Promoting Social Justice in the Field of Speech-Language Pathology

Judith Felson Duchan and Lynne Hewitt

Critical Professionals

As we have seen throughout this website, work within the field of speech-language pathology over the ages has reflected what was going on in the larger society. That is to say, the understandings and treatment of communication differences and impairments are socially and politically embedded. Often these larger influences are presupposed rather than clearly articulated in the writings of our predecessors. Indeed, those creating theories and practices in keeping with their times may not even have been aware of the larger influences on their work. They were like the apocryphal fish who don’t know they are swimming in water (Wallace, 2005). This obliviousness to social and political influences on professional thinking and practice in speech-language pathology is still prevalent in this 21st century.

But there are strong indications of late that this lack of awareness of outside influences on our profession is changing—dramatically. The change comes a group of professionals who are criticizing unfair practices in the field. While there have always been professionals who have critiqued different aspects of the profession, there is a recent seismic increase in their numbers and a considerable broadening of their scope. The critical work of these 21st century professionals has been aimed at all areas of the profession, resulting in calls for dramatic changes throughout the field.

Those doing the criticizing, the group we will be calling “critical professionals”, have taken issue with underlying assumptions associated with traditional clinical practice, especially assumptions that have to do with unjust power relationships between teachers and their students, and professionals and their clients, and researchers and those they study. The primary focus of their critical stance is not to correct communication problems of the marginalized but to work together with the marginalized to achieve social justice. Critical professionals have also revealed the profession’s elitism and its unfair practices in student recruitment, professional education, and research.  They are now calling for changes in each of these areas.

Critical professionals in the past, and in this 21st century, have shown how the field has been built around oppressive assumptions. One such assumption is “linguicism”—the notion that departures from a created speaking norm should be “corrected” (Skutnabb-Kangas, 2015). Linguicism is pervasive in a professional field such as ours that sees its mission to be the regulation, “improvement” or “correction” of communication “disorders.” A reframing that regards this linguicist stance as oppressive requires a radical departure from traditional thinking in the profession.

Another fundamental oppressive construct that has long been sacrosanct in the field has to do with the key role that diagnosis plays in all aspects of the profession (Duchan, 2018).  This central role of diagnosis is ableist, by definition. That is, traditional professionals aim to diagnose speech, language, and hearing “pathologies” of those they identify as being impaired and then work to eliminate their “communication disorder”. The pervasive use of the medical model in the field involves identifying and classifying departures from a presumed norm as pathological.  This approach is antithetical to the social justice movement being forged by 21st century critical professionals, one that promotes diversity.

Finally, the field’s very promulgation of itself as a profession brings with it an attitude of “elitism” (Duchan & Hewitt, 2023).  The aim of the profession has been to empower individual professionals and to “qualify” or “certify” them as experts who know what is best for their clientele. It is the elite professional who places him or herself in the role of making decisions for others who are seen as lacking the needed professional expertise.  Clients are seldom consulted, nor are their ways of speaking regarded as legitimate. Critical professionals have been working with clients to create less elite, and more egalitarian relationships with them.

No area of the profession has been left unaffected by the 21st Century movement engendered by critical professionals. Samplings of the wide-ranging impact of the movement are illustrated below. The areas of the field that have been under scrutiny and altered as a result include professional education, national professional policies, research paradigms, clinical practice, and professional history.

A final section of this essay, in keeping with this website’s focus on the history of the profession, argues that one way to become a critical professional is to examine the social and political assumptions that were made by our predecessors. A teaching module is offered as an example of how a Critical History Approach can serve as a means for today’s traditional professionals to educate themselves to become critical professionals, and in so doing to work toward the creation more socially just practices.

