Purpose: This study examined the effects of conceptual scoring on vocabulary performance of bilingual children with and without language impairment and the classification accuracy of an expressive vocabulary test across four scoring methods, single language and conceptual scoring, for bilingual (English-Spanish) children with and without language impairment. Method: Participants included English speaking monolingual children (n=14) and Spanish-English bilingual children (n=116) ages 5-11. Children completed the English and bilingual versions of the Expressive One-Word Picture Vocabulary Test. Four different scores were derived representing monolingual scores in English and Spanish, and three conceptual scores. Within-test conceptual scores credited children’s other language responses during the test; and across-test conceptual scores compiled a conceptual score across Spanish and English administrations of the test. Results: Across-test conceptual scoring resulted in better overall classification, sensitivity, and specificity than within-test conceptual scoring, which resulted in better overall classification, sensitivity, and specificity than monolingual scoring; however, neither method achieved minimum standards of 80% accuracy in sensitivity and specificity. Conclusions: Results suggest that bilingual children are not always able to readily access their second language in confrontation naming tasks. Priming or inhibition may play a role in test performance. Cross-test conceptual scoring yielded the highest classification accuracy and is the recommended method for clinical practice. / text