Is This Normal? How clinicians view disability can make a meaningful difference in their relationships with clients. From My Perspective
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From My Perspective  |   April 01, 2018
Is This Normal?
Author Notes
  • Mary Alice Keller, MA, CCC-SLP, is a clinician at the Vanderbilt Bill Wilkerson Center in Nashville, Tennessee, where she focuses on the evaluation and treatment of young children with autism and applied autism research. She is an affiliate of ASHA Special Interest Groups 1, Language Learning and Education; and 12, Augmentative and Alternative Communication. mary.a.keller@vanderbilt.edu
    Mary Alice Keller, MA, CCC-SLP, is a clinician at the Vanderbilt Bill Wilkerson Center in Nashville, Tennessee, where she focuses on the evaluation and treatment of young children with autism and applied autism research. She is an affiliate of ASHA Special Interest Groups 1, Language Learning and Education; and 12, Augmentative and Alternative Communication. mary.a.keller@vanderbilt.edu×
Article Information
Special Populations / Autism Spectrum / Language Disorders / From My Perspective
From My Perspective   |   April 01, 2018
Is This Normal?
The ASHA Leader, April 2018, Vol. 23, 8-9. doi:10.1044/leader.FMP.23042018.8
The ASHA Leader, April 2018, Vol. 23, 8-9. doi:10.1044/leader.FMP.23042018.8
“Is this normal?”
This question—which parents and caregivers ask me all the time in reference to their child with a communication disorder—is familiar to audiologists and speech-language pathologists, regardless of the population with which they work. To answer it, we must ask ourselves, “What does normal truly mean?”
The key factor in this question is the framework through which the clinician considers disabilities and how or if they should be treated. The many models of disability—while rarely discussed in communication sciences and disorders graduate training programs—include the most-often used medical and social models.
Health professionals are generally trained using the medical model, which defines disability as a deviation from the norm and views the disability as the cause of a person’s challenges. This model inherently views disability as something harmful in need of a cure.
In contrast, the social model instead identifies social and environmental barriers as the cause of activity and participation restrictions.
Here’s an example of the difference in perspective. Consider a man who has unintelligible speech and can’t communicate his restaurant order in a way that a server can understand. The medical model of disability identifies the communication disorder as the cause of the man’s difficulty, so the solution would be to find a cure for his communication disorder or for him to continue to participate in speech-language services until he can speak “normally” (that is, be understood clearly by a variety of communication partners).
The social model of disability requires that the restaurant be open to and welcoming of accommodations or alternative ways to order, such as by writing or using a speech-generating device.
The medical and social models of disability may at first seem abstract, but they make a meaningful difference in my practice as an SLP. Below are practical ways to implement them to improve your rapport with clients and the effectiveness of your treatment.

Operating from a strengths-based perspective provides more dignity to the client and is a more effective therapeutic approach.

Mind identity language
There has been significant discussion about using person-first language, which places a person’s diagnosis last—and keeps their humanity first. As an example, someone who has a diagnosis of autism would be called “a person with autism,” rather than “an autistic person.” Use of person-first language can be a great first step in treating people with disabilities with dignity.
However, not all people with disabilities prefer person-first language. I find it most effective to use person-first language when first meeting a person, and then follow their lead if they model different language (“I’m autistic”) or directly indicate a different preference (“I prefer identity-first language”).
Similarly, some people with communication disorders and their caregivers identify as having a disability, while others decidedly do not. As a provider, I regularly give diagnoses to clients to provide my clients access to services. A client may have a diagnosis of mixed receptive-expressive language disorder, hearing impairment or any number of other communication disorders that must be labeled to receive reimbursement for treatment services.
These diagnoses, however, do not require that the person identify as having a disability. I try to avoid labeling someone as having a disability until that person or caregiver has indicated how they identify. This practice may seem like just semantics to some, but to many, the way a clinician uses these words has a real impact on the therapeutic relationship and, therefore, on the effectiveness of treatment.
Operate from a strengths-based perspective
In diagnosing and treating people with communication disorders, we often focus on deficits. However, operating from a strengths-based perspective provides more dignity to the client and is a more effective therapeutic approach. Of course, we must acknowledge areas of deficit and use this information to establish treatment goals. In a strengths-based perspective, as defined by ASHA, challenges are acknowledged, yet strengths create a bridge to achieving valued life outcomes.
Because my clients are children I find it helpful to ask caregivers, “What do you consider to be your child’s best strengths?” and “What do you enjoy most about your child?” during evaluations and initial treatment sessions. Prompts like these help me establish rapport and operate from a strengths-based perspective from the outset of an evaluation or treatment.

Treatment of communication disorders is truly a partnership in which the client and the provider are equal stakeholders.

Allow models of disability to inform your practice
Simply being aware of different ways of thinking about disability can improve how you interact with people with disabilities and their families, as well as people without disabilities. Using only the medical model to inform your practice can lead to a top-down method of treatment: The clinician has all the knowledge and power, and the client is simply the receiver of this expertise.
Keeping in mind that many people view disability not as a weakness to be fixed, but as a difference that may or may not require supports, can help us remember that treatment of communication disorders is truly a partnership in which the client and the provider are equal stakeholders.
In his book “Uniquely Human,” Barry Prizant states, “Autism isn’t an illness. It’s a different way of being human.” I believe this sentiment is applicable to all people with communication disorders. If we, as clinicians, view our clients as people first, use their strengths to provide effective treatment in a way that preserves dignity, and keep empathy at the center of our practice, our clients and our field will be better for it.
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April 2018
Volume 23, Issue 4