Manifesto

The ATLAS-Leiden Manifesto was launched at the House of Lords on 30th January 2024.

The Manifesto has been endorsed by over 60 organisations including the British linguistics associations LAGB, BAAL and BACL, Speech and Language UK, Autistica, the Down Syndrome Association, and the Association of Youth Offending Team Managers.

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The ATLAS Leiden Declaration: Think Language First!

I. OUR VISION

We want a world in which every child and young person has equal opportunities to fulfil their potential. Language is the gateway to lifelong wellbeing, including educational attainment. However, around 10% of school-age children have language difficulties, either on their own (Developmental Language Disorder) or in association with other diagnoses such as autism or learning disabilities. Deafness and hearing loss, too, often leads to delayed and atypical language development in children, and even to language deprivation, since they commonly have no access to sign language early enough. Also, living in areas of social disadvantage is associated with an increased prevalence of language difficulties. Furthermore, even though multilingualism is positive in itself, growing up with more than one language has associated challenges that impact large numbers of children and young people. Yet language needs are often not recognized, or are attributed to other causes.

We are calling for:

all types of language needs to be recognized and understood;
diagnosis for language difficulties that does not miss a single child or young person;
language difficulties to be fully acknowledged as a disability wherever appropriate;
every child who needs it, to have access to adequate language support throughout the school journey.
the removal of barriers that children and young people with communication difficulties face

II. WHAT NEEDS TO CHANGE

As human beings, we need language to make sense of the world and each other. Research shows that language paves the way to education and is one of the strongest predictors of quality of life and wellbeing. However, school-aged children with language needs are often unidentified. Severe language difficulties may be associated with behavioural problems, school drop-out or exclusion, mental health problems, unemployment and even criminality (for example, in the UK, 60% of young offenders have a language impairment). In addition, unsupported language difficulties result in staggering costs for health and justice systems. Failure to improve the vulnerable language skills of a current UK cohort of 3-year-olds (14%) has been estimated to cost society £330M later in life.

Language needs are often overlooked and constitute an ‘invisible challenge’.

We want to:

improve identification of language needs by
- providing reliable language measures that can be used by a wide range of professionals, including teachers;
- recognizing potential failure to diagnose language needs in children who are multilingual, have sensory impairment or a general learning disability;
- assessing language at critical points of transition in the school journey;
make language support systematically available across all education and health systems;
train and support education, health, social care and justice professionals in how to recognize language challenges and how to address them;
raise public awareness of the this invisible difficulty

III. ACTIONS

In order to ensure that all school age children with language needs have access to language support, between now and 2026:

We will…

contribute to the formation of an international and interdisciplinary platform for scientists and professionals in the fields of education, linguistics, speech and language therapy, psychology, law, and social work to raise awareness of children and young people’s language needs;
ensure that research evidence and expertise from these fields is shared and made accessible;
promote best practices within and across national boundaries.

We will call on decision makers to …

develop policy to ensure that school age children with language needs are properly identified and supported throughout the school journey;
mandate regular language and communication checkpoints (spoken or signed) for all children throughout the school journey, with follow-up assessment as required;
ensure appropriate educational support and language intervention for all children and young people with language needs;
ensure that future developments in school curricula and educational policies are informed by an understanding of typical and atypical language development;
ensure access for all schools to multidisciplinary teams to support language needs, and train and empower school teachers to provide communication-supportive classroom environments.

We will work together with…

all stakeholders, including schoolchildren with language needs and their parents, (head)teachers, social workers, professionals in youth justice, child health and educational support to raise awareness of language difficulties as an invisible difficulty (“Think Language First”);
International, European, national and regional speech and language therapy associations to streamline and facilitate information about interventions and share experiences and best practices;
International, European, national and regional associations supporting children and young people and families with language needs, including multilingual families and families with deaf children, to facilitate access to support programs and share experiences and best practices.

IV. FINANCING

The actions we call from decision-makers will need to be funded initially by pooling relevant state budgets of Ministries of Education, Health and Justice, but will pay for themselves over time with increased employability and reduced calls on justice and social welfare.

V. ABOUT US

We are the participants of the NIAS-Lorentz meeting that took place in Leiden during the week of 27^th September – 1^st October 2021 (Language Development, Diagnosis and Assessment in School Ages (6-16): Next Steps in Research and Practice).

