Abstract

Although scientists have often overlooked the role of language used to refer to people with disabilities in their identities, language may reflect societal attitudes that are critical in shaping the experiences of people with disabilities, particularly during formative periods. International controversy surrounds disability-first versus people-first language, but little research to date has explored specific linguistic references to people with disabilities. This study draws on a content analysis of 22 qualitative interviews with students, parents, teachers, and administrators to explore language used to refer to students with disabilities. Results offer the first framework of language in a U.S. urban school district, including people-first, disability-implicit, and disability-first language. Results demonstrate noteworthy variation in form and content, and offer a values-based and contextual understanding of language. This nuanced way of understanding experiences of students with disabilities has implications for potentially improving language used to refer to people with disabilities, as well as creating a more positive disability identity.


Across the globe, 650 million people are estimated to be living with a disability (Disabled World, 2016), raising questions about how a group so large functions in societies. This concern is well-founded: individuals with disabilities have experienced widespread marginalization, stigmatization, and discrimination (Baynton, 2001). A specific aspect of society's treatment of people with disabilities that contributes to their experience is the language used to refer to them. Language reflects how people view each other (Blaska, 1993) and, if disrespectful or negative, can perpetuate discrimination. For students with disabilities, the verbal environment in the classroom or school can be particularly transformative, although previous research has not comprehensively explored the language used in these settings. In the current study, interviews with students, parents, teachers, and administrators are analyzed to understand disability language use during students' transition from a specialized school to inclusive schools, with the goal of creating a framework of language use.

Models of Disability

Within disability studies, scholars and activists have developed various models to describe the complex phenomenon of disability. Although any model may be criticized for being incomplete, it is crucial to be aware of the ways in which these frameworks define and represent disability, as well as personal identity and political activism. In particular, much debate exists around the use of a medical versus social model of disability; an understanding of these competing models aids in contextualizing frameworks of disability language.

In a medical model, individuals are seen as possessing a problematic trait specifically tied to a diagnosis and labeled an "impairment". Disability is then defined as a restriction caused by the impairment (Shakespeare, Bickenbach, Pfeiffer, & Watson, 2005). In this model, individuals are identified by deficiencies, thereby minimizing strengths and environmental factors that create barriers for people with disabilities. However, few would outright deny the role of social barriers in the lives of people with disabilities. The limitations of a medical model of disability are countered in a social model (e.g. Marks, 1996), which opposes the prejudice and devaluing that some claim are implicit in medicalization. In a social model, impairments are seen as socially constructed and result in oppression and exclusion from full participation in mainstream social activities: individuals are "disabled by society, not by our bodies" (Shakespeare, Bickenbach, Pfeiffer, & Watson, 2005, p. 1104). Some scholars find a social model problematic because it tends to write off the significance of impairment. When considering various models, "the choice is between an attempt to minimize the differences between disabled and nondisabled people and the drive to celebrate disability identity, cultural distinctiveness, and disability pride" (Shakespeare, Bickenbach, Pfeiffer, & Watson, 2005, p. 1104).

Supporters of the medical model in disability studies believe that this perspective, often utilized by those in power in the medical field, could be used as an opportunity for health care professionals to empower patients through effective, diagnosis-specific treatment (Evans, 2004). However, critics point out that the emphasis on impairments as the cause of disability is a form of victim-blaming (Shakespeare, Bickenbach, Pfeiffer, & Watson, 2005), and that by focusing on reducing discrimination and social barriers, the quality of life of people with disabilities would be greatly improved. Lavine (2010) described problems with the medical model in the education system, as her son with a disability was segregated and refused services based on an "impairment". The social model of disability, then, "has great moral power: if society has constructed disability, then it has a duty to remedy the situation and remove barriers" (Shakespeare, Bickenbach, Pfeiffer, & Watson, 2005, p. 1106).

In an attempt to reconcile existing debate, Stephens (2011) has advocated for a more nuanced understanding of disability, as disability identity construction may be neither completely societal nor completely medical. The World Health Organization seeks to integrate multiple models by centering on problematic features of bodies but simultaneously acknowledging social and environmental factors (WHO, 2016). In this model, the term "disability" refers to the entire experience of impairment and social implications. Debate around social and medical models of disability is reflected in debate around disability language, offering further insight into the experiences of people with disabilities.

Disability and Language

According to theory and empirical research, the words or phrases people speak or write, as well as their structure, affect society's perception of people with disabilities and the self-image of those individuals (Blaska, 1993; Froschl et al., 1984; Zola, 1993). Negative perceptions may result in a lack of access to resources, feelings of well-being, or acceptance (Clinton & Higbee, 2011; Link et al., 1989). Language provides a forum to both construct and understand reality and current power structures. Language use can help society become responsible for including individuals with disabilities; unfortunately, the language used to refer to people with disabilities has historically kept them in their marginalized position by portraying them in a derogatory way (Haley & Brodwin, 1988). By defining individuals on the basis of disability, they may be reduced to their disability and thereby dehumanized (Bandura, 1999).

