Last updated 2026-07-09
TL;DR
Growing up bilingual does not cause speech delays. A child with a real language disorder shows the same trouble in both languages, not one. Bilingual speech therapy treats kids in both their languages, and research consistently finds better outcomes than English-only therapy. Finding a bilingual SLP is the hard part: fewer than 8% of ASHA-certified clinicians identify as bilingual.
No, being bilingual does not cause speech delays. This is the most repeated myth in pediatric speech therapy, and it costs families real time waiting on advice they didn't need to follow.
The American Speech-Language-Hearing Association (ASHA) is unambiguous: bilingualism does not cause language disorders, and it does not cause speech delays [1]. A bilingual child may mix languages (code-switching) and may have a smaller vocabulary in each individual language than a monolingual peer at certain ages. But count the words across both languages together and the total lines up with monolingual norms [2].
Where the myth gets sticky is that some bilingual children hit milestones a few weeks later in one language, and parents, or even well-meaning pediatricians, misread that as a problem. The real red flag is a child who's behind in both languages at once, or one who isn't communicating socially in any language at the expected age. If a pediatrician tells you to "just pick one language," that advice isn't supported by current evidence. ASHA's bilingual service delivery guidance spells out the clinical reasoning [1].
What bilingual speech therapy actually looks like
Bilingual speech therapy means the clinician assesses and treats a child using both (or all) of their languages, not just the dominant or school language. Sessions may move between languages, materials come in both, and goals are set to apply across both language systems.
There are two models in practice. One is a bilingual SLP who speaks the child's home language fluently and delivers therapy directly in it. The other is a monolingual SLP working alongside a trained interpreter or bilingual assistant. The first is strongly preferred for assessment, since misdiagnosis risk climbs when interpreters aren't part of a structured protocol [3]. For ongoing therapy, a qualified interpreter-assisted model can work well if the SLP has experience with it.
This isn't translation work. It means knowing which sounds, grammatical patterns, and social norms exist in each language, because what looks like an error in English may just be correct transfer from Spanish, Mandarin, or Arabic. A clinician who only knows English norms can flag errors that aren't really there, or miss the ones that matter.
For kids on the autism spectrum, bilingual therapy also intersects with AAC planning. If a child uses a speech-generating device, that device should support both languages. Learn more about alternative augmentative communication devices for autism.
Spotting a real language disorder in a bilingual child
This is the hardest clinical question in the field, and honest SLPs will admit there's still real uncertainty in how to answer it.
The clearest indicator is cross-linguistic deficit: the child shows the same type of difficulty, not just reduced vocabulary but processing errors, morphological errors, or phonological errors, in both languages [3]. A child who speaks Spanish at home and English at school might have a smaller English vocabulary simply from less exposure. But if that same child also struggles with verb conjugations in Spanish, that's a meaningful signal.
Clinicians combine parent report, dynamic assessment (teaching the child something new and measuring how fast they learn it), and standardized tests normed on bilingual populations. Tests normed only on monolingual English speakers overidentify language disorders in bilingual children, which leads to unnecessary special education labels and wasted therapy time [3].
One concrete data point: a 2021 study in the Journal of Speech, Language, and Hearing Research found dynamic assessment had significantly better diagnostic accuracy for bilingual children than static standardized tests alone [4]. "Dynamic assessment may help differentiate language difference from language disorder in bilingual children," the study's authors wrote [4].
If you're worried, get an evaluation by a bilingual SLP or a team that includes one. A standard evaluation by a monolingual English-speaking clinician beats nothing, but the error rate runs meaningfully higher [3].
Which languages bilingual SLPs cover
Spanish is by far the most available, which tracks U.S. population demographics. ASHA's 2023 survey data shows Spanish is the most common non-English language reported by bilingual SLPs, followed by Mandarin, Cantonese, and Vietnamese, though coverage for those languages is far thinner [5].
For families who speak less common languages (Somali, Haitian Creole, Hmong, many South Asian languages), finding a native-speaker SLP may not be possible in most metro areas. Those families usually work with a monolingual SLP plus a trained interpreter, or turn to teletherapy through a national platform with a larger roster. Online speech therapy has widened access here, since a bilingual SLP in Los Angeles can now serve a family in rural Minnesota.
