researchers have discussed this issue across many of the communicative and cognitive exceptionalities (Gibbs & Elliott, 2015; Gipps, 1999; Glaser & Silver, 1994; Klassen, Tze, Betts, & Gordon, 2011; Messick, 1984; Rogers, 2002; Rolison & Medway, 1985; Skrtic, 1991; Sleeter, 1996).
Positive impact, however, goes even further with services provided. An appropriate label does not just create reactionary influences to provide service delivery; it also enables a discerning clinician to carefully prepare a treatment plan that is tailored to the needs of the individual now accurately identified and labeled. In doing so, having the valid diagnostic label may lead to specific intervention that will overcome the identified deficits (Archer & Green, 1996; Brinton & Fujiki, 2010; Gross, 1994; Kamhi, 2014; Müller, Cannon, Kornblum, Clark, & Powers, 2016). In effect, strong assessment resulting in an accurate diagnosis is essential for good intervention to occur. To use a metaphor from Brinton and Fujiki (2010), “you must know where you are going to plan your route.”
Finally, an accurate diagnosis may have positive psychological and social consequences. For instance, individuals affected by various behavioral or medical symptoms can legitimate their problems and achieve self‐understanding once an accurate and valid diagnostic label is provided (Broom & Woodward, 1996). The individuals with impairment can address feelings of confusion, isolation, or inadequacy and construct new identities, and this, in turn, can assist in dealing more effectively with their problems (Gross, 1994; Gus, 2000; Kelly & Norwich, 2004; Riddick, 2000). Therefore, the diagnostic label can have a substantial positive impact on the lives of the individuals with disabilities (Broom & Woodward, 1996; Damico & Augustine, 1995; Gibbs & Elliott, 2015; Link, Cullen, Struening, Shrout, & Dohrenwend, 1989).
1.4.2 Negative Consequences
Labels, however, may also have negative effects. This is particularly true if the applied labels are not valid, or if a valid label is inappropriately or incorrectly applied. The most obvious destructive consequence occurs when an inaccurate label is applied. There are two ways that this may happen. For instance, a schoolchild may exhibit communicative or academic difficulties that are not due to actual impairment, but is misdiagnosed and labeled as disordered. In such a case, the mislabeled individual may be placed in special education or other remedial program. Often this means that the curriculum is reduced so that more time and effort may be spent on content that is deemed most important and salient, or that specific learning strategies are employed that may be necessary for impaired learners, but that limit learning by average students (Grigorenko, 2009; Van Kraayenoord, 2010). In these cases, inappropriate labeling provides poor opportunities for normal learners, and the expectations directed toward the inappropriately labeled individuals are reduced (Brantlinger, 1997; Connor & Ferri, 2005; Frattura & Capper, 2006; Rogers, 2002). Such situations often arise in contexts where students have language or learning difficulties arising out of cultural or language differences. When such students are referred for assessment, they are often mislabeled (Artiles & Ortiz, 2002; Cummins, 2000; Hamayan, Marler, Sanchez‐Lopez, & Damico, 2013; Trueba, 1988; Wilkinson & Ortiz, 1986). Their difficulties due to differences are categorized as disorders, and they are placed inappropriately in special education (Connor, 2006; Hamayan et al., 2013; Magnuson & Waldfogel, 2005; Trent, Artiles, & Englert, 1998).
The second type of misdiagnosis occurs when an individual with a difficulty due to some actual impairment is identified as having a different impairment. In these instances, the genuine impairment is not adequately addressed, remedial plans and the expectations for improvement may be inappropriate, and little positive change occurs. Labeling is particularly problematic in these cases due to the tendency to attach a stereotype to a label, and then to focus on the stereotypic behaviors in the labeled individuals regardless of the presence of other, even conflicting, symptoms (Madon, Hilbert, Kyriakatos, & Vogel, 2006).
