Story #1: Speech-Language Pathology’s Culture About Culture Has Been Improving For a Long Time and Currently Features Several Impressive Bright Spots (A Distinctly Optimistic Story in Four Distinctly Optimistic Parts)

Part One: Researchers Have Focused for Decades Now on Developing Methods For Addressing All Clients’ Needs Appropriately

The publication patterns we analyzed in Module 13 are undeniable, but the problems they reflect are in the past and have been solved. Since the early 1970s, approaching 60 years ago now, researchers and other authors have recognized that our profession’s speech and language services must take dialect and clients’ other cultural and identity variables into account.

In one early example of the awareness that our profession needed and has gained, Drumwright et al. (1973) wrote that “the majority” of the many standardized measures of articulation that existed at the time had been “constructed with white, middle-class children who spoke standard American English” (Drumwright, 1973, p. 4). To help address everyone else’s needs, Drumwright et al. (1973) developed and validated an articulation screening instrument that used only those phonemes and word positions that were produced by typically developing children from White, Black, and Mexican American backgrounds (e.g., their final test did not use /θ/ in the final position, so as not to penalize children whose dialects may produce words such as “bath” with the phoneme /f/). This approach, known as testing only for “non-contrastive” features of the dialects, was widely recommended by the 1980s (e.g., Seymour, 1986), including in an important textbook about cultural issues for speech-language pathology (Taylor, 1986; see also Seymour et al., 1998, for a later explanation and study).

The original Peabody Picture Vocabulary Test (PPVT; Dunn, 1959), similarly, was widely used (Stark, 1971) but was known by the early 1970s to result in lower scores for Black children than for White children of the same socio-economic background (Kresheck & Nicolosi, 1973). Multiple researchers worked hard to understand the racial, ethnic, social, economic, and other cultural variables that influence scores on the PPVT, its later versions, and related tests (e.g., Meline, 1981; Uhl et al., 1972; see Restrepo et al., 2006, for one comprehensive summary of the issues).

Beyond the limited issue of testing, many other researchers were also organizing their work by the early 1970s around the (rather obvious) point that individuals’ social and linguistic backgrounds affect their language use, literacy development, social communication patterns, and other broader issues. Labov’s (1972) now-classic masterwork Language in the Inner City: Studies in the Black English Vernacular summarized extensive socio-linguistic and educational research that he and his colleagues had been conducting since 1965. Many of the conclusions Labov emphasized, and his supporting data, established several points that quickly became central to both linguistics and speech-language pathology (and, again, have now directed our field’s work for close to 60 years).

1. The Black American Englishes, and Black English Vernacular in particular, are complete, rule-governed dialects of English that deserve to be treated with as much scientific rigor and respect as any other dialects of English.

2. The use of any dialect is an issue of social communication. Our dialects reflect and sustain our social relationships, our communities, and each individual’s sense of belonging in those relationships and communities.

3.  Many formal measures of literacy development and educational achievement tend to be low for speakers of the Black Englishes in the U.S., an outcome that needs to be understood in context. Parts of the problem, clearly, must be attributed to the measures themselves. Other parts can be attributed to differences between speakers’ native dialects and the dialects that tend to be expected in written academic English. And parts of the problem must also be attributed to what Labov referred to, quite starkly, as the “ignorance” (see especially his Chapter 1) of educational professionals about the relationships between Black Vernacular English and written academic English and about appropriate methods for teaching children who speak the former to read and write the latter.

Within speech-language pathology, Seymour (1977) added a fourth basic conclusion and recommendation that, at many levels, must also be obvious: children’s developing speech and language abilities must be judged against the adult standard for the dialect they are learning (see Seymour’s 1977 original explanation), not judged against the standards of a language or a dialect they have not been exposed to and do not know. By 1979, Evard and Sabers (1979) could summarize multiple methods for improving the validity of speech and language test scores for clients from different dialect, ethnic, or racial groups: modify test items, develop new norms for an existing test, or develop a new test.

