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.
Does being bilingual cause speech delays?
No. This is the most repeated myth in pediatric speech therapy, and it costs families real time.
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 (called 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 reach milestones a few weeks later in one language, and parents or even well-meaning pediatricians misread that as a problem. The actual red flag is when a child is behind in both languages at once, or when they're not communicating socially in any language at the expected age. If your child's pediatrician tells you to 'just pick one language,' that advice is not supported by current evidence. ASHA's bilingual service delivery guidance spells out the specific clinical language [1].
What is bilingual speech therapy, exactly?
Bilingual speech therapy means the clinician assesses and treats a child using both (or all) of their languages, not only the dominant or school language. The therapist may run sessions that move between languages, use materials in both, and set goals that apply across both language systems.
There are two delivery models in practice. The first is a bilingual SLP who speaks the child's home language fluently and gives therapy directly in that language. The second is a monolingual SLP working alongside a trained interpreter or bilingual assistant. The first model is strongly preferred for assessment, because 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 is experienced with it.
Bilingual therapy isn't translation. It's knowing which sounds, grammatical structures, and social norms exist in each language, because what looks like an error in English may be correct transfer from Spanish, Mandarin, or Arabic. A clinician who only knows English norms can easily flag errors that aren't there or, just as badly, miss real ones.
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.
How do you tell if a bilingual child has a real language disorder?
This is the hardest clinical question in the field, and honest SLPs will tell you 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 (more than reduced vocabulary, and 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 stated directly [4].
If you're worried, the right move is 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].
What languages do bilingual SLPs actually cover?
Spanish is by far the most available, which tracks the demographics of the U.S. population. 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 set.
How many bilingual SLPs are there, and why is it so hard to find one?
Too few. 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 for you: the search may take longer than you want. The best starting points are ASHA's 'Find a Professional' tool (you can filter 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.
Should bilingual kids be treated in both languages or just one?
Both. 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. Language skills transfer across a bilingual child's 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 too. Parents and grandparents often speak the home language. 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, this principle applies to device programming too. Both languages should be present and modeled.
How does early intervention work for bilingual children?
Early intervention (EI) for children birth to age 3 runs under Part C of the Individuals with Disabilities Education Act (IDEA) [8]. Under Part C, services must happen in the 'natural environment,' which the law describes as settings 'natural or normal for the child's age peers who have no disabilities' [8]. For a bilingual family, the natural environment is a bilingual household, and that should shape how services are delivered.
IDEA also carries rules about communicating with families in their native language for evaluation and procedural safeguard purposes [8]. In practice, your state's EI program should provide an interpreter if no bilingual SLP is available, and you have the right to ask for one before evaluations begin.
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 must use 'nondiscriminatory' assessment procedures, which bars tests biased against children because of their language background [8].
Early intervention speech and language therapy covers the full Part C process at Little Words. The short version: refer early, request a bilingual evaluation in writing, and don't let 'wait and see' run past 18 months if you have real concerns.
For school-age children (3 and up), services shift to Part B of IDEA, where the school district takes responsibility. The same nondiscriminatory assessment requirement applies, but bilingual school SLPs are even scarcer than in private practice.
What does bilingual speech therapy cost, and does insurance cover it?
Private bilingual speech therapy sessions usually cost between $100 and $350 per hour in the U.S., depending on region and the clinician's specialty [9]. Bilingual SLPs in high-demand languages (Spanish) often price close to monolingual SLPs. For rarer languages, the rate can run higher because supply is thinner.
Insurance coverage follows the same rules as any speech therapy. Most private plans cover speech therapy when a licensed SLP provides it and a documented medical diagnosis is on file (the relevant ICD-10 codes for speech and language disorders are F80.0 through F80.9) [10]. Medicaid covers speech therapy for children in all states, and many states cover it with no session limits for kids under 21 under EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) provisions [11].
The wrinkle with bilingual therapy is that insurance doesn't separately reimburse 'bilingual services.' The service code is the same regardless of language. If the only bilingual SLP you can find is out of network, you're looking at higher out-of-pocket costs and a possibly long reimbursement fight.
School-based services under IDEA are free to families if the child qualifies for an IEP or IFSP. The catch: the school district picks the clinician, and if no bilingual SLP is on staff, you may end up with interpreter-assisted services of uneven quality.
For a broader look at how speech therapy for kids is funded and delivered, that page covers the main pathways including EI, school services, and private practice.