This text has been prepared by the NIAS-Lorentz Theme Group ATLAS (María J. Arche, Angeliek van Hout, Alexandra Perovic, Josep Quer, Jeannette Schaeffer and Petra Schulz) and collaborators (Anne Baker, Karen Bryan, Ellen Gerrits, Jean Gross and Derek Munn).

The manifesto has been endorsed by the following workshop participants so far:

Bencie Woll, University College London

Laurice Tuller, University of Tours

Caterina Donati, CNRS/University of Paris

Mai van Dijk – Fleetwood-Bird, Erasmus University Rotterdam

Gordana Hrzica, University of Zagreb

Victoria L Joffe, University of Essex

Ianthi Tsimpli, University of Cambridge

Ljiljana Jeličić, Institute for Experimental Phonetics and Speech Pathology of Belgrade

Marilyn Nippold, University of Oregon

Maria Kambanaros, University of South Australia

Alfonso Igualada Pérez, Open University of Catalonia

Marcel Giezen, Basque Center on Cognition, Brain and Language

Evelien Krikhaar, Expertisecentrum Nederlands

Susan Ebbels, Moor House School and college

Sarah Spencer, University of Sheffield

Janneke de Waal-Bogers, Dutch SLT Association NVLF

Tobias Haug, Interkantonale Hochschule für Heilpädagogik Zürich

Merle Weicker, Goethe University Frankfurt

Elma Blom, Utrecht University

Eliane Segers, Radboud University

Margreet Vogelzang, University of Cambridge

Leona Talsma, Canterbury Christ Church University

Eleni Peristeri, Aristotle University of Thessaloniki, Greece

Naama Friedmann, University of Tel Aviv

Jess Turnbull, Guy’s and St Thomas’ NHS Foundation Trust

Elissa Porter, University of Greenwich

Erika Kalocsanyiova, University of Greenwich.

Endorse

Key Facts

Language is the gateway to lifelong wellbeing and educational attainment

Language development is key to children’s health, as defined by the World Health Organization (WHO), as well as to children’s rights, as defined by the United Nations [1, 2]. When language ability is affected the consequences are wide-reaching. Language difficulties affect the core of children’s well-being and their ability to learn and progress in life [3]. Language and communication needs have a wide-ranging negative impact, such as poor literacy, low(er) academic achievement, school drop-out, and unemployment [4]. Underachievement at school is also common among many multilingual children, especially those arriving in their new country during late childhood [5, 6]. Autistic people and those with attention deficit (hyperactivity) disorder (AD(H)D) are also more likely to experience language and communication needs, as are people with mental health conditions such as anxiety and selective mutism. As a result, language needs themselves sometimes remain unidentified [7, 8, 9, 10, 11, 12].

[1] The WHO Constitution (1946) defines health as “physical, mental and social well-being”, and highlights that “healthy development of the child is of basic importance”. https://www.who.int/about/governance/constitution (Retrieved on 2023-4-3)

[2] The United Nations Convention on the Rights of the Child (1990) formulates several articles that speak to children’s development [highlights are ours]. https://www.unicef.org/child-rights-convention/convention-text (Retrieved on 2023-4-3)

– Article 6: Life, survival and development — “Governments must make sure that children survive and develop in the best possible way”.

– Article 1: Sharing thoughts freely — “Children have the right to share freely with others what they learn, think and feel, by talking, drawing, writing or in any other way”.

– Article 29: Aims of education — ”Children’s education should help them fully develop their personalities, talents and abilities”.

[3] Law, J., J. Charlton & K. Asmussen. 2017. Language as a child wellbeing indicator. Early Intervention Foundation. Report.

https://www.google.com/url?q=https://www.eif.org.uk/files/pdf/language-child-wellbeing-indicator.pdf&sa=D&source=docs&ust=1686645459031788&usg=AOvVaw2ULRddzyrSJsgrvCkDtaC0 (Retrieved on 2023-6-13)

[4] Law, J., R. Rush, I. Schoon & S. Parsons. 2009. Modeling developmental language difficulties from school entry into adulthood: literacy, mental health, and employment outcomes. Journal of Speech, Language and Hearing Research, 52(6): 1401-16.

