Critical Perspectives in Speech-Language Therapy: Towards Inclusive and Empowering Language Practices

Abstract

This conceptual paper critically examines the use of traditional medicalized terminology in speech-language therapy, with a particular focus on the Quebec context. It highlights how current language practices, rooted in a medical model of disability, often marginalize individuals with communication differences such as stuttering, autism, and aphasia by pathologizing these variations. Drawing on contemporary frameworks such as the social model of disability, neurodiversity, and “diversité capacitaire” (a French term that translates to “capacity diversity” or “ability diversity”, emphasizing the richness of diverse abilities and communication styles), the article advocates for more inclusive and empowering language that respects and reflects communicative diversity. The authors emphasize the importance of participatory approaches, including consultation with the communities directly involved and the establishment of terminological committees, to develop respectful and affirming language. Ultimately, this paper calls for a shift in speech-language therapy practices to promote a more inclusive understanding of communication, enabling individuals with communication differences to fully participate in society.

1. Introduction

In recent years, new terminologies have emerged in the field of disability to empower people living with disabilities. Neology, or the creation of new terms, is a complex procedure that begins with the need to accurately and respectfully name new discoveries, conditions, or practices that were not previously covered by the existing language. For example, “neurodiversity” is a neologism formed through the process of derivation, which involves adding affixes to an existing word to create a new one. Here, the Greek prefix “neuro-”, relating to the nervous system, is combined with “diversity” to signify variety within the nervous system. This term can also be considered a portmanteau word, as it merges the concepts of neurology and diversity into a single expression. The term, often credited to Judy Singer, an autistic rights activist, and journalist Harvey Blume, actually reflects a broader collective effort by autistic activist communities in the mid-1990s. The foundational concept of “neurological diversity”—later termed “neurodiversity”—emerged through discussions on platforms such as the Independent Living email list, where autistic individuals collaboratively theorized neurodiversity as a means of challenging disabling labels and promoting acceptance of neurological differences [1].

While some terms are more easily adopted due to their transparent meaning or natural integration into the structure of the language [2], neologisms must address a linguistic need and prove their relevance, often with the support of practice communities, research institutions, or professional organizations for their dissemination and standardization [3]. This article examines the terminology used in the field of speech-language therapy and the need for a shift to encourage and reflect more inclusive practices.

Speech-language pathology is a discipline that focuses on human communication. More specifically, speech-language pathologists support individuals who experience communication-related disabilities, such as stuttering, hearing loss, autism, or aphasia. Initially formalized as a distinct profession closely associated with the medical field [4,5], speech-language pathology first focused on the correction of “disorders” of speech or language. The very essence of the term “speech-language pathologist” reflects the birth of this discipline within the medical sphere. As Chesworth [6] emphasizes, the term “pathologist” comes from the Greek word pathos, which means “suffering”; a pathologist is someone who identifies and defines conditions as pathological. For the purposes of this article, the term “speech-language therapy/therapists” will be used.

This medical approach has naturally influenced the way disabilities are conceptualized and described [7], which is reflected in the choice of words still used today, often carrying a perspective that pathologizes the individual by presenting them as suffering from a deficiency or personal misfortune [6]. A medical perception of communication and its variations has guided speech-language therapy toward a corrective practice aimed at deviations from a norm, thereby promoting uniformity in speech and language [8].

The language we use plays a crucial role in shaping our perceptions of both the world and ourselves [9]. For instance, recent studies in experimental psycholinguistics have demonstrated that the application of the grammatical rule in French, where the masculine form overrides the feminine, triggers masculine representations of concepts [10,11]. In practice, this means that when referring to a mixed-gender group, such as a group of firefighters, only the masculine term “pompiers” is used. This tends to activate a predominantly male image of the group, leading individuals to envision only male firefighters. However, when both masculine and feminine forms are used—“pompiers” and “pompières”—individuals are more likely to imagine a group that includes both male and female firefighters. This example illustrates how language can serve to reinforce stereotypes [10,11]. In this case, language perpetuates the stereotype that firefighting is an exclusively male profession. Moreover, language shapes cognitive representations, which in turn influence societal practices [12]. Continuing with this example, women may be less likely to perceive the profession of firefighting as accessible to them, under the assumption that it is traditionally reserved for men. Thus, inclusive language emerges as a critical tool for promoting gender equality.