In 2010, the state of New Jersey in the United States banned use of the term "retarded" and its variations in references to people with disabilities in state laws or regulations. Originally used for medical purposes, "retardation" became a term of devaluation and exclusion, although it was less stigmatizing than terms like "mental deficiency", which it replaced. The bill called for use of people-first language in reference to any person with an intellectual disability (New Jersey Legislature, 2010). Other states have adopted similar laws. At the national level, Rosa's Law (2010) eliminates the term "mental retardation" in federal law. These changes suggest that some legislators believe the words or phrases people speak or write reflect values. Terms to refer to people with disabilities may have a strong effect on their inclusion in society (Blaska, 1993; Clinton & Higbee, 2011; Froschl, Colon, Rubin, & Sprung, 1984; Zola, 1993).

For many people with and without disabilities, education presents an initial encounter—and potential struggle—with inclusion. According to Doubt (2003), students with disabilities may occupy a secondary, excluded position in the classroom, and could face issues with peer acceptance, classroom attitudes, and teacher support (Boer, Pijl, Post, & Minnaert, 2013). Therefore the verbal environment created in school settings, in particular by teachers and administrators, can create a context that influences students' self-esteem and perceptions of others (Kosteinik, Stein, & Whiren, 1988). As the number of students with disabilities placed in least restrictive environments such as inclusive classrooms increases, language may be especially relevant to understanding the experiences of students with disabilities who are both attempting to engage with their peers and receive an appropriate education. This potential relationship between language and inclusive education prompts a need for further exploration of disability language among individuals in mainstream school settings.

Notwithstanding support for the elimination of derogatory language demonstrated in recent legislation, controversy surrounds disability language use. This controversy may be based on differing values regarding disability and inclusion, often aligned with adherence to particular models of disability, and the belief that language use can reflect these values. According to Snow (2007), "old and inaccurate descriptors and the inappropriate use of these descriptors perpetuate negative stereotypes and reinforce an incredibly powerful attitudinal barrier" (p. 2).

People-first language, a semantic approach that "puts the person before the disability…describes what a person has, not who a person is" (Kids Together, Inc., 2009), e.g., "students using wheelchairs". Currently preferred by many (The Association for Persons with Severe Handicaps [Bailey, 1991]; American Psychological Association [APA, 2014]), advocates posit that people-first language may reflect positive attitudes and promote inclusion of individuals with disabilities by referring first to the person, then the disability (Blaska, 1994; Griffin, Peters, & Smith, 2007). Given these preferences, we use the people-first form in this paper. Over the last generation individuals with disabilities have made efforts to break free from a medical model of disability that focused on impairment, and instead advocate for a culture of disability emphasizing group identity and belonging (Gilson & Depoy, 2000). This shift is reflected in literature from the health field: Jensen et al. (2013) championed people-first language for psychiatric mental health nurses in order to facilitate recovery-oriented practices and foster respect, dignity, and stigma prevention. For those who prefer people-first language, the move to language with positive connotations and less stigma allows individuals with disabilities to be viewed, by others and themselves, more favorably and experience more acceptance in society.

In contrast, individuals with disabilities are sometimes referred to in general terms, without particular attention paid to a disability (e.g., "inclusion students"). This implicit language does not name a disability directly but indicates a disability through context or connotation. It may be used when the disability is considered assumed, and/or as a substitute or indirect way to refer to a disability. This type of language may also be used to emphasize sameness. For example, in a study of language used in group homes for people with severe intellectual disabilities, house managers noted that "we just call them people…that just seems way more respectful" (Bigby, Knox, Beadle-Brown, & Clement, 2015). Similarly, the mother of a daughter, Erin, with a disability, wrote in a narrative that, "the only reason the disability should be noted is when it is germane to the issue or conversation" (Regan, 2014, p. 29). This category was developed by researchers for the purposes of the current study, in order to characterize a common but subtle type of language that refers to people with disabilities.

In some countries and among some disability groups in the U.S., language with a focus on disability (e.g., "disabled person") is preferred. This "disability-first" preference may be due to either a medical model of disability, emphasizing deficits, as in Japan (Gottlieb, 2001), or adherence to a social model of disability, in which a disability is understood as a result of society's standards and must be confronted, as in Ireland (Fernald, 1995). Also, some people with disabilities, like those with autism, argue that disability is a primary part of their identity instead of a disconnected medical flaw (Mackelprang, 2010). All explanations for these three categories of language usage demonstrate a values-based approach to disability language.

Controversy surrounding disability language and its relationship to values is furthered by inconclusive research. Whiteman and Lukoff (1965) found that social work students who were asked their opinions on "the blind" versus "blind people" had more favorable ratings when the phrase "blind people" was used. Patterson and Witten (1987) placed college students in an experimental setting to study attitudes toward people with disabilities using people- and disability-first descriptors; they did not find a significant difference in attitudes. Another study found a positive relationship between people-first language and attitudes and intentions toward people with disabilities (Feldman, Gordon, White, & Weber, 2002). In a study by Haag Granello and Gibbs (2016), undergraduate students, adults in a community sample, counselors-in-training, and professional counselors completed measures of tolerance using either the term "the mentally ill" or "people with mental illnesses". Tolerance scores were lower for those who completed measures using the term "the mentally ill". These results demonstrate that, in some cases, language use may reflect values related to inclusion. However, in others, a values-based explanation may be insufficient, such that the nuances of language use should be considered.

