Section Four
Module 14: Stories About Culture, Language, and Identity in Speech-Language Pathology
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How do our stories about culture, language, and identity in speech-language pathology influence our professional actions?
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After working with the material in this module, readers will be able to
tell a distinctly optimistic story about how speech-language pathology has addressed and currently incorporates culture, language, and identity
tell a distinctly pessimistic story about how speech-language pathology has addressed and currently incorporates culture, language, and identity
tell their own personal story about the influence of culture, language, and identity on their work in speech-language pathology
discuss how the stories we tell ourselves about our profession influence our professional actions and then influence our profession itself
Module 14 uses two interpretations of selected information to tell two competing stories about our profession’s culture and about our profession’s approaches to people’s cultures. What stories do you tell about our profession, about culture in our profession, and about your actions as a professional? What influences do our stories have on our actions and on our profession as a whole?
Among the greatest dangers inherent in attempting to describe any culture are both the Columns and Rows problem and the related out-group homogeneity bias (Park & Rothbart, 1982). We see things from the vantage points that we have. We can try to be aware of our vantage points, work hard to understand other vantage points, and do our best to respect other vantage points. Still, in the end, we are each taking the single journey through life that we are taking.
How, then, can we finalize Section Four’s discussion of something as diffuse as our entire profession’s history, underlying assumptions, and culture?
One partial solution, as we have mentioned in several other places throughout this website, is to be aware of the fallacies and biases that characterize human thinking and to actively use the tools of critical thinking to at least attempt to counteract those biases (for examples in speech-language pathology in particular, see Finn, 2011; Finn et al., 2016; Thome et al., 2025). Let’s try, therefore, to seek and interpret evidence from multiple directions, or, in this case, to tell two different and competing stories about our profession’s “culture about culture” — and then to think about your stories and about the influence of our stories on our actions.
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). 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.
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.
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 for us to get there, admittedly, but 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, we are now aware that 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.
Box 14.1. Number of ASHA Leader covers that highlighted stories related to diversity, equity, inclusion, access, and related topics, May 2020 - July/August 2025.
2020: 1 of 5
2021: 5 of 10
2022: 4 of 6
2023: 3 of 6
2024: 4 of 6
January/February - July/August 2025: 3 of 4
To my count, 20 of these 37 recent issues, over 54%, highlighted as cover stories or emphasized on the cover one or more stories about diversity, equity, inclusion, and related topics. Daughrity’s (2020) article about racial injustice was first, in this 5-year set. Other topics followed, including neurodiversity, health-care disparities and implicit bias, ableism, and anti-Asian actions in CSD during 2021 and then many others in 2022 and later. We as a profession are not only talking about race, language, dialect, access, the social determinants of health, and related issues; we are emphasizing them on the cover of more than half of current issues of ASHA’s most-read publication.
Without meaning to suggest that everything is perfect, in other words, we can definitely end this story on a distinctly optimistic note. Our founding in 1925, and our first journal in 1936, were a very long time ago, and we have come a very long way in the meantime.
Your Turn
What did you think of Story #1, the distinctly optimistic version? Why?
Story #2: Speech-Language Pathology’s Culture About Culture Has Always Been Terrible and Still Is — The Circular and Never-Ending Story of a Racist, Sexist, Ableist Profession Determined to Do Everything Wrong (A Distinctly Pessimistic Story in Four Distinctly Pessimistic Parts)
Part One: A Profession Going Nowhere
As we addressed in Module 13, our profession’s publications started by asserting that bi-/multilingualism is essentially a disorder to be solved. We also noted that, decades later, as our publications began to address other cultural, linguistic, and identity issues, they did so primarily through frankly bigoted assertions about entire groups of people.
Unfortunately, most of the materials presented by and for speech-language pathologists, most of the discussions had by speech-language pathologists, and most of the actions taken by speech-language pathologists over the years have continued to reflect these and other distinctly problematic views, as many other reviewers of our profession have previously noted.
