Diagnosogenic thinking in speech-language pathology and some viable alternatives


  • Judith Felson Duchan SUNY at Buffalo




Speech pathology, disability rights, diagnosis


Diagnosis has long played a central role in the field of speech-language pathology. It governs how clinicians define what they do, who they work with, and how they carry out their practice. Diagnosis also impacts individual clients, often negatively. In this sense, our field can be characterized as diagnosogenetic. This article describes the historical role diagnosis has played in the field since the late nineteenth century, argues how diagnosogenic thinking can be probematic, and offers alternative ways of construing and executing our clinical practices.

Author Biography

Judith Felson Duchan, SUNY at Buffalo

Judith Felson Duchan is Emeritus Professor, Department of Communication Disorders and Sciences, SUNY at Buffalo, New York, USA.


Ambrose, N. and Yairi, E. (2002). The Tudor study: Data and ethics. American Journal of Speech-Language Pathology, 11, 190–203. https://doi.org/10.1044/1058-0360(2002/018)

American Academy of Audiology. (2010). Practice Guidelines for the Diagnosis, Treatment, and Management of Children and Adults with Central Auditory Processing Disorder (CAPD). Available from: https://audiology-web.s3.amazonaws.com/migrated/CAPD%20Guidelines%208-2010.pdf_539952af956c79.73897613.pdf

American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and variations [Relevant Paper]. Available from http://www.asha.org/policy/RP1993-00208/

American Speech-Language-Hearing Association. (1996). Inclusive practices for children and youths with communication disorders [Position Statement]. Available from http://www.asha.org/policy/PS1996-00223/

American Speech-Language-Hearing Association. (2015). History of ASHA. Available from http://www.asha.org/about/history/

American Speech-Language-Hearing Association. (n.d.). SLP Education Summit Glossary. Available from https://www.asha.org/events/slp-summit-glossary/

Ayres, A. (1880). The Orthoepist: A Pronouncing Manual Containing about Three Thousand Five Hundred Words, Including a Considerable Number of the Names of Foreign Authors, Artists, etc., That Are Often Mispronounced. New York: Appleton.

Baker, E., Croot, K., McLeod, S., and Paul, R. (2001). Psycholinguistic models of speech development and their application to clinical practice. Journal of Speech, Hearing, and Language Research, 44, 685–702. https://doi.org/10.1044/1092-4388(2001/055)

Balandin, S. and Duchan, J. (2007). Communication: Access to inclusion. Journal of Intellectual and Developmental Disability 32 (4): 230–232. https://doi.org/10.1080/13668250701693902

Bamiou, D., Musiek, F., and Luxon, L. (2001). Aetiology and clinical presentations of auditory processing disorders – a review. Archives of Disease in Childhood, 85, 361–365. https://doi.org/10.1136/adc.85.5.361

Barnes, C. (1992). Emancipatory disability research: Product or Process? Available from http://citeseerx.ist.psu.edu/viewdoc/download?doi=

Barrow, R. (2008). Listening to the voice of living life with aphasia: Anne’s story. International Journal of Language and Communication Disorders 43 (1): 30–46. https://doi.org/10.1080/13682820701697947

Barton, L. (Ed.). (1996). Disability and Society: Emerging Issues and Insights. New York: Longman Publishing.

Beasley, D. and Manning, J. (1973). Experimenter bias and speech pathologists’ evaluation of children’s language skills. Journal of Communication Disorders 6, 93–101. https://doi.org/10.1016/0021-9924(73)90013-0

Bell, A. G. (1900). Visible speech. Werner’s Magazine, 25, March to August (pp. 213–221).

Bell, A. G. (1932). English Visible Speech in Twelve Lessons. 4th edition. Revised by Caroline A. Yale. Washington, DC: Volta Bureau.

Becker, H. (1963). Outsiders. New York: The Free Press.

Berko, J. (1958). The child’s learning of English morphology. Word 14 (2–3): 150–177. https://doi.org/10.1080/00437956.1958.11659661

Biklen, J. and Duchan, J. (1994). ‘I am intelligent’: The social construction of mental retardation, Journal of the Association for Persons with Severe Handicaps 19, 173–184. https://doi.org/10.1177/154079699401900303

Bonner, T. (1963). American Doctors and German Universities: A Chapter in International Intellectual Relations, 1870–1914. Lincoln, NE: University of Nebraska Press.

