by Sarah Masters, University of Kentucky
Speech language pathologists (SLP) work to treat a variety of communication, language, swallowing, and speech disorders for people of all ages. In order for an SLP to diagnose, assess, or interpret an individual’s present means of communication, they must consider the patients linguistic and cultural differences. A language difference does not equal a language disorder, yet it is relatively common that children are misdiagnosed with a language disorder, when in fact they only present with a language difference. For example, when assessing a bilingual child, in order to classify a true language disorder, errors must be present in both languages. A language difference is any style of communication that differs from standard American English norms (ASHA, 2016). When clinicians are providing services for a client and their family, they must understand the distinction between a language difference and disorder, in order to ethically approach a client who is culturally and linguistically diverse.
The American Speech Language and Hearing Association (ASHA) has a Code of Ethics in place as a guide for clinicians when making professional decisions. This Code of Ethics educates not only professionals working in the field, but also students, other professionals, and the public on ethical principles, considerations, and expectations (ASHA, 2016). Clinicians are expected to abide by the Rules and Principles of Ethics when addressing clinically specific situations or questioning possible ethical dilemmas. Misdiagnosing a child with a language disorder when they actually present with a language difference is a potential ethical challenge a clinician may face when providing services. Cultural and linguistic competence is important for clinicians to acknowledge, especially when working with clients whose values, experiences, and language are different from their own.
Clinicians may approach therapy with an implicit bias when providing services to clients with language differences. Implicit bias is defined as “the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner” (Rudman, 2004). Vocabulary to catch in that definition is “unconscious”. Implicit bias is different from other biases that are recognized by an individual and often concealed due to social correctness. A clinician may assess a client’s language and interpret some communicative behaviors or utterances as wrong, solely because it’s different from Standard American English. In this situation, it can be presumed that the clinician has manifested an implicit bias. Implicit biases are not necessarily a reflection of our beliefs. Therefore, in the potential scenario stated, this clinician may not believe that a client’s language difference is truly wrong, but rather their subconscious has developed feelings and attitudes from a collection of experiences over their lifetime. The good news about implicit biases is that our brains can slowly unlearn them through varying techniques (OSU, 2015).
ASHA’s Code of Ethics is an important resource to utilize when faced with ethical dilemmas. The potential ethical dilemma of a clinician misdiagnosing a language disorder over a language difference due to lack of research on the cultural and linguistic differences of the client, is in violation of Principles of Ethics I. Principles of Ethics I states that, “Individuals shall honor their responsibility to hold paramount the welfare of persons they serve professionally or who are participants in research and scholarly activities, and they shall treat animals involved in research in a humane manner” (ASHA, 2016). This potential violation relates best with Rule C under the first Principle of Ethics. Rule C states, “Individuals shall not discriminate in the delivery of professional services or in the conduct of research and scholarly activities on the basis of race, ethnicity, sex, gender identity / gender expression, sexual orientation, age, religion, national origin, disability, culture, language, or dialect” (ASHA, 2016). In this potential ethical dilemma, in order for the clinician to make necessary changes in their practice, they must acknowledge why and how they were in violation of Rule C.
There are necessary actions that need to be taken by the clinician in response to this dilemma in order to prevent violations of the Code of Ethics. The clinician would have to ask themselves if proper background information was obtained and considered before assessing a client who was culturally and linguistically different from them. The clinician would also have to consider the possibility for implicit biases that could have manifested during a client’s evaluation. Implicit bias could have influenced the assessment results if a child presented with a language difference and the clinician marked that difference as incorrect. Re-assessment and proper diagnosis would need to be made on any client where implicit bias could have played a role.
The Code of Ethics is a helpful resource that should be utilized by all clinicians in any clinical scenario. The Code specifically addressed cultural and linguistic competence and how clinicians are to appropriately abide by their standards. Fully reading and referring back to ASHA’s Code of Ethics and reviewing additional resources provided on their practice portal is good practice to ensure successful and quality service.
American Speech-Language-Hearing Association. (2016). Code of ethics. Available from www.asha.org/policy/.
American Speech-Language-Hearing Association. (2017). Issues in ethics: Cultural and linguistic competence. Available from www.asha.org/Practice/ethics/Cultural-and-Linguistic-Competence/.
Ohio State University. (2015). Understanding Implicit Bias. Retrieved from http://kirwaninstitute.osu.edu/research/understanding-implicit-bias/.
Rudman, L.A. Social Justice in Our Minds, Homes, and Society: The Nature, Causes, and Consequences of Implicit Bias. Social Justice Research 17, 129–142 (2004).