The aim was to evaluate conceptual scoring of lexical organization in bilingual children with language impairment (BLI) and to compare BLI performance with monolingual children with language impairment (MLI). Word associations were assessed in 15 BLI and 9 MLI children. BLI were assessed in Arabic and Swedish, MLI in Swedish only. A number of syntagmatic (semantic link, different word class) and paradigmatic associations (semantic link, same word class) were calculated. Arabic and Swedish scores were compared with a conceptual score (total number of concepts from both languages). For BLI, the paradigmatic conceptual score was significantly higher than single language scores, confirming the distribution of lexical knowledge across languages. The BLI group had significantly higher conceptual paradigmatic scores than the MLI group. Conceptual scoring may reduce the over-identification of language impairment (LI) and underestimation of lexical knowledge in bilingual populations.