Why we should all use “people first” language

About the authors:

hudockDaniel Hudock, Ph.D., Certificate of Clinical Competence of Speech-Language Pathology (CCC-SLP), is an Assistant Professor at Idaho State University in Pocatello, Idaho, USA. As a person who stutters himself, he is very passionate about fluency disorders and helping those with fluency disorders. He currently serves on the International Cluttering Association and International Stuttering Association website committees, is the Northwestern Regional Chapter Coordinator for the National Stuttering Association in the United States, and is a Chapter Leader for the NSA’s Southeastern Idaho Chapters. He is a regular presenter at conferences and has several publications. His research interests are exploring: the communicative process during the observation of normal and disordered speech using eye-tracking, biobehavioral and neurophysiological measures, stuttering inhibition during the perception of second speech signals, EEG temporal and spectral components for sensory and motor involvement and integration during speech perception and production, and forming effective collaborations between Speech-Language Pathologists and Mental Health Counselors for the treatment of people who stutter. He is also Director of the Northwest Center for Fluency Disorders, which hosts a two-week summer intensive clinic. For more information about research, clinical, or support opportunities please visit http://www.northwestfluency.org/.
altieriDr. Nicholas Altieri, PhD is an Assistant Professor at Idaho State University. His research investigates speech and language perception, including the extent to which listeners benefit from visual speech under different listening conditions. He has worked to develop and apply capacity measures to investigate efficient information processing, auditory-visual integration, and brain functioning in normal-hearing and hearing-impaired listeners.
odonnellJody O’Donnell, M.S., Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP) is a Clinical Assistant Professor at Idaho State University. Her expertise is in school age speech and language disorders with a special interest in fluency disorders given over 20 years working as a SLP in public schools and recent participation as a clinical supervisor at the Northwest Center for Fluency Disorders (NWCFD) Interprofessional Intensive Stuttering Clinic (IISC) in Pocatello, ID USA.
knudsonSarah Knudson, MS-CCC-SLP, is a Clinical Associate Professor and Clinic Director at Idaho State University. Her primary interests have been in working with people with Autism, and school age speech and language disorders. Sarah is a member of Northwest Center for Fluency Disorders (NWCFD), and recently supervised the inaugural Interprofessional Intensive Stuttering Clinic (IISC) in Pocatello, ID USA.

Why we should all use “people first” language

Stutterer or Person who Stutters (PWS); why we should all put the person before the disorder and use “people first” language

Daniel Hudock, Nicholas Altieri, Sarah Knudson, and Jody O’Donnell; Department of Communication Sciences and Disorders, Division of Health Sciences, Idaho State University

Correspondence concerning this paper should be addressed to Daniel Hudock, Ph.D., Department of Communication Sciences and Disorders, Division of Health Sciences, Idaho State University, 921 South 8th Ave, Mail Stop 8116, Pocatello, ID 83209-8116, USA. Phone: (011) 208-282-4403; Fax: (011) 208-282-4571; E-mail: Hudock@isu.edu, website: http://www.northwestfluency.org/


 “But if thought corrupts language, language can also corrupt thought”
– George Orwell, 1984

Introduction

George Orwell’s quote concerning the impact of language on collective thought patterns perhaps provides the best illustrative introduction to the main aim of our paper. The primary aim is to encourage the use of “people first” language, putting the person before the disorder, to describe those with fluency disorders. Here, we mean use of terms such as people-first language: “people who stutter” (PWS), or “I stutter” rather than “stutterer” or “stammerer”. Describing a speaker as a “stutterer”, we argue, has the potential to instill negative stereotypes through the use of a label that intimately associates personhood with a fluency disorder.

This type of labeling, even when inadvertent and otherwise not malicious, is of course not limited to individuals with fluency disorders, or even those with medical problems or other developmental or physical abnormalities. Historically speaking, cultures have during many points defined and referred to groups of people by outward characteristic features of individuals from that group. This may be witnessed when large groups of non-native people move from one country to another, and their new country places them into lower social class rankings by using terms that have a demeaning effect—even when that was not the original intent. To use an example, this may be illustrated using the historical context from the 1800’s when groups of immigrants willfully moved or were sold into slavery in the United States of America. People from Ireland, China, and Africa were subjugated and placed in lower social rankings. Many factors of course conspire to produce social class rankings, and the discussion of these is beyond the scope of this paper. However, one factor that can be identified, and one that we have immediate control over, is the avoidance of the use of physical descriptions (i.e., easily identifiable group characteristics) instead of allowing them an identify that supersedes the descriptor.  Examples of these, from the historical perspective, may be referring to someone as an “Irishman” or a “Chinaman” instead of a “person from Ireland” or a “person from China”.  Likewise for clinical cases, it is deemed offensive to refer to someone as a “retard” or a “schizo” instead of a “cognitively impaired” or “mentally ill” person.[1]

Therefore the notion that we, as an advanced scientifically oriented society, understand the socially unacceptable and acceptable use of group classifiers brings into question why the dehumanizing terms “stutterer and stammerer” are still commonly used. These classifications of individuals who stutter are used in the general public, media, and even by practicing Speech-Language Pathologists.  We understand the inappropriateness of using dehumanizing language when referring to ethnic groups and some groups of individuals with disabilities, so why the delay in understanding and implementing appropriate use of language when referring to people who stutter?

