Disability

When you are writing, you need to follow general principles to ensure that your language is free of bias. Here we provide guidelines for talking about disability with inclusivity and respect.

Disability is a broad term that is defined in both legal and scientific ways and encompasses physical, psychological, intellectual, and socioemotional impairments (World Health Organization, 2001, 2011). The members of some groups of people with disabilities — effectively subcultures within the larger culture of disability — have particular ways of referring to themselves that they would prefer others to adopt. When you use the disability language choices made by groups of disabled individuals, you honor their preferences. For example, some Deaf individuals culturally prefer to be called “Deaf” (capitalized) rather than “people with hearing loss” or “people who are deaf” (Dunn & Andrews, 2015). Likewise, use the term “hard of hearing” rather than “hearing-impaired.” Honoring the preference of the group is not only a sign of professional awareness and respect for any disability group but also a way to offer solidarity.

The language to use where disability is concerned is evolving. The overall principle for using disability language is to maintain the integrity (worth and dignity) of all individuals as human beings. Authors who write about disability are encouraged to use terms and descriptions that both honor and explain person-first and identity-first perspectives. Language should be selected with the understanding that the expressed preference of people with disabilities regarding identification supersedes matters of style.

Person-First Language

In person-first language, the person is emphasized, not the individual’s disabling or chronic condition (e.g., use “a person with paraplegia” and “a youth with epilepsy” rather than “a paraplegic” or “an epileptic”). This principle applies to groups of people as well (e.g., use “people with substance use disorders” or “people with intellectual disabilities” rather than “substance abusers” or “the mentally retarded”; University of Kansas, Research and Training Center on Independent Living, 2013).

Identity-First Language

In identity-first language, the disability becomes the focus, which allows the individual to claim the disability and choose their identity rather than permitting others (e.g., authors, educators, researchers) to name it or to select terms with negative implications (Brown, 2011/n.d.; Brueggemann, 2013; Dunn & Andrews, 2015). Identity-first language is often used as an expression of cultural pride and a reclamation of a disability that once conferred a negative identity. This type of language allows for constructions such as “blind person,” “autistic person,” and “amputee,” whereas in person-first language, the constructions would be “person who is blind,” “person with autism,” and “person with an amputation,” respectively.

Choosing Between Person-First and Identity-First Language

Both person-first and identity-first approaches to language are designed to respect disabled persons; both are fine choices overall. It is permissible to use either approach or to mix person-first and identity-first language unless or until you know that a group clearly prefers one approach, in which case, you should use the preferred approach (Dunn & Andrews, n.d.). Mixing this language may help you avoid cumbersome repetition of “person with . . .” and is also a means to change how authors and readers regard disability and people within particular disability communities. Indeed, the level of disability identity integration can be an effective way to decipher the language that is preferred by the persons about whom you are writing. Those who embrace their disability as part of their cultural and/or personal identity are more likely to prefer identity-first language (Dunn & Andrews, 2015). If you are unsure of which approach to use, seek guidance from self-advocacy groups or other stakeholders specific to a group of people (see, e.g., Brown, 2011/n.d.). If you are working with participants directly, use the language they use to describe themselves.

Relevance of Mentioning a Disability

The nature of a disability should be indicated when it is relevant. For example, if a sample included people with spinal cord injuries and people with autism—two different groups with disabilities—then it makes sense to mention the presence of the particular disabilities. Within each group, there may be additional heterogeneity that should, under some circumstances, be articulated (e.g., different levels of spinal cord injury, different symptom severities of autism spectrum disorder).

Negative and Condescending Terminology

Avoid language that uses pictorial metaphors or negativistic terms that imply restriction (e.g., “wheelchair bound” or “confined to a wheelchair”; use the term “wheelchair user” instead) and that uses excessive and negative labels (e.g., “AIDS victim,” “brain damaged”; use the terms “person with AIDS” or “person with a traumatic brain injury” instead). Avoid terms that can be regarded as slurs (e.g., “cripple,” “invalid,” “nuts,” “alcoholic,” “meth addict”); use terms like “person with a physical disability,” “person with a mental illness,” “person with alcohol use disorder,” or “person with substance use disorder” instead, or be more specific (e.g., “person with schizophrenia”). Labels such as “high functioning” or “low functioning” are both problematic and ineffective in describing the nuances of an individual’s experience with a developmental and/or intellectual disability; instead, specify the individual’s strengths and weaknesses. As with other diverse groups, insiders in disability culture may use negative and condescending terms with one another; it is not appropriate for an outsider (nondisabled person) to use these terms.

Avoid euphemisms that are condescending when describing individuals with disabilities (e.g., “special needs,” “physically challenged,” “handi-capable”). Many people with disabilities consider these terms patronizing and inappropriate. When writing about populations or participants with disabilities, emphasize both capabilities and concerns to avoid reducing them to a “bundle of deficiencies” (Rappaport, 1977). Refer to individuals with disabilities as “patients” (or “clients”) within the context of a health care setting.

Examples of Bias-Free Language

The following are examples of bias-free language for disability. Both problematic and preferred examples are presented with explanatory comments.

1. Use of person-first and identity-first language rather than condescending terms

Problematic:
special needs
physically challenged
mentally challenged, mentally retarded, mentally ill
handi-capable

Preferred:
person with a disability, person who has a disability
disabled person
person with a mental illness
people with intellectual disabilities
child with a congenital disability
child with a birth impairment
physically disabled person, person with a physical disability

Comment: Use person-first or identity-first language as is appropriate for the community or person being discussed. The language used should be selected with the understanding that disabled people’s expressed preferences regarding identification supersede matters of style. Avoid terms that are condescending or patronizing.

2. Description of Deaf or hard-of-hearing people

Problematic:
person with deafness, person who is deaf
hearing-impaired person, person who is hearing impaired
person with hearing loss
person with deafness and blindness

Preferred:
Deaf person
hard-of-hearing person, person who is hard-of-hearing
Deaf-Blind person

Comment: Most Deaf or Deaf-Blind individuals culturally prefer to be called Deaf or Deaf-Blind (capitalized) rather than “hearing-impaired,” “people with hearing loss,” and so forth.

3. Description of blind people or people who are visually impaired

Problematic:
visually challenged person
sight-challenged person
person with blindness

Preferred:
blind person
visually impaired person, vision-impaired person
person who is blind
person who is visually impaired, person who is vision impaired

4. Use of pictorial metaphors, negativistic terms and slurs

Problematic:
wheelchair-bound person
AIDS victim
brain damaged
cripple, invalid, defective, nuts
alcoholic, meth addict

Preferred:
wheelchair user, person in a wheelchair
person with AIDS
person with a traumatic brain injury
person with a physical disability, person with a mental illness
person with alcohol use disorder, person with substance use disorder

Comment: Avoid language that uses pictorial metaphors, negativistic terms that imply restriction, and slurs that insult or disparage a particular group. As with other diverse groups, insiders in disability culture may use these terms with one another; it is not appropriate for an outsider (nondisabled person) to use these terms.