Ask any telehealth platform how their bilingual clinicians are credentialed, and whether the interpreter, if one is used, has been trained in clinical interpretation versus general translation. Those are not the same skill.
Why bilingual SLPs are so hard to find
There just aren't enough of them. ASHA's member data shows that fewer than 8% of its certified members self-identify as bilingual [5]. Roughly 22% of U.S. school-age children speak a language other than English at home (U.S. Census Bureau, American Community Survey). That gap is huge.
The shortage has structural roots. Speech-language pathology graduate programs run almost entirely in English. Clinical training, supervision hours, and national certification exams are English-only. A clinician who grew up speaking Spanish at home may never have had the chance to build clinical vocabulary and assessment skills in that language during training.
Some states try to close the gap with bilingual authorization systems. California, for example, has a Bilingual Specialization credential that authorizes SLPs to provide services in a specific language if they can demonstrate proficiency [6]. New York uses similar authorization frameworks for school-based clinicians [6]. These are state-level efforts, not a national standard, and enforcement varies.
What this means practically: the search may take longer than you'd like. The best starting points are ASHA's "Find a Professional" tool (filterable by language), state early intervention programs (which often have bilingual staff), and university speech-language clinics, which sometimes have multilingual graduate students supervised by licensed clinicians.
One language or both?
Both, and the research on this is pretty consistent.
A frequently cited 2010 study by Thordardottir and colleagues, published in the American Journal of Speech-Language Pathology, found bilingual intervention produced outcomes at least equal to monolingual intervention in the dominant language, and that the home language benefited from therapy even when the therapist mostly targeted the school language [7]. More recent meta-analyses have strengthened that picture.
The clinical logic holds up too. Skills transfer across a bilingual child's language systems: improve phonological awareness in Spanish and you'll see gains in English reading readiness. Build vocabulary concepts in the home language and the child can map English words onto concepts they already own instead of learning from scratch.
There's a family argument as well. Parents and grandparents often speak the home language, and if therapy only targets English and the child can't talk to grandma in Tagalog, you've traded one problem for another. ASHA's position on multilingual speakers states directly that clinicians should "support and maintain the home language" while building skills in the community language [1].
For families using AAC with a nonspeaking or minimally speaking child, the same principle applies to device programming: both languages should be present and modeled.
How does early intervention work for bilingual children?
Early intervention for children from birth to age 3 runs under Part C of the Individuals with Disabilities Education Act, and it must happen in what the law calls the "natural environment," meaning settings normal for the child's age peers without disabilities [8]. For a bilingual family, that natural environment is a bilingual household, and services should be delivered with that in mind.
IDEA also requires that families be communicated with in their native language for evaluations and procedural matters [8]. In practice, your state's EI program should provide an interpreter if no bilingual SLP is available, and you can ask for one before evaluations start.
Here's what many families don't know: you can request a bilingual evaluation when you refer your child to early intervention. Put it in writing. States are required to use "nondiscriminatory" assessment procedures, which rules out tests biased against children because of their language background [8].
Early intervention speech and language therapy walks through the full Part C process. The short version: refer early, request a bilingual evaluation in writing, and don't let "wait and see" stretch past 18 months if you have real concerns.
Once a child turns 3, services shift to Part B of IDEA, and the school district takes over. The same nondiscriminatory assessment rule applies, but bilingual school SLPs are even harder to find than in private practice.
What does bilingual speech therapy cost, and does insurance cover it?
Private bilingual speech therapy sessions usually run $100 to $350 per hour in the U.S., depending on region and the clinician's specialty [9]. Bilingual SLPs in high-demand languages like Spanish often charge close to what monolingual SLPs charge. For rarer languages, rates can climb higher simply because supply is thin.
Insurance coverage follows the same rules as any speech therapy: most private plans cover it when a licensed SLP provides it and there's a documented medical diagnosis on file, using ICD-10 codes F80.0 through F80.9 [10]. Medicaid covers speech therapy for children in every state, and many states place no session limits for kids under 21 under EPSDT provisions [11].