Language and the Educational System

In 1976, the United States Congress passed Public-Law (PL) 94-142, which protected rights of children with disabilities in the public education system; note the use of person first language in the terminology. Decades later, in 1990, the Americans with Disabilities Act PL 103-336 was enacted and titled using person first language. In 1990 PL 94-142 “The Education of All Handicapped Children Act” was reauthorized and renamed PL 103-476 “The Individuals with Disabilities Education Act (IDEA)”— both of which maintain the person first identifiers and language throughout the documents.

Significantly the 1990 IDEA legislation specifically describes people first language and recommends that it be the default language when describing people within the affected populations. It states “language intentionally and unintentionally propagates stigma: the mark of dishonor, disgrace, and different that depersonalizes people, depriving them of individual personal qualities and personal identity. Stigma is harmful, distressing, and marginalizing to the individuals, groups, and populations who bare it” (p. 218, Broyles, et al., 2014). This is not without significance at the level of the individual person. Individuals who are stigmatized have higher rates of depression, social isolation, lower self-esteem, and poorer academic performance (Blood, et al., 2003; Crocker, et al., 1999). Woods (1978) presented Speech-Language Pathologists and School Teachers stories of a school-aged boy that either directly mentioned that he was a “stutterer”, or did not mention his speech. Results revealed that both groups were significantly more negative in their ratings of the “stutterer” (more nonassertive, tense, insecure, and afraid to talk). Woods interpreted these results that listeners’ reactions and stereotypes shape the clients behaviors. Using such labels when describing groups of people emphasizes the disorder and takes away from the individuality of the person affected. As depicted in the 1990 IDEA legislation the person should not be defined by their disorder, but should be defined by their own merits.

“Stutterer/stammerer” has the unfortunate effect of reinforcing negative stereotypes and stigma associated with the behavior. It gives the general population permission to hold PWS in lower social standings both inside and outside the classroom and possess control over us as a population. Not surprisingly, many people who stutter report feeling “less than human” and do not perceive themselves as equals to their fluent counterparts (Iverach et al., 2011). This may occur in part due to the use of such dehumanizing terminology—a problem that can readily be remedied through proper education.

When developing a stigma, there is public opinion of that stigma, which we have described, but there is also an internalized belief influencing the stigma. Blood, et al. (2003) reported that younger adolescents between 13-15 years old perceived an increased stigma and negative consequences when compared to an older teenager group from ages 16-18 years old. Another interesting finding from this study was the internalized stigma that, 60% of the respondents rarely or never talked to anyone about their stuttering. Being a Speech-Language Pathologist and PWS, the first author has experienced this both personally and professionally. First author – “My family never talked about stuttering growing up, even though I had family members who stuttered. I was in speech therapy from a very early age and would openly talk and often be reprimanded for not using my fluency enhancing techniques. Unfortunately, we never truly talked about stuttering. A majority of the clients who stutter that I have worked with over the years have reported similar events. They report feeling that they don’t have the right to talk about it, or because the Speech-Language Pathologists does not bring it up, they don’t know how to or don’t think it is appropriate to talk about. “

The Stuttering Foundation of America (SFA) has a webpage that sets the foundation to break this stigma (http://www.stutteringhelp.org/stuttering-myths-beliefs-and-straight-talk-teens). Recently, Boyle (2013) created an assessment of stigma associated with stuttering (Self-Stigma of Stuttering Scale) that is used to measure public and self-stigma as a metric for improvement. A foundational point from items on the SFA’s webpage and the Stigma Scale are to talk about stuttering, not just the use versus non-use of techniques. By understanding stereotypes and stigmas associated with stuttering, clinicians can help alter their beliefs to increase holistic functioning and decrease impact on the individual. One such way is to use appropriate terminology that is not dehumanizing to individuals from a specific group, but rather language that puts the person before their disorder and empowers individuals from that group.

Implications for Treatment

The emphasis on person-first language brings with it broader implications for therapeutic and clinical theory. Traditional clinical approaches for addressing stuttering and fluency disorders have been based on achieving fluency (Blomgren, 2013; Euler, et al., 2014). This approach is, in some respects, a logical consequence of a failure to use person first language, and instead, refer to clients as “stutterers”. After all, if a client is a “stutterer”, achieving fluency ought to be the goal. Alternative approaches—based in part on the emphasis of the importance of interdisciplinary and inter-professional education—pursue a more holistic avenue (Iverach & Rapee, 2014). Here, fluency itself is not the goal per se; instead, overcoming and confronting the social-emotional barriers that have resulted from the disorder become paramount (Blomgren, 2013; Iverach & Rapee, 2014). Fluency enhancing strategies, while still utilized, thus begin to play a slightly different role in therapeutic settings. Instead of acting to change the “stutterer” and transforming him or her into a fluent person, the aim is to guide the individual who stutters accept themselves, while gaining enhanced social confidence by improving verbal and non-verbal communication techniques (Lee & Manning, 2010). Fluency is not the goal – communication is the goal.

Conclusion

Using people first language is a commonly used practice in many social spheres that promote confidence, acceptance, and inclusion from individuals within groups (Broyles, et al., 2014). As such, these terms and language that promote recovery should be our default semantics when describing populations. The stigma associated with non-people first language is most explored in the substance abuse literature and should be used as a comparison in this instance.