Perhaps the most interesting, and potentially most serious, scenario for misdiagnosis occurs when the actual label applied is suspect, that is, when a diagnostic category itself may be invalid. Due to the subjective and fluid nature of labeling and application of diagnostic categories, numerous categories have been challenged in the research literature (Elliott & Grigorenko, 2014; Fairbanks, 1992; Van Kraayenoord, 2010). These challenges focus on the construct validity of the diagnostic categories themselves or indicate that the definitions used are too broad or subjective. For example, these claims have been made with regard to the recent definition of autism spectrum disorders (Bagatell, 2010; Gernsbacher et al., 2005; Waterhouse, 2013), dyslexia, auditory processing disorders (Cacace & McFarland, 1998), attention deficit hyperactivity disorder (Bussing, Schoenberg, & Rogers, 1998; Conrad & Potter, 2000; Prior & Sanson, 1986; Reid & Katsiyannis, 1995; Searight & McLaren, 1998), and specific language impairment (Cole, Schwartz, Notari, Dale, & Mills, 1995; Conti‐Ramsden, Crutchley, & Botting, 1999; Dollaghan, 2004; Peña, Spaulding, & Plante, 2006; Ukrainetz McFadden, 1996).
While the most obvious harmful consequences may result from errors in labeling, the negative impact of the process is more complex and insidious. It must be remembered that labels are actually summaries of complex symptoms, a “mental shorthand” that plays into the human inclination to stereotype and make generalizations (Leyens et al., 1994). While this propensity does assist in communicating ideas underlying the labels, there is also the tendency to stop looking at the individual and start assuming that he or she is defined by the label and its characteristics. This assumption enables the professional to stereotype the unique aspects of the labeled individual so that all children with the same label are considered similar. This results in a failure to notice and account for personal strengths and difficulties. The consequence is a reduction of individual differences and a limitation on the ways in which the individual is perceived and treated (Lubinski, 2000; Madon et al., 2006).
Another negative consequence of labeling arises from the very practice of assigning a label. If the intent is to label an individual, then often there is an assumption that not only the symptoms, but their origins exist within the individual being labeled. Consequently, there is a predisposition to localize the problems within the individual rather than to search for multiple factors and extraneous variables, including, for example, teaching styles, prior exposure to opportunities to learn and apply the targeted skills, and diversity issues in schoolchildren (Brown, 1995; Coles, 1987; Conrad, 2000; Forness, 1976; McDermott, 1987, 1993; Rapley, 2004). The decision to focus on intrinsic causal factors rather than extrinsic factors (or at least a combination) is likely a primary reason for the overrepresentation of various ethnic and socioeconomic groups in some aspects of special education (e.g., Cummins, 2000; Damico, 1991; Hamayan et al., 2013; Hood, McDermott, & Cole, 1980; McDermott & Varenne, 1995; McNamara, 1998). Treating labels as verification of intrinsic disability may also be based on the assumption that the source of all educational difficulties is related to causes that are intrinsic to students (Carroll, 1997; Gutkin & Nemeth, 1997). This assumption is exacerbated by the general lack of familiarity that the public has with the principles of language and learning in academic and communicative contexts.
Unfortunately, this belief in the primacy of intrinsic causal factors, exacerbated by labeling, frequently results in negative consequences. The label is often used to “explain away” the problem, so that if, for example, a child experiences poor teaching or unresponsive therapy, the propensity is to place blame on the child, not the methods or the teacher/therapist. The within‐child deficit model makes for an easy and effective excuse.
Since most people are not oriented to the complexity of human meaning making and the importance of systems theory when addressing learning and communicative processes (MacWhinney, 1998; Nelson, 2003; Perkins, 2005; Thelen & Smith, 1998; van Geert, 1998), they are often willing to localize problems in the individual; it is simply easier to do so. To ignore the complexity is often soothing even if it is misdirected. The problem with using the label to reduce the complexity, of course, is that poor results ensue. Even if teachers or rehabilitative professionals are dedicated to the remediation process, their best attempts at assistance often are misguided and ineffective. In fact, research has documented that labeling with a focus on an intrinsic deficit model typically results in overlooking various environmental factors that may