A Critical History Module for Teaching Social Justice to Professionals in Speech Language Pathology

Judith Duchan & Lynne Hewitt

This teaching module responds and adds to a growing literature in the field of speech-language pathology that has taken a critical stance toward established professional practices. The critical stance offers researchers and clinicians a way to examine different kinds of power relationships between service providers and their clientele. Included in the broader critical literature are studies examining professional attitudes and assumptions about race, class, ethnicity, sexuality and disability. The aim of critical studies in speech-language pathology has been to reveal and eventually eliminate clinical attitudes and practices toward others that are oppressive, iniquitous, and dehumanizing. The overall aim has been to create a profession that is emancipatory, one that is grounded in practices that foster social justice.

This module offers a set of readings, both historical and current, along with activities, that are designed to guide participants as they adopt a critical approach to their studies and practices.

Learning Outcomes

Upon the completion of this module, participants will be able to:

  1. Identify professional goals of the founders of “Speech Correction” in the US in the 1920s.
  2. Identify racial, ethnocentric or ablest biases expressed in the writings of the profession's 20th century founders in the US.
  3. Identify and analyze historical paths not taken, that could have offered our early 20th century ancestors with alternative, less biased views of those they served.
  4. Identify and analyze alternative frameworks currently being promoted to counter todays oppressive practices.
  5. Identify their own racial, ethnocentric or ableist practices.
  6. Identify oppressive practices in their curriculum and/or clinical practices.
  7. Adopt critical frameworks that counter oppressive practices and that foster cultural humility and social justice.

There are four sections to this module.  The first has participants examine historical depictions of those with speech problems beginning around the time that the profession defined itself in the US as its own field of study and practice. Participants are asked to employ techniques of critical discourse analysis to identify the demeaning language and disabling, oppressive attitudes that our founders expressed toward their clients. The second section of this module provides alternatives to the oppressive language, attitudes, and practices found in the historical writings.  It also offers readings that critique such oppressive practices in today's critical literature. A third section of the module offers participants a way to engage in critical self-reflection—an approach based upon what was learned in the first two modules. An annotated bibliography is presented in the fourth section of the module offering source material for participants to draw from when completing the activities of the first three sections. It is recommended that participants who are new to the methods involved in critical science, or to the 20th century historical antecedents of the profession, proceed through all the steps in the order that they appear in the module. Those familiar with the methods and findings of the critical literature, can pick freely from the selected readings to bolster their teachings or learning.

Section 1: Identifying Dehumanizing and Oppressive Practices

Our founders’ response to social and political trends of that time were to create practices that were oppressive including those that were racist, ethnocentric, ableist, and elitist (Duchan & Hewitt, in press).  Once again, we are experiencing sea changes in our society, ones that offer us the opportunity to reverse the practices shaped by our predecessors. We can counter the demeaning and marginalizing attitudes of our founders by creating practices that eliminate injustices toward those now diagnosed with communication differences or disabilities.

Racial and Ethnic Bias

Select an article from the below list of historical works that describe clients who speak in dialects considered deviant as or as a kind of pathology, that is, works that display linguicism" (Skutnabb-Kangas, 2015). Domains in the literature that are particularly susceptible to linguicism are ones having to do with correcting" those who speak African-American English or those who are described as having a foreign accent".   When reading the article, consider the following:

  1. How does the author of this article identify or describe the person's dialect? Make special note of the negative connotations associated with terms such as defects or deficits and whether language variation is pathologized.
  2. How does the author describe the job of the speech "correctionist" or :pathologist" in relation to the person's dialect? Be aware of demeaning language associatesettingd with goal.
  3. Select a recent article recommending "accent modification" programs and evaluate it from a critical perspective (use Yu, et al. 2022 as a guide).

Ableist Bias

Select, read, and critique an article about communication disorders from the list of works below written in the 1920s. Having read the article, consider the following questions:

  1. How does the author identify or describe the persons communication? What language is used, and what are the implications of the choice of terminology?  Would you want your communication to be described in this way?
  2. How does the author describe the goals and role of the "correctionist" or "pathologist" in relation to the persons communication?
  3. Are clients preferences brought to bear in the process of goal setting?
  4. How might you go about changing the ableist wording or the practice to achieve more social equity?