Equity in Professional Education

21st century critical speech-language pathology professionals have identified the need to change educational practices that oppress marginalized people.  College courses and accompanying textbooks have usually presumed a medical model. The profession has used negative, demeaning, and disabling terminology to describe departures from a presumed norm (e.g., symptoms, deficits, errors). Many texts task students with imposing an artificial dichotomy wherein clinicians are supposed to classify deviations from General American English as either “differences”, which would not be targeted by SLP’s, or “disorders” which would be in need of correction. This terminology marginalizes speakers of other dialects (Moland & Oetting, 2021).

Critical professionals have argued that today’s education of speech and language professionals have failed to give voice to clients judged disabled and that have employed racist standards when evaluating students of color (Yu, 2022a). They have also identified the need to change educational practices that oppress marginalized people.  College courses and accompanying textbooks have presumed a medical model, have treated dialects as disorders in need of correction, and have used negative, demeaning, and disabling terminology to describe departures from a presumed norm (e.g., symptoms, deficits, errors). Critical professionals have argued that today’s education of speech and language professionals are structured around oppressive models, ones that have failed to give voice to clients judged disabled and that have employed racist standards when evaluating students of color (Yu, 2022a). 

Some 21st century critical professionals have promoted a shift from medical to social model practices (e.g., Goering, 2015; Simmons Mackie, 2000); others have advocated countering ableism by using more positive clinical terminology (e.g. Bottema-Beutel, 2021); and still others have advocated using person-centered practices that move away from professional elitism and ableism toward egalitarianism (e.g., Chapey et al, 2000).

Other scholars have proposed wide-ranging curricular changes for the development of a critical perspective in their students (Abrahams, et al., 2019; Khamis-Dakwar, 2021). For example, a group of South African critical researchers have developed a Curriculum of Practice”. Their aim has been to create new practices to counter existing ones that have arisen from colonialism, professionalism, and racism, and from the ableist assumptions that are built into existing medical model practices (Abrahams et al., 2019). And textbooks based on critical science are now available that are designed for use in courses on cultural responsiveness and critical professionalism (e.g., Hyter & Salas-Provance, 2019, 2023).

Horton (2021) has compiled a set of articles describing educational models for how students and professionals can work toward social justice.  One model, called an ethics of care approach (Boult, Whited, & Easley, 2021), engages students from different cultural backgrounds in special projects such as face-to-face meetings, designed to build cross-cultural relationships. A second approach to more accessible practices trains students in how to work with interpreters during multilingual exchanges by using simulated scenarios (Horton & Olivares, 2021).  A third recommends that practicing professionals adopt methods of restorative justice, such as conversational circles, when working with young people with communication disorders who are in conflict with authorities (Dalmage, 2021). And a fourth approach uses social media to create a community for Speech-Language Pathologists of color to provide students of color with professional role models (Navas, Tisi, & Close, 2021).

Another area targeted by critical academics is student admission requirements. In 2007, the Council of Academic Programs in Communication Sciences and Disorders voted to develop a set of prerequisite “essential functions” or competencies that potential students should have before being accepted into professional training programs (Horner, et al., 2009).  In 2021 Newkirk-Turner and colleagues examined those prerequisites, pointing out how they can serve to exclude marginalized students (Newkirk-Turner et al, 2021).  And Yu and her colleagues (Yu, et al. 2022a) have also criticized these requirements as being ableist and racist.  Some critical professionals are advocating that admission criteria be expanded or replaced.  For example, there is a call for the use of student interviews as a central part of the admission process (Scheer-Cohen, et al. 2022).  The aim of this approach and others is to address the problem of underrepresentation of marginalized groups in the profession (Ellis & Kendall 2021; Fannin and Mandulak, 2021). The Council on Academic Programs in Communication Sciences and Disorders convened a task force to examine the 2007 policy and bring forward recommendations to the membership to reform it in light of the critiques that have been made.