Given the controversy surrounding values-based disability language and inconclusive research, we acknowledge context-dependence as another explanation for language use. In their review of psychological aspects of language, Pennebaker, Mehl, and Niederhoffer (2003) find that the words we use vary depending on the situation we are in, rather than depending solely on our values. Similarly, Halmari (2011) found that, in a study of disability language in the Houston Chronicle, disability-first language was often used to stress an undesirable trait. Additionally, Rohmer and Louvet (2009) found that when describing individuals, disability is more salient than gender or ethnicity, but they did not explore differences in "disability" as a descriptor. Recently, Peers, Spencer-Cavaliere, and Eales (2014) argue that context—including cultural and disciplinary standards—should be considered in our understanding of language. Specifically in academic journals, the authors recommend that we subscribe to "an expanded set of language standards in which authors have more choices in their disability terminology and in which all authors are held explicitly accountable for the disability terminology they use" (p. 267). Given these context-dependent variations and preferences, we utilize the current study to explore disability language in an education setting, specifically in urban high schools. As urban schools face unique issues that may make disabilities especially salient, an analysis of disability language yields a framework for language use in these schools, provides an alternative to values-based language use, and helps to understand the experiences of urban students with disabilities.

Although preferences for people- and disability-first language have been established for a multitude of reasons, variations in the forms of language use in a particular setting have not yet been thoroughly empirically examined. Language is a crucial aspect of the inclusion and identity of individuals with disabilities, especially during the formative period of adolescence, and reflects the experiences of individuals within society. Thus, we attempt to describe the ways people refer to students with disabilities in this context, rather than indicate what language use is preferred or correct, as there are positive and negative rationales for each form of language presented. This study explored the following research questions: (1) What language patterns are used to refer to students with disabilities in an urban U.S. school system, by students, parents, teachers, and administrators? (2) How can these language patterns be categorized?

Method

The current project is part of a larger evaluation of the transition of students with disabilities from a specialized school to mainstream high schools in a major urban Midwestern public school district. Researchers, who were commissioned to evaluate the transition by the school district's office of specialized services, included two faculty (C.K. and S.M.), one graduate student (L.B.), and two undergraduate students (K.O. and L.P.) with interests in disability research and advocacy. Several researchers had multiple years of experience working with people with disabilities. All researchers were involved in the overarching study, and one undergraduate student researcher chose to conduct additional interviews with stakeholders for her honors thesis. This researcher used a wheelchair and designed a protocol to focus on the distinctive experiences of students using wheelchairs within the transition. The first author drew on the sample collected for this initial study subsequently for her M.A. thesis research. For this study, researchers conducted a content analysis (Yang & Miller, 2008) of the resulting interview data, analyzing language patterns and allowing for the development of a framework of language use from the observation of students, parents, teachers, and administrators.

Research Participants and Schools

The 22 interviews were conducted with 7 students, 4 parents and 1 guardian, 7 teachers, and 3 administrators in three urban Midwestern U.S. high schools. See Table 1 for demographic information. Each high school had a culturally and ethnically diverse student body and enrollment between 1500 and 4200 students. Two schools had two or more years of experience in educating small numbers of students with physical disabilities. One school enrolled students with physical disabilities for the first time the year the study was conducted. When the study was conducted, students with disabilities who were interviewed had transitioned six months previously from a school in which approximately 80% of students had a disability to these urban high schools where fewer than 25% of students had a disability.

All 7 students interviewed used wheelchairs; 3 students attended a general education neighborhood high school, 3 students attended a general education high school that accepted students from outside neighborhood boundaries, and 1 attended a selective enrollment high school for students from all over the city. Because two students were not in the care of parents or official guardians, the researcher was unable to reach any caretakers suitable for in-depth parent or guardian interviews. One parent spoke only Spanish, and a translator was used. One teacher taught special education, and six were general education teachers. Two administrators were principals, and one was an assistant principal.

Interviews

In order to gain a multi-perspective understanding of the transition, parallel semi-structured interviews were developed for students, parents, teachers, and administrators. Interviews were conducted by one researcher, an undergraduate student collecting data for her honors thesis, at participating schools. All participants responded to questions about academic, social, and emotional experiences related to the transition and their new schools. Participants were not asked specifically about disability language and the interviewer did not know that the language in these interviews would be subsequently examined. Moreover, as participants consistently referred to students with disabilities, their responses provided an opportunity to realistically evaluate everyday discourse in an educational setting.

Procedure

After receiving IRB and school system approval, researchers selected three schools for participation of the 30 schools that received 4 or more students from the school that closed. These selections were based on recommendations from central office personnel who considered transition experience, number of students received, and likely willingness to participate. Administrators of these three schools were asked to voluntarily participate in the study, and after receiving information about the purpose and process, gave written permission. Teachers were invited to participate, and also consented to be interviewed. Finally, students and parents were invited to participate. Parents consented for their own interviews and gave permission for their children's participation. Students also assented. As two students were wards of the state, temporary guardians gave permission for participation. Interviews were conducted at the participants' convenience by a primary investigator, who used a wheelchair. Interviews were digitally recorded and ranged from 30 to 60 minutes in duration. Following completion of each interview, it was transcribed verbatim for future coding.

