Consideration of Bilingual Language Proficiency When Testing Pediatric Cancer Survivors: A Case Study

Abstract

Abstract Objective This case study illustrates the importance of considering English-language proficiency (ELP) when testing linguistically diverse individuals with medical conditions. Case Description Julia is a 10-year-old girl born to immigrant parents. She was primarily exposed to Spanish at home. At 4 years, she was diagnosed with medulloblastoma, had a craniotomy (gross total resection), craniospinal radiation, and 1 year of chemotherapy. Although in remission, lasting effects included ataxia, fine-and gross- motor impairment, hand-dominance switch, and mild hearing loss. Moreover, Julia’s schooling was delayed until she was 6 years old. Julia has struggled academically with vocabulary, phonemic awareness, reading fluency/comprehension, and listening comprehension. At 9 years, Julia was evaluated in English only and was reported to be in the Extremely Low range of cognitive function, attributed to her medical history. Despite her history of bilingual language acquisition, Julia’s ELP was not assessed and her abilities were likely underestimated. When Julia was 10 years old, a bilingual clinician conducted an evaluation to better assess Julia’s cognitive ability. Her performance greatly improved when tested in Spanish (increase in scores of >1 standard deviation). Diagnostic Impressions and Outcomes Julia was diagnosed with mild neurocognitive disorder due to another medical illness. However, her performance was likely impacted by her ELP as well, which was not being addressed. Discussion In order to accurately assess bilingual children with neurocognitive deficits resulting from medical complications, ELP and acquisition should be considered. In Julia’s case, her brain tumor, radiation, and chemotherapy likely disrupted her cognitive development during a critical time for language development.