As one recovers from using substances and may reside in an infinite state of recovery (never truly being healed), a person who stutters may recover from stuttering in the sense that they decrease the negative impact and control that stuttering has on their life. The authors of this report strongly advocate for incorporating the use of disclosure statements such as “I stutter, I am a person who stutters”, or voluntarily pseudostuttering when introducing one’s self and use this in common practice during our two-week interprofessional intensive stuttering clinic. If directly stating that you stutter, it should be done using people first language. Using people first language starts to break the negative stereotypes associated with stuttering and increases self-confidence. Although changes in societies take decades, if not longer, the starfish analogy may be applied; I may not make a difference to all of the starfish washed along the beach, but by throwing one back in the ocean made a difference to that one’s life (Dean, 1986). By using people first language and confidently stating “I stutter or I am a person who stutters” your listener may interact differently with the next person who stutters that they meet. If we use the term “stutterer or stammerer” our communication partner may call someone by that name, which re-instills the cycle of dehumanization for another person. We should follow societal appropriateness and congressional legislation for the benefit of all of us who stutter.

 

For a list of “person first” phrases please visit the following websites:

http://odr.dc.gov/page/people-first-language

http://www.familytofamilynetwork.org/parent-resources/people-first-language

[1] One fascinating historical example of a failure to use “person first” language involves the famous Russian neuroscientist V.M. Bekhterev. According to one common account, he openly referred to the Soviet premier J.V. Stalin as a “paranoiac” immediately after examining him (Moroz, 1989). V.M Bekhterev’s sudden death three days later was allegedly an assassination ordered by Stalin himself.

References

Blomgren, M. (2013). Behavioral treatments for children and adults who stutter: a review. Psychology research and behavior management6, 9-19.

Blood, G. W., Blood, I. M., Tellis, G. M., & Gabel, R. M. (2003). A preliminary study of self-esteem, stigma, and disclosure in adolescents who stutter. Journal of Fluency Disorders28(2), 143-159.

Boyle, M. P. (2013). Psychological characteristics and perceptions of stuttering of adults who stutter with and without support group experience. Journal of fluency disorders38(4), 368-381.

Broyles, L. M., Binswanger, I. A., Jenkins, J. A., Finnell, D. S., Faseru, B., Cavaiola, A., … & Gordon, A. J. (2014). Confronting Inadvertent Stigma and Pejorative Language in Addiction Scholarship: A Recognition and Response.Substance Abuse35(3), 217-221.

Crocker, J. (1999). Social stigma and self-esteem: Situational construction of self-worth. Journal of Experimental Social Psychology35(1), 89-107.

Dean, A. (1986). Night Light. Hazelden Publishing.

Euler, H. A., Lange, B. P., Schroeder, S., & Neumann, K. (2014). The effectiveness of stuttering treatments in Germany. Journal of fluency disorders,39, 1-11.

Folkins, John (December 1992). “Resource on Person-First Language”. American Speech-Language-Hearing Association

Iverach, L., Menzies, R. G., O’Brian, S., Packman, A., & Onslow, M. (2011). Anxiety and stuttering: Continuing to explore a complex relationship. American Journal of Speech-Language Pathology20(3), 221-232.

Iverach, L., & Rapee, R. M. (2014). Social anxiety disorder and stuttering: Current status and future directions. Journal of Fluency Disorders, 40, 69-82.

Lee, K., & Manning, W. H. (2010). Listener responses according to stuttering self-acknowledgment and modification. Journal of fluency disorders35(2), 110-122.

Manning, W. H. (2010, November). Evidence of clinically significant change: the therapeutic alliance and the possibilities of outcomes-informed care. In Seminars in speech and language (Vol. 31, No. 04, pp. 207-216). © Thieme Medical Publishers.

Moroz, Oleg (1989). “The Last Diagnosis: A Plausible Account That Needs Further Verification”. Soviet Review (30) (6 ed.). pp. 82–102.

Woods, C. L. (1978). Does the stigma shape the stutterer?. Journal of communication disorders11(6), 483-487.

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Comments

Why we should all use “people first” language — 45 Comments

  1. Thank you all for this paper. I am currently a post-bac student and before starting the program I had not been exposed to the concept of people first language. Although I never doubted the importance of people first language, until reading this paper I didn’t truly understand the impact one can have by not using people first language. Do you ever work with clients who do not wish to use people first language and if so how do you handle that desire?

    Thank you,
    Emily Dunn

    • Emily,

      Thanks for reading the article and posing the great question. Different programs use various person first and nonperson first terminologies for a variety of reasons, most of which do so with a specific goal or rationale. That being said, there are many clients that I’ve seen from a variety of other programs, including some who we’ve seen in our clinic that prefer to use nonperson first language as they see it being empowering. People are entitled to their differing views and uses, so we just explain our rationale and are supportive in whatever choice they make. As we make the point in the article using such terminologies by people within the group, is and can be empowering, it’s when such terms are used by outsides in improper contexts that it becomes dehumanizing. With clients that have attended our clinic and prefer to use such labels, I just make them aware of that fact, that it may affect others down the road negatively. Ultimately, I would hope that the clients offer that same distinction to their communication partners (e.g., this word is empowering for me to use, but inappropriate for you “the fluent speaker” to use when describing us). This is once again, their choice, so who am I to stifle someone’s empowerment.