Coding and Analysis

One graduate student and one undergraduate student, trained in qualitative analysis, conducted interview coding. Once all interviews were transcribed, a single coding manual was developed for student, parent, teacher, and principal interviews. Data reduction began with one sample interview for each role group separately (viz., students, parents, teachers, administrators). Using a strictly inductive coding technique (Auerbach & Silverstein, 2003), such that coding occurred without attempting to fit the data into a pre-existing framework, coders identified central and recurring language patterns. These codes were further refined by applying them to interviews from each role group, until themes were identified and integrated across all interviews for all groups. Each interview was recoded two to three times to ensure that codes were sufficient to cover all interview material and did not overlap. A minimum of two appearances was required for a code to be included in the final codebook.

Specific codes were inductively added or adapted based on emergent patterns to encompass all existing language and offer a nuanced framework of language usage. See Table 2 for categories, subcategories, and frequencies. Using these codes, a second rater recoded a representative sample of 25% of all interviews, and achieved acceptable reliability (Kappa=.82). This qualitative approach yielded both a description and a framework of categories of the language used to refer to students with disabilities in a school setting. A comparison of frequency (Miles & Huberman, 1994) and descriptive strength of similar quotes demonstrated emerging variations, commonalities, and differences in language use that emerged. Frequencies were used to calculate percentages of language use categories and subcategories within total language use to provide a complete picture of disability language in the sample.

Results

The variations of language used to refer to students with disabilities fall under three broad categories, initially introduced in the literature review of this paper: people-first language, disability-implicit language, and disability-first language. Then, each category was further divided into subcategories to provide a more nuanced understanding of contemporary linguistic conventions used in the target schools (see Table 2). These categories appeared across student, parent, teacher, and administrator interviews.

People-First Language

People-first language places emphasis on the individual by referring to the person first, followed by a reference to the disability. People-first language was used more than disability-first language and less than disability-implicit language. This category was further defined into five subcategories: general, disability-domain, specific, severity-focused, and historically sensitive people-first language.

General people-first language. One form of people-first language involves making a general reference to a disability, following the primary reference which is to the individual or groups of individuals. One parent said, "If they [students] are only going to be around other people with disabilities, they're never going to learn what it's like out there." Additionally, a teacher commented, "We have some class activities that require pairing up. That pairing up doesn't work so well for the students with disabilities."

Disability-domain people-first language. Another form of people-first language focuses on the individual, then refers to the domain of the disability, e.g., physical, sensory, emotional, or cognitive. These domain names are often used to categorize students into groups for placement in classrooms. One teacher said, "We were instructed to take care of students with physical disabilities as far as getting them out of the building…like a fire drill." Similarly, one teacher noted with regard to one of her students that "she has cognitive learning disabilities and also her attention span and her motivation is very, very limited."

Specific people-first language. This form of people-first language makes reference to an individual, followed by a mention of the specific disability. One teacher said, "We have a map drawing exercise in one of my classes. The paper for the maps is quite large and the students in wheelchairs weren't able to join in. I rigged something up…so they could also participate." One student also commented, "When you leave school and go work you are already going to be a minority in a chair. That's the way it is. Might as well be that way in school too."

Severity-focused people-first language. Another form of people-first language mentions the individual first, followed by a reference to the severity of the disability. Similar to disability domain language, references to severity are often used to categorize students or explain modifications made. One teacher explained, "We do have kids here with behavior problems but not in any major way. It is not a major part of my day at the school." One teacher echoed this language use, saying, "I have one student with a pretty severe disability so timewise, it would take them too long to do the whole test.""

Historically sensitive people-first language. The final form of people-first language focuses on the individual, then makes a reference to the disability using an outdated term, that may have once been considered an appropriate term. The speaker may be making an effort to use people-first structure, but may not be informed about current best practices or preferences regarding word choice for referring to students with disabilities. One teacher said, "Every Tuesday we have meetings and we discuss various subjects and this time [the topic] was how to help students with special needs." Another administrator commented, "Students with special needs need to be in a regular classroom because they see what their peers are going through."

People-first language places emphasis on the individual and leads with similarity, rather than the disability. This format could allow people with disabilities to reduce or prevent being defined on the basis of disability. A great deal of variation exists within the category, and the identified subcategories help illustrate the various forms of language used.

Disability-Implicit Language

Disability-implicit language is defined as a reference to individuals with disabilities when the reference to the disability is indirect and unstated, rather than explicitly stated. It is crucial to note that these terms of reference may be neutral in their denotation; yet this language may have positive or negative connotations when read in the context of the rest of an interview. These references are clear to the listener who understands the context; however, the indirect reference to the disability itself is relatively neutral and not stated directly as disability-first or people-first. For the purposes of this study, language without an overt reference to disability is regarded as disability-implicit. Disability is understood to be part of the meaning conveyed by the context. Across the set of interviews, disability-implicit language was used more than any other form of language; more than 2 of every 3 references to students with disabilities used this form (Table 2).

General disability-implicit language. One type of disability-implicit language involves general references to students who have disabilities, without attaching the disability to the individual in any way in the phrase or term used to identify them. Instead the broader context demonstrates that the reference was to an individual with a disability. One teacher spoke about difficulties with scheduling for students with disabilities, "If I were a parent, I would have a problem with the students [with disabilities] leaving early and coming into class late." An administrator also commented, "The first thing we have to do is make sure the kids [with disabilities] feel wanted and comfortable in being here."