These psycholinguistic studies shed light on similar debates within disabled communities. For example, Epp [13] has highlighted that reductive terms like “mentally retarded” were strongly criticized by self-advocacy groups, as they stigmatize individuals by reducing them to a single identity, obscuring the complexity of their experiences. Similarly, the binary division between “normal” and “abnormal” in speech-language therapy discourse reinforces a hierarchy that marginalizes disabled individuals [6]. These categorizations, deeply rooted in language, reflect social biases that view disability as inferiority, biases that are often perpetuated by both external forces and the communities themselves.

The ableist orientation of medicalized terminology is thus being challenged. It risks imposing limitations on individuals with disabilities or those who are deaf by pressuring them to conform to dominant communication norms. This could in turn hinder their ability to fully participate in civic life [14]. This process of “othering” also reduces the richness of human diversity to rigid clinical categories, further marginalizing individuals and contributing to the stigmatization of their communication [15,16].

In this context, the issue of language in speech-language therapy also arises. Despite a shift towards more inclusive and less medicalized practices, speech-language therapists continue to encounter terms inherited from a traditional medical framework, terms that do not always reflect progress toward a more respectful and affirming view of different forms of communication.

This conceptual article critically examines the terminology in use in the field of speech-language therapy, focusing on the Quebec context, a French-speaking province of Canada where the authors live and work. In Quebec, speech-language therapists hold a protected professional title regulated by the “Ordre des orthophonistes et audiologistes du Québec”, a protection closely tied to the medicalization of professional acts. The article explores the evolution and implications of such medical terminology in speech-language therapy, highlighting critiques and limitations of a medicalized view of disability. While a paradigmatic shift is underway toward a social conception of disability, which promotes person-first approaches, the field’s continued reliance on evidence-based practice remains rooted in a medical framework that often reduces participants to homogenous groups based on shared clinical characteristics, overlooking individual identities. By examining these tensions, this article broadens the discussion to a global context, encouraging readers to generalize these reflections and take action toward more inclusive and empowering language practices.

2. Implications of Medical Terminology

One of the responsibilities of speech-language therapists is to assess a person’s communication in order to determine the nature of any variations in their communication. To do this, speech-language therapists use a terminology that allows them to describe groups of communication profiles under a single name. Many of these terms are problematic. For example, terms such as “communication disorders”, “fluency disorders”, and “language disorder” are commonly used. The umbrella term “communication disorders” is often employed to refer to a set of ways of communicating that deviate from more commonly used methods of expression, comprehension, interaction, writing, or reading. “Fluency disorders” refer to speech that is considered disfluent, meaning it may have interruptions in its rhythm. Stuttering is an example of a “fluency disorder”. Finally, “language disorder” is a term used to describe a speech-language therapy diagnosis indicating neurodevelopmental difficulties in understanding or expressing a message, whether orally or in writing. Similar difficulties can also result from acquired variations labelled as “aphasia” (from Greek, aphatos ‘speechless’, from a- ‘not’ + phanai ‘speak’). All these terms implicitly suggest a disruption of the norm, thereby minimizing the richness of different ways of communicating and reinforcing a deficit-based view of communication, in contrast to an appreciation of communicative diversity.

Similarly, the expression “autism spectrum disorder” can pathologize a neurological variation, implying something to be corrected rather than understood and accepted as a valid human difference. Furthermore, terms like “dyslexia” and “dysorthographia” to describe developmental or acquired variations in reading (e.g., difficulty decoding written words) or writing (e.g., difficulty writing words according to established spelling norms), respectively, which carry connotations of intrinsic defect or difficulty, reinforce the idea that these ways of learning are inferior.