Section 2: Countering Disabling Practices

Identify a current article or clinical guideline resource (textbook, practice standards, etc.) that celebrates differences and compare that article with a more disabling and marginalizing work.

  1. Do the two articles differ in how clients and their communication differences are described?
  2. Do they differ in how the relationships between clinicians and clients are depicted?
  3. Do they differ in how goals are selected and achieved?

Section 3: Carrying out Critical Self-Reflection.

Write a reflection that incorporates your own experiences and reactions to what you have read and analyzed for the first two sections. How might your practice be affected by the ideas and knowledge that these activities have generated?  Your reflection may include your answers to questions such as:

  1. How has my thinking changed about working with those who are marginalized because of their dialect?
  2. How might the concept of disorder within dialect influence what I do clinically?
  3. What can I do to counter the ableist ideas inherent in traditional professional practices?
  4. What influence has the medical model had on the ways I might go about selecting my caseload, creating goals, interacting with and supporting my clients?
  5. How can I incorporate social justice goals into my practices?

Section 4: An Annotated Bibliography of Guided Readings

Source Material

ASHA's Office of Multicultural Affairs and Resources (ND). ASHA resources for increasing diversity, cultural competence https://www.asha.org/practice/multicultural/. This valuable website links to several resources produced by ASHA's committee on Multicultural Affairs for upgrading the cultural sensitivities of those in the field of Speech-Language Pathology.

Blanton, M. & Blanton, S. (1920) Speech training for children: The hygiene of speech.  The Century Company. https://babel.hathitrust.org/cgi/pt?id=osu.32435016033219&view=1up&format=plaintext&seq=286&skin=2021  This early text by two leaders in the newly developing field of "speech correction" is aimed at parents and teachers.  It contains the views that learning to speak well is a child's avenue to becoming "cultured", and that "poor speech" reflects "lack of breeding".

Borden, R. & Busse, A. (1925) Speech Correction. Ballou Press https://www.google.com/books/edition/Speech_Correction/-JtqAAAAMAAJ?hl=en&gbpv=1&dq=Borden,+RD.+%26+Busse,+A.+(1925)+Speech+Correction.+Ballou+Press&pg=PR2&printsec=frontcover Borden and Busse were charter members of ASHA.  In this 1925 text they describe speech problems as "lowering the national speech standards" and "foreign dialect" as a "defect" arising from carelessness and in need of being "corrected."

Duchan, J. & Hewitt, L. (2023, Mar 10, 1-13). How the charter members of ASHA responded to the social and political circumstances of their time.  American Journal of Speech Language Pathology. 32, 3. https://pubs.asha.org/doi/abs/10.1044/2022_AJSLP-22-00273.  This article identifies elitist, ethnocentric, racist, regionalist, classist and ablist attitudes toward their clients as indicated in their writings.  It also presents other options they had that would have been more egalitarian.

Han, A. (2012). Children's mental health in the United States: The development of child psychiatry at Johns Hopkins, 1890-1945. Unpublished Dissertation, Berkeley, CA. https://escholarship.org/uc/item/7d55073c. Han describes the early 20th century work in child psychiatry done by Adolf Meyer and Leo Kanner at Johns Hopkins. The work involved contextualizing interventions rather than working to test and remediate problems in the child. This work in psychiatry was popular in the US when ASHA was being founded. It offered a possible alternative to medical model approaches taken by ASHA's founders.

 Hoegaerts, J. (2020). Stammering, stuttering and stumbling. Journal of Interdisciplinary Voice Studies, 5, 2, 129-146(18) https://doi.org/10.1386/jivs_00021_1 This author describes how norms of speech shifted throughout the nineteenth century, especially related to dysfluency. That century's use of scientific language, statistical calculation and systematic classification changed the rendering of stuttering. At the same time, those who stuttered were still considered to be the experts on the condition.

Martin, F. (1918) Foreign accent, a supplement to the syllabus in English for the Elementary Schools of the City of New York. NY: Board of Education. https://babel.hathitrust.org/cgi/pt?id=uiug.30112111165236&view=1up&format=plaintext&seq=6&skin=2021 This pamphlet, very popular in its day, was addressed to teachers, offering them information on how to "correct" foreign accent "errors".