  2. Very interesting paper thank you. I think in terms of client/Clinician relationships of course “people first” language is important and respectful. Personally though as a person who stutters I am comfortable calling myself a stutterer and over people who stutter that also. Is this a case of owning the word as a “community”. I am unsure. Also when I present about stuttering I usually use “stutterer” in order to help my presentation flow more and not having to repeat 3 words all the time instead of a single one. I do however usually disclose this choice of phrases early on in the speech.

    • Grant,

      Thanks for reading and commenting. Great perspective and I do agree that if your rationale is disclosed, it informs the audience and can be used for empowerment.

      Thanks,
      Dan

  3. Hello Dan, Nicholas, Jody, and Sarah,

    I agree with gmeredith that your paper is interesting. I also found your reply to Emily equally interesting. Yet here comes the “but…”

    I hope I’m not so ego-involved that I only agree with papers that cite my work; yet, I am a bit surprised that you did not do a Google search and find the published articles that have investigated person-first vs. direct labeling in the area of stuttering. While not expecting that you’ll agree with me, I would be interested in your reactions to the following research studies: (St. Louis, K. O. (1999). Person-first labeling and stuttering. Journal of Fluency Disorders, 24, 1-24. and Dietrich, S., Jensen, K. H., & Williams, D. E. (2001). Effects of the label “stuttering” on student perceptions. Journal of Fluency Disorders, 26, 55-66.). An overview of my paper appears as an ISAD paper which I posted in 2006 on the topic (http://www.mnsu.edu/comdis/isad9/papers/stlouis9.html). The threaded discussion of that paper was interesting indeed.

    Basically, I showed that people know what labels are pejorative and which ones are not. Your examples of “retard” or a “schizo” are not good examples. How about the terms “murderer” vs. “person who murders” on the extreme negative side (relative to who the person is–not someone’s mistaken impression of that person) and “composer” vs. “person who composes” on the positive side. Neither makes a difference in public, professional, or consumer ratings.

    A more recent series of journalistic articles were written for the Canadian Medical Association Journal by Roger Collier (http://www.cmaj.ca/content/184/18/1977). From his phone interview with me, I kinda wish he had not quoted me as saying, “If you are going to be a jerk,…you can be just as much of a jerk using person-first language as using the direct label.” But I said it. Dan, you know I have only great respect for you and the way you have been an advocate for the stuttering community. There are jerks out there and for them, I don’t believe the language used will make any difference. That said, I’ve personally never met a well-meaning speech-language pathologist, teacher, or lay person who used the term “stutterer” in any other than a descriptive term, like “firefighter.” Maybe I’ve been lucky or too sheltered.

    I won’t belabor you with more of what I’ve already written or said, except to reiterate that for me, being labeled as a “PWS” is dehumanizing while being labeled as a “stutterer” simply makes note of the FACT that I stutter.

    Thank you again for the well-written paper and for setting forth a good forum for a debate. Please accept these comments in that spirit alone.

    Ken St. Louis

    • Ken,

      Thanks for your response and for reading the paper. I do not think you’re ego involved at all, quite contrary I greatly respect your opinion, advice, expertise and our friendship.

      While writing this paper, we did search PubMed, Google Scholar and other resources for such studies examining this topic area. I’m quite surprised that we didn’t come across the citations that you note. I also agree that our terms may have not been the best representations.

      I completely agree that the term is most often not intentionally used as a pejorative to demean an individual. And as with you, I have also never personally experienced this, nor have I heard reports of clients / friends express such experiences. The mocking, and demeaning experiences I’ve encountered and had related to me are mainly mimicking forms of stuttering, or comments made in directly address the disruptions (e.g., get it out already and the like). I also completely agree that there are jerks out there that use of specific terminology isn’t going to change a person’s nature or a person’s negative experience with such an individual. To be honest, I’ve never thought of it how your presented it, in viewing PWS as dehumanizing, contrary it’s always just not sat right with me when other people call me a stutterer. I experience it as a social violation, an act of intrusion that they were not given permission to use terms from my stuttering culture. I equate it more to social appropriateness that changes over time. For example, decades ago we labeled African Americans as Negros, then Black, then African Americans, and currently, I believe people who are black, being sensitive to individuals who are from other continents than Africa.

      Many of my friends, clients etc who stutter adhere to the notions that you and Grant described, and anecdotally less ascribe to the notion we put forth. So so you indicate, it’s spawned a good lively discussion, which is what I am in favor of. Not that one opinion is truly right, but having the discussion is worth while.

      Thank you so much for you comments and time. More so for all that you do for our profession and community.

      Best Regards,
      Dan

      • Hi Dan,

        You’re welcome. Thank you for responding in the true spirit of this conference. Good debate is healthy and invigorating.

        Ken

  4. Interesting paper. I personally interchange “person who stutters” and “stutterer” when referring to myself and my stuttering. I will often state “I stutter” as well. Sometimes, as Grant mentioned in his comment, it’s easier for me to not say “Person” because “p” is one of my hard sounds and it may be easier for me that day to say “stutterer.” And sometimes it’s more efficient to say one word rather than three.