During the 1980s, multiple researchers with expertise in multiple languages and dialects continued to add to our profession’s understanding. This era included expansive work in Spanish-English bilingualism (by Gutiérrez-Clellen, Peña, and others), the African American English dialects (by Craig, Washington, and others), and many other languages and dialects. By the 1990s, the next, expanding generations of researchers had added their expertise (see the work of Restrepo, Oetting, Hyter, B. Yu, and others). Well-established linguists were publishing in ASHA journals (see, among other examples, Wolfram, 1997, explaining the Ebonics controversies from the Oakland, CA, school districts), and specific recommendations for clinical targets (and, importantly, non-targets) were available in ASHA journals for clients who speak a range of languages, from Spanish to Cantonese and beyond. By 1998, Yavas and Goldstein (1998) could use this extensive research base as the support for their specific and comprehensive clinical recommendations, which were pitched so broadly that the article used Turkish, Mandarin, Swedish, and Spanish as its examples.

The range of expertise developed and used in our field has only continued to expand, for well over 35 years now. Among many other examples, researchers and clinicians have worked to address the specific needs of gay, bisexual, and transgender individuals who are seeking help with their voice (Wolfe et al., 1990); families from multiple backgrounds thinking about their children’s early literacy development (van Kleeck, 1994); and the cultures and subcultures of people thriving with a range of developmental or lifespan abilities, allowing us to support people who are living with aphasia, dementia, and other abilities in positive and affirming ways (see, among other examples, Hall & Gilliland, 2019). Our research has also now long addressed a wide range of intersectionalities, from bilingual children with Down syndrome (Kay-Raining Bird et al., 2005) to older African American adults who have had strokes (Harris, 2006).

In short, at this point in our history, many of our profession’s undeniable original problems are history.  

Part Two: We Have Been Reflecting, Recommending, and Requiring for Over 50 Years

Other parts of our success story are evident in many other clinical and professional areas, not solely in our research journals. As Higby et al. (2024) recently summarized, ASHA created its first Office of “Urban and Ethnic Affairs” (now our active Office of Multicultural Affairs) in 1969. ASHA recommended cultural competency education for graduate programs in 1985, and ASHA certification requirements have included cultural competency for over 20 years (since 2004 for academic standards and since 2005 for clinical standards).

Similarly, the newsletter that became Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse (CLD) Populations was started in 1995 and has been available through ASHA since 1997. That first 1997 issue – almost 30 years ago – addressed the needs of bilingual (Anderson, 1997a; Patterson, 1997), Spanish-speaking (Restrepo, 1997), and internationally-adopted (Pearson, 1997) children, in addition to providing specific practical information about code switching (Brice, 1997) and bilingual internet resources (Anderson, 1997b).

A decade later, Deal-Williams (2009) wrote about “ASHA’s accomplishments in the multicultural arena,” which she described as including “the entire national office, the work of ASHA committees, boards, councils, and special interest divisions, and work with related professional organizations.” Even as long ago as 2009, she could describe our profession as able to “look back” at the changes and successes that “allowed us to implement the components required to foster diversity and inclusion.”

This era of reflection, around 2010, was also characterized by our profession’s growing awareness that responding appropriately to culture, language, and identity is never finished but must include continuing to recognize ongoing and newly emerging issues. This was the era when notions such as “achieving cultural competence” were replaced by expanded, second-order recognition of the dynamic complexities raised by culture, language, identity, history, and society. A 2013 special issue of Perspectives, as one of many examples, addressed the notion of “White privilege,” which had become a popular notion in general media at the time (Kohnert, 2013; McIntosh, 1988), including presenting some relatively specific information about how to teach about White privilege in our field (Preis, 2013).

In these examples and many other ways, our field has been actively incorporating an awareness of culture, language, identity, intersectionalities, and their inherent dynamism into all aspects of our profession for decades. Currently, of the 305 master’s programs listed on ASHA’s EdFind service, 64 advertise a multi-cultural emphasis, 52 describe themselves as “Hispanic serving” institutions, and 51 describe themselves as providing emphases in bilingual speech-language pathology.

Regardless of where our field might have started, that’s a lot of programs, preparing a lot of well-informed speech-language pathologists.

Part Three: We Have Moved Beyond the “Difference or Disorder” Trap

Our profession’s historic improvements in the areas of culture, language, and identity can also be assessed in other ways, including the important rise and then the equally important fall of the shorthand “difference, not disorder.”

