1/24/2022, by Nicole Lobsey, Certified Practicing Speech Pathologist
Like most health and education fields, Speech Pathology is a heavily ableist field.
Speech Pathology practices are based on:
- Assessment against neurotypical standards,
- Reporting on what people are able or unable to do,
- Calculating scores and percentiles to compare people to “normal” or “typical”,
- Developing goals based on neurotypical targets, and therapy based on the behaviourist principles.
The field of Speech Pathology uses terminology like deficit, impairment, disorder, normal, delayed, targets, results, behaviour analysis, compliance, trials, remediation, low functioning, mental age, intervention, severity, reinforcement, withholding, manipulation, sabotage…
We determine what people should be able to do based on their age and then label them as delayed, disordered, or impaired. We determine what areas people are performing below average in, and determine what goals they need to change, get better at, or fix, and when this has been achieved to an acceptable or “functional” level.
We determine the gold standard of social skills and train people to do it. We write reports listing things a person (often a non-consenting child or adult) is unable to do or is doing atypically, and recommendations to remediate it.
We speech pathologists are predominantly neurotypical clinicians who are often working with predominantly neurodivergent people. And because of this, we need to have a solid understanding of what ableism is and how it is infused into every aspect of our assessment and therapy.
When ableism is pointed out to speech pathologists, common responses may include:
“We are teaching clients skills for the real world and to be able to function independently in society.”
“We prioritise independence over autonomy and speech pathologists determine what independence should look like for other people.
“Surviving in a future real world is more important than thriving authentically and joyfully in the neurodivergent person’s actual real world.
But, nothing will change if speech pathologists keep using these kinds of justifications as a reason to continue ableist practices While we keep arguing that this is just how neurotypical society and systems work then we continue to be complicit in supporting ableism to continue. Speech pathologists are in a powerful position to be at the forefront in making changes against ableism – not resisting them.
Many neurodivergent speech pathologists face ableism when they try to speak out.
Neurodivergent speech pathologists who speak out are often removed from social media groups or feel they have to leave groups because of bullying and advocacy burnout.
Neurodivergent advocates deal with tone policing by their colleagues and have to defend and justify their actual experiences.
More often than not in social media speech pathology groups, as neurodivergent speech pathologists educate their peers about neurodivergent-affirming practices, or advocate for neurodivergent clients, the other speech pathologists in the group will focus on the emotion behind a message rather than the message itself:
“If you just said it in a nicer way, people would be more likely to listen.”
“If you calm down people will be more open to what you have to say”.
Speech pathologists are the communication specialists yet we often struggle to accept different types of communication and tone.
We need to understand that direct (“bunt”), or “not polite enough” communication styles do not equal rude or confrontational. We need to understand the many problematic issues with expecting politeness and comfort when we are being educated by neurodivergent and other marginalised groups.
Neurodivergent advocates get told they are “sweating the small stuff” or being “too picky” when they point out ableism.
Neurotypical Speech Pathologists expect our neurodivergent colleagues to mask so that we can feel more comfortable around them. We often focus more on how information is delivered rather than what the information is. For many neurodivergent people, the “what” is direct, blunt, and “unfluffy”.
The “what” is the important part, but we miss it because we are focused on the “how”.
Hearing information that goes against or questions what we have been doing for decades is confronting and difficult to hear. We can’t use “tone” as an excuse to ignore it. If our neurodivergent colleagues are dealing with these misunderstandings then our clients are dealing with it as well. As predominantly neurotypical clinicians working with predominantly neurodivergent clients, it is our obligation to understand these issues.
Commonly heard comments defending ableism in speech pathology practices include:
- “So we just don’t do anything then?”
- “We just let them do whatever they want in therapy?”
- “It’s getting ridiculous now, we won’t be doing therapy for anything soon.”
Acknowledging the ableism in our field doesn’t mean our profession is worthless.
The speech pathologist’s role in the neurodiversity movement is massive and valuable.
Neurodivergent-affirming speech pathologists help clients
- Develop positive self-identities
- Advocate against damaging and non-supportive systems and environments.
- Support transitions.
- Fight for our client’s empowerment, autonomy, and right to exist authentically.
- Educate clients, families, and peers about neurodivergent communication, learning and social skills.
- Assist in recognising and dismantling internalised ableism.
- Assist clients with healing from behaviourist trauma.
- Support access to education, literacy, and robust communication systems.
- Facilitate connection with neurodivergent peers.
- Teach self-advocacy, consent, and boundaries.
- Teach families and support systems about consent, autonomy, and control.
We are doing far from nothing.
“You keep telling us what not to do but not what we should do instead”.