Disability euphemism disability-implicit language. Another form of disability-implicit language involves referring to students with disabilities by using a euphemistic term rather than "disability". There is no reference to the disability directly, but instead an alternate word is used as a replacement for "disability". The speaker and listener understand the reference to a disability. This language use may refer to the school from which students transferred, inclusion practices, or the transition itself as a substitute for a disability reference. One teacher said, "We had…a lecture that was to ease the apprehension that teachers felt when they heard we were getting students from Wilson [alias for a school primarily for students with disabilities]." A student discussed his mode of transportation to school using disability euphemism disability-implicit language, saying, "Other times I always came to school on the yellow bus with all the other kids [only students with disabilities ride the yellow bus]."

Name/individual-focused disability-implicit language. A final form of disability-implicit language refers to the student by name or by a direct reference to the individual. Because interview questions focus specifically on the transition experiences of students with disabilities, it is understood that references to students are students with disabilities. In response to a question about including students with disabilities, one teacher said, "This kid [with a disability], I was concerned about him not being social in the classroom. He misses a lot of days because his [wheel]chair is broken." Another teacher commented, "My other student, Carla [alias], her thing is she has a lot more skills. She has wonderful verbal skills."

Disability-implicit language is a complicated form of language in that it can vary in meaning. Some usages are relatively neutral, meaning that the disability is irrelevant and therefore no reference to it is implied, while other usages reference the disability indirectly. This study has determined the form of language usage based on straightforward coding and interpretation of interview transcriptions. Disability-implicit language could potentially be positive or negative depending on connotation and/or context.

Disability-First Language

Disability-first language, once thought of as the conventional usage, is defined as a reference to the disability before the person. Disability-first language encompasses disability-only language, when no reference is made to the person. This language emphasizes the disability over the individual. Across the set of interviews, disability-first language was used the least; less than 1 in 10 references to people with disabilities were in this form (Table 2). The types of language usage are generally parallel to those for people-first language.

General disability-first language. One specific type of disability-first language makes only a general reference to the disability. That is, there is no clarification of what the disability is. One parent said, "She's in a division [homeroom] with only other disabled students. She hates that." A student also commented on his experience in school using general disability-first language: "I think that the teachers make me more mad. I don't like the way disabled people are treated."

Disability-domain disability-first language. Another form of disability-first language utilizes the domain of disability an individual has: for example, physical, sensory, emotional, or cognitive disability-domain labels. This disability domain receives the primary focus, followed by the individual. One teacher said, "I've never had like the IEPs [individualized educational plans], ah…I don't know if they do them for physically disabled kids." Another teacher used disability-domain disability-first language when he noted, "I am familiar enough with physically disabled people. Both my parents, uh, were special ed teachers and have run a group home."

Specific disability-first language. Another form of disability-first language involves a more specific reference to the disability with which the individual is living. The disability is still mentioned first, and the reference to the person follows, but this type of language allows the individual a more personalized mention of his or her disability. One teacher said, "I had my deaf girl read in class." Similarly, another teacher stated, "I think that the regular ed kids gained a huge respect for the wheelchair kids when they saw them out there playing [basketball]."

Severity-focused disability-first language. One form of disability-first language focuses not only the disability, but also the severity of the disability, followed by a reference to the person. A focus on severity of disability allows students with disabilities to be separated, most often by level of functioning, into multiple groups. A teacher said, "Certainly a student [with a physical disability] would not want to be in a class with severe and profound [intellectually disabled] students, but something could be done." Additionally, another teacher shared her thoughts on inclusive education for all students: "Very severely disabled students? No [they should not be in general education classrooms], because it takes time away from the other students."

Historically sensitive disability-first language. Another type of disability-first language involves any term that may have at one point been considered an appropriate way to refer to an individual with a disability. This language usage typically demonstrates care or caution toward the situation, as well as knowledge that there are preferred ways to speak about individuals with disabilities. This type of non-people first language may include references to special education, special needs, or handicapped individuals among others. One teacher said, "They [teachers] see special ed kids coming in here and thinking automatically the negative things…". Another teacher commented on potential accommodations for students with disabilities: "With the special ed students, in general, you might have accommodations other than the time accommodations."

Disability-only language. A unique form of disability-first language with no parallel category in people-first or disability-implicit language frameworks is disability-only language, which places all of the emphasis on the disability, without any reference to the individual at all. Disability-only language may be a reference to a general or a specific disability or to a disability domain. Disability-only language may also refer to the severity of disability, or to a historically sensitive term. This type of language completely depersonalizes the reference by defining the individual solely by the disability. One student said, "I was happy at first and then not because the old school was made for the disabled. It was more accessible for the disabled." Additionally, an administrator discussed difficulties providing supports for students with disabilities: "Try and get something for the disabled. Well, you know, some people there are very rude."

Disability-first language places emphasis on the disability, not the individual. In this way, this type of language may be considered less inclusive and at times quite divisive. In contrast, disability-first language may call attention to the reality, culture, and identity of people with disabilities. In general, disability-first language varies in content as demonstrated in its subcategories, which is an important consideration when determining effects.

Language Use by Role

Of all participant role groups, students used mostly disability-implicit language, and predominantly more people-first language than disability-first language. Parents used more disability-implicit language than anything else, as they primarily called their children by name, and were equally divided in their usage of primarily people-first versus disability-first language. Teachers also used more disability-implicit language relative to other forms of language. Following students and administrators, teachers were third most active in their use of people-first language compared to disability-first language. Administrators also used more disability-implicit language compared to other forms of language, and following students, were second most active in their use of people-first language compared to disability-first language. Primary language use by role, as well as the subcategory used most frequently, is included in Table 3.