As our Module 12 discussed, our efforts as a whole and as a profession continue to reflect our professional ancestors’ “elitist, ethnocentric, racist, regionalist, classist, and ableist systems” (Duchan & Hewitt, 2023; see also Duchan’s 2002 original discussion of our ancestors’ backgrounds). Almost everything about speech-language pathology, as Duchan and others have noted, continues to focus on testing, labeling, and normalizing, rather than on challenging our continuing “ableist and technocratic view of communication” (St. Pierre & St. Pierre, 2018, p. 180). We might dress it up now in words like “support” and “empower,” but as often as not what we mean is supporting people as they work on making the change we selected for them to make, or empowering people to select which specific methods they want to use to make the change we think they need to make.
Our entire profession, in other words, continues to conflate variation from an educated, White, male, monolingual standard with disorder, and evidence of the problem comes from many directions. Holt’s (2022) analyses and observations from speech science, for example, emphasized the depth of the problem by noting that even the pieces we often describe as simple scientific fact, such as vocal fold closure patterns and the perception of voice quality, are not nearly as “universal” as we like to claim. Those data and expectations actually stem from “cis men, the group most likely to demonstrate complete glottal closure in both the anterior and posterior aspects of the vocal process” (Holt, 2022, p. 2165). As she concludes, our profession has yet to “attend to,” much less to answer appropriately, “how disorder is defined and by whom” (p. 2166).
Similarly, as Rogus-Pulia et al. (2018) highlighted, the relatively few men in our profession, most of them White, still serve in more of the leadership roles, receive more of the research funding, receive a disproportionate share of other awards and accolades, and generally wield an outsized portion of the influence. And as Millager and colleagues (2024) showed, our research is still disproportionately about non-Hispanic White people. Of the 407 experimental studies articles comprising a total of 80,058 research participants published in ASHA journals in 2020, Millager et al. calculated that only 33.7% included information about participants’ race, and only 13.8% addressed participants’ ethnicity. When race or ethnicity was reported, the proportions underrepresented “all non-White racial groups and Hispanic participants” as compared with the U.S. population. And even when race or ethnicity data were gathered and reported, over two thirds (67.2%) of studies did not bother to “consider these respective variables in analyses or discussions” (Millager et al., 2024, p. 836).
As a profession, overall, we are actively refusing to address culture, language, or identity.
Part Two: A Specific Example
But what about a more focused lens? Does the story change if we move from thinking about our entire profession as a whole to thinking about any specific parts of it? Haven’t we done better in child language, early intervention, and some other specific areas?
Maybe, and I have used some examples from those sub-areas throughout this website. But it is also relatively easy to choose any of the ways of being that our profession traditionally lists as “disorders” and recognize that we still have a long way to go.
Given my own journey with our profession, for example, I might start by thinking about stuttering, which our profession has long intertwined with culture. One of the first theories of stuttering in the U.S. was essentially cultural: Johnson’s (1944) highly influential diagnosogenic theory posited that stuttering is caused by a culture of inappropriate parental expectations. This theory led to embarrassing and untrue claims that stuttering did not occur in cultures stereotyped by White researchers from Iowa as being “easy” or placing “low” expectations on children (see Zimmerman et al., 1983), and it has also all but trapped our profession in versions of the “Demands and Capacities Model,” which is based on unfounded assumptions about parents’ culturally-mediated expectations for children’s speech (see Finn & Cordes, 1997, and Marcotte, 2018).
Our profession’s institutional racism also allowed such articles as Leith and Mims’ (1975) summary of stuttering in Black speakers. While such a paper could have contributed to the then-nascent attempts to educate majority-White speech-language pathologists about people from other backgrounds, the article instead asserted that Black people stutter differently and approach therapy differently from some presumed typical or standard way. It repeated awful old stereotypes about Black culture as if they were clinical fact (“black Americans are essentially an oral people like their ancestors in Africa”), and it presented Black culture as a problem (clinicians will be required to deal with the “unique problems presented by the black stutterer. Our clinical experiences have been, for the most part, quite negative”). Shames (1989), similarly, claimed that stuttering therapy outcome with “minority groups” is “poor,” regardless of type of therapy.