[5] PISA 2018 and the EU. Striving for social fairness through education. Directorate-General for Education, Youth, Sport and Culture. Brussels: European Commission. Report. https://education.ec.europa.eu/sites/default/files/document-library-docs/pisa-2018-eu_1.pdf (Retrieved on 2023-4-3)

[6] Middlemas, J. 2019. Attainment of pupils with English as an additional language. Early years, Schools and SEND Analysis and Research Division. Department for Education of the UK. Report. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/908929/Attainment_of_EAL_pupils.pdf (Retrieved on 2023-4-3)

[7] Royal College Speech & Language Therapists. 2020. Talking about mental health: Speech, language, communication and swallowing. Statement. https://www.rcslt.org/wp-content/uploads/media/docs/Talking-about-mental-health_-communication-and-swallowing-needs—FINAL—May-2020.pdf (Retrieved on 2023-4-3)

[8] Bryan, K. 2013. Psychiatric disorders and communication. In Cummings. L. (Ed.), Handbook of Communication Disorders. Cambridge: Cambridge University Press.

[9] NHS Digital. (2018). Mental Health of Children and Young People in England, 2017. Report. https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2017/2017

[10] Hollo, A., J.H. Wehby & R.M. Oliver. 2014. Unidentified language deficits in children with emotional and behavioral disorders: A meta-analysis. Exceptional Children 80(2). 169–186. https://doi.org/10.1177/001440291408000203-186.

[11] Botting, N., U. Toseeb, A. Pickles, K. Durkin & G. Conti-Ramsden. 2016. Depression and anxiety change from adolescence to adulthood in individuals with and without language impairment. PLOS One 11(7). e0156678. doi:10.1371/journal.pone.0156678

[12] S.A. Sullivan, L. Hollen, Y. Wren, A.D. Thompson, G. Lewis, S. Zammit. 2016. A longitudinal investigation of childhood communication ability and adolescent psychotic experiences in a community sample. Schizophrenia Research 173(1-2). 54-61. doi: 10.1016/j.schres.2016.03.005. Epub 2016 Mar 10. PMID: 26972475; PMCID: PMC4847740.

10% of school-age children have language difficulties

About 10% of school-age children have language difficulties they will not grow out of. Of these, at least 7.5% have developmental language disorder and about 2.3% have language difficulties associated with another diagnosis (e.g. autism, Down Syndrome, sensori-neural hearing loss).

Developmental Language Disorder (DLD) explained

Developmental Language Disorder (DLD) (formerly called: Specific Language Impairment, or SLI) is a developmental, genetic, and arguably hereditary disorder that is noticed as the child develops. It is characterized by a primary difficulty in the acquisition of speech and language: understanding and producing sounds, words and/or sentences [13, 14]. This language impairment can be present without deficits in nonverbal intelligence, although problems with working memory and other executive functions often (but not always) co-occur. It is estimated that at least 7% of the overall population has DLD [15, 16]. People with DLD are six times more likely to have reading difficulties and four times more likely to struggle with mathematics [17]. There can be serious and long-term impacts, as it puts children at greater risk of failing at school and struggling with mental health and future employment.

The Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5) uses the term “Language Disorder”. The term “Developmental Language Disorder” is used by the World Health Organization in the latest International Classification of Diseases (ICD-11, February 2022).

References

[13] Leonard, L. 1998/2014. Children with specific language impairment. 2nd edition. MIT Press.

[14] Bishop, D.V.M., M.J. Snowling, P.A. Thompson, T. Greenhalgh & the CATALISE-2 consortium. 2017. Phase 2 of CATALISE: a multinational and multidisciplinary Delphi consensus study of problems with language development: Terminology. The Journal of Child Psychology and Psychiatry, Special Issue: Developmental Language Disorders 58(10). 1068-1080. doi: 10.1111/jcpp.12721.

[15] Tomblin, J.B., N.L. Records, P. Buckwalter, X. Zhang, E. Smith, M. O’Brien. 1997. Prevalence of specific language impairment in kindergarten children. Journal of Speech Language and Hearing Research 40(6). 1245-60. doi: 10.1044/jslhr.4006.1245.

[16] Norbury, C.F., D. Gooch, C. Wray, G. Baird, T. Charman, E. Simonoff, G. Vamvakas & A. Pickles. 2016. The impact of nonverbal ability on prevalence and clinical presentation of language disorder: evidence from a population study. Journal of Child Psychology and Psychiatry 57(11). 1247-1257. doi: 10.1111/jcpp.12573.

[17] Young, A.R., J.H. Beitchman, C. Johnson, L. Douglas, L. Atkinson, M. Escobar & B. Wilson. 2002. Young adult academic outcomes in a longitudinal sample of early identified language impaired and control children. Journal of Child Psychology and Psychiatry 43(5). 635-645. doi: 10.1111/1469-7610.00052.