Bloom L. and Lahey, B. (1978). Language Development and Language Disorders. New York: Wiley.

Brinkerhoff, C. (1880). The Brinkerhoff Method for singing. The Voice 2 (3) 64.

Brown, R. (1973). A First Language: The Early Stages. Cambridge, MA: Harvard University Press. https://doi.org/10.4159/harvard.9780674732469

Byng, S. and Duchan, J. (2005). Social model philosophies and principles: Their applications to therapies for aphasia, Aphasiology 19, 906–922. https://doi.org/10.1080/02687030544000128

Chomsky, N. (1965). Aspects of the Theory of Syntax. Cambridge, MA: The MIT Press. https://doi.org/10.21236/AD0616323

Damico, J. and Armstrong, M. (1990–1991). Empowerment in the clinical context: The SLP as advocate. The NYSSLHA Journal, 18, 34–44. https://www.asha.org/uploadedFiles/asha/publications/cicsd/1991EmpowermentintheClinicalContext.pdf https://doi.org/10.1016/S0009-9260(05)80210-7

Damico, J., Müller, N., and Ball, M. (2010). Social practical considerations in labeling. In J. Damico, N. Müller, and M. Ball (Eds), The Handbook of Language and Speech Disorders, 11–37. Malden, MA: Blackwell. https://doi.org/10.1002/9781444318975.ch1

Duchan, J. (2001). Impairment and social views of speech-language pathology: Clinical practices re-examined. Advances in Speech Language Pathology 3 (1), 37–45. https://doi.org/10.3109/14417040109003707

Duchan, J. (2004). Assessment frames. In J. Duchan, Frame Work in Language and Literacy, 42–71. New York: Guilford Press.

Duchan, J. (2005). The phonetically-based speech therapy methods of Alexander Graham Bell. Journal of Speech Language Pathology and Audiology 29: 70–72.

Duchan, J. (2009). Where is the person in the ICF? Advances in Speech-Language Pathology 6 (1): 63–65. https://doi.org/10.1080/14417040410001669444

Duchan, J. (2011a). Diagnostic taxonomy of Stinchfield and Robbins. Available from: http://www.acsu.buffalo.edu/~duchan/history_subpages/stinchfieldtaxonomy.html

Duchan, J. (2011b). The social construction of relationships in healing interactions from ancient times to the present. In R. Fourie (Ed.), Therapeutic Processes for Communication Disorders, 153–165. Hove: Psychology Press.

Duchan, J. (2013). Professional issues: A view from history. In R. Lubinski and M. Hudson (Eds), Professional Issues in Speech-language Pathology (4th edition). Boston, MA: Cengage Learning.

Duchan, J. (2014). Case studies and their frameworks: Positivist, interpretive, emancipatory. In M. Ball, N. Müller, and R. Nelson (Eds), Handbook of Qualitative Research in Communication Disorders, 3–16. New York: Psychology Press.

Duchan, J. (2015). The elocution movement. Available from: https://www.acsu.buffalo.edu/~duchan/new_history/hist19c/elocution.html

Duchan, J. and Katz, J. (1983). Language and auditory processing: Top down plus bottom up. In E. Lasky and J. Katz (Eds), Central Auditory Processing Disorders, 31–45. San Diego, CA: College Hill Press.

Duchan, J. and Kovarsky, D. (Eds). (2005a). Diagnosis as Cultural Practice. Hawthorne, New York: Mouton De Gruyter Publishers.

Duchan, J. and Kovarsky, D. (2005b). Introduction. In J. Duchan and D. Kovarsky (Eds), Diagnosis as Cultural Practice, 1–13. New York: Mouton de Gruyter.

Dunglison, R. (1874). A Dictionary of Medical Science (2nd ed.). Philadelphia, PA: Henry C. Lea.

