.

A multilingual person can communicate in more than one language, has been exposed to more than one language, or may be learning English in addition to the language(s) they use (ASHA, 2023a). Multilingualism is a continuum of language skills. A person’s proficiency in any of the languages they use can change over time; across social settings, topics, and conversational partners; and additional variables (Bialystok, 2001; Grosjean, 1989).

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 (Valdés, n.d.). As a result, terminology is evolving to describe a multilingual person and the languages they use. Some examples are as follows:

  • Multilingual learners—individuals who speak two or more languages. This is a more inclusive term because it also includes students who are fluent in English and are learning another language in a dual-language program (Najarro, 2023).
    • Dual language learners—individuals learning two languages simultaneously from infancy or who are learning a second language after the first language in early childhood.
    • English language learners (ELLs)—children and adults who are learning English as an additional language for social, educational, and/or employment purposes.
    • Emergent bilingual—a child who acquires another language through school (i.e., the language of instruction) and who is still able to function in their heritage language (García et al., 2008).
  • Limited English proficient—a term used for “English Learners” in the Individuals with Disabilities Education Act. Some administrative offices may still use this classification, but this term is not preferred. Many providers now focus on the strengths of learning another language instead of viewing it as a limitation.
  • Heritage language—language(s) that are different from the dominant language in a given social context (Kelleher, 2010).

Multilingual service delivery occurs in two ways:

  • Cross-linguistic—involves clinical practice with an individual who uses a different language than that of the clinician. For example, an SLP who uses English would be providing cross-linguistic services to a patient who uses Navajo while working with an interpreter.
  • Language-matched—an individual and a clinician share language(s) in service delivery. For example, an SLP who uses English and Navajo would be able to provide language-matched services to a patient who uses Navajo.

This Practice Portal page will use the terms “multilingual,” “multilingual service delivery,” and “heritage language” to encompass the varied experiences of using more than one language. Being multilingual is not a communication disorder, but it is a significant consideration when there are concerns regarding a hearing or communication disorder. Not appropriately responding to cultural and linguistic influences may lead to misdiagnosis, which can reinforce disproportionality in schools (e.g., over- or underrepresentation of a racial/ethnic group in special education) and disparities in health care (e.g., access to medical services).

Content Disclaimer: The Practice Portal, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting.

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