Equity in Professional Policies

Critical professionals have also worked to promulgate new national statements, policies, and guidelines to redress exclusionary practices.  The American Speech Language and Hearing Association has issued statements about diversity and inclusion (ASHA, ND); condemned racism and violence against African Americans and Asian Americans (ASHA, 2021); and outlined what ASHA is doing to combat systemic racism (ASHA, 2021).  The ASHA leader, ASHA s house magazine, has published articles arguing against ableism (e.g., Watson, S. & Constantino, C., 2022). And Deal-Williams (2020), ASHA s CEO, has offered a set of guiding questions for speech-language pathologists to ask themselves about racism.

The Council on Academic Accreditation of the American Speech-Language-Hearing Association (CAA) has for many years required graduate programs seeking accreditation to document how diversity is reflected in the curriculum. But in recent years this requirement is being examined in a new light with a much-expanded set of prompts requiring responses. For example, in 2023, programs submitting reaccreditation applications were asked to respond to the following question: “Describe how students are given opportunities to identify and acknowledge approaches to addressing culture and language that include cultural humility, cultural responsiveness, and cultural competence in service delivery.” (CAA, 2023) Programs were also asked to document how students have opportunities to reflect on their own biases, and how diverse perspectives on communication options, including signed languages, for deaf and hard of hearing individuals are incorporated in the curriculum.

Critical Research

Critical professionals who are researchers in the field have also examined traditional practices for their oppressive effects.  Specifically, they have pointed out the negative impact of scientific positivism.  This positivistic paradigm that is widely adopted in the research literature assumes a world detached from subjective observation wherein hypotheses about that world can be tested and verified through controlled experimentation and objective observation (Ellis, Jacobs, Kendall, 2021; Park et al, 2020; Stockman, 2007; Travis, 1931; Yu, et al 2022a). Positivism marginalizes the lived human experience of research participants and recipients of clinical services. It asserts that scientists and clinicians are charged with locating and articulating truth and are justified in the pursuit of truth to create an unequal power structure that enables oppressive practices.

Critical researchers have recommended replacing the positivistic approach to research with an emancipatory one. Emancipatory research focuses on the experiences of research participants, especially those oppressive experiences resulting from power inequities. The methods of critical researchers favor the use of qualitative research methods and are often carried out in natural contexts. Whereas the aim of positivistic science is to discover objective truths, an emancipatory research paradigm aims to reveal and free people from social injustices, and to thereby work to achieve social emancipation (e.g., Duchan, 2014). The emancipatory methods are designed to invert the power relationship between researcher and those researched that is built into positivism.

Most research journals in the discipline have been restricted to research based in positivistic science. That has changed during the 21st century as well as is indicated by the emergence of a new journal dedicated to critical science.  In 2022 the first issue of a new journal called the Journal of Critical Study of Communication and Disability was published.  The journal invites critical researchers to publish their work on “groups who are marginalized and/or pathologized for their languaging and ways of communicating.”  The stated aims of the journal are “to advocate for linguistic justice, equity, and access for diverse communicators.”

Equity in Clinical Practice

Changes growing out of the critical stance to professional practices have also focused on specific areas of communication disability and difference. In the area of autism, there is a trend to promote neurodiversity, thereby countering the ableist assumptions of the past (Santhanam & Bellon-Harn, 2021); in the literature on stuttering there is a new call to challenge ablest assumptions associated with non-fluency (Gerlach-Houck & Constantino, 2022); and accent modification programs, as they are called in current terminology, are being critiqued by those who argue for a halt to past and current trends—ones that pathologize dialect differences (Bell, 2020; Muller, Ball, & Guendouzi, 2000; Stockman, 2010; Yu et al., 2022b).

These critiques of ableism in specific areas of the field of communication disorders are compatible with those being created within the thriving disability movement, one called Critical Disability Studies (Hall, 2019). That movement has critically examined the social and political factors leading to oppression of those with all kinds of disabilities (Meekosha & Shuttleworth 2009). A consistent focus of this group has been to point to the oppressive and liberating effect of different conceptual frameworks. For example, they have forwarded a social model when construing a person’s disability arguing that the social model should replace the pervasive medical model that treats disabilities as impairments in the individual.