How do you find a bilingual speech therapist?
Start with ASHA's online directory at asha.org. On the 'Find a Professional' search, there's a language filter. It's not exhaustive, since not every bilingual clinician has updated their profile, 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 an internal referral list too.
University training clinics are an underused resource. Programs with bilingual SLP faculty often have graduate clinicians who are native speakers of other languages, supervised by licensed bilingual SLPs. Fees are usually reduced, sometimes a lot. The waiting list can be long, but it's worth calling.
Teletherapy platforms have widened bilingual coverage. Platforms like Bilinguistics, Therapy First, and others specifically recruit bilingual SLPs. This doesn'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 on teletherapy, which for speech-language services is generally comparable to in-person for school-age children.
If you use an app like Little Words (an AI speech companion designed for neurodivergent kids) for home practice between sessions, set the content up in the child's home language too. Home practice in one language only isn't the goal.
How do bilingual assessments work, and what should I ask for?
A proper bilingual speech and language evaluation has several parts that a standard English-only evaluation skips.
First, the clinician should gather a thorough language history. How much exposure does the child have to each language? At what age did each language begin? Who speaks which language at home? Exposure history matters because vocabulary norms shift with how much input a child gets [3].
Second, standardized testing should use tools normed on bilingual populations where they exist. The Bilingual English-Spanish Assessment (BESA) is one example for Spanish-English children [3]. For many language pairs, no standardized bilingual tools exist, which is exactly why dynamic assessment matters.
Third, a language sample analysis in each language (or both, in a code-switching context) gives the clinician real data on mean length of utterance, grammatical morpheme use, and error patterns. This can't run through an interpreter alone. The interpreter has to transcribe accurately and the SLP has to know the grammar of both languages to score it.
When you call to schedule, ask two questions: 'Do you assess in both languages?' and 'Do you use tests normed on bilingual children or dynamic assessment procedures?' If the clinician sounds shaky on what dynamic assessment means, that tells you something.
For autism evaluations, the mix of ASD and bilingualism adds another layer. Autism spectrum speech therapy has more on how autism affects language assessment generally.
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 readiness before handing them strong language tools. For a bilingual or multilingual family, a good AAC system is one that supports communication in the home language, the school language, and ideally lets the child switch 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 practical barrier is that most AAC specialists are trained in English-language programming and may not know how to build out a full Spanish or Mandarin vocabulary set correctly.
Ask your SLP specifically about vocabulary organization in both languages and whether core vocabulary words are available in the home language. 'Core vocabulary' (the 200 or so high-frequency words that make up the bulk of what anyone says) exists in every language, but the specific words and their grammatical behavior differ.
Families who communicate mostly in a language other than English should make clear to the AAC team that the device needs to serve real communication at home, not only at school. A device that only supports English cuts a child off from half their social world.
For a broader look at 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 abandon when they get worried about speech.
Children need rich input in each language to develop it. If you speak Cantonese fluently and switch entirely to English at home because someone told you it would help, you're cutting the quality of language input in both languages at once. You speak English less fluently (probably) and your child gets thinner language models. Nobody wins.
Read in both languages. Sing in both languages. Label objects at home in both languages. These aren't exotic therapy techniques. They're the normal behaviors of bilingual families, and they work.
For children in speech therapy, ask your child's SLP for specific home practice strategies in the home language. Most therapy homework comes written in English. Ask the clinician to adapt it or at least explain it to you in your language, so you can run the activities at home in the language your child uses most with you.
If you're using a speech practice app at home, the same principle applies. Little Words, for example, is designed to support neurodivergent kids, and home practice in the language the child actually uses with you matters more than drilling English vocabulary they'll never say to their grandparents.
Parent coaching in the home language is an area where research is still building. 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 language outcomes in toddlers and preschoolers, though most studies were run in English [13]. The mechanism (parent models language in natural routines) carries directly to any language.
For more structured guidance on therapy at home, pediatric speech therapy covers the parent coaching model in detail.
Frequently asked questions
Does speaking two languages at home delay speech development?
No. ASHA's position is explicit: bilingualism does not cause language disorders or speech delays. Bilingual children may have smaller vocabularies in each individual language at certain ages, but their combined vocabulary across both languages is comparable to monolingual peers. If your child is behind in both languages at once, that's worth evaluating, but two languages themselves are not the cause.
How do I know if my bilingual child needs speech therapy or just more exposure to English?