The words used by speech-language therapists to describe communication variations are not without consequences. These terms can be adopted by the individuals they refer to, who may use them to describe themselves and shape their identity. In an online synchronous forum titled “More About the Language We Use” [17], participants emphasized that terms like “disorder” and “impediment” are “words given to [them] by speech-language therapists”. It is possible that before speech-language therapists applied these terms to describe their communication, individuals with communication differences did not perceive any issues with their ways of speaking. In fact, it is not uncommon within the stuttering community to hear that it was only after a child consulted a speech-language therapist that they began to view stuttering as a problem [18]. In this regard, St. Pierre [15] points out that although speech-language therapists often act with altruistic intentions, they reinforce norms of efficiency, clarity, and rhythm, which contribute to the social construction of stuttering as an “anomaly”, a form of speech to be eradicated. By using pathologizing terminology, speech-language therapists may inadvertently lead individuals to believe that their way of communicating is inadequate, potentially reinforcing negative self-perceptions and exacerbating self-stigmatization [19]. Reflecting this, participants in the forum [17] also expressed their desire for a future where “individuals can choose the terms they wish to use” to describe themselves, underscoring the need for more empowerment and self-determination in shaping their own identities.

Thus, speech-language therapists use vocabulary and terminology to name, describe, and justify in their everyday work. But what are they really naming? Like any field in healthcare, speech-language therapy evolves, and with this evolution come new practices that are increasingly rendering the terminology inherited from the medical model outdated. A closer look at these transformations helps us better understand the growing gap between current terminology and new inclusive approaches.

3. Paradigm Shifts in Speech-Language Therapy

3.1. New Models for Conceptualizing Speech-Language Therapy and Disability

Emerging models in speech-language therapy are rethinking how disability and communication differences are conceptualized, driving the field toward more inclusive practices. These practices have been increasingly influenced by social conceptions and models of disability, particularly the social model, which highlights that social and environmental barriers, rather than individual impairments, play a major role in the limitations experienced by people with disabilities [20]. Notably, disability experts from Quebec significantly contributed to the development of inclusive frameworks that align with the principles of the social model by emphasizing the role of social and environmental barriers in the experiences of people with disabilities [21]. Among them was Patrick Fougeyrollas, a health anthropologist who, alongside the creation of the International Classification of Functioning, Disability, and Health, collaborated in updating the concept of disability for Quebec’s Office des personnes handicapées in the 1990s. This work led to the creation of the Quebec Classification: Disability Creation Process [21,22]. Since then, this model has been revised, enhanced and renamed the Human Development Model-Disability Creation Process (HDM-DCP) [23].

The HDM-DCP is promoted in rehabilitation (which includes speech-language therapy) in Quebec, favored in clinical settings [24], and largely taught in Quebec rehabilitation curriculum. The HDM-DCP is an ecosystemic or interactionist conceptual model that explains the causes and consequences of disability situations. It is based on the idea that the disability situations experienced by a person result from the interactions between personal and environmental factors [23]. Therefore, it is relevant and usable for any domain, including speech-language therapy.

In speech-language therapy, the application of this model allows for a rethinking of traditional practices focused on correcting communication deficits. Rather than considering only individual limitations, the HDM-DCP emphasizes the importance of the social and physical environment in either creating or reducing disability situations. This means that an individual with communication difficulties may experience an amplified disability due to environmental barriers (e.g., lack of adapted tools, negative attitudes) or, conversely, see their disability reduced through proper accommodations and support (such as assistive technologies or changes in social attitudes). This model shifts the focus from the individual’s impairment to transforming the environment to promote greater social participation and to value the diversity of communication methods.