Language difficulties in autism and learning disabilities

Language difficulties in autism
Autistic children are at increased risk of experiencing language and communication difficulties. Some autistic children are non-speaking while others have difficulties with language-in-context (pragmatics), which is the case for virtually all autistic individuals. Impairments in grammar are present in a sizeable proportion of autistic children, with figures varying from 20% [18] to 50% [19] or even over 70% [20].

Language difficulties and learning disabilities
In Down syndrome, a common genetic cause of a general learning disability, the majority of affected individuals have structural language impairments [21]. The acquisition of sentence structure is also subject to delay in other developmental disorders such as Williams syndrome [22, 23].

References:

[18] Larson, C., Rivera-Figueroa, K., Thomas, H., Fein, D., Stevens, M., Eigsti, I-M. (2022). Structural language impairment in Autism Spectrum Disorder versus Loss of Autism Diagnosis: Behavioral and neural characteristics. NeuroImage: Clinical, Volume 34. doi: 10.1016/j.nicl.2022.103043.

[19] Kjelgaard MM, Tager-Flusberg H. (2001). An investigation of language impairment in autism: implications for genetic subgroups. Lang Cog Proc., 16:287–308. doi: 10.1080/01690960042000058

[20] Loucas T, Charman T, Pickles A, Simonoff E, Chandler S, Meldrum D, Baird G. (2008). Autistic symptomatology and language ability in autism spectrum disorder and specific language impairment. J Child Psychol Psychiatry. 2008;49:1184–1192. doi: 10.1111/j.1469-7610.2008.01951.x.

[21] Martin GE, Klusek J, Estigarribia B, Roberts JE. (2009). Language characteristics of individuals with Down syndrome. Top Lang Disord. 29(2):112-132. doi: 10.1097/tld.0b013e3181a71fe1.

[22] Perovic, A., Wexler, K. (2007). Complex grammar in Williams syndrome. Clinical Linguistics and Phonetics, 21(9), 729-745. doi: 10.1080/02699200701541409

[23] Joffe, V., Varlokosta, S. (2007). Patterns of Syntactic Development in Children with Williams Syndrome and Down’s Syndrome: Evidence from Passives and Wh-Questions. Clinical Linguistics & Phonetics, 21 (9), 705-727. doi: 10.1080/02699200701541375

Deafness, language development and language deprivation

A sign language, as a visual language, is fully accessible to children with a hearing impairment. However, most children born deaf or with hearing impairment (90-95% in the case of the US, for example) [24] are not exposed to sign language from birth because they have hearing parents who do not know it. Thus access to language input during the first years of life is seriously restricted. The language acquisition process that takes place during the first years of life (0 to 5) is at risk and can suffer a delay, with all the consequences thereof. Only 5-10% of deaf or hearing-impaired children are born into families where a sign language is used, enabling them to acquire language through signing.

In many developed countries, babies are screened at a very young age, and, if a hearing impairment is detected, a cochlear implant is proposed to the parents as a solution. The expectation is that the child will “hear” with training over several years and will acquire a spoken language fully. Many audiologists and speech therapists recommend that the child not be offered any sign language in parallel, because that could create the risk of interference with the acquisition of the spoken language. However research on bilingual acquisition in this context shows that parallel exposure to a sign language constitutes a safety net for language acquisition [25], [26], [27]. Even though many cases with cochlear implants are very successful, not all implanted children acquire a spoken language fully [28], [29], and, when this is detected, it is sometimes too late, namely, past the critical period for language acquisition. In extreme cases, this unsuccessful access to a spoken language leads to significant language deprivation, as a result of which the child does not acquire language in any modality. That is, some of the problems that deaf and hearing-impaired children face are therefore not the direct consequence of deafness or hearing impairment but of choices professionals and parents may have made based on wrong assumptions about parallel exposure to sign language [30].

[24] Mitchell, R. E., M. A. Karchmer. 2004. Chasing the Mythical Ten Percent: Parental Hearing Status of Deaf and Hard of Hearing Students in the United States. Sign Language Studies 4(2). 138-163.

[25] Trovato, S. 2013. Stronger Reason for the Right to Sign Languages. Sign Language Studies 13(3). 401-422.