Edwards, M. and Shriberg, L. (1983). Phonology: Applications in Communicative Disorders. San Diego, CA: College Hill.

Foster-Galasso, M. (2005). Diagnosis as an aid and curse in dealing with others. In J. Duchan and D. Kovarsky (Eds), Diagnosis as Cultural Practice, 17–31. New York: Mouton de Gruyter. https://doi.org/10.1515/9783110199802.17

Gill, V. and Maynard, D. (1995). On ‘labeling’ in actual interaction: Delivering and receiving diagnoses of developmental disabilities. Social Problems, 42 (1): 11–37. https://doi.org/10.1525/sp.1995.42.1.03x0453k

Goffman, E. (1963). Stigma. Englewood Cliffs, NJ: Prentice Hall.

Green, S. (2003). ‘What do you mean “what’s wrong with her?”’: Stigma and the lives of families of children with disabilities. Social Science & Medicine 57, 1361–1374. https://doi.org/10.1016/S0277-9536(02)00511-7

Ingram, D. (1982). The assessment of phonological disorders in children: The state of the art. In M. Crary (Ed.), Phonological Intervention: Concepts and Procedure, 1–12. San Diego, CA: College Hill Press.

Johnson, W. (1938). The role of evaluation in stuttering behavior. Journal of Speech and Hearing Disorders 3, 85–89. https://doi.org/10.1044/jshd.0302.85

Johnson, W. (1939). Language speech and hygiene. General Semantics Monograph #1.

Jorgensen, C., McSheehan, M., and Sonnenmeier, R. (2010). The Beyond Access Model: Promoting Membership, Participation, and Learning for Students with Disabilities in the General Education Classroom. Baltimore, MD: Brookes Publishing Co.

Kagan, A. (2008). Supported conversation for adults with aphasia: Methods and resources for training conversation partners. Aphasiology, 12 (9): 816–830. https://doi.org/10.1080/02687039808249575

Kamhi, A. (2011). What speech-language pathologists need to know about auditory processing disorder. Language, Speech, and Hearing Services in Schools, 42, 265–272. https://doi.org/10.1044/0161-1461(2010/10-0004)

Katz, J. (1983). Phonemic Synthesis and other auditory skills. In E. Lasky and J. Katz (Eds), Central Auditory Processing Disorders: Problems of Speech, Language and Learning, Baltimore MD: University Park Press.

Kirk, S. and McCarthy, J. (1961). Illinois Test of Psycholinguistic Abilities. Urbana, IL: The University of Illinois Press.

Klingbeil, G. (1939). The historical background of the modern speech clinic. Journal of Speech Disorders 4 (2): 115–132. https://doi.org/10.1044/jshd.0402.115

Kofler, L. (1889). Take Care of Your Voice: Vocal Hygiene, Practical Hints. New York: E. S. Werner.

Koppenhaver, D., Spadorcia, S., and Erickson, K. (1998). Inclusive early literacy instruction for children with disabilities. In S. B. Neuman, and K. Roskos (Eds), Children Achieving: Instructional Practices in Early Literacy, 77–97. Newark, DE: International Reading Association.

Kovarsky, D. (2008). Representing voices from the life-world in evidence-based practice. International Journal of Language and Communication Disorders. Supplement 1: 43, 47–57. https://doi.org/10.1080/13682820701698036

Lahey, M. (1988). Language Disorders and Language Development. New York: Macmillan.

LPAA Project Group. (2001). Life participation approaches to aphasia. In R. Chapey (Ed.), Language Intervention Strategies in Aphasia and Related Neurogenic Communication Disorders. Fourth edition. Philadelphia, PA: Lippicott, Williams & Wilkins (with R. Chapey, J. Duchan, R. Elman, A. Kagan, J. Lyon, and N. Simmons Mackie).

Lund, N. and Duchan, J. (1983). Assessing Children’s Language in Naturalistic Contexts, Englewood Cliffs, NY: Prentice Hall.

Manning, W. (2010). Clinical Decision Making in Fluency Disorders. San Diego, CA: Singular.