    My mom is an alcoholic – she has been sober for 25 years – but still refers to herself as an alcoholic, as do most in the alcohol community. I’ve never heard person first language used in that context, like “person who drinks to intoxication.” I don’t think alcoholic is a dehumanizing label – it just is what it is.

    I think this is a topic that may have people on both sides of the camp. People could argue for both points of view. Thanks for the opportunity to ponder this good topic.

    -Pam

    • Thanks, Pam, I agree with you.

      I, too find myself using “stutterer” and “person who stutters” interchangably. To me the degree of stigma is the same either way.

      As with so much abour stuttering, how to deal with this topic is an individual choice.

      Jeff

    • Pam and Jeff,

      As with using the term alcoholic “stutterer” can be empowering and humbling. In my experience with friends and family who have attended Alcoholics Anonymous and the few meetings I have went to offer my support to them the term is used in the sense of releasing control, blame and guilt. In other words using the term of course makes people confront their ideology and commitment, but also humbles them in saying that I am this and the disorder is at the level of a higher power. The rationale for these benefits can very well be described similarly to people who stutter. There are several interpretations and ideas about how stigma’s are formed. Likewise, there are several beliefs and perceptions of the use of such terms, which fluctuate with cultural norms. I think since the person first language push in the Clinton era the culture is shifting in it’s norms. This may just be my belief, but we thought it was worth discussing and presenting.

      Thank you both for your comments and contributions,
      Dan

  5. First of all, I would like to say thank you for taking the time to write this paper and submit it for the rest of the world to read and ponder about. I think this is a very important topic to be discussed. While reading all of the posts in response to the article, it has brought many points to the forefront of my mind that I would like to discuss with all of you. I am a graduate student of the Communication Sciences and Disorders program at Western Carolina University, where I have the privilege to study under the instruction of David Shapiro, PhD. As a student of his, this topic has been brought up and discussed several times. The point I want to make is in regard to something Dr. Shapiro and the rest of our class discussed in class one day. A student of ours stated that if asked to define herself, she would do so by saying that she was a friend, a lover, a sister, a daughter and not just (blank) (to preserve her privacy, I am not going to say what other people would often define her as). I think that is a very potent and important point to make. Granted, some people may very well take pride in the fact that they stutter and may want to be referred to as a stutterer, but that person cannot ONLY be defined as a stutterer. They may also identify as female or male, for example. I can see it from both sides, but my point is that Dr. Shapiro always emphasizes that a person is more than his/her disorder and to treat that person as such; not to solely define them as a “stutterer” because we don’t know that person’s personal construct and experiences regarding this topic. Our personal constructs continually change based on our experiences and I think that when considering calling a person to stutterer, we should ask that person what he or she would like to be called or referred to and not assume either way. I also believe that we should consider what else makes that person who he/she is as an individual. We never want to box people into their disorders and assume they cannot achieve just as much with their communication disorder as they would without one.

    With all of that said, my question to Dr. Hudock is “how do you believe your personal construct has effected your life today and the decisions you have made or currently make clinically in our field?

    • Likewise, thank you for reading and commenting. You are lucky to work with such a great person and educator, he’s a very special person.

      You raise many very good points. Throughout my education, especially in education classes or special education classes taken during my undergraduate degree similar points were emphasized.

      Wow, great question! I know that I am more than my disorder and I have always felt this way, albeit to varying degrees over time. My disorder has definitely enhanced some personality components and has made me feel the need to overcompensate and prove myself for others. For example, for years of my schooling I felt the need to be a class clown, because I felt that my true intellect would be disguised due to my stuttering. Similarly, rightfully or wrongfully, I felt a drive to demonstrate overcompensation for my stuttering in my activities and leadership positions held. So stuttering has influenced me to become more empathetic, compassionate, caring, and definitely the drive to help others like myself. Understanding my construct, and it’s evolution over time and life changes has me take an individually focused holistic approach for my clients, and research. Not every decision that I have made personally or professionally has been guided by my stuttering, especially over time they are influenced less and less, but early on my decisions were more heavily influenced by my stuttering.

      Truly great question, hopefully I didn’t ramble to much and answered your question.
      Dan

  6. Thank you all for this informative paper. I am currently a graduate student at Appalachian State University and am enrolled in a Fluency Disorders class. I have never had any experience with working with persons who stutter, but I am very interested in this area. I have worked with several children with autism and have become very aware of the importance of people first language. As mentioned in several comments, disorders do not define a person. A child is not “autistic;” they have autism. However, I know some persons who stutter that refer to themselves as “stutterers” to emphasize that stuttering is not something negative. Also, several people on here have stated that they refer to themselves as “stutterers.” When working with a person who stutters, do you immediately explain the rationale of using “person who stutters” as opposed to “stutterer?” Also, do you think level of acceptance impacts the preference of using one or the other?

    Thank you for your time!

    • Please tell Dr. Klien that I say hello. Thanks for reading and commenting.

      Great points! I certainly think level of acceptance influences use of the terms. Some of the clients that I’ve seen, who are in the early phase of acceptance prefer to indirectly disclose using statements like I’m collecting information about stuttering (if they’re doing stuttering surveys), or I have a speech disorder, and the like. As therapy progresses a majority of the clients are then able to accept the fact that they stutter and no longer need to describe it in indirect methods. This mental process may take longer for some than others, but is a choice that people have the right to make for themselves. I do think the responsible thing to do is describe why they are using such terms and the benefits that it may provide. I don’t immediately explain my preference, but give it time until the client is to the level of acceptance that they can have such a discussion more objectively. Early on it may be too intrusive.