Nothing changed in the ensuing 25 years, meaning that in 2001 Van Borsel et al. could assert in a relatively comprehensive review paper that “stuttering is probably more prevalent in bilinguals than in monolinguals,” implying that bilingualism is clearly not normal and causes other problems. More generally, Van Borsel et al. (2001) made it clear that culture itself is a problem, and that cultures that differ from a presumed White northeastern American or White Western European standard are not merely different but obviously problematic:
“some cultures have a different orientation to time so that scheduling diagnostic and therapeutic sessions may be a problem” (p. 198);
the diagnostic process will be hampered “if the father always functions as the spokesperson for the family in the family's culture so that direct questioning of the mother is not possible or if family matters are private and not to be shared with strangers in the client's culture” (p. 199); and
“therapy may suffer if the family's culture does not allow a female child to be alone with a male stranger or if females do not assume an authority's role” (p. 199).
Overall, even in an article ostensibly intended to address bilingualism, multiple cultures, and stuttering, Van Borsel et al. (2001) communicated little more than the belief generally held by most speech-language pathologists that bilingual clients are so different, and so difficult to work with, that the only solution is for specialized clinicians to develop specialized expertise: “diagnosis and treatment in bilingual stutterers seem to require a particular approach” (p. 179).
And nothing has changed in the 20 years since 2001! As recently as 2023, Souza Mumy drew on the same older ideas to note that “several questions arise when working with bilingual children who stutter. Does bilingualism cause stuttering? Is removing the home language justifiable in these cases? Considering the behavioral, affective, and cognitive factors inherent in the stuttering experience, is there evidence that would warrant forced monolingualism?” (Souza Mumy, 2023, p. 166).
Really?
The first “questions [that] arise when working with bilingual children who stutter” include “Is removing the home language justifiable”?
That question has never been on my list, much less ever been my first question, but there it is, in an ASHA journal in 2023.
“Removing the home language.”
Stop for a moment and think about what that means.
If that doesn’t hit you like a punch in the stomach about the current state of our current profession, I do not know what would.
The message here, in a 2023 article titled “Culturally Responsive Guidelines for Serving Families of Bilingual Children Who Stutter,” was that among the first questions that will probably occur to speech-language pathologists working with bilingual children who stutter is whether we should take away one or more of their languages. A 2023 article titled “Culturally Responsive Guidelines” seriously considered, through 8 pages of relatively dense professional analyses, whether or not it might make sense for a speech-language pathologist to tell a family not to use their home language.
Imagine that possibility, for yourself, if you can even begin to wrap your mind around what it might mean.
Regardless of how many languages or dialects your family might or might not use at home or elsewhere, what would you do, and how would it irreparably harm your life, your relationships, your goals, your identity, and everything else about you, if a professional told you that you should not, or must not, use your own language in your own home? What kind of thought process could lead a professional to ask that question, to seriously consider that possibility — or to make that recommendation to another human being? What does it say about us, as a profession, that we are publishing serious 8-page analyses of this idea, rather than having sent the entire concept to the dustbin of history with ideas like medical decisions based on the four humors?
To be fair, Souza Mumy reached the correct conclusions (including that such a suggestion would have “unintended and long-term detrimental consequences for bilingual families” and that “the language of the home is valuable”).
But the question was considered seriously and at some length in one of our central professional journals — and the ultimate conclusions, while correct, were phrased amazingly blandly.
In 2023.
Nothing has changed since Volume 1, Issue 1, page 1, in 1936.
Part Three: A Profession Going Backwards
So — where are we, in this distinctly pessimistic version of the story?
I do not believe that we are all telling other people to give up their home languages, but we, as a profession, are definitely studying, emphasizing, and centering White people (Millager et al., 2024). We use professional and academic practices that keep our profession White (Whitfield, 2023). We give awards and promotions to White men (Rogus-Pulia et al., 2018). We recognize the need for our own cultural knowledge, but we blame our clients for our needs (e.g., “patients or caregivers often omit pertinent information during the initial assessment”; Hayes et al., 2022, p. 1530). We investigate our needs as professionals by asking multiple questions about the many complexities of working with “multicultural” clients, a catch-all term that is clearly intended to be read as the opposite of “normal” clients (Hayes et al., 2022). Even when the context is a set of relatively creative, thoughtful, multicultural, and multilingual suggestions, we position being multilingual as a problem to be solved: “To further complicate matters, Bruno is a multi-language learner” (Telford Rose, 2023).