However, despite the HDM-DCP’s environmental and interactionist perspective, the persistence of medicalized terminology within speech-language therapy can still reinforce an individualized, pathology-centered view of communication differences. For instance, the HDM-DCP describes identity aspects—such as age, gender, and sociocultural background—as “personal factors”. This framing alone risks obscuring the systems of power and oppression that shape these identities and communication experiences [25]. From an intersectional perspective, treating identity dimensions as solely personal attributes can erase the societal norms and structural power dynamics that influence communication and, by extension, limit the capacity of speech-language therapists to fully implement socially inclusive practices [25].

Adopting more inclusive terminology could help address this limitation by encouraging clinicians to approach communication differences within a broader social context that acknowledges both the diversity of communicative experiences and the impact of environmental factors. Such a linguistic shift could foster a more inclusive speech-language therapist practice, creating environments where individuals with communication differences are respected and valued as integral members of the social fabric. In this context, the adoption or creation of new, non-medicalized terms is intrinsically tied to transforming the professional environment—including its language practices—to promote inclusion and appreciation for communicative diversity.

3.2. New Ways of Conceptualizing Differences

Since the arrival of the HDM-DCP in the 1990s, other conceptual frameworks have built upon this social understanding of disability and have gained significance in the field of speech-language therapy. For example, neurodiversity goes beyond considering the environment in the understanding of disability situations. It recognizes and celebrates neurological differences as natural variations of humanity, encouraging the acknowledgment and appreciation of these differences in the same way we value ethnic or gender diversity. This perspective promotes the acceptance of individuals as they are, rather than seeking to “correct” them [26]. Similarly, the concept “diversité capacitaire” (which could be translated as “capacity diversity” or “ability diversity”) advocates the idea that all forms of abilities (and thus disabilities) constitute human richness and contribute to our social fabric [27], a notion that could be beneficially adapted to the specific context of speech-language therapy with the term “communication diversity” to encompass the full range of human communication variations. Constantino’s concept of stuttering gain exemplifies what communication diversity can look like in speech-language therapy, by suggesting that stuttering can foster meaningful connections through vulnerability, trust, and unpredictability, enriching communication in ways that fluent speech cannot [28]. Similarly, JJJJJerome Ellis’ concept of the clearing sees stuttering as an opportunity to create a pause, or a space, in time where traditional expectations of fluent speech disappear. These moments offer a “clearing” in communication, allowing for a deeper presence in the conversation and creating alternative temporalities that resist the norms of fluent time [29].

3.3. Theoretical Shifts Impacting Practices

This shift in paradigms adopted in speech-language therapy has been reflected in the work of numerous researchers as well as in professional practices, particularly through the consideration of the impact of the environment on the daily lives of individuals with communication differences.

The field of clinical aphasiology is illustrative of a shift toward a more social approach in speech-language therapy. Since the 1980s, researchers have been studying interventions for aphasia that take into account the impact of the social and environmental context on the lived experiences of people with aphasia [30,31]. With these approaches, it is recognized, among other things, that the responsibility for communication is shared between the person with aphasia and their conversation partners. For example, communication partner training, which involves teaching interlocutors strategies and resources to support communication [32], is recommended in several international best practice guidelines, not only in aphasia [33] but also in major neurocognitive disorders [34] and traumatic brain injury [35]. In this context, where the focus is on adapting the environment and sharing communication responsibilities, can the use of terms like “disorder” still be justified, especially when we seek to integrate these differences as part of the social fabric?