McCarthy, D. (1946). Language development in children. In L. Carmichael (Ed.), Manual of Child Psychology, 476–581. New York: John Wiley & Sons. https://doi.org/10.1037/10756-010

McSheehan, M., Sonnenmeier, R., Jorgensen, C. M., and Turner, K. (2006). Promoting learning of the general education curriculum by students with significant disabilities. Topics in Language Disorders 26 (3): 266–290. https://doi.org/10.1097/00011363-200607000-00008

Mercer, G. (2002). Emancipatory disability research. In C. Barnes, M. Oliver, and L. Barton (Eds), Disability Studies Today, 228–249. Cambridge: Polity.

Mercer, J. (1973). Labeling the Mentally Retarded. Berkeley, CA: University of California Press.

Miller, J. (1981). Assessing Language Production in Children: Experimental Procedures. Austin, TX: Pro-ed.

Mowrer, O. H. (1954). A psychologist looks at language. The American Psychologist 11 (9): 660–694. https://doi.org/10.1037/h0062737

Nation, J. and Aram, D. (1982). The diagnostic process. In N. Lass, L. McReynolds, J. Northern, and D. Yoder (Eds), Speech, Language and Hearing. Volume II. Pathologies of Speech and Language. 443–476. Philadelphia, PA: W. B. Saunders Company.

Nisbet, J. (Ed.). (1992). Natural Supports in School, at Work, and in the Community for People with Severe Disabilities. Baltimore, MD: Paul H. Brookes Publishing Co.

Nittrouer, S. (2002). From ear to cortex: A perspective on what clinicians need to understand about speech perception and language processing. Language, Speech, and Hearing Services in Schools 33, 237–252. https://doi.org/10.1044/0161-1461(2002/020)

Oliver, M. (1988). If I had a hammer: The social model in action. In J. Swain, S. French, C. Barnes, and C. Thomas (Eds), Disabling Barriers – Enabling Environments. Thousand Oaks, CA: Sage Publications.

Oliver, M. (1992). Changing the social relations of research production, Disability, Handicap, & Society, 7 (2): 101–115. https://doi.org/10.1080/02674649266780141

Osgood, C. (1957). A Behavioristic Analysis of Perception and Language as Cognitive Phenomena. Contemporary Approaches to Cognition. Cambridge MA: Harvard University Press.

Paden, E. (1970). A History of the American Speech and Hearing Association. Washington, DC: The American Speech and Hearing Association.

Parr, S., Byng, S., Gilpin, S., and Ireland, C. (1997). Talking about Aphasia. London: Open University Press. https://doi.org/10.1044/0161-1461(2010/10-0004)

Parr, S., Wimborne, N., Hewitt, A., and Pound, C. (2008). The Communication Access Toolkit. London: Connect Press.

Porter, E. (1827). Analysis of the Principles of Rhetorical Delivery as Applied in Reading and Speaking. Andover: Flagg & Gould.

Potter, S. (1882). Speech and its Defects. Philadelphia, PA: P. Blakiston Son and Co.

Pound, C., Duchan, J., Penman, T., Hewitt, A., and Parr, S. (2007). Communication access to organisations. Aphasiology, 21: 23–38. https://doi.org/10.1080/02687030600798212

Prizant, B. (1983). Echolalia in autism: Assessment and intervention. Seminars in Speech and Language, 4 (1): 63–77.

Prizant, B. and Duchan, J. (1981). The functions of immediate echolalia in autistic children. Journal of Speech and Hearing Disorders, 46, 241–249. https://doi.org/10.1044/jshd.4603.241

Rees, N. (1973). Auditory processing factors in language disorders: The view from Procrustes’ bed. Journal of Speech and Hearing Disorders, 38, 304–315. https://doi.org/10.1044/jshd.3803.304

Robb, M. (1954). The elocutionary movement and its chief figures. In K. Wallace (Ed), A History of Speech Education in America, 181–184. New York: Appleton-Century-Crofts.

Rosenthal, R. (1966). Experimenter Effects in Behavioral Research. New York: Appleton-Century-Crofts.

Rosenthal, R. and Jacobson, L. (1992). Pygmalion in the Classroom. New York: Irvington (with Lenore Jacobson).