[26] Davidson, K., D. Lillo-Martin & D. Chen Pichler. 2014. Spoken English language development among native signing children with cochlear implants. Journal of Deaf Studies and Deaf Education, 19(2) 239-250.

[27] Hrastinski, I. & R.B. Wilbur. 2016. Academic achievement of deaf and hard-of-hearing students in an ASL/English bilingual program. Journal of Deaf Studies and Deaf Education 21(2). 156-170.

[28] Boons, T., L. de Raeve, M. Llangereis, L. Peeraer, J. Wouters & A. Wieringen. 2013. Expressive vocabulary, morphology, syntax and narrative skills in profoundly deaf children after early cochlear implantation. Research in Developmental Disabilities 34(6). 2008-2022.

[29] Geers,A.E., C.M. Mitchell, A. Warner-Czyz, N-Y. Wang & L.S. Eisenberg. 2017. Early Sign Language Exposure and Cochlear Implantation Benefits. Pediatrics 140(1), e20163489.

[30] Humphries, T., P. Kushalnagar, G. Mathur, D.J. Napoli, C. Padden, C. Rathmann & S. Smith. 2017. Discourses of prejudice in the professions: the case of sign languages. Journal of Medical Ethics 43 (9) 648-652. DOI: 10.1136/medethics-2015-103242

Multilingual children

Across the world, many children grow up with more than one language. This multilingual setting can take on many different forms. A child may speak a language at home that is not the majority language in the country. For example, in the United States, 22% of the children (that is, more than 12 million children in total), speak a language other than English at home according to a survey from 2016. Between 2006 and 2016, this rate rose by 2%, that is by 1.2 million children [31]. Also, a child may grow up speaking two or more languages at home; these are often the languages that the parents speak. In Canada, for example, between 18 and 25% percent of children use two or more languages at home [32]. The situation in Europe is similar. In Germany, for example, 39% of the children speak another language at home besides German [33]; in the UK, 19.5% of school children have a first language other than English [34]. Importantly, whether children grow up with one or several languages is in principle not dependent of where they or their parents were born. To illustrate, in Germany, half of the preschool children (between 3 and 7 years old) whose parent(s) moved to Germany speak German as one of their first languages; the other half do not speak German at home [35].

When compared to a monolingual standard, typically developing bilingual children often fail to reach that norm in their second language. Typically developing bilingual children need language support in all their languages to foster language development throughout the school journey.

[31] https://datacenter.kidscount.org/updates/show/184-the-number-of-bilingual-kids-in-america-continues-to-rise

[32] Schott, E., Kremin, L. V., & Byers-Heinlein, K. 2021, November 12. The youngest bilingual Canadians: Insights from the 2016 Census regarding children aged 0-9. Retrieved from osf.io/2gzfw.

[33] Stanat, P., Schipolowski, S., Schneider, R., Sachse, K. A., Weirich, S. & Henschel, S. Hrsg.. 2022. IQB-Bildungstrend 2021. Kompetenzen in den Fächern Deutsch und Mathematik am Ende der 4. Jahrgangsstufe im dritten Ländervergleich. Waxmann.
https://www.iqb.hu-berlin.de/bt/BT2021/Bericht

[34] https://www.bildungsbericht.de/de/bildungsberichte-seit-2006/bildungsbericht-2020/pdf-dateien-2020/bildungsbericht-2020-barrierefrei.pdf

[35] UK Office of National Statistics https://explore-education-statistics.service.gov.uk/find-statistics/school-pupils-and-their-characteristics#explore-data-and-files

Language difficulties and behavioural and mental health problems

Language difficulties affect children’s ability to engage with others at school, and negatively affect literacy, which can lead to lack of attainment and to disengagement with school [41]. This effect is commonly associated with psychological and behavioural problems, which may eventually result in being expelled from the school [42, 43]. In one study, two thirds of children facing school exclusion had language difficulties [44] and about 88% of boys and 74% of girls in custody [in the UK in 2021] had been excluded from school. Longitudinal studies have shown that language impairment is a significant risk factor for offending [45, 46] and that language disorders are among the strongest predictors of reoffending [47].

[41] Conti-Ramsden, G., Durkin, K., Simkin, Z., and Knox, E. 2009. Specific language impairment and school outcomes. I: Identifying and explaining variability at the end of compulsory education. International Journal of language and communication disorders, 44(1): 15–35.