The social model promotes greater access and participation of those with disabilities (Shakespeare, 2010).  It holds that a disability should not be construed solely as a deficit or impairment within a person but rather it be seen as how the person with an impairment is responded to within their social milieus.

Social model approaches have been applied in different areas. The school inclusion movement, for example, is based on the idea that all children have a right to receive an education within the least restrictive environment. This movement replaces past educational policies when those with disabilities were educated separately, in specialized classrooms and even in segregated schools.

These policies hold that children with complex communication needs have the right to regular education. To achieve this goal, approaches have been developed to adapt standard curricula to accommodate children with communication disabilities into regular classrooms (Jorgensen, McSheehan & Sonnenmeier, 2009).  Programs have also been created to train family members to converse with their children.  Their aim is to enhance learning and social engagement of children rather than fix the child’s impairment (Hanen, 1975, is an early and continuing example of this trend).  And school personnel have been trained to emphasize the competencies of their students, rather than their deficits (Erickson, Koppenhaver, Yoder, & Nance, 1997). Learning environments and educational practices, such as those implemented in the Universal Design for Learning program aim support all learners, including those with disabilities (Gargiulo & Metcalf, 2022).

Similarly, new programs have promoted the social participation of adults with disabilities.  The programs aim to alter environments to achieve communicative access for adults with communication disabilities (for example, Byng & Duchan, 2005; Chapey et al 2000; Duchan, 2006; Holland & Elman, 2021) and to promote their meaningful participation in everyday life activities (Parr, Pound, & Hewitt, 2006; Pound et al, 2007).  One popular set of social model practices for adults with aphasia have been described as Life Participation for Approaches to Aphasia (LPAA) (Azios & Damico, 2020; Chapey et al, 2000; Holland & Elman, 2021).  For example, clinicians have designed methods to train conversational partners in how to best communicate with adults with language disabilities (Kagan, et al, 2001; McVicker et al, 2009).

Critical History

The need to approach current social justice practice from a historical perspective is pressing as the profession of speech-language pathology in the United States nears its 100th anniversary. The centennial year of the profession’s declared birth in the United States, 2025, arrives at a time when those throughout the United States and the world are raising concerns about social justice in the United States, (Arnold, 2015; Duchan & Hewitt, 2023; Nario-Redmond, 2019; Vortex Group, 2023).  It is in this context that the critical professional needs to ask questions about the profession’s history.  How and where did current, oppressive attitudes and practices originate?  What were our founders’ attitudes toward disability, race, ethnicity? What choices were available to them in 1925, when they formed the profession?

While celebrating our profession’s 100th milestone we should avoid the temptation of creating whitewashed tributes to our predecessors (Duchan & Hewitt, 2023; St. Pierre & St. Pierre, 2018).  If we celebrate our professional history without holding the founders accountable for their oppressive attitudes and choices, we are continuing to promote injustice and ignoring the important advances being made in this 21st century to create a more equitable profession. It is to this end that we have developed a sample teaching module for using history to teach critical practice. The module contains activities and readings for participants to develop a critical stance toward their profession.


The profession of speech-language pathology has been deeply affected by critiques made by professionals in these first decades of the 21st century. The critiques include challenges of the field’s foundational concepts. Indeed, the field’s very name embraces a medicalized model with its use of the term “pathology”. Much of the profession presupposes a medical model that regards differences as deficits in need of fixing. There is a clarion call from critical professionals for replacing this deficit model with a social model--one that supports those with diverse identities and communication profiles using person-centered practices.

This move toward social justice by critical professionals requires continued examination of past practices that have been harmful or misguided. It also requires new collaborations with the disability rights movement and disabled community, and with speakers of dialects that have been marginalized and minoritized. The critical professionals of these first decades in the 21st century are thereby both rewriting past history with a critical lens, and creating new more just practices for the profession’s future.   The next phase in the history of speech-language pathology is being written now, as the work toward becoming a more socially equitable profession is taking place.


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