Schraeder, T., Quinn, M., Stockman, I., and Miller, J. (1999). Authentic assessment as an approach to preschool speech-language screening. American Journal of Speech-Language Pathology 8: 195–200. https://doi.org/10.1044/1058-0360.0803.195

Shriberg, L. and Kwiatkowski, J. (1980). Natural Process Analysis: A Procedure for Phonological Analysis of Continuous Speech Samples. New York: Macmillan.

Stathopoulos, E. and Duchan, J. (2006). History and principles of exercise-based therapy: How they inform our current treatment. Seminars in Speech and Language 27: 227–235. https://doi.org/10.1055/s-2006-955113

Simmons-Mackie, N., Kagan, A., O’Neill Christie, C., Huijbregts, M., McEwen, S., and Willems, J. (2007). Communicative access and decision making for people with aphasia: Implementing sustainable health care systems change. Aphasiology 21: 39–66. https://doi.org/10.1080/02687030600798287

Simmons-Mackie, N. (2000). Social approaches to the management of aphasia. In L. Worrell and C. Fratalli (Eds), Neurogenic Communication Disorders: A Functional Approach, 162–187. New York: Thieme Medical Publishers.

Skinner, B. F. (1957). Verbal Behavior. Cambridge, MA: Harvard University Press. https://doi.org/10.1037/11256-000

Stackhouse, J. and Wells, B. (1997). Children’s Speech and Literacy Difficulties: 1. A Psycholinguistic Framework. London: Whurr.

Stinchfield, S. and Robbins, S. (1931). A Dictionary of Terms Dealing with Disorders of Speech. Boston, MA: Expression Company.

Swain, J., French, S., Barnes, C., and Thomas, C. (Eds). Disabling Barriers – Enabling Environments. Thousand Oaks, CA: Sage Publications.

Tallal, P. (1980). Auditory processing disorders in children. In P. Levenson, and C. Sloan (Eds), Auditory Processing and Language, 81–100. New York: Grune & Stratton.

Templin, M. (1957). Certain Language Skills in Children: Their Development and Inter-relationships. Minneapolis, MN: The University of Minnesota Press. https://doi.org/10.5749/j.ctttv2st

Turner, S. and Whitworth, A. (2006). Conversational partner training programs in aphasia: A review of key themes and participant roles. Aphasiology 20 (6): 483–510. https://doi.org/10.1080/02687030600589991

United States Access Board. (2015). Mission. Available from: http://www.access-board.gov/the-board

UPIAS. (1976). Fundamental Principles of Disability. London: UPIAS.

Van Riper, C. (1981). An Early History of A.S.H.A. ASHA Magazine 23, 855–858.

Wepman, J. and Jones, L. (1961). The Language Modalities Test for Aphasia. Chicago, IL: University of Chicago.

Wepman, J., Jones, L., Bock, D., and Van Pelt, D. (1960). Studies in aphasia: Background and theoretical formulations. Journal of Speech and Hearing Disorders 25: 323–332. https://doi.org/10.1044/jshd.2504.323

Werner, E. (1881). Stuttering therapy. The Voice 3 (1): 1–2.

Werner, E. (1887). Werner’s Directory of Elocutionists, Readers, Lecturers, and Other Public Instructors and Entertainers. New York: Author.

West, R., Kennedy, L., and Carr, A. (1947). The Rehabilitation of Speech. 2nd edition. New York: Harper and Bros.

Wingate, M. (1962). Evaluation and stuttering: III. Identification of stuttering and the use of a label. Journal of Speech and Hearing Disorders, 27, 368–377. https://doi.org/10.1044/jshd.2704.368

Wingate, M. (1997). Stuttering: A Short History of a Curious Disorder. New York: Praeger.

Yairi, E. and Ambrose, N. (2001). The Tudor experiment and Wendell Johnson: Science and ethics reexamined. ASHA Leader 6: 13–17.



How to Cite

Duchan, J. F. (2020). Diagnosogenic thinking in speech-language pathology and some viable alternatives. Journal of Interactional Research in Communication Disorders, 9(2), 215–234. https://doi.org/10.1558/jircd.36997