How we use language and how we refer to people are important. The words we use reflect how we perceive someone—either as an individual or as a group—and in turn affects how they see themselves. Word choice can also influence or determine how we and others perceive individuals or groups. The most obvious example is terminology that is used to describe racial minority groups or individuals. While the terminology that is considered acceptable has changed over time, there are nevertheless some race-related terms that are never considered acceptable.
The same can be said about words we use to describe individuals or groups of individuals with disability. These terms reflect stigma or even cause stigma of individuals or groups. Here are a few important examples:
Mental retardation (the “R-word”) was used for many years to describe intellectual disability. However, this term has now been removed from the international classification systems that identify diseases and disabilities and is considered unacceptable. In 2013, the Social Security Administration published a notice that it was replacing the term mental retardation with intellectual disability, based in large part on the negative and offensive connotation associated with the term and the fact that it is often used in a derogatory, disrespectful, and demeaning way. Intellectual disability conveys the message that early intervention is warranted in the developmental period and may result in earlier and more effective treatment approaches.
Controversial, the term special needs is often used to soften the image of a person with a disability (usually a child) by avoiding the word disability altogether. However, many disability advocates and organizations have cautioned against using this term for several reasons. It is an imprecise, non-legal term that is considered offensive because it avoids use of correct terminology, and as a result, stigmatizes persons with disability. Some see the term as patronizing and condescending. The results of a recent study indicate that the term special needs is viewed more negatively than the more accurate term disability. This supports the use of disability rather than euphemisms such as special needs or challenged (as in physically challenged); however, some parents of children with disability use and prefer these terms. It’s best to ask individuals with disabilities how they would like to be described.
There have been several changes in terminology that relate to hearing. The terms hearing impairment and hearing impaired are no longer considered acceptable terms by many people. The terms deaf, hard of hearing, and hearing loss are generally considered more respectful. Also important is the use of the terms Deaf and deaf. The word Deaf (with a capital D) is used by many individuals with very little hearing from birth or at a very early age to signify their identification with the Deaf community. Members of the Deaf community do not consider themselves to have a disability. Those who acquire hearing loss later in life generally identify themselves as deaf or late-deafened (with a lowercase d). The way people with hearing loss prefer to be described may reflect their identification with others with comparable hearing loss.
Dementia is another term that is strongly associated with stigma. As a result, the term neurocognitive disorder has been adopted as the correct term to describe this disability. Although this is the preferred terminology, some healthcare professionals, the public, and organizations will likely continue to use the term dementia for the time being.
Another important concept related to use of language in the area of disability is the use of first-person language. A person with a disability, which puts the person first, is preferable to the disabled person or even more unacceptable is the disabled to refer to a group of people with disability. First-person language emphasizes that the individual is a person first and not defined by their disability.
Although using singular rather than plural terms to designate disability (people with disability rather than people with disabilities) has become increasingly acceptable and more widely used in recent years, its use is not universal. Many authors, organizations, and journals have adopted the singular form because it suggests commonalities rather than differences. It has been suggested that the singular term, people with disability, may command more recognition as a united group of people with similar interests and experiences in terms of unmet needs in the areas of social justice, healthcare, and a political voice. While well-established documents and even laws, such as the Americans with Disabilities Act of 1990 and the Americans with Disabilities Amendments Act of 2008, use plural forms, the use of the singular form of the word may convey the growing understanding of the similarities shared across types of disability that could lead to solutions that would have a positive effect on multiple individuals despite different types of disability (McDermott & Turk , 2014).
The wording and terminology issues discussed here are not intended to hamper how nurses and other healthcare professionals communicate with individuals with disability. A few recommendations will promote positive communication with individuals with disability:
- Determine what communication strategy works best for the person; don’t assume you know.
- Use the name of the person with a disability, just as you would anyone else.
- Talk directly to the individual with a disability rather than accompanying persons, including family members or interpreters.
- Consider the individual with a disability to be the expert on his or her disability.
- Treat adults with disability as adults—not as children.
- Ask individuals with disability how their disability affects their ability to carry out activities; don’t ignore the disability and pretend it doesn’t exist.
- Give individuals with communication problems time to respond to questions.
- Learn more about barriers that affect communication and strategies to address those barriers.
When in doubt though, ask individuals with a disability how they would like to be described. There are different preferences, and they have the right to tell you theirs.
Suzanne C. Smeltzer, EdD, RN, ANEF, FAAN, is the Richard and Marianne Kreider Endowed Professor in Nursing for Vulnerable Populations at Villanova University M. Louise Fitzpatrick College of Nursing in Villanova, Pennsylvania, USA. She is a member of Sigma’s Alpha Nu Chapter. Dr. Smeltzer is the author of Delivering Quality Healthcare for People with Disability published by Sigma.
