Function & Disability

Person-first vs. Identity First Language

We cannot talk about disability and how to talk about it appropriately without addressing person-first and identity-first perspectives on the language of disability.

"The overall principle for using disability language is to maintain the integrity (worth and dignity) of all individuals as human beings." (APA, 2020; 2022)

Reflection 1

In addition to how it might affect patients, function and different abilities are present in the classroom. There are learners in each MD class that have accommodations for different abilities.

How, as an instructor, can you be more inclusive in your class to make sure that all can participate in your class?
You might use a term learned back when you were a medical student that's now considered archaic. How can you make room to receive feedback about using a preferred term? (Example, "intellectual disability" or something else, rather than "mental retardation")

Models for Disability

Biopsychosocial Model

Medical model of disability perceives disability as an attribute of the individual, stemming from disease, trauma, or other health conditions. This perspective advocates for medical or other interventions to "fix" the individual's issue.

Social model of disability emphasizes an unaccommodating physical environment shaped by societal attitudes and other social factors as the driver of disability rather than individual attributes.

Both models capture only a piece of the truth since disability involves the interaction of both internal and external factors. Guidance from the WHO International Classification of Functioning, Disability and Health (ICF) is based on a blend of these models: the biopsychosocial model for disability.

Impairments are problems in body function or structure such as a significant deviation or loss.

Activity is the execution of a task or action by an individual.

Participation is involvement in a life situation.

Activity Limitations are difficulties an individual may have in executing activities.

Participation Restrictions are problems an individual may experience in involvement in life situations.

Environmental Factors make up the physical, social and attitudinal environment in which people live and conduct their lives.

Definitions

Ableism

"Stereotyping, prejudicial attitudes, discriminatory behaviour, and social oppression toward people with disabilities to inhibit their rights and well-being" (APA, 2021c; Bogart & Dunn, 2019).

Ableism is so pervasive that it bleeds into everyday language that most people use without knowing how they contribute to this culture. This type of language can implicitly devalue people with disabilities. For ableist terms and phrases in everyday language refer to the table on the right.

Accessibility
“A process shaped by what one needs to do, one’s interactions with the environment, and one’s personal preferences. Accessibility is achieved when people with disabilities can ‘acquire the same information, engage in the same interactions, and enjoy the same services’ as people who do not have disabilities” in “an equally effective and equally integrated manner with substantially equivalent ease of use” (Office of Civil Rights, 2013, para. 3).

Universal design
The process of creating products and building environments to be usable by all people, to the greatest extent possible, without the need for adaptation (APA, 2019).

Reflection 2

Take a few minutes to review the table to the right and answer the following questions:

Are you surprised by any terms that you are advised to avoid?
What does the pervasiveness of some of the terms tell you about systemic ableism?
Do you notice any terms in the suggested alternative section that seem out of place?

Note that this APA language guide was last updated in 2021. However, terms like "little person" or "dwarfism" are not appropriate to be used in practice. This is both a reflection of:

Language can change over time and we need to be adaptive/responsive to those changes.
Guidelines on terms can be wrong or outdated; it is best to be open to feedback for long-term success.

Adapted from the American Psychological Association (APA) Inclusive Language Guide

Additional Language Guidance

References

American Psychological Association. (2019). APA resolution on support of universal design and accessibility in education, training, and practice. https://www.apa.org/about/policy/resolution-support-universal-design-accessibility-education.pdf
American Psychological Association. (2021c). Equity, diversity, and inclusion framework. https://www.apa. org/about/apa/equity-diversity-inclusion/equity-division-inclusion-framework.pdf
American Psychological Association. (2024). Inclusive language guide (2nd ed.). https://www.apa.org/about/apa/equity-diversity-inclusion/language-guidelines.pdf
Bogart, K. R., & Dunn, D. S. (2019). Ableism special issue introduction. Journal of Social Issues, 75(3), 650–664. https://doi.org/10.1111/josi.12354
Office of Civil Rights. (2013, February 28). Resolution agreement: South Carolina Technical College System. OCR Compliance Review No. 11-11-6002. U.S. Department of Education. https://www2.ed.gov/about/offices/list/ocr/docs/investigations/11116002-b.html
World Health Organization. (2002). Towards a common language for functioning, disability and health: ICF. World Health Organization. https://www.who.int/classifications/icf/en/

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