A Note on Content Versus Form

It is important to note that, while in general the categories of language defined in this study are applicable to all language used to refer to individuals with disabilities, they are the result of qualitative analysis of a specific set of interviews. In these interviews, the content of language used to refer to individuals with disabilities was largely positive; therefore, much of the focus in developing categories was on the order of the referents. However, in certain cases, the content may be so negative that the order is of secondary importance. It is useful to think of language existing on a continuum in two directions: positive to negative for form, and positive to negative for content. In this particular study, people-first language, disability-implicit language, and disability-first language were often positive for content. It is possible for language to also be negative for form and content or positive for form and negative for content. This study emphasizes form over content, as there is little variability in the positive quality of the content presented here in referring to people with disabilities.

Discussion

According to Gottlieb (2001), an initial understanding of disability language use is insufficient. It is crucial to keep language issues in the public eye to help people understand how their words matter. Based on discussion surrounding the power of language (e.g. Clinton & Higbee, 2011), this study explores language used to refer to people with disabilities in an education setting. In a values-based stance, some current state and federal legislation in the United States has banned the use of derogatory content in language used to refer to people with disabilities (viz., New Jersey Legislature, 2010; Rosa's Law, 2010). Currently arguments for people-first, disability-implicit, and disability-first language are made between and within groups of people with and without disabilities related to values (APA, 2014; Fernald, 1995; Mackelprang, 2010). However, some research posits that language use is also and at times primarily contextual (Halmari, 2011; Peers, Spencer-Cavaliere, & Eales, 2014; Pennebaker, Mehl, & Niederhoffer, 2003), and/or related to disability salience (Rohmer and Louvet, 2009).

The results of the current study demonstrate large variability in language use, even within general categories. These distinctions are crucial to note because, in addition to raising awareness around the variations in language and disability (Gottlieb, 2001), they may be useful in understanding the ways language relates to how members of society perceive, interact with and/or exclude individuals with disabilities. Previous research has attempted to use general categories of language (e.g., people-first language) and attitudes toward inclusion, but results were mixed (Feldman et al., 2002; Haag Granello & Gibbs, 2016; Patterson & Witten, 1987; Whiteman & Lukoff, 1965), perhaps due to overly broad conceptualizations of language. Also, international debate around disability- and people-first language makes clear the value of conducting an in-depth exploration of disability language in a particular setting such as urban high schools. Such a study also has value because the verbal environment in education settings influences youth development, motivation, and attribution (Kosteinik et al., 1988; Sylvia, 1994).

The current study was able to establish meaningful variations within people-first, disability-implicit, and disability-first language categories. Based on this sample of interviews, no language is explicitly derogatory; such positive or at least non-negative use is consistent with the goals of recent legislation. However, illustrating the controversy surrounding language preferences, results do not demonstrate a clear language preference or a "correct" way to refer to people with disabilities. Rather, results demonstrate a combination or integration of previous language research: in an education setting, while some language use appears to be values-based, some other use, such as disability-implicit language, may be more driven by context.

Within disability-implicit language, which was used most frequently, it is difficult to distinguish between neutral terms and euphemistic ways of referring to a disability. On the surface, all of the language forms that fell into this category were relatively neutral. When analyzed further, many people interviewed may have been using euphemistic terms to avoid the perceived implications of using the term "disability" and the confusion about the best way to refer to individuals with disabilities. In the current study, the fact that the interviewer was in a wheelchair was likely impactful. Participants may have avoided mentioning disability, potentially reflecting discomfort or uncertainty regarding interactions with people with disabilities. Alternatively, the disability reference may be assumed in the interview context. However, the disability may be considered so unimportant, in that context or overall, that it is omitted completely (Bigby, Knox, Beadle-Brown, & Clement, 2015; Blaska, 1994), reflecting an inclusive or transcendent view of the individual beyond the disability.

Values associated with language can keep people with disabilities in their marginalized position within society, or help move them out of it. The use of metonymy, or naming a part to represent the whole, is reflected in disability-only disability-first language, seen in the current study, as well as Haller and colleagues' (2006) work. Reducing an individual to a diagnosis or disability, as in a medical model of disability, ignores strengths and abilities and has long been recognized as having negative consequences (Scheff, 1966). Relatedly, an emphasis on the severity of a disability is often used to justify negative attitudes toward disability in both previous research (Henry, Keys, Balcazar & Jopp, 1996) and the current study. Such language usage is consistent with research that demonstrates students with disabilities may occupy a secondary, excluded position in education settings (Doubt, 2003).

However, disability-first language may have been used, especially by students, because some people with disabilities view disability as part of their identity and culture (Mackelsprang, 2009). According to advocates of the medical model within disability studies, the social model of disability could benefit from expanding to include the impairment inherent to a disability (Stephens, 2011), consistent with the World Health Organization's integration of characteristics of several models (WHO, 2016). Although it may be useful to acknowledge the role of society in disabling students, it could also be neglectful to completely eliminate the impairment within the body. However, a purely medical model risks perpetuating negative stereotypes, creating obstacles "to both self-esteem and social inclusion" (Shakespeare, Bickenbach, Pfeiffer, & Watson, 2005, p. 1103). Still another explanation for use of language with an emphasis on a specific disability is that of context-specific language use, similar to Rohmer and Louvet's (2009) and Peers, Spencer-Cavalaiere, & Eales' (2014) research: regardless of form, when a disability is particularly salient to a situation, it will be mentioned in some capacity.

