By Ana Paula G. Mumy, MS, CCC-SLP

I recently printed off a Thanksgiving Mad Lib page to try out with a couple of my clients.  I made the mistake of not reading it in its entirety before beginning the activity with one of them.  As we went along generating adjectives, nouns, and verbs to fill in the blanks, it became clear that the “typical” Thanksgiving meal experience was atypical to her.  The “cook and bake all day-gather around the table-enjoy food and fellowship” experience that is common to us was not at all a relatable scenario for this child.  Watching Thanksgiving Day Parades and football games on TV was also foreign…her response, “We don’t watch TV!”  A more accurate statement would probably have been, “We don’t have a TV!”  No matter how culturally versed I believe myself to be, I still err when it comes to the culture of poverty.  I take for granted that my experiences and my own children’s experiences align with many of the children I serve.  It’s so easy to make assumptions and inadvertently be insensitive to the way others experience life in general.
How about immigrant families?  I recently had a 20-month-old (from an Indian family) who came to me for an evaluation only speaking 3-5 words.  Based on the REEL-3 (parent report), she was in the low average range receptively but delayed expressively.  As I began to work with the child, because I’m in a private practice setting where I welcome the parent to be present, especially for little ones, I was able to quickly see that mom felt “awkward” playing with the child.  As I modeled play-based therapy and gently probed more for how her interactions with the child were at home and what kind of toys she enjoyed at home, I discovered that her “play time” was the iPad and that the parents spoke very little at home.  There were very limited parent-parent and parent-child interactions going on.  Though some of the silence at home was due to trauma (both parents were military and dealing with PTSS), some of it was also cultural.  Based on my understanding of Indian culture, relationships even within a home are still influenced by social order and status, so I had to tread carefully as I recommended changes to the home environment, being sensitive to their natural ways of relating, but also attempting to suggest simple ways they could increase the quantity and quality of language input the child was receiving without violating their cultural norms.
As a foreign-born speech-language pathologist in the United States, and as one who has traveled to seven other countries in the last 10-15 years, I have become accustomed to encountering different cultures, languages, and ways of life.  Though some cultural practices and norms still catch me by surprise at times, due to my background, I feel I’ve been able to view the families that I serve as a speech-language pathologist with an open lens, taking into consideration the different family dynamics and cultural norms that impact how I provide speech-language therapy.  Even so, I have to remind myself that cultural differences are not always obvious, and sensitivity to cultural differences does not always come naturally, as with the first example I cited.
The worldview of individuals varies greatly based on where they grew up, and since our worldviews inform our beliefs, our attitudes, our family relationships, our work ethic, and so on, it is important to understand the influences and differences that emerge within the culturally diverse families we serve.  Cultural understanding fosters patience, acceptance, and respect, and most importantly, it assists us in reaching appropriate diagnoses and treatment recommendations.
So as you encounter different cultures in the workplace, even in relation to your colleagues, I offer the following list of considerations to ponder (not all-inclusive and in no particular order) that I believe can make you a better therapist and co-worker:

• Gender roles
• Power structures
• Social rules
• Adult-child interactions
• Child-child interactions
• Male-female interactions
• Views about child-rearing
• Cultural drive towards independence or dependence
• Views and practices concerning illness and disabilities
• Views about therapy and rehabilitation
• Communication styles (loud vs. soft-spoken, talkative vs. quiet, turn-taking rules, initiating conversations, maintaining dialogue, appropriateness of eye contact, etc.)
• Accepted signs of respect
• Immediate versus extended family norms
• Learning styles (active vs. passive, visual vs. verbal, etc.)
• Awareness of time and time management
• Poverty and experiences within low-income families

As we encounter culturally and linguistically diverse (CLD) populations, it is important that we educate ourselves in terms of cultural differences.  We should also ask the right questions with sensitivity and tact, never making assumptions based on our cultural biases and never imposing our cultural norms upon an individual or a family.
 
About the Author:  Ana Paula G. Mumy is a trilingual speech-language pathologist and the author of various continuing education courses, leveled storybooks, and instructional therapy materials for speech/language intervention.  She has provided school-based, pediatric home health, and private services for 13 years, and thoroughly enjoys providing resources for SLPs, educators, and parents on The Speech Stop.