Bilingual Aphasia Test

The Bilingual Aphasia Test (BAT) was designed to assess each of the languages of a bilingual or multilingual individual with aphasia in an equivalent way. The various versions of the BAT are thus not mere translations of each other, but culturally and linguistically equivalent tests. The criteria of cross-language equivalence vary with each task. The translation of standard aphasia batteries into languages other than the one in which they were constructed would not be adequate, for a number of reasons: In a translation, stimulus items may be culturally inappropriate, as they may refer to objects that either are not part of the culture or look or work differently, and hence would not be recognized or would be misunderstood. The translations might test grammatical constructions that present very different levels of difficulty than the original: syntactic constructions, such as the passive in English, are rarely if ever used, or are structurally much simpler, in some languages. Most obviously, any task that is based on phonological minimal pairs –or rhyming words– will simply not work at all in any other language. Therefore, corresponding items in another language were selected so as to tap the same information as the original, in accordance with the rationale that motivated the construction of the items in the first place. As a result, the original principles of the BAT (in particular those concerned with the technicalities of instrument development and adaptation, test administration, documentation and interpretation) happen to comply with those of the current International Test Commission Guidelines on Adapting Tests for use in various different linguistic and cultural contexts, which were initiated more than a decade later (Hambleton, 1994, first presented formally at the 1999 ITC Conference on Test Adaptations).

A version of the BAT is an adaptation of the battery to the structure and culture of a particular language. It is not carved in stone. There is no end to how much it can be adapted to a particular dialect, a given population, a specific patient. Suggestions on how to adapt the BAT to your specific needs, or how to construct a new language version, are found in Michel Paradis and Gary Libben (1987) The Assessment of Bilingual Aphasia, Mahwah, NJ: LEA (also available in Spanish (Evaluación de la afasia en los bilingües, Barcelona: Masson, 1993), Italian (Valutazione dell’afasia bilingue, Bologna: E.M.S. (1999), and Chinese (Shuangyu shiyuzheng de pinggu, Guangzhou: Jinan daxue chubanshe, 2003). More generally, the book serves as an implementation manual and provides answers to questions about the theoretical foundations of the BAT, standardization, objectivity, validity, tasks, stimuli, design considerations, cross-reference among sections, cross-language equivalence, as well as scoring procedures and interpretation of results. This manual should be consulted before administering the test.

Data on the psychometric properties of the BAT (construct validity: factorial analysis, discriminant function analysis; and reliability) may be found in Gómez Ruiz (2008: 421-490).

Practical information about the e-BATs

How to put together a stimulus book after downloading and printing it

The stimulus book is prepared so as to be printed back to back so that, once the book is bound, each set of stimulus pictures is facing an X in the verbal auditory discrimination section (example + 48-65), at times on its right, at other times on its left; and so that each word or sentence occurs facing its stimulus picture in the reading comprehension section (408-427). This is why some blank pages are inserted in strategic positions. Make sure the book is printed back to back, starting from the first to the last page, and that each picture corresponds to its stimulus word or sentence that appears next to it.

The book may then be bound or stapled on the left or the right, depending on the reading direction in that language. The tests and stimulus books for the following languages are to be bound (or stapled) on the right-hand side: Arabic, Azari, Farsi, Hebrew, Kurdish, Urdu, and Yiddish. Stimulus books are re-usable.

Individual language tests

Since each language test serves as a score sheet, a new copy must be downloaded or photocopied for each patient, or for each assessment when replicated at different time intervals (e.g., pre- and post-therapy).

When time is limited, the short version may be used. For equivalence across studies, the following items of the following sections have been selected for all languages. (for comments on the use of this short version, see Muñoz & Marquardt (2008) and Ivanova & Hallowell (2009).

  • Spontaneous speech (514-539)
  • Pointing (23-32)
  • Simple and semi-complex commands (33-42)
  • Verbal auditory discrimination (48-65)
  • Syntactic comprehension (66-70; 81-96; 121-124; 129-132; 137-144 only)
  • Synonyms (158-162)
  • Antonyms (163-167)
  • Word repetition (odd numbers only: 193-251; 566-573)
  • Sentence repetition (253-259; 574-622)
  • Series (260-262)
  • Naming (269-288)
  • Sentence construction (289-313)
  • Semantic opposites (314-323)
  • Listening comprehension (362-366)

For literate patients only:

  • Reading of words (367-376; 623-628)
  • Reading of sentences (377-386; 629-708)
  • Reading of paragraph (387-392)
  • Copying (393-397; 709-743)
  • Dictation of words (398-402; 744-783)
  • Dictation of sentences (403-407; 784-812)
  • Reading comprehension for words (408-417)
  • Reading comprehension for sentences (418-427)

See The Assessment of Bilingual Aphasia (pp. 191-200) for criteria for posttest scoring (514-812).

Language-pair specific tests (Part C)

The stimuli for items 428-437 appear at the end of the test and should be detached from the test. Present them to the patient while reading the stimuli out loud, as per instructions provided in the test. There is only one Part C for any given language pair. For the sake of convenience, however, they appear alongside each language of a pair (e.g., it will appear as English-French in the English list and as French-English in the French list) so that, at a glance, one can see which languages are paired with any given language that a patient may speak.