There are literally 100’s of hours of free and inexpensive professional development available on the neurodiversity paradigm. Neurodivergent-affirming practices are not the latest program or course, therapy technique, or list of therapy activities. There are no quick answers to questions like “What do I do with this client?”. It is not something we just add to our toolbox. We can’t take the bits we like and combine them with the stuff people are comfortable with. It is a whole shift in how we view our role, our clients, and our society. It impacts our entire practice – assessments, therapy, reports, and collaboration. It is overwhelming to start and it does take work.
What changes do speech pathologists need to make?
- Talk less and listen more.
- Listen to what people from the groups we serve are telling us.
- Don’t argue or talk over them. Their knowledge is worth more than any course.
- Don’t argue against what they live.
If our clients are our top priority, and the communities we serve are telling us that what we are doing to them is damaging, then how we feel and what we think about it doesn’t matter. Because it’s not about us.
- Don’t tone police neurodivergent colleagues.
- Focus on the MESSAGE rather than how it is said.
This may be the 100th time this neurodivergent person has said this same thing and been misunderstood, spoken over, ignored, or silenced. Neurodivergent people are often direct communicators, and if the topic is about neurodivergent human rights, they are more likely than not going to have strong feelings about it. Don’t tone police them. If you are asking for advice from a neurodivergent person then actually listen to what they are saying, rather than how they are saying it. Respect and expect neurodivergent social communication styles from neurodivergent people. Don’t take it personally.
- Be actual allies of the neurodivergent movement and not just “performative” allies.
- Don’t use neurodiversity for marketing or as a buzzword because it is trendy.
We can’t be neurodiversity affirming and combine it with traditional techniques we think “still have a place”. It means going all in even if this means difficult conversations with families, schools, and support systems.
- Centre practices on the needs and goals of the client and not the needs of the people or systems around the client.
- Be an unapologetically advocagte for the client and what they need/want to live an autonomous, authentic and joyful life, even if this doesn’t match what those around the person want or think they need.
- Only speak positively about clients. Don’t use deficit-based language. Be mindful of how you talk about clients in social media groups. It is possible to assess and report while upholding positivity, respect and dignity. Ask yourself how you would feel if this was said or written about you? How would this child feel if they read this about themselves in 10 years’ time?
- Question programs and courses. Don’t just do them because they are from a popular or well-known source.
- Follow and learn from true neurodiversity-affirming advocates and how to recognise performative marketing.
- Teach clients and the people around them about ableism, discrimination and disability rights.
- Be mindful of internalised ableism and external influence when people are setting their “own goals”.
- Be open to noticing ableism and non-neurodiversity practices in our everyday assessment and therapy even when working with our most straightforward and neurotypical clients.
- Use correct terminology and labels. Don’t get hung up on the fact that it’s not what you were taught, it keeps changing or you don’t agree. Just listen, adapt and move on.
- Don’t judge people against arbitrary neurotypical standards and assessment scores. We don’t get to decide that a person is going to learn a skill or achieve a goal that we have decided is important and that we happen to find easy. We don’t get to decide what the functional level of independence or the “gold standard” of being human is.
- Make clients feel like they are worthy and valuable exactly as they are now without constantly having goals to meet, improvements to make and interventions to complete.
Respect differences. Respect advocacy. Respect authenticity. Respect autonomy.
About the author: Nicole Lobsey is a Certified Practicing Speech Pathologist at Yass Valley Speech Pathology in NSW, Australia. Nicole is a neurodivergent therapist who is passionate about the social model of disability, neurodivergent advocacy and identity, and gaming therapy.
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What an excellent blog post – thank you Nicole. I love this dialogue that is happening more and more in our industry. It is making us think as speech pathologists, we have lived in a medical model for so long and it’s time to change. All neurodivergent people are not broken, don’t need a cure, and cannot be compared against neurotypical norms. We all think and behave differently and our differences should be respected. As a mum of a neurodivergent child, I have moved from a medical model of diagnosis to a social model of advocacy. I want my son to see his strengths – he is so talented. Thank you for challenging us as allied health professionals to be better and for reminding us to listen.
Nicole, I am so happy to be reading blogs like yours. It gives me so much hope for the future of Neurodivergent people. I am disappointed that I can’t be part of this cycle of change professionally as I retired….a bit early with autistic burnout. I am proud of my small contribution, and excited to watch this space. Thank you.
This was very cool to read. I received speech therapy as a young child (6-8 I believe) and struggle to remember any of it. As I’ve come into my autistic identity as an adult, I look back at that time and wonder how it might have helped, and how it might have done damage, as I have a sense that some parts of it were hurtful. It’s affirming to see someone talking about issues in speech therapy, and not just how great it is for helping kids normalize. I’m glad to be able to speak clearer as an adult, I just want a fuller perspective on the process I went through to get here.