      Good luck with your studies,
      Dan

  7. The article was very informative about the benefits of using people first language for people who stutter. I think the immigrants analogy can make the concept of people first language very clear to people who have not been introduced to the concept before. I think its important to take a holistic approach to the person when treating stuttering. I believe that is why negative feelings and anxiety is so important to address in therapy. There is a connection between people first language and the negative feelings and anxiety. It is often heard people will realize they are more than their stutter and go on to have much less anxiety resulting in less tension and increased fluency. Do you feel there is a connection between the people first language and negative feelings and anxiety as well?

    • Lynn,

      Thanks for your comments and question. I agree with everything you stated and as with you do believe that there is a connection between people first language and negative feelings / anxiety, however currently I do not think there is enough support for or against this. Hopefully, Dr. St. Louis and Dr. Boyle will further explore this idea in the future.

      Cheers,
      Dan

  8. I really enjoyed reading this article about person first language. I have been immersed in the Special Education field for many years now, and I believe that any attention that is brought to person first language is a great thing! I am wondering what some specific techniques are that could be used with a child who stutters who has come to therapy disheartened from lack of person first language used towards them. I am wondering how to approach this with a client who is in upper elementary school who seems to notice that people are using negative language towards him. Thank you!!

    • Emily,

      Good questions. The textbook Counseling Skills for Speech-Language Pathologists and Audiologists is a very good reference. Likewise, the Stuttering Foundation of America has great resources for these topics. It’s difficult to answer this concisely and it would greatly depend on the individual client. I would say a good place to start is with a referral to the school counselor. From here the client could be treated using in interprofessional collaboration of the counselor working more directly on the concepts that you mention. I wish I could answer with more detail, but it really depends on the client. Counselors can work on assertiveness training, anti-bullying strategies, and reducing negative impacts from experiencing bullying.

      Hope this helps,
      Dan

  9. Your view on people first language and how it relates to therapy is really great! In your experience, have you run across clients whose whole identity is based on being a “stutterer” that even they call themselves a stutterer? Does this impact therapy? Would the change in terminology be something that should be pushed if they are not bothered by it? Thank you

    • Deborah,

      Great questions. I have come across several clients / friends who completely identify themselves in that manner. In my experience up until taking an approach targeting openness and acceptance etc these clients exhibited a victim mentality with notable signs and self-reporting of depression. It makes therapy a very difficult situation. However, terminology alone does not create the negative influences that I previous described. Reframing is an important process, which also includes rationale for use of “stutterer”. As I’ve mentioned in some of my other responses, I don’t force people / clients to use one over the other. If they prefer to use “stutterer” that is fine with me, I just try to educate them on how people may interpret it.

      Thanks,
      Dan

  10. This is a very interesting topic that we have discussed in my Fluency class at WCU, where I am a graduate student. Do you find the term “people who stutter” dehumanizing because person first language is generally only advocated for use with conditions that society has labeled as “disordered,” but not for other human conditions, such as profession? I have no problem with being labeled as a “southerner” or “SLP grad student” or many other labels that I identify with, but would be offended if someone implied that any of these labels made me somehow inferior. Maybe the problem is not the use of a descriptive label per se, but rather the use of certain labels that listeners perceive as indicative of a speaker’s pejorative attitude. I am definitely going to read your article. Thanks for sharing!

    • This post is a response to Ken St. Louis’ comment above but for some reason appears down here below. Thanks!

      • Kristen,
        Thanks, I missed this earlier.

        I fear you missed my point about my finding “PWS” dehumanizing. I was talking about the acronym, not “person who stutters.” You gave the example of “SLP,” which was coined no doubt because it takes so long to write “speech-language pathologist.” But “PWS” and its various off-shoots (e.g., CWS, CWNS, PWDNS, PWC [person who clutters], etc.) are simply in my opinion a politically-correct convention run amuck. You state an excellent example of not worrying about being called a “southerner.” Yet some people from the south have felt that “being southern” carries some negative stigma, and there is some evidence that they are right. Thus, if we wanted to carry this argument to it’s logical conclusion, just in case you MIGHT be offended at being regarded as a “southerner,” we should all refer to you to your face and to everyone else as a “person who lives in south-eastern USA.” And since that gets hard to write, soon someone will start referring to you a “PLSEUSA. PLS, PWLITS, etc.” I ask you, “Would you find that dehumanizing? Neutral? Trivial? Empowering?

        I made the point the I have never met a well-meaning SLP, professional, or person on the street who used the term “stutterer” in a pejorative way. Of course, a “jerk” (see my quote in the Collier piece referenced in my post) will be a “jerk” regardless of the language used. In a word, I believe that what is behind the words are far, far more important that the words themselves, except in those cases where the entire society perceives a word as negative, e.g., “idiot,” “leper,” etc.

        Thanks for your interest.

