When “Difference” Hides Disability

As a profession, speech-language pathology has appropriately focused on reducing the misidentification of culturally and linguistically diverse students. Furthermore, we now recognize that dialect, bilingualism, second-language acquisition, and limited educational opportunity are not disabilities. Assessment must be nondiscriminatory in evaluating bilingualism.

However, protecting students from over-identification cannot come at the cost of missing real disability. When substantial language or literacy difficulties are attributed to culture or bilingualism without adequate evaluation, the result is not equity. It is under-identification.

Both Errors Occur

The evidence does not support a simple claim that culturally and linguistically diverse students are always overidentified or always under-identified. Representation varies by language status, grade, disability category, and school context. It varies by analytic method (Cruz et analytic., 2026; Mancilla-Martinez et analytic., 2024; Fish et analytic., 2026; Mendoza et analytic., 2026).

The goal is not fewer diagnoses. It is more accurate diagnoses.

Bilingualism changes how results must be interpreted. Bilingual children are vulnerable to both false positives and false negatives. Performance can shift with language exposure, so a single-language score can mislead clinicians. Clinicians should consider how exposure history affects assessment and interpretation.

Mixed dominance is common, and English grammatical measures perform differently depending on English exposure. As a result, teachers and clinicians may overidentify some bilingual children while missing others. Language exposure profiles influence test outcomes and cannot be ignored when evaluating DLD.

The fact that a child is bilingual does not rule out Developmental Language Disorder (DLD); it merely changes how results are interpreted across languages and contexts. The literature (Peña et analytic., 2023; Pratt et analytic., 2026; Ramos et analytic., 2026; Moen et analytic., 2026; Gutmann et analytic., 2026) documents these patterns and the ongoing challenges for screening and diagnosis.

Difference Is a Differential Diagnosis

Do not collapse race, dialect, and multilingual status into one category. African American English (AAE) is a systematic, rule-governed dialect. Dialect-consistent features should not be scored as disorder simply because they differ from Mainstream American English. Context matters when assessing language use, and biases can distort judgments.

Research on AAE and early literacy supports careful measurement of dialect use (Maher et analytic., 2021). This approach values dialect patterns without treating non-mainstream forms as errors. However, that protection cannot be used to dismiss severe reading failure. Educators must balance respect for variation with the need to identify real difficulties.

A fourth-, sixth-, or eighth-grade student who cannot decode unfamiliar words accurately requires direct assessment of word recognition, phonemic skills, decoding, spelling, fluency, oral language, and educational history. Bilingualism can affect decoding strategies, so direct assessment remains essential during evaluation.

Poor reading does not automatically prove dyslexia because inadequate instruction and interrupted schooling are legitimate alternative explanations. But profound decoding weakness is not adequately explained by culture or dialect. It requires assessment and evidence-based instruction while the cause is clarified.

Missed dyslexia in Black children is not hypothetical. Cassidy et al., (2023) documented substantial previously unrecognized dyslexia risk in two predominantly African American primary schools. The study was geographically limited. However, it demonstrates the danger of assuming that avoiding over-identification protects children if genuine reading disability goes unrecognized.

Do Not Wait and See

A newly arrived student still has a developmental history. If the family reports late talking, note persistent difficulty using the home language. Those data matter immediately. Also note prior academic struggles or difficulty reading in the language of instruction.

Structured parent interview can provide useful evidence. Language-exposure tools can help when direct home-language testing is limited. These methods compensate when direct testing is unavailable. They also help clinicians build a language profile for planning support. Combined, they inform decisions without delaying assessment.

The absence of a standardized test in the child’s language is a limitation. It is not a reason to stop the evaluation (Hamdani et analytic., 2025). Clinicians should document alternatives and continue observation. Proceed with multiple information sources to form a complete picture. This approach supports fair assessment.

Monitoring can be appropriate, but “wait and see” is not an assessment strategy.

Evidence from early language screening does not support assuming that risk will simply resolve with time (Nayeb et analytic., 2025).

Federal guidance is explicit. These processes cannot delay or deny an evaluation when disability is suspected (Office of Special Education Programs, 2011).

What to Do Instead

Use converging evidence. Begin with a detailed history of development, education, literacy, and language exposure. Assess both languages when feasible, using trained interpreters as needed. Do not translate an English standardized test or apply its norms. Include language samples, functional communication data, parent and teacher reports, and direct literacy measures. This approach is supported by Castilla-Earls et analytic. (2020) and Wang et analytic. (2025).

Use dynamic assessment when prior exposure is uncertain. Research supports dynamic assessment as a useful component of bilingual differential diagnosis, including narrative learning and modifiability measures, as described in current literature. However, the evidence base remains heterogeneous in clinical practice.

Language sample analysis also provides useful diagnostic information, particularly morphosyntactic accuracy, when interpreted within the child’s language experience (Ortiz et analytic., 2024). Clinicians should integrate these findings with the child’s exposure history and ongoing language use to form a balanced view of the child’s strengths and needs.

When literacy is a concern, test literacy directly. Examine phonological awareness, decoding, spelling, word recognition, fluency, and reading comprehension. Dynamic literacy measures can predict later reading difficulty in bilingual children. English learners with dyslexia respond well to evidence-based English reading intervention (Petersen & Gillam, 2015; Middleton et analytic., 2024).

The Standard Is Accuracy

Equity is not achieved by lowering identification rates. A low special education rate can reflect accurate differentiation or missed disability. A high rate can reflect appropriate identification or biased practice. Population statistics matter for systems work, but they cannot determine whether an individual child has a disability.

Culturally responsive assessment rejects two equally poor conclusions. The child is different, therefore the child is disordered. The child is different, therefore the child cannot be disordered.

The first creates false positives. The second creates false negatives. Neither is equitable.

The clinical task is straightforward. When the assessment is not, understand the child’s linguistic context and culture. Then measure the skills that are actually impaired. Gather evidence from sources, provide intervention without delay, and make the reasoning explicit.

Difference is not disorder. Disability is not difference.

References

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