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Many countries have large minority ethnic populations who rely on majority language speakers to refer them for assessment of communication disorders. This study addresses the questions: do referral patterns for bilingual children match those of their monolingual peers and can risk factors be identified to facilitate future referrals? Data were examined for bilingual and monolingual children referred in one area in England over a 2-year period. Chi-square analyses were used to compare the two data sets and identify significant differences. Referral patterns of bilingual children do show significant differences to those of their monolingual peers. There is evidence that bilingual children with speech disorders are being overlooked. Languages spoken by bilingual children are frequently misreported. The high incidence of prolonged bottle feeding in some communities is highlighted. There is a need to train referral agents, including interpreting staff. Consideration should be given to introducing a screening p...

Bilingual clients frequently feature on speech and language therapists' caseloads and yet they are rarely assessed and treated in their mother tongue. There are few assessments targeting languages other than English. Culturally and linguistically appropriate assessment and remediation materials should be devised for the differing needs of each distinct population. This paper describes the Pakistani Heritage Asian population in Rochdale and one of the first steps taken to address its needs: the development of an early expressive language assessment and remediation package for paediatric clients. Reference is made to the importance of identifying the exact languages spoken, especially when the use of one language may be perceived as denoting lower social status. Semantic and syntactic issues involved in constructing assessments are highlighted.

Diagnosis of speech disorder in children acquiring two languages is problematic. There are few norms for bilingual language acquisition, and speech-language path-ologists are unlikely to speak both languages of the bilingual populations they serve. Further, knowledge concerning the phonological structure of many languages is limited. This article describes the development of a phonological assessment for bilingual children. The assessment was administered to normally developing bilingual children as well as children suspected of speech disorder. The children with speech disorder were referred to the Rochdale Healthcare NHS Trust Speech and Language Therapy Department for assessment of their speech. All of the children spoke either Mirpuri, Punjabi or Urdu at home but were exposed to English at nursery or school. The phonological development of bilingual children in each language is described. The normally developing children showed phonological error patterns in English that would be considered atypical of normal monolingual development in English. The error patterns of two children with speech disorder are also described. The error patterns are consistent with research evidence concerning subgroups of speech disorder in monolingual and bilingual children. The findings provide further support for the hypothesis that symptoms (surface error patterns) of speech disorder are language independent, (i.e., that a single deficit underlies the speech disorder across both languages). The clinical implications for assessment and treatment of speech disorder in children exposed to more than one language are discussed.

INTRODUCTIONKing-Denborough syndrome is an autosomal dominant or sporadic genetic disorder characterised by malignant hyperthermia and a collection of phenotypical characteristics including short stature, skeletal abnormalities and facial dysmorphia (King et al. 1972, Graham et al. 1998). Speech and language disorder and dysphagia have not previously been reported as features of this syndrome.METHODThis paper presents two detailed case studies which describe the assessment and treatment of two brothers, Haider and Bilal presenting with the syndrome. Both children experienced communication impairments and the older brother has subsequently presented with progressive swallowing difficulties in his teenage years. The children come from a Pakistani heritage home where Mirpuri is spoken in addition to English. FINDINGSAged 3;0 Haider* was referred to speech and language therapy by the Paediatrician. Assessment showed that he was only using single word nouns in English and two-word combinations (verb + patient) in Mirpuri. Audiology reported hearing within normal limits and the Educational Psychology Service reported average non-verbal abilities. A diagnosis of language impairment (LI) was made and Haider was offered a place at the local language unit. At this time it was recognised that he had subtle gross motor difficulties and deformity of the spine and sternum. Haider was discharged from the speech and language therapy service aged 7;1 as his communication skills were satisfactory. King-Denborough syndrome was not diagnosed until age 10;0 following a malignant hyperthermia episode during surgery: a reaction to anaesthesia which is a recognised feature of this syndrome.Haider was re-referred by the Paediatrician aged 13;0 with dysphagia. Haider reported a one year history of painful swallowing and nausea. He had a recent chest infection, was coughing at night and had lost weight. A videofluoroscopy showed fluids were spilling into the pharyngeal area. Haider was using a chin-tuck to clear the bolus from the oral cavity. Repeated swallows indicated fatigue leading to an uncoordinated swallow. A gastrostomy was discussed but rejected by Haider. Currently Haider remains under the care of the multidisciplinary team.Aged 3;4 Bilal* was referred to speech and language therapy by the Community Paediatrician. At this time the speech and language therapist discussed the possibility that Bilal had the same syndrome as his older brother. This was confirmed following genetic tests. Bilal was able to follow simple instructions, had no recognisable words and some vocalisations. A diagnosis of LI was made and Bilal attended the language unit. Hussain continues to require speech and language therapy and has not as yet presented with any dysphagia.*(Names have been changed to protect anonymity).CONCLUSIONSThis paper will present the first evidence of language impairment and dysphagia as features of King-Denborough syndrome, expanding the existing evidence base. Additionally it will demonstrate that intervention for minority language children is effective when delivered in their mother tongue, regardless of the initial severity of the presenting disorder. Both children now have bilingual language skills which match their non-language impaired peers.REFERENCESGRAHAM, G.E., SILVER, K., ARLET, V., and DER KALOUSTIAN, V. HUSSAIN., 1998, King syndrome: further clinical variability and review of the literature. American Journal of Medical Genetics, 78, 254-259.KING, J.O., DENBOROUGH, HUSSAIN. A. and ZAPF, P.W., 1972, Inheritance of malignant hyperpyrexia. The Lancet, February 12, 1972, 365-370.

Background: The UK is a multicultural, multilingual society and the majority of paediatric speech and language therapists in England have at least one bilingual child on their caseload. There are many imperatives driving the profession to provide an equitable service for bilingual children. Evidence is beginning to emerge, however, that bilingual children with specific language impairment are not being identified and are, therefore, not accessing services. The situation facing clinicians in the UK is not unique: it is mirrored around the world. Aims: This paper reviews the literature relating to speech and language services for bilingual children and begins by providing an overview of the forces driving the need to provide equity of service. All aspects of the therapeutic process are then examined, from referral to therapy, in order to identify features that are regarded as best practice. Whilst the focus is on delivery of services in the UK, research findings from around the world are considered. Main contribution: Certain themes emerged during the review and their implications are discussed. In particular, the need for assessment tools, training and research is highlighted. Conclusions: Features indicative of best practice are highlighted and tentative suggestions made that would enable services to address the challenges of serving bilingual paediatric caseloads.

This paper describes the development of a phonological assessment procedure for children speaking Mirpuri, Punjabi or Urdu in combination with English. The Rochdale Assessment of Mirpuri Phonology (RAMP) was produced in response to the practical difficulties of a monolingual therapist wishing to assess a child's phonological systems across all languages used. The assessment is currently being used both as a clinical tool within the Rochdale Healthcare NHS Trust Speech and Language Therapy Department and as a research tool in collaboration with the Department of Speech, University of Newcastle to provide further data on patterns of bilingual phonological acquisition. Outcomes include therapy targeted more accurately at deficits within each phonological system.