Phonological development is critical for children's language development and literacy - and yet, it poses unique challenges for bilingual children with cochlear implants (CI), particularly in linguistically diverse societies. This study addresses the dearth of culturally and linguistically appropriate phonological assessment tools through the development and validation of a bilingual Urdu-English Phonology Test (UEPT), designed to assess phonological skills in children aged 3-6 years. Urdu-English bilingual children with normal hearing (NH) and hearing-age-matched children with CIs across four age groups (3.0-3.11, 4.0-4.11, 5.0-5.11, and 6.0-6.11 years) were assessed through spontaneous naming of 136 English-Urdu pictures. Validation was achieved through calculations of item-level (I-CVI), scale-level (S-CVI) content validity indices, internal consistency (Cronbach's alpha), inter-rater reliability (Cohen's kappa), test-retest reliability (ICC), and construct validity. The UEPT had a content validity [S-CVI = 90.1% (Urdu); 96.9% (English)], with Cohen's Kappa = 0.84, for CIs and 0.933 for NHs on Urdu-English (UE) pictures. High internal consistency (alpha = 0.95 for Urdu and 0.97 for English), strong inter-rater reliability (kappa = 0.85 for CIs & 0.93 for NHs) and test-retest reliability (ICC = 0.92 for CIs and 0.97 for NHs) were obtained on SPSS. Significant age-related score differences supported construct validity. The Urdu-English Phonology test is a reliable, culturally and linguistically relevant tool for assessing phonological acquisition in preschool bilingual UE children, addressing the need for the assessment of the CI population, providing insights for clinicians and researchers. It supports collecting normative data for better management of speech sound disorders in bilingual UE children with Normal Hearing and Cochlear Implant.