And, as if all that were not already enough, in the summer and fall of 2025, we actually removed previously existing requirements for education about diversity, inclusion, equity, culture, and identity from our own program-accreditation requirements (see my much longer blog post about this change) and certification requirements.
Our previous accreditation standards had at least been trying to fight some of the worst aspects of our profession’s history. Our previous standards had required that speech-language pathology master’s degree or other professional preparation programs were to be “organized and delivered in such a manner that…diversity, equity, and inclusion are reflected in the program and throughout academic and clinical education.”
But that language has now been struck, literally crossed out and replaced. The new accreditation standards do emphasize person-centered or family-centered care, and the implementation language mentions the importance of individuals’ “unique circumstances, culture, experiences, beliefs, and wishes” (see p. 7 of the side-by-side comparison) — but inclusion and equity have been removed from our accreditation standards. Our profession has moved from requiring our professional preparation programs to teach students about including people, and about giving people equitable opportunities for success, to requiring only that we sit back and acknowledge that some people have different circumstances and experiences than other people have.
Similarly, applicants seeking individual certification in speech-language pathology were previously required to demonstrate knowledge of professional issues that were described as including “cultural competency and diversity, equity, and inclusion (DEI).” Then, in late 2025, those words were literally struck from our certification requirements, replaced by the requirement that applicants must understand “service provision that aligns with the unique histories, values, and circumstances of individuals, families, and/or communities.”
It might not seem like much, but it was an enormous change. Aligning with history and circumstances differs in enormous ways from requiring and valuing diversity, inclusion, and an overriding commitment to seeking equitable circumstances and opportunities for all persons.
The old version of our certification standards, in other words, had committed us to a professional mindset of equity and inclusion. Our previous certification standards had required us to recognize many of the themes that this website addresses: that all cultures, individuals, interactions, and places along all continua are equally valued; that all people, from any background, history, or circumstances, deserve to be included in the conversations that shape their lives and that shape American life; and that all people deserve access to equitable opportunities to succeed (or fail) on their own merits, on the fair playing fields of our shared larger society.
The new version says merely that our clients and their communities have “histories” or “circumstances.” It says nothing at all about recognizing that those circumstances or that history might have been affected by systemic inequities or exclusions that we need to be part of changing. Our new certification standards take us back to the time characterized by Raph’s (1967) patently bigoted claims about “deprived backgrounds” or how children from “urban slums” can “show marked limitations…in both reasoning and speaking” (p. 205) — and leave us in a place where speech-language pathologists are required to do nothing more than notice this “circumstance” and possibly provide the relevant people with the minimal care that we can say “aligns with” their distinctly “less than” status.
Part Four: … Actually, Let’s Make That A Profession Proudly Marching Backwards, Clutching Its Knapsack of Privileges
The optimistic version of this story mentioned a 2013 special issue of Perspectives that included Kohnert’s (2013) reflection on the privileges that come with being an English-speaking White woman in speech-language pathology.
Based on McIntosh’s (1988) original imagery of a “knapsack” full of unrecognized advantages, Kohnert (2013) highlighted the often invisible or at least unacknowledged systemic advantages that she and other White professionals in our field have enjoyed. Many of you might recognize her experiences, while others of you will recognize that you have not enjoyed these privileges at all. (All of the following are direct quotes from Kohnert, 2013, p. 43.)
“As a graduate student in speech-language pathology, I did not stand out.... I looked not too different from everyone else. If I made a faux pas on the first day of class before instructors knew me, it would not be remembered—or at least not attributed to me [much less accepted as confirming evidence for stereotypes about people from my background]. If and when I stood out or became memorable, I was confident that it was because of my ability.”
“I never thought my credibility as a professional was suspect.... I was not [worried] that others could somehow think I received special privileges to get into a competitive graduate program, receive merit-based scholarships, or be offered a professional opportunity.”
“I never heard from [a] practicum supervisor that the parent of a young client with whom I was working requested a different clinician because her child was “afraid” of the way I looked. One of the talented graduate students I supervised in a very large diverse city in the southwestern United States [was given this message by another supervisor].”