O'Connell, A. (1990). The development of speech pathology in America, 1890-1940. https://ecommons.luc.edu/cgi/viewcontent.cgi?article=3743&context=luc_diss.  This is a noncritical history of speech pathology services in America early in the field's development.

Pardoe, T. (1937). A historical and phonetic study of Negro Dialect. LSU Historical Dissertations and Theses. https://digitalcommons.lsu.edu/gradschool_disstheses/7790/. This 1937 study shows that the sound structure of African American English spoken in the US South (Louisiana) drew from two main sources: "English-speaking overseers" and native African languages. It also describes how important US writers such as Mark Twain, Paul Lawrence Dunbar and Zora Neale Hurston depict "Negro" speech in their written texts.

Rabin, L. (2009). Language ideologies and the settlement house movement: A New history for service-learning. Michigan Journal of Community Service Learning, 15, Spring, 2009, pp. 48-55. https://quod.lib.umich.edu/m/mjcsl/3239521.0015.204?rgn=main;view=fulltext The leaders of the settlement house movement championed what is commonly known as a "cultural pluralism," in their work with immigrants early in the 20th century.  However, their attitudes toward language differences were less progressive in that they opposed bilingual education for immigrants, arguing for the monolingual use of American English.

Smith, D. (1954). Origins and development of departments of speech. In K. Wallace (Ed.) A History of Speech Education in America, pp. 447-471. Appleton. https://archive.org/stream/historyofspeeche012803mbp/historyofspeeche012803mbp_djvu.txt This wide sweeping history of the fields of deaf education, speech pathology and audiology offers a positive, non-critical view of advances in these fields up to the 21st century.

Racism and Ethnocentrism

The frameworks and approaches used in research and clinical practices led to their implementation of racist and ethnocentric practices. Those egregious attitudes and practices are especially evident in their treatments of dialect and foreign accent management. The recent awareness in the country about the existence of systemic racial and ethnic based linguicism has led some professionals in speech-language pathology to recommend changes in how researchers and clinicians represent and treat dialect differences.  The readings below have been selected to illustrate and reflect some of these countervailing forces against linguicism in the field.

American Speech-Language-Hearing Association. (1998). Students and professionals who speak English with accents and nonstandard dialects: Issues and recommendations [Position Statement]. https://www.asha.org/policy/ps1998-00117/  This is a statement of ASHA's position on accepting students with who speak dialects other than General American English into the profession.

American Speech-Language-Hearing Association (2021) Addressing Systemic Racism and Institutional Inequities in CSD https://www.asha.org/about/diversity-equity-inclusion/  This article describes ASHA's actions condemning racism and violence against African Americans and Asian Americans. It also outlines what ASHA is doing to combat systemic racism.

American Speech-Language-Hearing Association (ND). Statement of  Diversity and Inclusion at ASHA https://www.asha.org/about/diversity-and-inclusion-at-asha/ This statement of intent from ASHA describes the organization's commitment to achieving diversity and inclusion in ASHA's membership and at the National Office.  It outlines ways it plans to carry out their commitment.

Bell, A. (2020) Linguistic justice: Black language, literacy, identity, and pedagogy.  Routledge.  This book describes how speakers of African American English negotiate their linguistic and racial identities and the ways linguistic racism creates emotional harm and violence to them in the course of their everyday lives.

Daughrity, B. (2020). Standing up, speaking out for racial justice.  Leader Live, ASHA Wire https://leader.pubs.asha.org/do/10.1044/leader.FTR2.25082020.52/full/. In this first-person account, Daughrity, a black woman, describes her experiences of racism in her training and practice as a speech-language pathologist and an assistant professor in the field. She offers advice to her fellow professionals for what they can do to change their attitudes and work against racism

Deal-Williams, V. (2020). Addressing disparities in the wake of injustice, violence and COVID 19. ASHA Wire https://leader.pubs.asha.org/do/10.1044/2020-0601-addressing-disparities-of-injustice/full/. This author points to the health disparities related to COVID 19 and offers a set of guiding questions for self-examination in relation to racism.  She also presents resources for a curriculum in cultural competence and cultural humility.