This phrasing, and the initial or first-order awareness it reflected, was evident in our profession by the 1980s, as researchers and clinicians moved from addressing any difference from the “standard” White northeastern or western American Englishes as if it were a disorder toward understanding that dialects are not disorders and that the vast majority of differences between speakers are not disorders at all. As our knowledge about dialects grew, it became easier and more obvious to recognize that attempting to diagnose child language disorders on the basis of linguistic features that differed across dialects fell somewhere between problematic and absurd (again, see Seymour et al., 1998).

So it took some time, admittedly, but also we have now spent well over 20 years, a full professional generation, guided by ASHA’s (2002) clear statements that “no dialectal variety of American English is a disorder or a pathological form of speech or language” and that “[e]ach dialect is adequate as a functional and effective variety of American English.” 

Even more importantly, we as a profession have also made the next necessary cultural leap, moving on from the primitive “difference versus disorder” framework.

We now recognize, in other words, that “Does this child have a difference or a disorder?” is itself the wrong question, usually asked in the wrong way for the wrong reasons. We know now, as a profession, that there is no need to single out children whose home dialects or home languages happen to differ from the more common dialects or more privileged dialects in a geographic area and subject them to professional speech and language evaluations. We know that many referrals are based on listeners’ social judgments, not on actual linguistic features at all.

We are also aware that the ultimate conclusion that such a child has “only a difference” is not entirely benign.

If nothing else, our valuable professional time and energy have been spent on an unnecessary investigation, if the only reason for the referral or the evaluation was that the child’s dialect did not match our own or some other adult’s.

Much worse, the child at the center of this activity will have absorbed, through this process, that their speech or language is so problematic, as compared with what someone thought it “should” be, that it took a highly educated professional several hours, if not days or weeks, to sort it all out -- and ultimately to label them as formally, officially, and professionally “different.”

In test theory terms, recognizing that a typically developing child does not have a disorder correctly avoids a false-positive diagnosis. But labeling a child as different, much less labeling a child as so different that a professional had to get involved to figure out what was happening, is not a “true negative” test result in the sense that discovering you do not have a particular bacterial infection is a “true negative” test result. You had some symptoms. You had the sore throat, the runny nose. You felt sick; you did have a problem; you sought help; your physician completed a medically indicated test. That is a completely different situation from having evaluated a child who had no complaints, whose caregivers had no complaints, and who is clearly developing typically within their culture and community.

The ultimate formal designation that such a child is officially “different” is not a simple true negative. It is a problem in itself, and it must be recognized as a problem.

Moreover, we must understand that this problem is often made all the more insidious by the potential failure to recognize such a designation as a labeling error at all.

To avoid such errors, therefore, our profession has actually moved well beyond the original “difference versus disorder” formulation. We now think in terms of understanding that disorders must be envisioned and addressed as occuring within dialects (thus, “disorder within dialect,” a phrase often attributed to Oetting and colleagues and that reflects many other people’s work).

Our current clinical and professional work, in other words, does not start by noticing that a child speaks differently from some presumed standard and then asking if the difference is a dialect or a disorder. Our current model, instead, starts from dialects, assumes dialects, recognizes that all people speak a dialect – and recognizes that the only appropriate place for asking if there might be a problem with a child’s language development must be within that child’s dialect, not by comparing that child’s dialect to any other and certainly not by asking the “Difference or Disorder?” question that is guaranteed to result in a problematic answer.

And on top of all that, we have also developed the professional ability to consider a full set of next-order questions. We have recognized, for example, and can address in thoughtful and professional ways, that speakers of some dialects find it easier or more difficult to learn to read the kinds of texts that tend to be presented in schools. We can address the data from schools thoughtfully, realize that the issues will not be solved by pathologizing or changing anyone’s dialect, and go about the work of teaching reading in specific ways that bring success for all children (see especially the work of Craig and Washington on this critically important point, which we will also address in Modules 19 and 20).

Part Four: Just Look at the ASHA Leader Now!

And finally, as the fourth part of this distinctly optimistic story, we can return to our original strategy of analyzing our profession’s publications. The early data in Module 13 were undeniable, but the more recent data, such as in Box 13.4, showed that our profession has been steadily more willing to name and address culture, cultures, dialect, and dialects since approximately 1990.

Consider also Box 14.1, which summarizes the 37 ASHA Leader covers from May 2020 through July/August 2025.