The Handbook of Language and Speech Disorders

Given the fact that labeling has a long history of application in education, medicine, and the social and psychological sciences, that it arises out of the human propensity to generalize, stereotype and construct meaning, and that there appear to be both positive and negative consequences of labeling, the process is well ingrained in our sociocultural context. Progressively, however, as social science addresses complexity and has established developmental and epistemological orientations that are less positivistic in nature and focused more on social constructivism (Bruner, 1986, 1990, 1991; Danziger, 1990; Gergen & Davis, 1985; Goodman, 1978; Iran‐Nejad, 1995; O’Connor, 1998; Shuell, 1986), there have been growing concerns about the process of labeling. Labeling is seen as too subjective and vague, especially given its power in the spheres of social action. Foremost in the litany of concern is the linkage of labeling with assessment.

As a widespread practice, assessment is a fairly recent phenomenon (Broadfoot, 1994; Gipps, 1999). In the context of the attempt to develop a more scientific foundation for the discipline of psychology at the beginning of the twentieth century, assessment was seen as a way to demonstrate both scientific principles and practical utility (Gould, 1996; Mills, 1998). When psychometric theory was developed in tandem with the creation of intelligence testing (Bernstein, 1996; Goldstein, 1996; Lohman, 1997), there was an allure of the objective and scientific. This was a time of behaviorism and a belief in positivism and it was taken for granted that the assessment of human abilities, skills, and proficiencies could be effectively accomplished through the development of test instruments. The use of quantification and statistical formulae helped advance this perception. However, to construct testing with sufficient statistical power, especially regarding reliability indices, a strict standardization was required that impacted test design, item selection, administrative procedures, and scoring criteria of the tests; these efforts to boost technical reliability often had a negative effect on the construct validity and the practical and clinical impact of the tests (Cronbach, 1988; Damico, 1991; Goldstein, 1996; Lohman, 1997; Messick, 1984). This resulted in ineffective assessment tools that were typically perceived to be valid and effective.

In remedial public education in the United States, the major regulatory instrument is the Individuals with Disabilities Education Act (IDEA). Because of continued disenchantment with the traditional approach to special education, the recent IDEA re‐authorization discussed several obstacles to implementing effective special education services (Hamayan et al., 2013; Sternberg & Grigorenko, 2002). Among the obstacles cited were that implementation of the Act has been impeded by a disproportionately high number of referrals and placements of “minority children” in special education, and by the application of discrepancy models using inappropriate tests that often result in these disproportionate placements. Consequently, regulations have been modified to address the needs of the students and to determine eligibility for special education services; pre‐referral interventions (a kind of dynamic assessment) rather than tests and other assessments have been recommended, and the focus directly shifts from evaluation with testing instruments to intervention potential as the primary determinant of placement. Additionally, the new documents do not require test scores to make placement decisions into special education.

As professionals, we often operate within our sociocultural milieu without a critical analysis of our practices and the conceptualizations that underlie them. The problem with this, of course, is that we might become blind to our poorly justified practices, or we might ignore new or inconsistent data that could potentially undermine our assumptions about important processes like labeling and its impact on our practices. Since we are agents of our society and, as such, are defined by the same realities, practices, and assumptions as others, this is a natural tendency. Within our sociocultural milieu, however, we must also remember that we fulfill a role as agents of rehabilitation and scholarship. As Brantlinger (1997) has argued, this requires us to be more diligent in how we operate within our sociocultural and political contexts; our priority should not be the sociocultural or epistemological status quo. Rather, our priority should be as advocates and agents of positive change for our patients and clients.

There are at least three implications that should emerge from this realization of our role as advocates when dealing with the social complexity of labeling. First, we should acknowledge and strive to deal with labels as complex phenomena . Labels are not simple, direct, or objective. They are powerful sociocultural artifacts that transmit biases, assumptions, and facts. They are also catalysts in the construction of both positive and negative consequences. To effectively elicit the positive consequences and reduce the negatives ones, we must recognize the constructive nature of these labels and the fact that they are often context‐dependent, and at least partly context‐created. For example, a quantifiable impairment such as age‐related reduction in hearing (even within “age‐normal” limits) may constitute a career‐destroying handicap for the conductor of a symphony orchestra, but not for someone in a different walk of life. Consequently, as clinicians we should not simply reify labels and consider them as “absolute,” objective categories. Rather, we should carefully consider how important it is to properly identify actual difficulties, determine the severity and context‐dependence of the labeled difficulties, and avoid the tendency to label without addressing the complexity and obtaining definite and objective data to support a diagnosis.

Second, we should strive to avoid the most basic negative consequences of labeling that occur when relying solely on the label. Rather, we should strive to thoroughly describe the difficulties that underlie the label . This means not only carefully documenting actual behaviors and their impact on the context, but also determining how the context impacts the behaviors and whether there are other emergent factors that must be adequately described and addressed (Perkins, 2005). Rather than orienting to symptoms to determine labels, we should orient to the skills, abilities, and strategies that can determine functional adequacy within the relative communicative and learning contexts. Darley (1975) had this in mind when he suggested that, when diagnosing aphasia, we focus on ability not labels, and his chapter “Aphasia without adjectives” still offers relevant advice 45 years after its publication.

Finally, we must be circumspect with our current conceptualizations and practices . By employing a more sociocultural orientation when focusing on diagnosis and labeling, we can turn our analytic powers to the very contexts and assumptions that we often take for granted when working with labels, so that we can better serve the needs of our clients.

The focus of this chapter has been the process of labeling and how it is impacted by sociocultural processes and how, in turn, our practices are then impacted by the labels that we employ. There is of course much support in the professional literature for the process of labeling. Such support tends to focus on the positive consequences, while downplaying the negative ones. As competent professionals, however, we must consider the potential for both. Certainly, the practicing professional should strive to reduce the negative consequences of labeling whenever possible. As we discussed in an earlier publication (Damico et al., 2004), we need to be able to contextualize a diagnosis or label, and then we should strive to discover the reality behind the label and the individuality of each client’s condition. This will enhance our service delivery in the field of speech and language disorders.