The wrinkle with bilingual therapy is that insurance doesn't pay extra for "bilingual services." The billing code is the same no matter what language the session happens in. So if the only bilingual SLP you can find is out of network, you're facing higher costs and possibly a long reimbursement fight.
School-based services under IDEA cost families nothing if the child qualifies for an IEP or IFSP. The catch is that the district picks the clinician, and without a bilingual SLP on staff, you may end up with interpreter-assisted services of uneven quality.
For a wider view of how these pathways fit together, speech therapy for kids covers early intervention, school services, and private practice funding.
How do you find a bilingual speech therapist?
Start with ASHA's online directory at asha.org, which has a language filter under "Find a Professional." It's not complete, since not every bilingual clinician keeps their profile updated, but it's the best national starting point [1].
Call your state's early intervention program directly. In many states, the central EI office keeps a list of bilingual providers that never shows up in any public directory. Your county's regional center (in California) or equivalent developmental disability agency may keep its own referral list too.
University training clinics are underused. Programs with bilingual SLP faculty often have graduate clinicians who are native speakers of other languages, working under supervision from licensed bilingual SLPs, and fees are usually much lower. The waiting list can be long, but it's worth the call.
Teletherapy has widened bilingual coverage too. Platforms like Bilinguistics, Therapy First, and others specifically recruit bilingual SLPs. It won't replace in-person therapy for every child, but for school-age kids and families in areas with few bilingual SLPs, it's a real option. Online speech therapy covers the research, which shows teletherapy is generally comparable to in-person for school-age children. If you use an app like Little Words (an AI speech companion built for neurodivergent kids) for practice between sessions, set it up in the child's home language as well. Practice in only one language misses the point.
How do bilingual assessments work, and what should you ask for?
A real bilingual speech and language evaluation covers ground a standard English-only evaluation skips entirely.
First, the clinician should take a thorough language history: how much exposure the child has to each language, when each one started, who speaks which language at home. This matters because vocabulary norms shift depending on how much input a child gets in each language [3].
Second, testing should use tools normed on bilingual populations where they exist, like the Bilingual English-Spanish Assessment (BESA) for Spanish-English children [3]. For many language pairs, no standardized bilingual tools exist at all, which is exactly why dynamic assessment matters.
Third, a language sample analysis in each language (or both, if the child code-switches) gives the clinician real data on sentence length, grammar use, and error patterns. This can't happen through an interpreter alone: the interpreter has to transcribe accurately, and the SLP has to understand the grammar of both languages well enough to score it.
When you call to schedule, ask two things: whether they assess in both languages, and whether they use tests normed on bilingual children or dynamic assessment procedures. If the answer sounds shaky, that tells you something.
For families dealing with an autism evaluation as well, bilingualism adds another layer to consider, and autism spectrum speech therapy covers how autism affects language assessment more broadly.
Can bilingual children use AAC in both languages?
Yes, and they should be able to.
Presumption of competence in AAC means you don't wait for a child to prove they're ready before giving them strong language tools. For a bilingual or multilingual family, a good AAC system supports the home language and the school language, and ideally lets the child move between them [12].
Most major speech-generating device software (Proloquo2Go, TouchChat, LAMP Words for Life) supports multiple languages and can be set up with vocabulary pages in more than one. The real barrier is that most AAC specialists are trained in English-language programming and may not know how to build a full Spanish or Mandarin vocabulary set correctly.
Ask your SLP directly about vocabulary organization in both languages and whether core vocabulary (the roughly 200 high-frequency words that make up most of what anyone says) is available in the home language. That core exists in every language, but the specific words and how they behave grammatically differ.
Families who mostly speak a language other than English at home should tell the AAC team plainly that the device needs to work for real communication there, not just at school. A device that only runs in English cuts a child off from half their social world.
For more on device options, see alternative augmentative communication devices for autism.
What can parents do at home to support bilingual speech development?
Keep speaking your home language. This is the single most important thing, and it's the thing families most often drop when they get worried about speech.
Children need rich input in each language to develop it well. If you speak Cantonese fluently and switch entirely to English at home because someone told you it would help, you cut the quality of language input in both languages at once: you speak English less fluently than your first language, and your child gets thinner input overall. Nobody wins there.
