Even though it has been proved that the use of monolingual norm-referenced testing materials with bilingual children can lead to biased assessments and diagnostics, it continues to be a common practice (Cesar & Kohler, 2007). There is also considerable evidence about the lack of sensitivity and specificity in the identification of children from culturally and linguistically different backgrounds. The sensitivity of a standardized test is the rate at which a test correctly identifies a student with a language impairment as having a deficit.  In other words, how sensitive is the test to find a disability. On the contrary, the specificity of a standardized test is the rate at which a test identifies a child with typical skills as having normally developing skills. When we use a standardized test with low sensitivity and specificity with a bilingual child, we are making clinical decisions with scores that are less valid. This can result in underdiagnosis and over-diagnosis of our bilingual children, and in consequence, they will not receive the services and/or support they need. 

       This persistent bias in standardized language assessments goes together with the fact that many of the language features that standardized tests look for, are clinical markers of language impairment in speakers of mainstream American English.  Also, the norms used for monolingual children in standardized measures do not apply to bilingual or multicultural populations (Horton-Ikard & Ellis Weismer, 2007; Restrepo & Silverman, 2001). Unfortunately, norm-referenced standardized testing continues to be almost the preferred or most commonly accepted method of identifying and justifying services for children with language disabilities (Caesar & Kohler, 2007; Figueroa & Newsome, 2006; Gandara, 2010; National Research Council, 2002).

     When it comes to formal assessment, the most effective way to obtain information about both languages is using valid testing materials that are developed for this multicultural and multilingual population. Unfortunately, when it comes to culturally and linguistically diverse students, standardized test scores leave children at a disadvantage when it comes to diagnosis since most of the available tests do not have representation of all dialects and cultural backgrounds in their normative samples, affecting their reliability and validity and in consequence not getting an accurate diagnosis. Also, there’s a lack of testing and assessment materials developed for bilingual children with different linguistic backgrounds.  Caesar and Kohler (2007) demonstrated that the most frequently used language assessment measures with bilingual children were the Peabody Picture Vocabulary Test (PPVT; Dunn & Dunn, 1997), the Clinical Evaluation of Language Fundamentals, 3rd Edition (CELF-3; Semel & Secord, 1995), language sampling, and the Expressive One Word Picture Vocabulary Test (EOWPVT; Gardner, 1990). Although research suggests that there's a lack of validity and reliability when using these standardized tests as a basis for diagnosis in bilingual children, this continues to be a reality these days. For this reason, it is recommended that clinicians examine the tests manuals to ensure that the child’s demographic profile is represented in the normative sample of standardized assessments (Friberg, 2010; Padilla, 2007). Also, adaptation to scoring procedures could be employed to have a better picture of the child’s language competencies across the two languages.

       Two formal assessments that have been developed for a various majority and minority languages are the COST-LITMUS tests (Armon-Lotem et al., 2015) and the Bilingual English Spanish Assessment (BESA; Peña et al., 2018).  The Language Impairment Testing in Multilingual Settings (LITMUS) is a  battery of tools that includes assessments in both receptive and expressive knowledge of nouns and verbs through a picture-based test. These tools represent picture lexical tasks for preschool children, that are comparable across a wide range of languages (Haman, Łuniewska, & Pomiechowska, 2015). The Bilingual English Spanish Assessment (BESA) is an omnibus test of phonology, semantics, and morphosyntax that tests in both Spanish and English languages. This test was standardized with bilingual children aged 4-6 in the United States and was developed specifically for the purpose of identifying phonological and language disorders among Spanish–English bilingual children. 

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