How to construct a bilingual aphasia test for a new language and/or language-pair specific test

In order for results obtained from BATs in different languages used in any institution to be comparable to those from other institutions, it is essential that the instructions provided in Paradis & Libben (1987, pp. 152-167) regarding the construction of stimuli (including the order in which stimuli with particular structural properties are presented within a section) be scrupulously adhered to. A particular stimulus number must correspond to a stimulus with the same type of properties in all versions –not only the same type, as per the stipulated equivalence criteria, but must also correspond to the same stimulus number. Any discrepancy would result in a lack of comparability between this version and all others (both within and across institutions).

How to construct a language-pair specific test (Part C) is also described in The Assessment of Bilingual Aphasia (pp.167-173), and tips on how to find reversible contrastive features are provided in Chapter 3 of Paradis (2004).

BAT Screening test

The outline below may serve to construct a screening test in any language. The following ready-made versions, however, can be found in their respective language BAT location: Arabic, Castilian, English, French (Europeen, Québécois), German, Italian, Korean, Portuguese, Russian, Turkish. More ready-made versions will be posted as they become available.

The screening BAT comprises the following subtests and items from the BAT:

  • Spontaneous Speech (18-22 + 1 new item: Borrowing or code-switching: from very frequent (1) to absent (5))
  • Naming: select six among the best-suited stimuli (e.g. for English: 269-271, 282, 286, 288)
  • Pointing: select five items other than the ones chosen for naming (e.g. for English: 23-26, 31)
  • Simple and semi-complex commands: select three simple and three semi-complex commands (e.g. for English: 34-36, 39, 41, 42)
  • Complex commands: select one complex command (e.g. for English: 43)
  • Verbal auditory discrimination: select six among the best stimuli and one with X as an answer (e.g. for English: 48, 53, 55, 57, 60, 62, 65)
  • Syntactic comprehension: select ten of the best stimuli as follows:
    • one standard sentence (S) (e.g. for English: 66)
    • one pronominal reference sentence (P) (e.g. for English: 69)
    • one nonstandard 1 sentence (NS1) (e.g. for English: 84)
    • two nonstandard 2 sentences, one subject-topicalized and one object-topicalized (e.g. for English: 87 and 94)
    • one standard negative sentence (e.g. for English :121)
    • three reversible noun-phrase constructions (e.g. for English: 140, 143, 150)
  • Repetition of words and nonsense-words: choose five of the best nonsense word and seven of the best word stimuli. Make sure that both categories contain stimuli of increasing phonological complexity (e.g. for English: nonsense words: 199, 209, 219, 231, 247, and words: 193, 207, 237, 243, 245, 249, 251)
  • Repetition of sentences: choose three of the best sentences, including one standard sentence (S), one pronominal reference sentence (P) and on standard negation sentence (e.g. for English: 253, 254, 259)
  • Series: (260 and 261 (from 1 to 15))
  • Verbal fluency (“animals” if culturally appropriate 263, 264)
  • Semantic opposites: choose five of the best stimuli (e.g. for English: 314, 317, 320-322)

For literate patients only:

  • Reading: choose 5 of the best word stimuli (e.g. for English: 367-371) and four of the best sentence stimuli sentences including one standard sentence (S), one pronominal reference sentence (P), one non standard 1 sentence (NS1) and one non standard 2 sentence (subject topicalization) (e.g. for English: 377-380)
  • Copying: choose two of the best items (e.g. for English: 393, 397)
  • Dictation: choose three of the best word stimuli (e.g. for English: 399, 402, 406) and one of the sentence stimuli involving standard negation (SN) (e.g. for English 406))
  • Reading comprehension for words: choose four of the best items (e.g. for English: 410, 413, 414, 417)
  • Reading comprehension for sentences: choose four of the best items among the more complex, e.g. for English: P (419), NS2S (421), SN (422), and passive negation (427)


Gómez Ruiz, I. (2008). Aplicabilidad del Test de la Afasia para Bilingües de Michel Paradis a la población catalano/castillano parlante. Tesis doctoral, Universidad de Barcelona.

Hambleton, R.K. (1994). Guidelines for adapting educational and psychological tests: A progress report. European Journal of Psychological Assessment, 10, 229-240.

Ivanova, M.V. & Hallowell, B. (2009). Short form of the Bilingual Aphasia Test in Russian: Psychometric data of persons with aphasia. Aphasiology, 23(5), 544-556.

Muñoz, M.L., & Marquardt, T.P. (2008). The performance of neurologically normal bilingual speakers of Spanish and English on the short version of the Bilingual Aphasia Test. Aphasiology, 22, 3-19.

Paradis, M. (2004). A neurolinguistic theory of bilingualism. Amsterdam: John Benjamins.

Please report any infelicity found in any of the BAT documents (e.g., nonconformity to the specifications found in The Assessment of bilingual Aphasia, stimulus/picture mismatch, picture inappropriateness, language errors, or whatever) to so that it may be fixed.

Note that there is a sentence in the instructions to the patient before stimulus 48 (verbal auditory discrimination) that was omitted in error in the original French version. As a result, it is missing in a number of versions that took French as their guide. The last sentence before “Are you ready?” should be: If I say “bird” you touch this X because there is no picture of a bird on that page.” Please add its equivalent if it is missing in the version of one of the languages that you use (of course, use a different word if there happens to be a bird in one of the four choices).