In parallel, an anti-ableist trend is emerging in the field of stuttering research and scientific literature, challenging the traditional perspective of stuttering as a speech defect to be eradicated. For instance, Gerlach-Houck and Constantino [36] advocate for the adoption of inclusive language that recognizes and values the diversity of terminological preferences within the stuttering community. They emphasize the crucial role of speech-language therapists as allies in promoting positive social and attitudinal change regarding stuttering, particularly by aligning with the preferred terminology of those in therapy, whether it focuses on the person (person who stutters) or the identity (stutterer). Similarly, the academic, professional, and artistic collective Stuttering Commons also embraces this movement by considering stuttering not as a flaw to be corrected, but as a legitimate and creative form of expression [37]. In line with these efforts, their Bridging Dysfluency Theory and Clinical Practice workshop series, designed for speech-language therapists, has highlighted anti-oppressive practices, stressing the importance of using anti-pathologizing language in clinical settings [38].

Despite theoretical adherence by clinicians, the practical adoption of these approaches has been slow [39]. For instance, although the HDM-DCP is often taught in academic speech-language therapy programs and favored in Quebec clinical settings [24], clinicians face institutional challenges in fully implementing it in their practice. This duality creates discomfort for some professionals, who are confronted with the dissonance between traditional medical practices and the expectations of disability communities and research [40], highlighting the need for more inclusive and diverse approaches. Revising speech-language therapy terminology could better reflect this social perspective of disability and help bridge the gap between theory and practice, as language would promote these inclusive practices.

In this context, the adoption or creation of new non-medicalized terms is intrinsically linked to the idea of transforming the environment, including the language used in the profession, to promote inclusion and the appreciation of communicative diversity. This linguistic revision, far from being a mere change in vocabulary, is a concrete manifestation of the social models of disability, aimed at dismantling the prejudices and norms that stigmatize certain ways of communicating.

4. Specific Examples of More Inclusive Terminologies

In speech-language therapy, a movement toward more inclusive terminology is evident, particularly through significant changes in the language used. This section of the paper presents some of these initiatives conducted in the Quebec context and elsewhere in the world.

First, at McGill University in Montreal, Canada, the speech-language therapy program has adopted the name “sciences de la communication humaine” in French, which can be translated as “Human Communication Sciences” [41]. Interestingly, this inclusive terminology in the program’s French title is not reflected in its English name, “School of Communication Sciences and Disorders”, which retains the notion of disorders or problems with the term “disorders.”

Additionally, as shared by speech-language therapists Jade Cliche and Alexandra Seymour on the podcast Je je je suis un podcast, the language used in speech-language therapy practice is under review by an advisory committee at one of Montreal’s largest rehabilitation centers, the Marie-Enfant Centre of CHU Sainte-Justine, which offers services to individuals with motor or communication disabilities [42]. This committee has initiated a first phase of terminological revision with clinicians and plans to extend the consultation to service users, including children and adolescents with various communication conditions such as stuttering or dyslexia and their families. A key aspect of this revision is the reassessment of the vocabulary used in clinical records to ensure that it conveys a respectful and non-stigmatizing perspective. For example, instead of mentioning a “fluency disorder”, the term “stuttering” is preferred for its clarity and acceptance within the community [43]. The expression “problem perception” has been replaced by “perception of stuttering/the situation”, which evokes a more objective view. Moreover, the issue of “severity” has been replaced by the “degree of impact” on daily life activities. These terminological changes reflect a shift toward language that promotes acceptance, as illustrated by the recommendation to replace the goal of “increasing fluency” with that of “increasing comfort in communication” (e.g., pleasure, spontaneity).

The recommendations of the advisory committee at the Marie-Enfant Rehabilitation Centre are echoed in the reflections of Tichenor et al. [43], who question the use of the term “fluency” in stuttering therapy. They argue that this term defines stuttering by what it is not, contrasting it in a binary way with fluency and portraying stuttered speech as a failure, leading to stigmatization and misunderstanding of the lived experiences of people who stutter. Consequently, it is suggested that “fluency disorder” be replaced with “stuttering” in research and clinical practice. These changes are also steps toward embracing a social model of disability within speech-language therapy, as recommended by Constantino et al. [20]. By reframing terms, speech-language therapists can shift away from a pathology-centered view that defines communication differences as deficits, moving instead toward inclusive language that recognizes individuals’ experiences and adapts to their social contexts. For instance, replacing the goal of “increasing fluency” with “increasing comfort in communication” aligns with the social model’s focus on reducing environmental barriers and promoting acceptance. Indeed, having the goal of “increasing comfort in communication” will lead to exploration of strategies such as disclosing stuttering, teaching the family and allies to be mindful of stigmatizing language, and to act as advocates, etc. As highlighted by Constantino and colleagues, such shifts in terminology and therapy goals reinforce that individuals with communication differences are not inherently deficient but face disabling barriers within societal expectations of fluency [20].