“In my experience as a White instructor, when I talk about issues related to diversity, mostly White students and professionals are receptive to the message or willing to engage in honest discussion. In contrast, I have colleagues of color who, when delivering similar messages in similar ways to similar audiences, have been perceived as overly sensitive, hostile, or judgmental.”
“As a faculty or professional service committee member, when I point out instances of unintended bias in the language used in our collective documents, I am more likely to be thanked for my vigilance than considered hypersensitive.”
“When I travel and meet new professional colleagues, I am only asked the ‘where are you from” question once. My initial response is accepted rather than countered with a “but where are you originally from?’”
“In my first years as a new faculty member at a research-intensive university, I was not expected to serve as the diversity expert or representative on university committees. I was allowed to focus on my own research program, which is the area that carries the most weight in research faculty retention decisions.”
Did you recognize yourself or your experiences in these examples, either because you have shared the privileges Kohnert described or because you are well aware that you have not?
And what happens if we extend McIntosh’s (1988) and Kohnert’s (2013) metaphor forward in time?
Well, apparently, as of late 2025, people like me can add several more items to Kohnert’s list.
I am an over-educated, White, English-speaking woman from a Christian background, which makes me a member of the majority in speech-language pathology. I therefore have the privilege of reading that “inclusion” was removed from our program-accreditation standards in 2025 and not worrying that I am the one the change was meant to exclude. I do not worry that I myself was the one being literally and metaphorically struck from my own profession.
I am an over-educated, financially stable, married, cisgender, heterosexual, (currently) able bodied, White, English-speaking, culturally Christian U.S. citizen. I therefore have the privilege of reading that knowledge about inclusion was removed from ASHA’s certification standards in 2025 and only worrying a little bit that my profession has recently decided it would be acceptable to exclude me from some larger societal opportunities or exclude me from the best possible communication care, should I ever need it.
I am an over-educated, financially stable, married, cisgender, heterosexual, (currently) able bodied, White, English-speaking, culturally Christian U.S. citizen. I therefore have the privilege of reading that knowledge about equity was removed from ASHA’s certification standards in 2025 and only worrying a little bit that my profession has recently decided it would be acceptable for me to be treated inequitably based on my “history” or “circumstances,” should I ever need communication care.
At the same time, of course, my awareness of these privileges does make me worry, a lot, about pretty much everyone other than myself!
Many members of my family, and many other people who matter dearly to me, do not share all my identities. I have children, friends, in-laws, students, neighbors, cousins, other relatives, and colleagues who are not White, not monolingual, not heterosexual, living with physical bodies that differ from most descriptions of what a typical body looks like, and so on.
More generally, I am aware that there are other people in the world, and I do my very best to approach my life with a basic underlying assumption that they all matter as much as I do, whether I will ever meet them or not. As I have commented elsewhere, I find the “Walk a mile in my shoes and then you will understand” idea somewhat lacking, and I often find myself reacting negatively to activism that starts with “My life experience has included X, so now I am an advocate for X.” We need not have walked in all the shoes to recognize that the world is full of shoes that must hurt terribly, and I think we are all capable of advocating for other people’s needs even if we have never seen their shoes.
And for a while, at least for the last couple decades, I thought my profession shared these ideals. I was aware of the more strident critics of our profession, and I did not disagree with them entirely, but I thought our profession, overall, was at least trying to value everyone. At least our profession stated clearly in our educational and certification requirements that we valued the ideals of inclusion, equity, and the resulting diversity, even if we maybe had not quite been able to consistently act on those ideals quite yet.
I was wrong.
We do not have to look to 1936, or to 1967, to find evidence to the contrary. All the evidence we need of a profession going backwards is right there in the 2025 line-by-line revisions to our accreditation standards and certification requirements.
We are not merely actively refusing to address some issues or failing to move forward as a profession.
We are actively going backward.
Proudly going backward. And clutching and defending our knapsack of privileges as we go.
Your Turn
What did you think of Story #2, the distinctly pessimistic version? Why?
