Do we say a “child with autism” or “an autistic child”? The way society views disability is changing, and so is the language we use to talk about disability. There are two main schools of thought—person-first language and identity-first language. Most practitioners are taught to use person-first language in school, and most academic thought continues to focus on person-first language. But the tide in the communities we serve is turning.
I often think about my “Fundamentals of Occupation” class in occupational therapy school. Like the course title suggests, this class was about the basics of occupation and occupational therapy. We discussed what occupational therapy is, the science and research behind different treatment methods, and how OTs could help and empower their clients and communities.
In this class, we were also told that person-first language was the most appropriate way to address our clients. We were taught that if we didn’t use person-first language to address our clients, it would not only impact our grades and feedback in OT school but would also be poorly received by our clients outside the classroom.
The mindset that person-first language is the best and only way to refer to our clients is actually taught in most health professions, and mandated by many scholarly journals. You might have been taught to use person-first language in your own training. But as I’ve learned as a practicing OT, it’s not really reflective of what our clients want or need in the professional world.
The History of Identity-First and Person-First Language
In the early 1970s, the “People First” movement was started at the first self-advocacy conference. This movement aimed to empower people with disabilities by emphasizing their individuality and personhood, rather than their disabilities. Person-first language offered a way to do that. In daily conversations—and in medicine—person-first language separated the person and the disability, and focused on the person.
But since the 1970s, there’s been big shifts in the way we view and talk about disabilities in general. Institutionalization of disabled people has decreased, legislation has been passed putting more protections in place, and hurtful, derogatory language has started to fade from the vernacular—for the most part. Injured and disabled communities have new mediums and space to advocate for themselves, and communicate their needs to the public at large.
A major part of that shift is actually moving away from person-first language, despite its prevalence in academia and most medical communities. Many disabled communities are now advocating for a shift to identity-first language, an approach that views a person’s disability as an integral part of their identity.
Of course, not all communities feel the same way, and individuals within those communities are even more varied. But as awareness and understanding of disability increases, many people no longer see the need to separate the person from their disability.
Why the Emphasis on Person-First?
Looking back at my time in occupational therapy school, I can see what my professors were trying to do. We were young, bright-eyed students who wanted to do what was best for our clients, and they were trying to teach us how to do that. They wanted us to know that by addressing our clients with person-first language, we would be showing them understanding, empathy, and respect. Addressing them any other way was simply disrespectful and potentially harmful.
And it worked. What my professors taught me stuck. For years I used person-first language whenever I interacted with my clients. My clients were a man with a cognitive impairment, a child with autism, a teenager with dyslexia. The idea of using identity-first language and saying my client was an autistic child never crossed my mind.
It wasn’t until I had been working as an OT for several years that I became aware of the identity-first language movement and all the opinions, research, and advocates who were behind it.
Renewed Focus on Identity-First Language
I dug into the research and read some first-hand accounts from individuals who had a diagnosis or impairment that they weren’t ashamed of, or trying to distance themselves from. They saw their disabilities as an important part of their identity, and wanted to be referred to in a way that reflected that. They wanted to see identity-first language replace person-first language in our general discourse.
Around this time, I met a speaker at a conference, and they corrected me when I used person-first language. They told me that having autism was a part of who they were, and they wanted to be referred to as autistic. This was a pivotal moment for me—I realized I had a lot of new language to learn, and a lot of habits to unlearn going forward in my OT career.
Learning a New Way
I still struggle sometimes with not using person-first language as a default. I can hear my professors telling me that referring to a client in any other way is disrespectful. But I also realize that I started occupational therapy school in 2006, and a lot has changed in the last 15 years.
So what does this mean for our profession and other medical professionals moving forward? How should you address your clients in your practice? I’ve spent a lot of time speaking with individuals in the communities we serve, as well as colleagues and other professionals in other fields, and the response is. . . a bit of a mixed bag.
A lot of them maintain that person-first language has been the gold standard for so long for a reason, and we should use it unless we’re told otherwise. But many others said we need to constantly stay aware of the needs and wants of the communities we serve, and follow their lead—in this case, shifting to identity-first language unless we’re told otherwise.
How Do We Move Forward?
For me, “unless told otherwise” is the crucial part of both schools of thought that we can’t overlook. As practitioners, it’s our job to address our clients in the way that makes them feel the most comfortable. Our preference—or what we were taught in school—doesn’t matter. It’s about acknowledging, honoring, and respecting each client’s own lived experience.
This isn’t an old school vs. new school debate—or even really a debate at all. This is more an issue of approaching our clients with respect and not making assumptions based on our experiences. We need to listen to our clients and follow their lead in order to provide the best care.
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