Duchan, J. (2008). Dialectal prescriptivism and diversity in late 19th and early 20th century America. Communicative Disorders Review, 2, 2, 103-112. This article reviews two ways our founders could have gone, as exemplified in the writings of late 19th, early 20th century scholars. They chose dialectal prescriptivism over the promotion of dialectal diversity, for the most part.

Duchan, J. & Hyter, Y. (2008). Elocutionist Hallie Quinn Brown. ASHA Leader, 13, 2, https://leader.pubs.asha.org/doi/10.1044/leader.FTR4.13022008.20.  Hallie Quinn Brown, an elocutionist whose public performances were popular during the time of ASHA's founding celebrated the African-American vernacular.

Eisel-Hendricks, A., Watson-Wales, M., & Reed, P. (2021). Perceptions of African American English by students in Speech-Language Pathology programs. American Journal of Speech Language Pathology, 30, 5 1962-1972. https://pubs.asha.org/doi/abs/10.1044/2021_AJSLP-20-00339. Students in the field of communication disorders rated speakers who speak African-American English lower in personal attributes. The authors advocate more training to combat this oppressive bias and provide lesson plans and materials for such training.

Ellis, C., Jacobs, M., Kendall, D. (2021). The Impact of racism, power, privilege, and positionality on Communication Sciences and Disorders Research. American Journal of Speech-Language Pathology, 30, 5, 2032-2039. https://pubs.asha.org/doi/10.1044/2021_AJSLP-20-00346.  This article explores the impact that racism, privilege, power, and positionality have had on research in communication disorders. The authors advocate an overhaul on how research is done in the field, affecting the way research questions are formed, and by whom, and how methods are selected and data is analyzed. 

Kates, S. (1997). The embodied rhetoric of Hallie Quinn Brown. College English, 59, 1, 59-71. https://www.jstor.org/stable/378798?seq=3#metadata_info_tab_contents.  Hallie Quinn Brown, a Black elocutionist working in the early 20th century, designed practices that celebrated rather than stigmatized African-American dialect.

Mahendra, N., Cirolamo, T., Kasambira-Fannin, D. (2021). Advancing justice, equity in the pipeline to the professions. ASHA Leader Live https://leader.pubs.asha.org/do/10.1044/leader.FMP.26082021.8/full/ This article is by members of the Diversity, Equity, and Inclusion (DEI) Committee of the Council of Academic Programs in Communication Sciences and Disorders (CAPCSD). They offer definitions of key terms related to diversity, equity and inclusion, and a set of actions for programs in higher education aimed at achieving justice in our profession.

Mohapatra, B. & Mohan, R.  (2021). A proposed framework for increasing racial and ethnic diversity in Communication Sciences and Disorders academic programs. SIG 10, Issues in Higher Education, ASHA https://doi.org/10.1044/2021_PERSP-20-00285. The framework being proposed here includes ways to recruit, mentor, and evaluate students from diverse backgrounds into the field of speech-language pathology.

Müller, N., Ball, M., & Guendouzi, J. (2000). Accent reduction programmes: Not a role for Speech-Language Pathologists?  Advances in Speech Language Pathology, 2, 2, 119-129, Doi: https://doi.org/10.3109/14417040008996796. These authors argue that today's speech-language pathologists are not sufficiently trained to do work in accent reduction. They also offer an argument for why "accent reduction" is a wrong way to describe and think about working with clients who speak dialects other than General American English.

Oetting, J. (2020). General American English as a dialect: A call for change. The ASHA LeaderLive. https://leader.pubs.asha.org/do/10.1044/leader.FMP.25112020.12/full/. This article criticizes practices in which GAE is seen as a standard. Rather it should be seen as a dialect, just as AAE is considered a dialect.

Oetting, J., Gregor, K., & Rivière, A. (2016). Changing how speech-language pathologists think and talk about dialect variation, Perspectives of the ASHA Special Interest Groups: Sig 16, 1, 28-37. https://doi.org/10.1044/persp1.SIG16.28. The authors recommend that SLPs n o longer contrast dialect and disorder when classifying speech differences.  Rather, they think and talk about the disorder as being embedded in a dialect.