In contrast, language associated with positive values may be related to an improved position in society (Haller et al., 2006). Over recent generations, individuals with disabilities have developed both a positive group identity and view of themselves within society (Gill & Cross, 2009), suggesting that language may also improve. This phenomenon is reflected in other social movements: women in the U.S. advocated for non-sexist language in their effort to achieve dignity, respect, and inclusion that was not dependent on gender (Gay, 2007; Karlovic, 2009). Parks and Roberton (2009) found that men and women with more positive attitudes toward people of both genders used more inclusive, non-sexist language. Indeed, the results of this study build on research that found substantial use of people-first language (Haller et al., 2006). For those who experience segregation due to the use of the medical model of disability (Lavine, 2010), which may be reflected in disability-first language use, the use of people-first language may indicate more inclusive values (Boer, Pilj, Post, & Minnaert, 2013). However, an emphasis on disability and its centrality to individual identity and culture could also be indicated in disability-first language, and may also be distinctively inclusive. Current findings demonstrated that when people talk about individuals with disabilities with an interviewer with disabilities, they only infrequently use terms that could be considered derogatory in form and almost never use those that are derogatory in content. This language use reflects the positive societal status individuals with disabilities currently enjoy in the U.S relative to other times in history.

The current study also noted differences in language use amongst participant type, consistent with Pennebaker, Mehl, and Niederhoffer's (2003) findings that language varies depending on the situation. Students, parents, teachers, and administrators all interact differently in school settings based on their roles. Although used most frequently in all participant groups, disability-implicit language was used differently across role groups. In students' use of disability-implicit language, the subcategory of general disability-implicit language was used most frequently. This category does not mention a disability at all, and the term itself is neutral, but a disability reference is understood. Students may have used this type of language most frequently because they do not feel the need to reference the disability at all and assume it is understood because of their experiences. Also, as people with disabilities have recently made efforts to achieve a positive identity (e.g. Gilson & Depoy, 2000), these students' references to "us" may result from their feelings of similarity to others within the group or to the interviewer, as well as an identity that focuses on positives. Parents tended to use name/individual-focused disability-implicit language, demonstrating that, in a school context, parents may be less focused on disability and more focused on their child. This type of implicit language may suggest a transcendent view of the child beyond the disability that other uses of the disability-implicit category may not have. Teachers tended to use general or disability euphemism disability-implicit language, potentially resulting from a cognizance of disability for a group of students due to a need for accommodations and modifications. The euphemisms used by teachers are often related to inclusion practices, as these students are defined by a need for specific inclusive actions by teachers. Finally, administrators frequently used general disability-implicit language, to speak broadly about groups of students in their school, or potentially because they may not see the limitations of specific disabilities.

With regard to other differences in language use between participant role groups, students with disabilities used the most people-first language in comparison to disability-first language, reflecting the issue of naming in the disability rights movement and a positive identity (Zola, 1993). Administrators also used primarily people-first language compared to disability-first language, potentially resulting from administrators' efforts as leaders to be cognizant of the most preferred or appropriate way to refer to individuals with disabilities. Teachers were relatively evenly split (4 teachers to 3 teachers) in their use of primarily people-first language to disability-first language, and vice versa. Regardless of language use, teachers were most likely to use specific or domain references to disability, as they were aware of the disabilities of their students in relation to curriculum modifications or accessibility issues. These results indicate that, while disability language could be tied to values surrounding inclusion, the context of the language use is also crucial, and is often reflected in participants' use of particular subcategories.

Limitations and Strengths

In the current study, all students interviewed were in wheelchairs. People in wheelchairs have been particularly successful at unifying as part of the disability rights movement (Charlton, 1997). That common positive identity may have facilitated more positive language use for students. Additionally, all interviews were conducted by a researcher who uses a wheelchair herself. The presence of an interviewer who used a wheelchair may be considered both a strength and a limitation: students may have felt more comfortable with this interviewer and better able to relate to her than to someone without a disability. The interviewer may have been better able to facilitate conversations with parents whose children use wheelchairs, who may have perceived her as knowledgeable and credible. Others may have limited their language to more positive terms than they would use in talking with someone without any visible disability.

To the authors' knowledge, this study is the first to describe language use regarding individuals with disabilities in people-first, disability-implicit, and disability-first terms. The results of this study discuss language usage in a primarily descriptive, rather than prescriptive manner. An additional strength is the development of a nuanced framework of disability language and the emergence of values-based, contextual language use patterns. In general, language is so embedded in everything we do that it may be overlooked as important to research.

Implications

This study has implications for theory, research, and practice. The classifications of language usage contribute to the existing conceptualization of language patterns concerning disability status (Haller et al., 2006; Mackelprang, 2009). The primary and secondary descriptive categories clearly illustrate alternative forms of language. Previous research has not provided such a comprehensive understanding of language variations used to refer to individuals with disabilities, nor has it described how people use such language.

