New Considerations for Employers Regarding Workplace Integration: The Impact of Communication Disorders

Integration: The Impact of Communication Disorders

by Jacques Barrette Ph.D, Linda J. Garcia Ph.D. and Chantal Laroche Ph.D.


The aim of the present research was to examine with the help of manufacturing and service industry employers, the factors that may prevent the occupational integration of persons experiencing communication disorders. The identification of adjustment strategies that may be implemented by employers in order to facilitate the workplace integration of such persons was also an objective. The information was collected by using focus group and nominal group techniques and then analyzed on the basis of whether the barriers originated with the individual, the organization or society. The qualitative differences were recorded according to whether the participating employers were from the manufacturing or service industry. The results showed that many barriers differ according to the industry sector and that the majority of barriers pertain to the nature of the work. Recommendations regarding strategies to eliminate such barriers for persons with a communication disorder were also collected.


Current and upcoming technological change will make communication an increasingly pervasive feature of the workplace environment. In the past, the manufacturing sector provided a major part of job opportunities (e.g., manufacturing plant). However, today's workplace is shifting away from these types of jobs, as service industry positions are growing at full speed. Over the next ten years, the labour market, which is currently based on the secondary sector , is expected to become a job market dominated by services and communication technologies (Kutscher, 1992). The service industry will likely provide 90% of all new jobs, many of which will be related to customer services (Carey & Franklin, 1992). This technological revolution is forcing individuals to retrain in the service industry where communication is an important ability. This new workplace must and will have to provide for the effective management of disability and handicap situations. In fact, it is already faced with several new handicap situations resulting from the specific demands of service industry positions. For example, health problems related to the intensive use of computers (e.g., eyesight) are being observed.

Although less known, communication disorders may also lead to situations of handicap in the workplace. A communication disorder is defined as an impairment in the ability to receive, transmit, process and understand verbal and non-verbal concepts as well as systems of graphic symbols (American Speech-Language-Hearing Association, 1995). A communication disorder may be experienced at the level of hearing, language and/or speech. Its range may vary from light too severe and the disorder may be congenital or acquired. In 1986, a survey indicated that 30% of Canadians with disabilities experienced language-related (6%) and hearing-related (24%) problems (Statistics Canada, 1990). However, the 1986 survey did not necessarily identify individuals with more subtle communication disorders, such as problems of comprehension not related to hearing, such as those resulting from a stroke or cranial trauma or such problems as stuttering (Johnson, 1987). Nonetheless these groups may experience difficult situations with occupational reintegration. Considering how important communication has become in the workplace, one may reasonably think that persons with a communication disorder are likely to experience an additional difficulty when they are reinstated in their job or reintegrate the labour market. They could be particularly disadvantaged with respect to the administration of disability programs. The service industry runs the risk of becoming a source of frustration and stress, and of generating situations of handicap and discrimination. For individuals with a communication disorder, the workplace may involve several major challenges. First of all, many communication disorders, such as hearing disorders, are invisible at first glance. Their invisible nature prevents them from being taken into account when it comes to workplace adjustment, such as is seen in workplace modification for users of wheelchairs. Moreover, the lack of visibility along with the small amount of research in this field make it extremely hard for human resource management professionals, who are responsible for staff hiring, work organization and disability management, to be familiar with these types of handicaps.

Persons experiencing a communication disorder are often faced with the challenge of finding, either by their own means or with the help of professionals (speech language pathologists, and audiologists), strategies to overcome or avoid the barriers that prevent them from being full and active members of the working community. However, the challenge of work reintegration does not only rest on the shoulders of persons with communication disorders or on the professionals that assist them. Employers also have a vital role to play in this respect. They have the responsibility and the legal obligation to create a work environment free of discriminatory barriers by adapting their management processes and workstations and by providing reasonable accommodation (Garcia, Barrette & Laroche, 1999). This responsibility is extremely important as it involves substantial costs when it is ignored or poorly managed.

