Child healthcare nurses need easily accessible information and clear guidelines on the language development of bilingual children to ensure that bilingual and monolingual children receive equitable language screening services.

Research in language and communication disorders mainly involves monolingual individuals. Guidelines on clinical practice involving bilingual individuals are limited. However, bilingualism is prevalent worldwide and half of the world's population speak more than one language. 1 In this study, children are considered to be bilingual when exposed to two or more languages regularly. The mother tongue is referred to as the child's first language and Swedish as the second. Language development in typically developing bilingual children occurs at similar pace as in monolingual children, in both their

Aim We examined if routine Swedish language screening for developmental language disorder (DLD) carried out at three years of age could be performed as effectively six months earlier. Methods This study observed 105 monolingual Swedish‐speaking children (53% boys) aged 29–31 months at three Swedish child health centres. We compared their ability to combine three words, as per the existing protocol, and two words. They also underwent a comprehension task. Speech and language pathologists clinically assessed the children for DLD and their results were compared with the nurse‐led screening. Results The results for the three‐word and two‐word criterion were the following: sensitivity (100% versus 91%) specificity (81% versus 91%), positive predictive (38% versus 56%) and negative predictive value (100% versus 99%). The three‐word criterion identified 29 children with possible DLD, including 11 cases later confirmed, and the two‐word criterion identified 18 possible cases, including 10 confirmed cases. DLD was overrepresented in the 10% of children who did not cooperate with the nurse‐led screening. Conclusion Changing the required word combinations from three to two words worked well. The three‐word test identified one extra confirmed case, but resulted in 10 more false positives. Lack of cooperation during screening constituted an increased risk for DLD.

We read the commentary by Perry and Singhs 1 with great interest and would like to take the opportunity to respond to their concerns, namely exclusion criteria; quality of parental information; control for SES; limited languages; varying expertise of professionals; and low sample size.

Background The number of bilingual people increases worldwide. In Sweden, one-third of all preschool age children are bilingual. Previous studies reported that bilingual children are at risk of being overlooked for early identification of language difficulties. There is a need of validated assessment instruments for identification of language disorder in bilingual children. Aim To investigate whether the language screening for three-year-olds used in Swedish Child healthcare would detect developmental language disorder (DLD) in bilingual children 6 month earlier. Methods Overall, 111 bilingual children (51% girls), 29-33 months, were screened from November 2015 to June 2017. They were recruited from three child health centres serving areas of low socio-economic status in Gävle, Sweden. The children were screened both in their mother tongue and in Swedish at the child health centre and consecutively assessed for DLD by a speech and language pathologist, blinded to the screening outcomes. Results Preliminary results from combining screening in Swedish and the child's mother tongue showed good accuracy: 88% sensitivity, 82% specificity, 67% positive and 94% negative predictive values. DLD was confirmed in 32 children (29%), of which 87.5% had screened positive and 12.5% negative. Specificity and positive predictive value increased radically when both languages were assessed, whereas sensitivity was less affected. A majority of the children who did not cooperate in the screening turned out to have DLD. Conclusions A language screening should be performed in the child's both languages, in order to achieve adequate sensitivity, specificity and positive predictive value. This procedure is highly relevant for children from low socio-economic families with a complex linguistic environment who tend to be at an increased risk of severe DLD. Key messages The procedure combining the child’s two languages identified language disorder in bilingual children at age 2.5 compared with assessment in only one language. Child healthcare nurses should screen bilingual children in both their languages in order to reflect their full language capacity equally as in monolingual children.