New Studies Uncover Nuances in Disability and Mental Health Language Preferences

Recent investigations have delved into how individuals articulate and perceive their experiences with disabilities and mental health challenges. This week, *Mad in America* spotlights four distinct studies, each contributing to a deeper understanding of linguistic choices in these sensitive domains. A prominent theme across these studies is the interplay between a strong sense of disability identity and the inclination towards identity-first descriptors, such as 'disabled person,' contrasting with the person-first phrasing, like 'person with a disability.' These explorations collectively underscore the intricate and often personalized nature of language surrounding mental health and disability diagnoses, revealing that preferences are far from uniform and often depend on the specific condition and individual perspective.

The American Psychological Association (APA) has previously advocated for person-first language, suggesting it reduces stigma. However, some experts contend that this approach might inadvertently heighten stigmatization. While certain groups, like those with ADHD, may lean towards person-first terms, others, such as autistic individuals, frequently express a preference for identity-first language. This divergence highlights a critical discussion within the community, where the chosen words can significantly impact self-perception and public understanding.

A study published in *Rehabilitation Psychology* explored the connection between disability identity and language preferences, with Connie Janiszewski leading the research from Deakin University in Australia. The findings indicated a strong correlation: individuals with a more pronounced disability identity were more likely to favor identity-first language. Furthermore, the study noted that younger age, nonbinary gender identification, and visible disabilities were associated with both stronger disability identity and a greater preference for identity-first terms. This research, drawing from a self-report survey of 776 participants primarily from Australia, the US, and the UK, also found that neurodevelopmental, hearing, and pain disabilities often correlated with a stronger disability identity, whereas digestive and mental health disabilities showed a weaker link. Despite its valuable insights, the study acknowledged limitations, including its correlational design, unmeasured influencing factors like neurodiversity advocacy, potential self-report bias, and limited generalizability due to the predominantly Australian sample.

Another investigation, featured in *Schizophrenia*, examined the historical use of language in academic papers concerning schizophrenia. Maria Dino from the Universidade Federal de São Paulo in Brazil spearheaded this research, which revealed a notable decline over time in the use of identity-first language ('schizophrenic person') in favor of person-first ('person with schizophrenia') or neutral ('schizophrenia patients') terms. Analyzing 500 English-language articles published between 1951 and 2023, the study divided them into three timeframes. It found that while identity-first language was prevalent in earlier periods, it significantly decreased by the latest period (2014-2023), where neutral and person-first terms became dominant. The study acknowledged limitations, such as the underrepresentation of articles from low- and middle-income countries, the exclusive use of 'schizophrenia' as a search term, and the focus solely on English-language publications, which limits its scope regarding global linguistic practices.

In the *British Journal of Psychiatry*, Kate Cooper from University College London led research on ADHD language preferences among adults in the UK. This study found that most participants (77%) preferred person-first language ('I have ADHD'). However, higher rates of ADHD social identification were linked to a preference for identity-first language ('ADHDer') and increased psychotropic drug use. The study also observed a connection between learning about ADHD through social media and stronger ADHD social identification. While it suggested a possible association between ADHD social identification and higher self-reported anxiety and depression, these findings were not statistically significant. The research had limitations, including its inability to establish causation, the potential for self-report bias, a self-selected sample not fully representative of the UK ADHD population, and limited generalizability beyond the UK.

Finally, a study in *Frontiers in Psychology*, led by Patricia López-Resa from the University of Castilla-La Mancha in Spain, investigated language use in social media posts about autism. This research, analyzing 678 posts across five languages on the platform X (formerly Twitter), found that identity-first language was more common than person-first language. Furthermore, there was a significant increase in neuroaffirmative language since 2023, suggesting a shift away from a purely medical model in public discourse surrounding autism. The study indicated cultural and linguistic variations in framing autism, with neuroaffirmative framing being more common in English, French, and Norwegian posts, while medical framing was more prevalent in Spanish and Georgian. The authors attributed these trends to the growing influence of the neurodiversity movement. Limitations included the sole focus on X/Twitter, a potentially unrepresentative sample favoring vocal online advocates, and the inherent challenges in cross-linguistic mapping of complex concepts.

Collectively, these studies emphasize the dynamic and multifaceted nature of language when discussing disability and mental health. The shift from person-first to identity-first language in certain contexts, influenced by individual identity, social movements, and platforms, reflects a broader evolution in how society and individuals engage with these topics. This ongoing dialogue underscores the importance of respecting individual preferences and acknowledging the diverse ways people choose to define and express their experiences.