Skutnabb-Kangas, T. (2015) Linguicism. The Encyclopedia of Applied Linguistics. Blackwell. http://www.tove-skutnabb-kangas.org/dl/310-Skutnabb-Kangas-Tove-2015-Linguicism-Encyclopedia-of-Applied-Linguistics-Blackwell.pdf. This article gives a history and definition of the term "linguicism" and its devastating social impact.

Yu, B, Nair, V., Brea, M.,  Soto-Boykin, X., Privette, C., Reem Khamis, S., Chiou, H.,  Fabiano-Smith, L, Epstein, L., & Hyter, Y. (2022). Gaps in framing and naming: Commentary to a viewpoint on accent services. AJSLP, 31, 4, 1-6. https://www.researchgate.net/publication/361007288_Gaps_in_Framing_and_Naming_Commentary_to_A_Viewpoint_on_Accent_Services. These authors take issue with the recommendation that there be a terminological change from accent modification to accent expansion. They motivate their concern by arguing from a critical theory perspective that calls for a transformational conceptual shifts in how issues of dialect are conceptualized, moving from a terminological shift of "accent modification" to a social changes that will result in "linguistic adequacy" (Yu, et al, 2022, p. 5).



The field of speech-language pathology, because of its previous wholesale adoption of the medical model, has treated communication disabilities, impairments, and differences as if they were diseases. Those who do not fit measured or created "norms" are treated as "less than" or deficient. Indeed, the very definition of the job for many, whether it be research or clinical practice seems to presuppose that the person with the disability is in need of "remediation" services—of therapy, of intervention, of fixing. The advent of the disability rights movement and the adaption of social model practices to the field have offered alternatives to this normative-deficit view of disability and difference. The articles in this section provide possible alternatives to the ableist framework inherent in the medical model.

Abrahams, K., Kathard, H., Harty, M. & Pillay, M. (2019). Inequity and the professionalisation of Speech-Language Pathology. Professions and Professionalism, 9, 3, 1-16. https://journals.oslomet.no/index.php/pp/article/view/3285/3376. These authors describe the social-cultural choices and conditions that have led the field of speech language pathology to serve only a privileged minority. In their words: "The profession of SLP has its origins in a Euro-/American-centric, white, middle-class, male-dominated health care milieu largely influenced by the medical model" (p. 7). They also argue against using a normative frame of reference for identifying speech and language disorders. They lay out a "Curriculum of Practice" for decolonializing education, creating equity in clinical practice, and taking a critical theory approach to research. Their examples come from work going on in South Africa.

Bottema-Beutel, K., Kapp, S., Lester, J., Sasson, N. & Hand, B. (2021). Avoiding ableist language: Suggestions for autism researchers. Autism in Adulthood, 3, 11, https://doi.org/10.1089/aut.2020.0014. As is described in the title, this article, aimed at those who research autism, defines, describes, and offers alternatives to ableist language often used in autism research. The authors also argue that people with autism should be included in research on their disability.

Byng, S. & Duchan, J. (2005). Social model philosophies and principles: Their applications, Aphasiology, 19, 10-11, 906-922. https://www.tandfonline.com/doi/abs/10.1080/02687030544000128. This study describes the literature on the social model of practice. Principles are presented to guide planning and evaluate support services for people with aphasia. The principles also apply to other areas of communication difference.

Did I stutter (ND). A blog on stuttering and ableism. https://www.didistutter.org/blog/category/ableism. This blog written by a group of stutterers who, in their words: who want to be heard on our own terms, with two main goals: 1) resisting speech assimilation and 2) advocating for dysfluency pride. We are not a self-help group per se. Rather, we consider ourselves as part of the disability rights movement.

Dorsey, R. (ND). Reframing social difference. dorseyslp.com. Rachel Dorsey is a speech-language pathologist who has autism and who critiques today's clinical practices, especially the teaching of social skills. She points to the ways social skill training can have a negative masking effect on the natural expression of people with autism.

Duchan, J. (1999). Reports written by speech-language pathologists: The role of agenda in constructing client competence. In D. Kovarsky, J. Duchan, & M. Maxwell (Eds.) Constructing (In) Competence: Disabling evaluations in clinical and social interaction. (pp. 223-244) Mahwah, NJ: Erlbaum. It is argued here that reports are written for particular purposes and that diagnostic or evaluation reports are more negative than progress reports. The negativity is ableist in that it emphasizes what a person can't do well enough.