        Ken St. Louis

  11. Hi Dan, Nicholas, Jody, and Sarah,
    I am currently a graduate student at Appalachian State University studying Speech Pathology. I loved reading this article and all the interesting studies about person first language. I am currently in a fluency class and we have spoken a lot about not only treating fluency, but how it is also important to make sure that the client accepts themselves as a person who stutters first. I was wondering if you would recommend any activities to help the individual be more comfortable with their stutter other than simply talking and discussing it. I am currently working with a client who is in 4th grade and appears very insecure and upset about his stutter. Thank you so much for this article. I think it is such an important topic to educate people on.

    Blayke

    • Aligning and reframing their perception of how they view stuttering is much more important than what terms they use. If the client views stuttering in a more positive confident way, such as connecting with the idea that there are famous PWS that are successful etc it will change their belief system. Additionally integrating a inclusionary group mentality (i.e., introducing them to other PWS or attending NSA support groups or conferences / FRIENDS conferences ) they typically start to relate to stuttering differently. Dr. Klien would have great advice for this topic as well. I always try to have clients describe positive influences that stuttering has given them as a starting point to the reframing.

      Hope this helps,
      Dan

  12. I would love to hear from any of the authors regarding a few questions this paper has raised in my mind.
    1) Do you think that internalized stigma directly correlates with use of labels?
    2) Do you think use of person first language will empower PWS to talk about stuttering?
    3) Who has the responsibility to talk about stuttering? The PWS, their parents/family, SLP’s? All of us?
    4) And finally, to any PWS, what suggestions/recommendations do you have for SLP’s regarding talking openly about stuttering?
    Thanks in advance for any thoughts!
    Stephanie

    • Stephanie,

      Thanks for reading and for your great questions.

      1) I don’t think there is enough current evidence one way or the other. I believe that it might influence it, but also that the directionality of the influence may fluctuate from individual to individual.
      2) I think that it could be used as a step in the process, but there are also likely other avenues to open discussions about stuttering and reframing for more positive orientations.
      3) I would say all of us, but more often than not the covert (impact) features of stuttering are not openly talked about by the PWS or family. This could be due to the intuitive belief that talking about such topics will have negative effects, similarly to mental health problems, however as demonstrated in that realm, research supports open discussions. So I believe that if an open dialogue is not occurring, it is the SLPs role to set the framework and foundation for such discussions.
      4) Whoever initiates the conversation is great, and it is one that needs to be had. Depending on how the SLP was trained, and the experiences that they’ve had, they may not know how to talk about it either so it might be a new development for bother parties.

      Thanks,
      Dan

  13. I have really enjoyed reading this article about person first language. As a current grad student in a SLP program I have been taught to use person first language in regard to all clients, not just PWS. It seems very natural and normal for me to say “person who stutters” rather than “stutterer”. In addition I use “child with autism” or a “client with downs syndrome”. While I respect my friend and client’s abilities to identify themselves as “stutterers” or “Down’s Babies” as a SLP I believe it is only appropriate for me to always use person first language.
    K. Mortensen

  14. As soon as I saw the title to this article I knew that I had to read it! The use of person first language was brought to my attention several years ago when I started working with the University Participant Program for Individuals with Intellectual disabilities at the university that I attend and has since been a factor in every single day of my life after that. I am now a graduate student in a SLP program at the same university and I am thankful that I have the knowledge about person first language that I do, so that I can treat each client and person that I come in contact with with respect. I completely agree with recognizing a person’s abilities before any disabilities they might have. One of my professors has also taught me that, specifically for PWS, fluency is not a appropriate goal because that gives them the impression that we want their speech to be perfect. In reality, not one person’s speech is perfect one hundred percent of the time, so this cannot be expected of anyone. My question to all of you is, how can you respectfully correct someone who does not use person first language, who may not have any prior knowledge about the use of it, without them feeling as though you are criticizing them?
    Thank you for your time,
    M. Alexander

    • Thank you for your interest, enthusiasm, great personal examples, and question. I could not agree more with your statements, successful therapy is by no means fluency!

      This is a difficult concept. First of all, people will start to use terms that are portrayed to them, especially if they are novices in an area. So, I always try to use such terms when disclosing or talking about disorders. Next, I try to transition from one point to making that point during a conversation in which the other partner did not use the term. Therefore, you are not correcting them or instantly punishing them, you are taking a delayed opportunity to educate them. Finally, if nothing is sinking in, I take a more direct approach of describing my rationale for using person first language. As you mentioned people might not be aware.

      Best,
      Dan

  15. Dan, Nicholas, Jody, and Sarah,
    My name is Melissa Fricks and I am a graduate student for speech pathology. I have two questions that arose from reading your article!
    1) Have you ever had a client who did not want to discuss person first language and how it makes them feel? If so, do you have any recommendations for how I can change this?
    2) Do you find most settings forget about person first language? For example, I notice it is used a lot more in a school setting versus a rehab setting or group home.
    Thank you so much for your time!

    Melissa

    • Melissa,

      Thanks for reading and asking the questions.
      1) Starting off it is not uncommon for clients to be resistant to talking about stuttering at all, however much more often than not if another PWS approaches the topic it is seen as a release with a sense of empowerment. As it commonly takes many PWS a while to truly talk about stuttering (when they find a good clinician for example, or attend a support group). I have had several clients who preferred using the term “stutterer”, which I supported their choice.

      2) The media seldom uses person first language when talking about stuttering. There are also many many other settings that do not consistently use it either. I can’t say one over any other, because it changes so much from geographic location and workplace setting.