The key question is whether your child has difficulties in both languages, not only the one they've had less exposure to. A child who struggles only in English but communicates well in the home language likely needs more English exposure, not therapy. A child who has trouble communicating in either language, or who isn't meeting social communication milestones in any language, should be evaluated by a bilingual SLP.
Should I stop speaking our home language if my child has a speech delay?
No. This recommendation is not supported by evidence and can cause real harm by cutting your child off from family relationships and reducing the quality of language input at home. ASHA advises clinicians to support and maintain the home language. Keep speaking your home language. Your child can and should develop both languages, even with a speech or language disorder.
What is the difference between a language disorder and a language difference in bilingual children?
A language difference means a child's speech reflects normal variation from their bilingual environment, like code-switching or accent. A language disorder means there's an underlying processing deficit that shows up in both languages. Clinicians use dynamic assessment and cross-linguistic comparison to tell these apart. The distinction matters enormously, because a misdiagnosis of disorder can lead to unnecessary special education placement.
How do I find a bilingual speech therapist who speaks my language?
Start with ASHA's 'Find a Professional' directory at asha.org, which has a language filter. Also contact your state's early intervention office directly, as they often keep bilingual provider lists that aren't public. University speech clinics are another option. For rarer languages, teletherapy platforms with large bilingual rosters often have more coverage than local private practice.
Does insurance cover bilingual speech therapy?
Insurance covers speech therapy by a licensed SLP when there's a documented diagnosis. It doesn't separately pay more or less for bilingual services. The session codes are the same. Medicaid covers speech therapy for children in all states, often with no session cap under EPSDT rules. School-based services under IDEA are free if the child qualifies for an IEP. The challenge is that bilingual SLPs are sometimes out of network.
Can a bilingual child use AAC (a speech-generating device) in both languages?
Yes. Major AAC software platforms support multiple languages and can be set up with vocabulary in more than one. A child's device should support communication at home in the family's language as well as at school. Ask your AAC specialist explicitly about home language vocabulary setup. Core vocabulary, the 200 or so high-frequency words most used in any language, exists in every language and should be included.
What does IDEA say about bilingual evaluations for early intervention?
Part C of IDEA requires that evaluations be nondiscriminatory and not biased based on language background. It requires communication with families in their native language. You can request a bilingual evaluation in writing when your child enters the early intervention system. If no bilingual SLP is available, your state EI program should provide a trained interpreter for the evaluation.
At what age should I refer my bilingual child for a speech evaluation?
The same milestones used for monolingual children apply, just read across both languages. If your child isn't babbling by 12 months, saying any words by 16 months, combining words by 24 months, or if you notice regression in communication at any age, get an evaluation. Don't wait past 18 months if you have real concerns. Early intervention (under age 3) is free and doesn't require a diagnosis to access.
Is there research showing bilingual therapy is more effective than English-only therapy?
Yes. Research consistently shows bilingual intervention produces outcomes at least as good as monolingual intervention, and typically better for home language skills. A frequently cited study by Thordardottir et al. (2010) in the American Journal of Speech-Language Pathology found bilingual intervention resulted in gains in both languages. More recent meta-analyses support this. English-only therapy in a bilingual child doesn't protect the home language.
What questions should I ask a speech therapist before hiring them for my bilingual child?
Ask: Do you assess in both of my child's languages? Do you use tests normed on bilingual populations or dynamic assessment? Have you worked with children who speak (our specific language)? How do you involve the home language in therapy goals and home practice? If they use an interpreter, ask how that person is trained for clinical interpretation specifically. A good clinician will answer these confidently.
Is code-switching (mixing two languages) a sign of a language disorder?
No. Code-switching is a normal feature of bilingual communication, even in young children. Bilingual adults and children switch languages based on context, conversational partner, and topic. It reflects competence in both systems, not confusion. A bilingual SLP will not pathologize code-switching. It becomes relevant clinically only if a child seems to mix languages because they're missing words in both, which differs from typical code-switching.
My child's school says they need to learn English before getting speech therapy. Is that true?
No, and that position conflicts with IDEA requirements. A child with a speech or language disorder qualifies for services regardless of English proficiency. The evaluation must run in a nondiscriminatory manner, meaning in both languages. If a school is delaying evaluation or services on the basis that your child needs to learn English first, that may be a procedural violation worth raising with your state's special education parent advisory council.
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.