If you feel safe discussing Kohnert’s (2013) ideas of the privileges that some people hold in our profession, try discussing them. Which of her experiences have you shared, if any? Or which of her advantages are you well aware you have not received? Were you aware at the time that someone was being granted an advantage that another person was not being granted, or aware that someone was being discriminated against? If so, how did you respond at the time, whether you were receiving the advantage or not? If you became aware of the inequity later (as Kohnert was describing), how does that sequence of events and recognitions factor in to your journey through your profession or factor into the stories you tell about your career and about your profession?
Having now read both Story #1 and Story #2, what do you think about the two of them as a set? If you had written an optimistic version or a pessimistic version, how would yours have differed from mine?
Our Stories, Your Stories, and the Influence on Our Entire Profession of Our Stories About Culture, Language, and Identity
I obviously designed Story #1, the optimistic version, and Story #2, the pessimistic version, to both be a bit extreme. Whether you can accept one or the other, or parts of both, as true, what stories do you tell yourself about culture, languages, dialects, and identities in speech-language pathology?
(Were you aware that you tell yourself a story about culture, languages, dialects, and identities in speech-language pathology? You do. We all do.)
And most importantly, how do your stories influence your behaviors, and how have our collective stories and behaviors shaped our profession?
If your story is that many people speak incorrectly or have problems with their language and need to change, your actions will follow one path.
If your story is that people speak the way they speak, and society needs to accept the way people speak, your actions will follow another path.
If your story is that people speak in different ways and also sometimes want and deserve help with changing how they speak or changing how they think about speaking or changing something else about how they communicate, and that professionals with professional expertise who can provide people with evidence-based options and assistance therefore need to exist, because trendy academic assertions that all ways of speaking should be equally acceptable to all people at all times have no actual basis in the real lives of real people, then your actions will follow yet another path.
If your story is that removing the word “diversity” or the word “equity” or the word “inclusion” from our professional accreditation and certification requirements in 2025 was defensible for a series of reasons, or was indefensible for another series of reasons, your actions will follow the relevant path.
And if enough of us tell ourselves any of these stories, our combined actions end up moving our profession along a recognizable path. Our profession started because of some people who told themselves a story about other people’s speech. Our profession has since been shaped, and is currently being shaped, by other people who are telling themselves other stories.
As persons and as professionals, in other words, we are shaped less by the facts of our history, which can always be interpreted in many directions, and more by the stories we tell ourselves about those facts.
As folklorists and religious leaders teach us, groups of people use stories not merely to relay the facts of past events but to support current belief systems and to guide future actions. A man was hurt on the side of the road, so we value stopping to help when we see a stranger in need. A child was lost in the woods and eaten by a wolf or a witch, so never go into the woods alone.
Narrative therapy models for individuals use a similar principle. I can interpret the same basic facts (many difficult things that have happened to me) as evidence that I am resilient, powerful, beautiful, and prepared for anything, or to convince myself that I am obviously completely incompetent and might as well sit here in the corner. The same fact pattern, interpreted differently, can lead different people to anger, action, paralysis, resignation, or resolve.
How, then, will you interpret the facts of our profession’s dynamic interactions with culture, language, and identity?
And more importantly, how will you act going forward?
You have built a solid base now, as you have worked with the material in Sections One through Four of this website. It’s time to build on that base and to apply our stories. So let’s think more specifically about our clinical actions (Section Five), our other professional actions (Section Six), and how we want our careers and our profession to move forward (Section Seven).
Highlight Questions for Module 14
Tell a distinctly optimistic story about how speech-language pathology has addressed and currently incorporates culture, language, identity, and related topics.
Tell a distinctly pessimistic story about how speech-language pathology has addressed and currently incorporates culture, language, identity, and related topics.
What does it tell us about our profession that two such different versions of our story can be constructed? Which pieces of the two stories presented in this module struck you as true, false, exaggerated, inappropriate, or otherwise? How do the stories we tell ourselves about our profession influence our professional actions? (How do individual professionals’ actions then influence our profession itself?)
Use any story grammar you know to analyze any part of your own personal story about culture, language, identity, and related topics in speech-language pathology. You are one of the characters; who are the other characters, what is the setting, what is the plot? What conflicts have emerged, and how were they resolved or what twist did they reveal? What is the overall theme or lesson of your story? What will happen in the next book of your series?
Module 14: Copyright 2025 by Compass Communications LLC. Reviewed October 2025.