Duchan, J. (2021). Book Review of Susan Lamb (2014) Pathologist of the Mind. Johns Hopkins University Press. Journal of Interaction Research in Communication Disorders, 12, 2, 266-272.https://journal.equinoxpub.com/JIRCD/article/view/22563/24896. This review draws parallels between Adolf Meyer’s psychiatric practices and medical outlook in early 20th century America were in keeping with today's social model approaches.

Gerlach-Houck, H. & Constantino, C. (2022). Interrupting ableism in stuttering therapy and research: Practical suggestions. Perspectives, SIG 4, Fluency and Fluency Disorders, ASHA, 1-18. https://doi.org/10.1044/2021_PERSP-21-00109. This tutorial offers suggestions and scenarios for how to approach stuttering therapy in ways that are empowering rather than disabling.

Gore, K. (2021). How to avoid writing ableist goals in speech therapy. Speech IRL. https://www.speechirl.com/how-to-avoid-writing-ableist-goals-in-speech-therapy. Gore takes issue with the notion that those who use atypical speech or behaviors are disordered and in need of "correction" or "therapy". She illustrates ways of shifting from ableist to affirming treatment approaches by focusing on functional goals centered on what the person wants.

St Pierre, J. & St Pierre, C. (2018). Governing the voice: A critical history of speech-language pathology, Foucault Studies, 24, 151–84. https://rauli.cbs.dk/index.php/foucault-studies/article/view/5530. Speech correction is described by these Foucault theorists as a political movement intended to make people, especially those who are dysfluent, passive citizens, under the influence of the rule of the speech expert. These authors apply critical disability theory to the study of the history and current practices of speech-language pathologists.

Sanzo, K. (2021). Addressing ableism for DHH students. ASHA Leader Live. https://leader.pubs.asha.org/action/doSearch?AllField=Addressing+ableism&target=digital-object-search&content=+digitalObject. Sanzo points out how ableism infuses clinical practices provided to people with hearing impairment. She sees much of ableism arising from the medical model and offers ways to rectify ableist services to hearing impaired children in educational settings.

Simmons-Mackie, N., (2000). Social approaches to aphasia intervention. In R. Chapey (Ed.). (5th edition) Language Intervention strategies in aphasia and related neurogenic communication disorders. Williams and Wilkins. This book chapter describes and promotes the social model approach to aphasia assessment and intervention, contrasting it with the debilitating practices associated with the medical model.

Critical Self-Reflection

This third section in the module, offers works on critical self-reflection. The section is aimed at uncovering and challenging the dynamics that frame our decisions and actions, especially having to do with race, ethnicity, and disability. The goal is to illustrate how students can apply their critical understandings gleaned from the first two sections to their own histories and to invent new, emancipatory ways to construe and conduct their clinical work.

The references below offer general models and techniques for self-reflection. They provide a blueprint for carrying out critical self-reflection having to do with one's own personal and professional biases.

Cook, K. Tillard, G., Wyles, C., Gerhard, D., Ormond, T. & McAuliffe, M. (2019). Assessing and developing the written reflective practice skills of speech-language pathology students, International Journal of Speech-Language Pathology, 21, 1, 46-55, DOI: 10.1080/17549507.2017.1374463. This study is of a six-week training program on teaching students in training to reflect on their clinical experiences. The students improved in the depth and breadth of their reflections. The methods used in this training can be adapted for use when engaging in critical self-reflection of ones own attitudes on race, ethnicity, and disability.

Duchan, J. (2004). Reflecting frames. Chapter 8 in J. Duchan (2004). Frame work in language and literacy: How theory informs practice. Guilford Press. This chapter borrows from reflective practices used in other fields to encourage speech-language pathologists to choose from different frameworks when working to support school age children with language and learning differences and difficulties. It includes a discussion of critical practices in various clinical areas of the field.

Lewis, A. (2013). Reflective practice: What it is and how do I do it? Journal of Clinical Practice in Speech-Language Pathology, 15, 2, 70-74. https://ro.ecu.edu.au/cgi/viewcontent.cgi?article=1846&context=ecuworks2013. This article reviews the literature on reflective practice, offering a set of materials that can be used when examining ones own attitudes and practices about race, ethnicity, and disability.