Similarly, perspectives are evolving to adopt definitions of stuttering that move away from the traditional medical model. A classic medical definition characterizes stuttering as “a motor disorder of speech flow that is produced with increased muscular effort; this disorder […] causes psychological distress; as a result, the listener experiences a disruptive disorganization of speech intelligibility” (our translation, originally in French) [44]. This interpretation describes stuttering as an individual anomaly with negative consequences. In contrast, modern approaches, such as the one proposed by British speech-language therapist Sam Simpson [45], and later reiterated by Sisskin [16], present stuttering in a more neutral way, as “a neurodevelopmental difference that results in a disruption in the execution of speech sounds […] compared to social norms” (p. 117). This conception of stuttering highlights the discord between the individual and social expectations, rather than an intrinsic deficiency in the individual.

The autistic community is another group that has experienced significant evolution over time in the terms used to describe autism. Terms such as “pervasive developmental disorder”, “severe autism”, “high-functioning autism”, and “functional autistic” have been used, each carrying specific implications regarding the understanding and acceptance of autism [46]. Fecteau et al. [47] explored the most appropriate terminology for discussing autism within the French-Canadian autistic community. Based on responses from 327 participants, including both autistic individuals and professionals (e.g., speech-language therapists, occupational therapists), the study highlighted a preference for respectful terminology, respectful of the person’s personal choice, and prioritizes simple, precise, and community-recognized terms. The study also conducted individual interviews, revealing a strong preference among autistic individuals for the expression “autistic person”, which was seen as free of negative connotations and emphasized the primacy of the person. It is worth noting that in French, this term does not fully align with identity-first language as it does in English, since the word “person” appears first. Moreover, the study participants justified their preference for this term with arguments referencing person-first language, such as highlighting that it emphasizes the whole person and not just autism. The term “autistic” alone was also appreciated for its simplicity and its ability to be free from shame or prejudice. Similarly, research among Australian autistic adults has shown that although “autistic” remains a popular choice, it can be polarizing, suggesting that some individuals view identity-first language as empowering while others find it stigmatizing or limiting [48]. These two studies highlight that the terminological debate may not be about choosing between “person-first” or “identity-first” language but rather about emphasizing autism as a difference rather than a disorder or deficit, which terms like “person with autism” or “person on the autism spectrum disorder” suggest. In contrast, professionals tend to favor the term “person with autism spectrum disorder”, a choice of words often rooted in professional vocabulary. These results highlight a dichotomy between the personal perception of autism by autistic individuals and the terminology used by professionals in the field.

In the clinical world, the shift from “autism spectrum disorder” to simply “autism” or “autistic” can enhance the implementation of social approaches in therapy by moving away from a deficit-focused, medicalized view of autism and instead emphasizing acceptance and practical strategies for navigating social contexts. By adopting the term “autistic” rather than “autism spectrum disorder”, therapists can frame autism as a distinct, valuable part of identity rather than a pathology to be “treated.” This change in terminology can guide therapy toward helping autistic individuals understand and manage societal expectations, which often reflect ableist norms that may conflict with autistic modes of communication. For instance, instead of focusing on teaching eye contact as a rigid behavioral goal [49], therapy could center on building awareness of how societal norms around eye contact and communication vary, and developing strategies that respect the autistic individual’s comfort while allowing for effective interactions. This might include helping autistic individuals decide when and how to disclose their autism to others, educating teachers, employers, and peers about autism, and advocating for workplace or educational accommodations that foster inclusivity.