Read in both languages. Sing in both languages. Label objects around the house in both languages. None of this is exotic therapy technique. It's just what bilingual families already do, and it works.
If your child is in speech therapy, ask the SLP for home practice strategies in your home language. Most therapy homework comes written in English, so ask the clinician to adapt it or at least walk you through it in your language, so you can run activities in whatever language your child actually uses with you.
The same goes for practice apps. Little Words, for instance, is built to support neurodivergent kids, and practicing in the language your child uses with you matters more than drilling English words they'll never say to their grandparents.
Parent coaching in the home language is an area where the research is still catching up. A 2011 review by Roberts and Kaiser in the American Journal of Speech-Language Pathology found parent-implemented language interventions had meaningful effect sizes for toddlers and preschoolers, though most of the studies were conducted in English [13]. The underlying mechanism, a parent modeling language during everyday routines, works the same way regardless of which language it happens in.
For more on structured home therapy, pediatric speech therapy goes into the parent coaching model in detail.
Bilingualism itself is not the problem, and that's worth saying plainly before anything else: ASHA is explicit that speaking two languages at home does not cause language disorders or speech delays. A bilingual child might have a smaller vocabulary in each individual language at certain ages, but add the two together and their combined vocabulary matches monolingual peers. If a child is behind in both languages at once, that's worth looking into, but two languages on their own don't explain a delay. So how do you tell whether your child just needs more English exposure or actually needs therapy? Look at whether the difficulty shows up in both languages. A child who struggles only in English but communicates well at home in the family language probably just needs more time and exposure, not intervention. But a child who has trouble communicating in either language, or who's missing social communication milestones no matter which language you look at, should see a bilingual SLP for an evaluation. If your child does have a delay, don't drop the home language. There's no evidence behind that old advice, and it can actually cause harm, cutting a child off from family relationships and reducing the overall quality of language they hear at home. ASHA tells clinicians to support and maintain the home language, not eliminate it. Kids can develop both languages even with a diagnosed speech or language disorder. It helps to understand the difference between a language difference and a language disorder. A difference is just normal variation from growing up bilingual: things like code-switching or an accent. A disorder is an underlying processing deficit that shows up in both languages, not just one. Clinicians tease these apart using dynamic assessment and cross-linguistic comparison, and getting this right matters a lot, since misdiagnosing a difference as a disorder can lead to a child being placed in special education unnecessarily. Along the same lines, code-switching, mixing two languages mid-sentence or mid-conversation, is completely normal bilingual behavior, even in young children, and reflects skill in both languages rather than confusion. A good bilingual SLP won't treat it as a red flag. It only becomes clinically relevant if a child seems to be reaching for words they don't have in either language, which is a different pattern. Finding the right clinician takes some digging. ASHA's "Find a Professional" directory at asha.org has a language filter, and it's a good place to start. Your state's early intervention office is also worth a direct call, since many keep bilingual provider lists that never make it online, and university speech clinics are another avenue. If your family speaks a less common language, teletherapy platforms with large bilingual rosters often have better coverage than local private practices. Before hiring anyone, it's fair to ask whether they assess in both of your child's languages, whether they use tests normed on bilingual populations or dynamic assessment, whether they've worked with your specific language before, how they'll bring the home language into therapy goals, and, if they rely on an interpreter, how that person is trained for clinical interpretation. A clinician who knows what they're doing will answer all of this without hesitating. On cost: insurance covers speech therapy from a licensed SLP when there's a documented diagnosis, and it doesn't pay more or less depending on whether services are bilingual, since the billing codes are the same either way. Medicaid covers speech therapy for children in every state, often with no cap on sessions under EPSDT rules, and school-based services under IDEA are free once a child qualifies for an IEP. The real obstacle tends to be that bilingual SLPs are more often out of network. If your child uses or might use AAC, know that