[42] Beitchman, J, Wilson, B., Johnson, C.J., Atkinson, L., Young, A., Adlaf, E., Escobar, M., and Douglas, L. 2001. Fourteen-year follow-up of speech/language-impaired and control children: psychiatric outcome. Journal Journal of the American Academy of Child and Adolescent Psychiatry 40(1).

[43] Lindsay, G., Dockrell, J., and Strand, S. (2007). Longitudinal patterns of behaviour problems in children with specific speech and language difficulties: child and contextual factors. Br. J. Educ. Psychol. 77: 811–828.

[44] Clegg, J., Stackhouse, J., Finch, K., Murphy, C. and Nicholls, S. 2009. Language abilities of secondary age pupils at risk of school exclusion: A preliminary report. Child Language Teaching and Therapy, 25: 123-139.

[45] Brownlie EB, Beitchman JH, Escobar M, Young A, Atkinson L, Johnson C, Wilson B, Douglas L. 2004. Early language impairment and young adult delinquent and aggressive behavior. Journal of Abnormal Child Psychology 32(4):453-67.

[46] Smart, D., Vassallo, S., Sanson, A., Richardson, N., Dussuyer, I., Mckendry, W., Dussuyer, I., Marshall, B., Toumbourou, J., Prior, M. And Oberklaid, F., 2003.

Patterns and Precursors of Adolescent Antisocial Behaviour. Types, Resiliency and Environmental Influences. Melbourne: Australian Institute of Family Studies.

[47] Winstanley, M., Webb, R. and G. Conti-Ramsden. 2021. Developmental language disorders and risk of recidivism among young offenders. Journal of Child Psychology and Psychiatry 62(4): 396–403.

The economic cost of unsupported language needs

Studies from 2020 in the UK [48] show that 14% of children aged three were considered at risk of developing language difficulties. The lifetime economic costs of unsupported language skills in these UK children are estimated to be around £330 million. These costs accumulate across multiple cohorts of children. The cost derives from decreased lifetime earnings for the children and the demand on special education needs, mental health services, and potential costs associated with involvement of criminal justice services.

[48] Kerr, M. and Franklin, J. (2021). The economic cost of early vulnerable language skills. Pro Bono Economics.

Diagnosis of language needs in children who are multilingual

Assessing the language abilities of bilingual children is particularly challenging. This is because bilingual children vary widely regarding age at onset of acquisition, length of exposure to the other languages, and richness and frequency of input in their languages. Misdiagnosis of bilingual children is a pressing problem [49]. Overdiagnosis (i.e., incorrect classification of typically developing children as language impaired) occurs because children’s language abilities do not match those of same-aged monolingual peers. It also occurs because their language (e.g., errors with the forms of nouns (case) and verbs (inflection)) resembles those of impaired children, [50] -[53]). In this case, children are wrongly assigned to language therapy and may suffer from stigmatization. In addition, they take up the scarce therapy places needed to help children with language impairment. At the same time, many bilingual children experience underdiagnosis (ie non-identification of children with language impairment), because their (low) language abilities are not identified as Developmental Language Disorder (DLD), but incorrectly attributed to the result of acquiring two languages. If DLD is not diagnosed, children are at high risk for poor academic and social achievement [54].

[49] Grimm, A., & Schulz, P. 2014. Specific language impairment and early second language acquisition: The risk of over- and underdiagnosis. Child Indicators Research, 7(4), 821–841. https://doi.org/10.1007/s12187-013-9230-6

[50] Almeida, L. de, Ferré, S., Morin, E., Prévost, P., dos Santos, C., Tuller, L., Zebib, R., & Barthez, M.‑A. 2017. Identification of Bilingual Children with Specific Language Impairment in France. Linguistic Approaches to Bilingualism, 7(3-4), 331–358. https://doi.org/10.1075/lab.15019.alm

[51] Garraffa, M., Vender, M., Sorace, A., & Guasti, M. T. 2019. Is it possible to differentiate multilingual children and children with Developmental Language Disorder?. Languages, Society and Policy https://doi.org/10.17863/CAM.37928

[52] B. A. Goldstein. Ed. 2022. Bilingual Language Development and Disorders in Spanish-English Speakers. 3rd edition. Brookes.

[53] Paradis, J., Genesee, F., & Crago, M. B. 2021. Dual language development and disorders: A handbook on bilingualism and second language learning. 3. edition. Brookes.

[54] Leonard, L. 2014. Children with specific language impairment. 2nd edition. MIT Press.

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