The findings of Fecteau et al. [47] shed light on the current debate between the choice of “identity-first” terms (such as “autistic” or “stutterer”) and “person-first” terms (such as “person with autism” or “person who stutters”), illustrating individual preferences regarding identification. The use of “identity-first” language is often favored in communities like the autistic community, and it marks an acceptance and celebration of difference or disability as an intrinsic part of a person’s identity, manifesting positive self-esteem and destigmatization [50]. Conversely, the “person-first” approach is supported by others as a reminder that disability does not define the entirety of a person. This strategy seeks to emphasize the person above all, minimizing the dominance of the condition or disability [47]. However, proponents of the “identity-first” approach argue that disability constitutes an essential part of a person’s identity and individuality, contending that any attempt to minimize it conveys the idea that disability is a misfortune [51], which aligns with a medical model of disability.

Furthermore, in an episode of his podcast series “Ça prendra l’temps que ça prend: quête d’un bègue” (meaning “It Will Take the Time It Takes: A Stutterer’s Quest) [52] on Radio-Canada, the Canadian public broadcaster, Michel Montreuil, a producer living with stuttering, explores the nuances and balance between the contrasting expressions “stutterer” and “person who stutters.” He explains that stuttering is not simply “something he does”; ingrained in his brain function, it becomes “who [he is], [his] condition.” Montreuil continues his reflection on language in relation to his own journey of acceptance—”if this is who I am, maybe it’s easier for me to be less hard on myself […] what I need now is not only to accept, but to claim the word ‘stutterer’ because my fluency varies so much that if I am always a stutterer, I am not always a person who stutters.”

Ultimately, the preference for “identity-first” or “person-first” language reveals the complexity of personal identification, highlighting the importance of adopting a listening posture and collaborating with the concerned communities in establishing new terminology.

5. Implementing New Terminologies: The Future Is Participatory

Many professionals in speech-language therapy find their choice of terms guided by tradition and the desire to align with the language used in academic publications. However, these norms often persist without considering the preferences of the targeted communities, due to the lack of integration of these communities in key research positions. The CATALISE consensus is a good example of this. Developed by international experts on “language disorders”, the CATALISE consensus aimed to standardize terminology and diagnostic criteria associated with developmental language disorder [53,54]. CATALISE recommends using the term “developmental language disorder” to identify individuals exhibiting these characteristics. The consensus was reached using the Delphi method [55,56], a systematic consultation approach that achieves consensus on specific topics through a series of anonymous questionnaires, with successive feedback and adjustments until a final agreement is reached. The experts involved in this process included speech-language therapists, psychologists, and pediatricians. However, individuals directly concerned by “developmental language disorder” were not included in the discussions. While the CATALISE consensus has played a key role in harmonizing diagnostic criteria, it did not address the issue that the use of the term “disorder” could increase stigmatization by pathologizing communication differences. The continued use of the term “language disorder” persists without consultation with the individuals concerned, highlighting the need for more inclusive approaches that incorporate the perspectives of those living with these realities. This aligns with findings that genuine participatory methods not only demand clear processes for inclusion and power-sharing but also underscore the value of direct involvement by concerned communities in research decisions, fostering trust and better representation of their lived experiences [57].

Participatory research methods can help address this, encouraging the active involvement of the people concerned, both in research and in editorial decision-making. In these contexts, it becomes essential to involve the right people, at the right time, and for the right project, ensuring that their experiences and knowledge align with the research needs [58]. In particular, this would take into account the importance of individual preferences for terms such as “identity-first” or “person-first”, underscoring how these language choices can reflect and respect the identity and lived experiences of individuals. It aligns with the principles of active listening advocated by decolonization movements, where listening is an engaged process that centers marginalized voices. Decolonizing speech-language therapy, therefore, not only challenges dominant medicalized models that emphasize “correcting” communication deviations but also reshapes the language used to describe communication differences. Listening in this context acknowledges and values the experiences of those historically marginalized by such models [59].