      Best,
      Dan

  16. Thank you for this article. I am a graduate student in speech pathology and have discussed using person first language in our advanced fluency course. One thing that has come up in our class discussions is that some people still prefer to be called “stutterers” and our text book even states that some people take pride in calling themselves that. What are your thoughts on people taking pride in calling themselves a “stutterer”? Do you think that they should keep doing that or say it with person first language?

    • Michelle,

      Thanks for reading and for your questions. Dr. St. Louis posted a great discussion on this article about a very similar topic. Please look at our exchanges.

      Best,
      Dan

  17. Posted on behalf of Michael Sugarman;

    Thank you for your article. I wanted to give you a very brief historical perspective. As co founder of NSA in 1977. I lived near Berkeley, Ca. And that time the beginning stages to the civil rights movement for people with disabilities was taking shape. As well, I have always seen the stuttering self hep movement as part of a larger civil rights struggle to change the way PWS are viewed by themselves and general public. People first language was being used to denote a tone of how to be treated by professionals and by ourselves. Check out Wikipedia. People first language. And the example they give PWS.

    So, in 1978 at the asha conference small group of us maybe 5 attended a panel discussion by movers and shakers in stuttering therapy and researchers. I think there were 600 to 800 professionals and students. And the presenters kept on using stutterer. Well, I decided to take this rare opportunity. And asked the speakers to refrain from ‘stutterers’ and to use PWS. You can guess what happened. A five minute argument followed.

    By the early 1990’s ASHA wanted professional community in articles to use people first language.

    People first language has been evolving. For example people with AIDS or Cancer. Use the term people living with ….Or therapists are using people who drink or people who are substance users.

    People first language came from people who felt disenfranchised from society. And the argument of people first language to apply to Professions such as firefighter or lawyers was never the intention. Professions are accepted by the norm of society.

    Michael

  18. Hello,

    I am a graduate student in speech-language pathology and I thought your article was very interesting as person-first language is an important component of my overall education. I am curious, though. Is it there a possibility that telling a person who calls him or herself a ‘stutterer’ that the current person first term is person who stutters may inadvertently cause self-stigma? Could it give them a sense that this part of who they are is something they should dismiss? Thank you for your article.

  19. Thank you for your insightful paper. I am a graduate student in Speech-Language Pathology at Idaho State University, and have learned a lot from all four authors of this paper. During my educational career at ISU, I was introduced to “person-first” language, and feel very comfortable now using this to refer to all of my clients, not just in referring to people who stutter. I agree that it is derogatory to say that a child is “Autistic” or that they are a “Down’s Syndrome child”. Rather, we should say that they are a “child with Autism”, or a “child with Down’s Syndrome”. I now cringe when someone says to me that they are working with an “Autistic kid”. We are all people first and should not defined by the challenges we may have in life.

    That being said, I have thought about this topic a lot and have realized that there are some labels in our society that we are comfortable with using. For example, when I am finished with my schooling, I will refer to myself as a “Speech-Language Pathologist”, not as “someone who practices Speech-Language Pathology”. At the moment, I refer to myself as a “graduate student”, not a “person who is in graduate school”. Similarly, we have people who rightfully label themselves as a “doctor”, “attorney”, “humanitarian”, “nurse”. Then there are those who because of their inappropriate actions, have been labeled as a “murderer”, “terrorist”, “thief”, “rapist”. Society accepts that it is appropriate to label those people as such because of their horrific actions.

    I guess some labels are appropriate, while others are not. Some people who stutter refer to themselves as “stutterers” and some do not. Very interesting topic. Thank you for bringing this to our awareness and discussion. I will continue to ponder on this. Thanks.

    • Thanks for your comment Saunja. Dr. St. Louis’s second post would be of interest to you, per the employment comments. Please see above.

  20. Having talked about people-first language in school has heightened my awareness of how pervasive the use of dehumanizing terms is in relation to communication disorders, mental health disorders, and health conditions. It seems like it’s going to take an aggressive educational campaign to affect the use of this language in general society. I’ve also noticed the use of this terminology in professionals that haven’t been in school for many years. I work with a school-based SLP that is completely unaware of people-first language and uses terms like “apraxic,” “autistic,””stutterer,” etc. I’ll admit I’ve been a bit reserved and have yet to bring up people-first language as the more appropriate way to talk about these disorders. She grades me after all! I do model the correct verbiage and will try to find a way to address the topic after I’m more comfortable with our relationship. My point is that there is a lack of education and awareness within our profession and I hope to see this issue move to the forefront in the near future. Thank you for writing this paper to bring increased awareness to the topic.
    Naala

    • Likewise, thank you for your comment Naala. It is a difficult place to be in as a student who is being trained differently from their supervisor’s practices and beliefs. I’ve empathize with you. Hopefully experiencing this unique forum where PWS talk for themselves has been a good enlightening experience.

      Best.

  21. Thanks for your post! I am a grad student for speech pathology and this is a topic we have discussed in our fluency class. This paper really emphasized the impact of not using people first language. We talked about how some people do like being referred to as stutterers and do not view it as negative. I feel like it is important to ask the person their preference. For younger children, do you educate them on both and then ask what they prefer? If someone identifies with being a stutterer, does this change your therapy session ideas?