Meet Cynthia Quiroga, a certified bilingual speech-language pathologist from Arlington Heights, Illinois. Cynthia obtained a bachelors in Early Childhood Education with a special endorsement in Special Education before becoming a speech-language pathologist. Cynthia works both in an early child classroom as well as in private practice. Today she shares her experiences as a therapist and how she is using CVES with the early childhood population.
Communication makes my world go round. In my personal and career life, language has been an important component of my life. I grew up in a Spanish speaking home in Indiana with two older brothers. We were raised by Mexican immigrant parents, who taught me very early that eye contact itself could have a variety of meanings, especially, when an adult stares with eyes wide open into a child’s eyes. Although, I did not understand at the beginning of every summer why my friends flew to Disney World and others went to summer camp, yet we drove at least 24 hours to Mexico. Today, I appreciate and miss the ability to travel to Mexico for extended visits in the summer and see all of my family and cousins which go beyond counting on my fingers and toes. In Mexico, unknowingly at the time I learned Spanish, culture, manners, respect, lifestyle, body language and most importantly communication that allowed me to access the environment around me.
As a Bilingual Spanish-English Speech Language Pathologist, I frequently discuss with colleagues, student interns and other disciplines in the field that being culturally competent is crucial in our field, as it is being a person in our society. Throughout my career, I have worked with monolingual Spanish speaking students and families, simultaneous bilingual students, and my current speech and language disordered clients and students include early childhood students with origins including but not limited to Eastern Europe, India, China, Korea, Peru, Mexico and Myanmar. Therefore, my cultural competence continues to grow by reading, asking questions and having discussions about perceptions, expectations and traditions. However, it is always very important not to generalize, because even though it may be one culture, every family can be different.
As a Bilingual Speech Pathologist, I also have studied and witnessed communication development regarding second and simultaneous language acquisition. Families are also different in regards to generation and/or if they have felt the need to assimilate or unintentionally have because of societal pressures. Having learned and used different forms of aided language stimulation to help children obtain and express language, some methods have worked others have been hard to stay consistent. I’ve explained to parents that using pictures is not intended to stop verbalizations but to increase with visuals and modeling is a big part. Parents of many cultures expect expressive language to emerge and increase, however family education about the importance of receptive language acquisition and skills are as important as the expression. Conversations and discussions should be open where we allow parents to state concerns. For example, communicating that quitting one language will make another one stronger, is a myth, even if in some cases other professionals have recommended this as a personal opinion.
This past year I worked with a client who was of Eastern European origin. She presented with a limited set of skills both expressively and receptively. I understood we had a lot of work and explained to the parents her strengths of enjoying movement, dolls and toys as well as her needs of responding to her name, following a single step directive and the ability to express her wants, needs and ideas. Our treatment plan to gain approximations for single words was developed based on the idea that she presented with an array of vocalizations. We began treatment and indeed her vocalizations increased with communicative intent to a listener. However, the approximations to real words did not increase as expected and this was confirmed by the parents in their native language. I have always been a fan of Core Vocabulary and had used 50 word Core Vocabulary boards in the past by pointing to words during structured activities.
CVES, Core Vocabulary Exchange System brought it all together for myself and this student. The Intermediate felt like a leap from vocalizations but I felt that we could always take it at a slower pace. Since this student enjoyed movement we started with taking turns with a doll and a stroller, which was an activity we had done previously with trials for verbal approximations. The first days we worked on “go” and “stop,” however, I also modeled “I,” “wait” and “go again.”
The great part about working with early childhood is that their brains are so plastic that if we are consistent and intrigue via interest the child’s brain will absorb after repetition. After going around the school pushing a stroller, using the tri-fold out and a baby elephant in the stroller growth was seen every session from bringing “go,” “stop” and “wait” (for other students crossing in the hallway). By the third session she gained “do” and “pop/stop” verbally while using the words on the strip but receptively was understanding “my turn,” “take out,” “put in” and so much more. At the end of her sessions with this clinician she began putting two words together. My favorite was a spontaneous response “you wait” when I asked for a turn. As teachers, clinicians and staff know families move, make a different choice of placement or go to a private facility in the early childhood years. My recommendation for her was to continue using not only core vocabulary but the intermediate level of CVES. Since, CVES is a system that allows the facilitator to determine if a comment, response or request is appropriate for the clients skill set, depending on the particular goal. Granted the next Speech Pathologist can design a different plan but this system is low-tech communication system with high communicative potential for her.
When using CVES, I felt all I was left to do is what I consider the fun part, fringe and personal core, which allows us connect with our client and families. To be honest colleagues allow me to to do what I call “the fun part of an IEP” which is asking the parents their child’s strengths and their current concerns about their child. I truly enjoy interviewing the parents about interests, and funny moments with their child, family activities as well as investigating what draws the child to demonstrate communicative intent or intrigues them away from their norm. In the early childhood years, I tend to use any interaction modality to develop a relationship with a child, especially children with Autism or social pragmatic disorders. I remember being a young maybe 15 year old aunt playing with my nephew who did not speak much and was often “in his world.” He is actually a 25 year year old man today. Anyway, he and I would play a game where I would give him a soft hug and say 1, 2, 3, squeeze and give him a tight squeeze. Sometimes, the counting would go very slow, other times fast, the best was when the counting and hugging was initiated by him. This simple activity has taught me that I was trying to reach my nephew in an expressive and tactile way, which led him to receptively accept the interaction and then facilitate the interaction. It’s our job to see how we can connect with our students in order to build a relationship, because who wants to listen or talk to someone they do not like or enjoy. The foundation of building the relationship with the child begins by understanding the family, culture, expectations and gaining the respect in order to be able to treat and educate all involved. The fact is still participate with some of my clients the 1, 2, 3, squeeze game, with a much less tighter squeeze than I did with my nephew.