By integrating this perspective into the creation of new terminology in speech-language therapy, professionals can contribute to the empowerment and recognition of marginalized communities in defining their own linguistic realities. To achieve this, structured participatory processes are crucial. In the context of participatory and inclusive reflection on terminology in speech-language therapy, participatory research approaches, consultation with communities, and the creation of terminological committees are particularly relevant. In addition to the communities personally affected by terminology choices, it is essential to involve other stakeholders who use these terminologies, such as professionals and researchers. Indeed, a lack of consensus on the terms used to describe a communication profile or communication differences could impact access to services and hinder both practice and research on the subject [53,54].

Among the participatory research approaches in speech-language therapy, organizing a World Café and using consensus-building methods are promising strategies to include the perspectives of stakeholders. The World Café [60] facilitates creative and cross-disciplinary dialogue between people concerned, speech-language therapists, and researchers to co-create terminology that reflects everyone’s needs. This method unfolds in stages, where participants exchange ideas and perspectives in small groups. Similarly, consensus-building methods, such as the Delphi method [56] or the nominal group technique [55], solicit expert opinions, including those with lived experiences, through successive consultations to refine a consensus on terms such as “language disorder.” These approaches emphasize the importance of inclusion and adaptability in overcoming participation barriers, highlighting that the challenge is not people’s ability to contribute but rather how to facilitate their inclusion.

Like the study conducted by Fecteau et al. [47], online surveys are another method that can reach a large number of people and gather valuable data on the preferences and perspectives of the communities concerned.

In both clinical and community settings, as well as in research and beyond, a terminological committee, like the one established at the Marie-Enfant Rehabilitation Centre, can be created to examine and discuss linguistic practices in a field or setting. It is essential that the concerned communities are included. This committee would first identify and list potentially problematic terms in use, in light of critical perspectives in speech-language therapy. The committee could be temporary or permanent, depending on the needs.

While awaiting the adoption of new terminology, speech-language therapists face administrative and work culture challenges that sometimes require them to use non-preferred terms. Since many speech-language pathologists in healthcare work closely with other healthcare professionals, including physicians, they may find it more convenient to use terminology grounded in a medical model of disability, as it aligns with the jargon used in their field. As emphasized by the CATALISE project team, using common terminology remains essential for service accessibility [53,54]. Speech-language pathologists must therefore develop strategies to introduce more inclusive terminologies in their workplaces while ensuring continued access to services during these transitions. For example, in response to such constraints, the stuttering community of practice in Quebec has adopted a pragmatic approach: while complying with the requirements for accessing public services, which impose terms like “fluency disorders”, it recommends adding an explanatory note in official reports [61]. This note clarifies that the use of the term is solely due to administrative constraints, affirming the recognition and respect for the diverse experiences of people who stutter. This practice emphasizes the importance of balancing respect for administrative procedures with consideration of individual preferences, promoting transparent and respectful communication.

6. Conclusions

A critical reevaluation of the terminology used in speech-language therapy is essential in a context where communicative diversity must be valued rather than stigmatized. In addition to marginalizing individuals, ableist and medicalizing terms can negatively influence their identity and social participation. Approaches such as the social model of disability, neurodiversity, and capacity diversity have the potential to transform speech-language therapy into a more inclusive discipline, one that respects different ways of communicating. This reflection on terminology is part of a broader process of decolonization and linguistic reappropriation, aimed at promoting a holistic view of disability. The adoption and creation of new terms, in consultation with the communities concerned, could not only enrich speech-language therapy practice but also contribute to better acceptance and recognition of diverse ways of being and communicating.