the major platforms support multiple languages and can be programmed with vocabulary in more than one. A device should let a child communicate at home in the family's language just as well as it does at school, so ask your AAC specialist directly about setting up home language vocabulary. Core vocabulary, the roughly 200 high-frequency words used constantly in any language, exists across all languages and should be built in from the start. For early intervention specifically, Part C of IDEA requires evaluations to be nondiscriminatory and free of bias based on language background, and requires that families be communicated with in their native language. You can request a bilingual evaluation in writing as soon as your child enters the EI system, and if no bilingual SLP is available, the state program should provide a trained interpreter for the evaluation itself. If a school ever tells you a child needs to learn English before they can get speech therapy, that's not accurate and conflicts with IDEA: a child with a genuine speech or language disorder qualifies for services regardless of English proficiency, and delaying evaluation on those grounds may be a procedural violation worth raising with your state's special education parent advisory council. As for when to seek an evaluation, the milestones are the same ones used for monolingual kids, just checked across both languages: no babbling by 12 months, no words by 16 months, no word combinations by 24 months, or any regression in communication at any age. Don't wait past 18 months if something feels off. Early intervention under age 3 is free and doesn't require a diagnosis to get started. And the research backs bilingual intervention specifically. Studies consistently show it produces outcomes at least as good as English-only intervention, and typically better results for the home language. Thordardottir et al. (2010), published in the American Journal of Speech-Language Pathology, found bilingual intervention led to gains in both languages, and more recent meta-analyses back this up. English-only therapy doesn't protect or preserve a child's home language.Sources
- ASHA: Bilingual Service Delivery (Practice Portal): Bilingualism does not cause language disorders; ASHA advises clinicians to support and maintain the home language.
- ASHA: Spoken Language Disorders (Practice Portal): Bilingual children's combined vocabulary across both languages is comparable to monolingual peer norms.
- Peña, E.D. et al., 'Differentiating Language Difference from Language Disorder,' Language, Speech, and Hearing Services in Schools (LSHSS, ASHA Journals): Cross-linguistic deficit and dynamic assessment are the clinically preferred methods for distinguishing language disorder from language difference in bilingual children; monolingual-normed tests overidentify disorders.
- Hasson, N. et al., dynamic assessment meta-analysis, Journal of Speech, Language, and Hearing Research (JSLHR): 'Dynamic assessment may help differentiate language difference from language disorder in bilingual children,' as stated by JSLHR study authors (2021).
- ASHA: 2023 Member Counts and Demographic Profile: Fewer than 8% of ASHA-certified members self-identify as bilingual; Spanish is the most common non-English language reported.
- California Commission on Teacher Credentialing: Bilingual Authorizations for Speech-Language Pathology: California issues a Bilingual Specialization credential for SLPs who demonstrate proficiency in a specific language for service delivery.
- Thordardottir, E. et al. (2010), 'Bilingual Assessment,' American Journal of Speech-Language Pathology (AJSLP): Bilingual intervention produced outcomes at least equivalent to monolingual dominant-language intervention and produced home language gains.
- U.S. Department of Education: IDEA Part C Regulations (34 CFR Part 303): IDEA Part C requires nondiscriminatory evaluation in the child's native language and services in the natural environment; Part C covers children birth to age 3.
- ASHA: Speech-Language Pathology Survey (SLP Health Care Survey, per available member data): Private speech therapy sessions in the U.S. typically range from $100 to $350 per hour depending on region and specialty.
- CDC/CMS: ICD-10-CM Coding for Speech and Language Disorders (F80.x codes): ICD-10-CM codes F80.0 through F80.9 cover specific speech and language developmental disorders used for insurance billing.
- Medicaid.gov: Early and Periodic Screening, Diagnostic, and Treatment (EPSDT): EPSDT requires states to cover medically necessary speech therapy for Medicaid-enrolled children under age 21 with no federally mandated session limits.
- ASHA: Augmentative and Alternative Communication (AAC) Practice Portal: AAC systems for bilingual children should support communication in both languages; presumption of competence applies regardless of language background.
- Roberts, M.Y. & Kaiser, A.P. (2011), 'The Effectiveness of Parent-Implemented Language Interventions,' American Journal of Speech-Language Pathology: Parent-implemented language interventions showed meaningful effect sizes for toddler and preschool language outcomes; the mechanism transfers across languages.