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Play therapists and the terminology of autism

When discussing autism, terminology is significant, and much has been discussed about the use of identity vs person first language when referencing autism. An example of identity first language would be “autistic child” or autistic individuals.” An example of person first language would be “child with autism” or “individuals with autism.”

A basic inquiry in research, writings, and comments on social media will find play therapists and other child therapists very mixed in using both types of language, but is there a right way and a wrong way? A research study by Kenny (2015) sampled 3,470 participants in the UK – a mix of autistic adults, parents of an autistic child, and professionals who worked with autistic individuals. The study focused on preferred ways of describing autism and the rationale for such preferences. The term “autistic” (identity first language) was endorsed by a large percentage of autistic adults and family members/friends and parents, but by considerably fewer professionals. “Person with autism” (person first language) was endorsed by almost half of professionals but by fewer autistic adults and parents. None of the groups were unanimous in a preference or endorsement.

Bottema-Beutel (2020) stated that research on Australian samples has shown that autistic people rated the terms “autistic,” “person on the spectrum,” and “autistic person” significantly preferable than “person with autism.” Other U.S. and U.K. based research has shown that self-identification as autistic and awareness of the neurodiversity movement are associated with stronger preferences for the term “autistic person” over “person with autism.” In summary, research indicates the majority of autistic adults and those who support neurodiversity initiatives endorse identity first language, parents have a greater range in endorsement of either identity first or person first language, and the majority of professionals tend to endorse person first language.

I can remember when the person first language movement was in full application. It was considered the progressive and enlightened way to refer to someone. There was quite a mindful shift to using person first language as a way to show respect and value. This was a significant movement in medical and mental health care which might explain some of the reason many professionals are still using person first language. It is also true that some individuals/groups outside of autism still prefer the use of person first language when addressing a disability or disorder. Thus, play therapists are taxed with the responsibility of understanding the particular person/issue/group they are working with and being able to switch back and forth depending on the endorsement/preference.

Further awareness for many play therapists involves the fact that most of us work with children, and many children will not have processed or understood these concepts and it will likely be the endorsement/preference of the parent the play therapist is addressing. Research has not been as clear on parents’ endorsement as parents seem more evenly divided on language endorsement/preference. To further complicate issues, an older child or teen may be in a position where they are expressing a preference and their parents prefer something else. For the play therapist, this becomes an issue in therapy that will require sensitivity to navigate.

Due to the person first movement, I primarily used person first language for many years as this was identified as the respectful and professional guideline. I began to shift my language usage as I heard more from autistic adults about their preference for identity first language. At that point, I spent a considerable amount of time integrating both preferences in my writings and trainings trying to provide affirmation to different beliefs. More recently, I have committed to a more complete shift to using identity first language in reference to autism. There are a couple of reasons for this; 1) Research overwhelming supports that the majority of autistic adults endorse and prefer identity first language, and for me, this is vitally important – if the majority of individuals are expressing this is their want and preference – we should be validating (hearing and recognizing their voice). 2) As someone who is non-autistic but neurodivergent, I can identify with the awareness that there are things about me that are who I am and are not going to change with therapies, treatments, etc. I greatly appreciate when professionals understand this, and we work on what really needs to be addressed based on this understanding.

As play therapists, moving forward in our own growth, I have discovered a few tips that might be helpful:

  • In the therapeutic setting the client’s voice should be heard and respected. If the client prefers certain language be used, we should honor that preference.
  • A general default should be identity first language and certainly this can accompany an explanation if someone is inquiring why you are using identify first language. Often when I present or write, I will provide a disclaimer at the beginning that states “I am choosing to use identity first language due to research showing that the majority of autistic adults prefer identity first language. I realize there may be different thoughts in the audience. I respect differing views, but for our purposes today (or in this writing), I am defaulting to identity first language for the reason I just identified.”
  • Stay committed to learning and growth and pursue listening to and reading works by autistic adults who are writing, speaking, and training on the subject of autism.

In my history of work with autistic children and their families, there is one thing that has remained constant – this vulnerable population is greatly underserved in obtaining mental health services. Each time I meet a play therapist who provides therapy to autistic children, I am further delighted. Whether it is addressing terminology, or any other issue related to autism, we need to keep encouraging each other and growing together to help improve mental health access and services to autistic children and their families.

– Robert Jason Grant Ed.D, LPC, RPT-S, ACAS

Bottema-Beutel, K., Kapp, S. K., Lester, J. N., Sasson, N. J., and Hand, B. N. (2020). Avoiding ableist language: Suggestions for autism researchers. Autism in Adulthood. doi: 10.1089/aut.2020.0014

Kenny L, Hattersley C, Molins B, Buckley C, Povey C, Pellicano E. (2015). Which terms should be used to describe autism? Perspectives from the UK autism community. Autism, 20(4):442-462. doi:10.1177/1362361315588200

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