The results of this study contribute a framework of language used to refer to individuals with disabilities, which can ultimately be used and enhanced to examine language in a variety of settings and to evaluate language's relationship to inclusion practices in schools and elsewhere. The existence and complexity of the disability-implicit category have not been noted previously and the category is important conceptually and practically. The values-based (Mackelprang, 2010) and contextual (Pennebaker, Mehl, & Niederhoffer, 2003; Rohmer and Louvet, 2009) patterns of language use offer another possibility for exploring meanings associated with disability language. These two language patterns also integrate previous research on language use, demonstrating that disability language use is relatively fluid and may vary by individual and situation. Future research could explore variations in disability language preference depending on identity. Second, the potential link between people- or disability-first language and individuals with disabilities' acceptance into or exclusion from society can be empirically studied using the specific categories designated from the results of the current study. Third, this study examines language use in the context of the United States' preference for people-first language. As previously acknowledged, other countries have different language preferences (Fernald, 1995; Gottlieb, 2001) and so do some disability advocates (Mackelsprang, 2009). Future research may usefully explore this framework within and across different disability-related groups and across nations and cultures to compare disability language, variations, and impacts on policy and practice.

All participants in this study were associated with schools that received students with disabilities in the context of the closing of a specialized school that primarily served students with disabilities. This transition was the result of preparation and effort by both the schools and the school district, and interviewees may have been well-versed and well-aware of language issues. However, frustrating transition experiences related specifically to individuals and their disabilities may have coincided with more contextual language, emphasizing the disability and the barriers to educating students with disabilities presented during the transition. Future research could study language use in different contexts; for example, in schools not in the midst of a transition period that focused on students with disabilities.

This study has implications in education settings for staff trainings. According to Blaska (1993), it is possible to train people to use people-first language. Schools may want to consider training staff in the use of a type of language (e.g. Jensen et al. [2013]), particularly if future research finds a link between language and inclusion. Until then, staff could be trained in the role of disability language in the identities of people with disabilities. Many conceptions of people with disabilities are taken from often negative and stereotypical media depictions (Ralph & Haller, 2009). By raising awareness around disability and language, teachers' attitudes toward inclusion can become more positive (Campbell, Gilmore, & Cuskelly, 2003). Specifically in education settings, staff members have the power to facilitate an inclusive and positive environment for all students through appropriate language (Kosteinik et al., 1988). The likely benefits for students, with and without disabilities, and society as a whole, may be substantial. Mackelprang & Salsgiver (2009) advise that, if school staff are unsure about appropriate language, they ask students with disabilities about their preferences. In general, it is encouraging that the language used in this study is not derogatory in content.

Conclusion

The current study identified three forms of language use to refer to students with disabilities, people-first, disability-implicit, and disability-first, which can be further categorized into useful subtypes and values-based or contextual patterns. Language patterns may have many implications for attitudes and action toward, and the identity of, people with disabilities. Study of these patterns may be extremely relevant to the nature of education for those with and without disabilities. For disability studies, language can be another avenue to address in advocacy for equality and justice. Language is one of the ways individuals with disabilities are held in a marginalized position in society and are hindered in developing a unified positive identity. Without understanding language's forms and power, it may remain a relatively undeveloped and seldom utilized resource in understanding and improving the experiences of people with disabilities in society.

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Table 1. Participant demographics.
Participant RoleGenderRaceExperience
Students (n=7)3 Female,
4 Male
3 Black,
2 Caucasian, 2 Hispanic
About 6 months in their new schools
Parents (n=5)5 Female2 Black,
Caucasian, 2 Hispanic
Teachers (n=7)6 Female,
1 Male
5 Caucasian, 2 Hispanic1 with 2 years, 6 with over 3 years
Administrators (n=3)2 Female,
1 Male
2 Black,
1 Caucasian
All over 5 years in current position
Table 2. Overview of language use framework.
Language TypeDefinitionFrequencyPercent of Total
People-First LanguageEmphasis on the individual; refers to the person first, followed by the disability9821.1%
General References disability using an overarching or broad term275.8%
Disability-domain References disability using a subcategory153.2%
Specific References an individual disability459.7%
Severity-focused References the level or extent of the disability2.4%
Historically sensitive References disability using an outdated term91.9%
Disability-Implicit LanguageReferences to disability are indirect and unstated32369.6%
General Overarching or broad reference; context required11224.1%
Disability euphemism References population using a neutral or indirect term in the place of "disability"122.6%
Name/individual-focused References the individual directly or by name 19942.9%
Disability-First LanguageReferences the disability before the individual439.3%
General References disability using an overarching or broad term91.9%
Disability-domain References disability using a subcategory51.1%
Specific References an individual disability112.4%
Severity-focused References the level or extent of the disability2.4%
Historically sensitive References disability using an outdated term122.6%
Disability-only All emphasis on disability; no reference to individual/group4.9%
Table 3. Primary language use and subcategory by role.
RolePrimary Language UsePrimary Subcategory
Students1. Disability implicit
2. People-first
1. General disability-implicit
2. Disability-specific
Parents1. Disability-implicit
2. People-first
1. Name/individual focused
2. General disability
Teachers1. Disability-implicit
2. People-first
1. Disability euphemism; general disability-implicit
2. Disability-specific; disability-domain
Administrators1. Disability-implicit
2. People-first
1. General disability-implicit
2. General disability
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