It is estimated that disability management costs have increased by 35% since 1986 (Shrey & Lacerte, 1997). Given the importance of communication disorders in society and the preponderance of necessary communication-dependent skills, one may logically think that a substantial portion of these costs will be allocated to the management of disabilities related to communication disorders. However, the non-reinstatement of persons with a disability does not only have a major monetary impact. The ineffective management of disabilities produces negative effects such as the deterioration of the incumbent¹s health, lower productivity, the dissatisfaction of colleagues and manager, the reinforcement of prejudices with respect to the alleged lack of productivity associated with disabled persons, to name only a few. The absence of effective management programs would also be likely to have a discriminatory impact on some groups based on their type of functional limitations (Rice & Kroll, 1994).

For the past few years, many researchers have attempted to better understand the challenges experienced in the workplace by persons with a communication disorder (Black-Schaffer & Osberg, 1990; Carriero, Faglia, & Vignolo, 1987; Ezrachi, Ben-Yishay, Kay, Diller, & Rattock, 1991; Felsenfeld, Broen & Mcgue 1994; Garcia, Barrette & Laroche, 2000; Hétu, Getty, & Waridel, 1994;). These authors stated that a wide range of factors confronting persons with a communication disorder could affect their chances of being reinstated in their job or their chances of being considered fairly in organizational processes such as staffing and performance review. This literature suggests that such barriers be related to the work environment, job requirements, working conditions, psychosocial relations and certain human resource management policies and systems.

As far as the work environment is concerned, one may argue that the widespread use of communication equipment (phone sets, telephone answering service, computers) and the physical layout of the work premises (e.g., open space office) create barriers that hinder work integration. Moreover, with respect to employment, the new forms of work organization (e.g., self-managing and partially self-managing groups) could prove to be obstacles likely to make it harder for persons with communication disorders to adapt to the workplace. On this subject, Rolland and Belin (1991) think that extrinsic factors (the lack of adaptation of work environment) impede the reintegration of persons experiencing language disorders.

Interactions with customers, colleagues and the supervisors could turn out to be an additional difficulty for persons affected by certain disorders, thus creating barriers at the social level. Hetu, Getty and Waridel (1994) showed that subjects suffering from hearing loss feared triggering negative perceptions and had a tendency to isolate themselves in order to conceal their disability. In his work, Rice (1995) showed that social alienation was a factor affecting employment accessibility for stutters. Likewise, Rolland and Belin (1991) showed that obstacles related to social acceptance jeopardized the occupational reinstatement of persons experiencing language disorders as a result of a stroke.

Several studies indicate that persons with communication disorders were likely to be perceived negatively by those around them (Hetu, Getty & Waridel, 1994; Kalinowski, Stuart, Armson & Lerman, 1996; McKinnon, Hess & Landry, 1986). Negative biases against persons with communication disorders could be especially significant during the selection interview.

Once on the job, these persons must confront the internal promotion system. In fact, current research indicates that employment status and a decrease in advancement opportunities would be a major challenge for persons with communication disorders (Felsenfeld, Broen & McGue, 1994; MacLeod-Gallinger,1992; Rice & Kroll, 1994).

Historically, the workplace integration problems experienced by persons with a functional limitation were attributed to the person, i.e. his/her personal characteristics (education, motivation, physical and mental skills, etc.). However, current models stress the interaction between the person and his work environment (Fougeyrollas et al., 1999). These models enable researchers to identify incompatibilities and explain them according to whether the limitations are associated with the individual or the environment. Once the incompatibilities have been identified, the authors specify if the solution requires a modified environment, the use of technological aids or the treatment of the individuals functional limitations. In these models, and particularly in the Disability creation process model (Fougeyrollas et al., 1999), the handicap is not perceived as inherent to the individual but rather as a situation that could occur as a result of the interaction of both Personal Factors and Environmental Factors.

In such a model, the Environmental Factors may range from physical factors such as noise to social factors such as the attitude of co-workers. For example, a person suffering from hearing loss could find that e- mail is a work facilitator, whereas the phone set is a barrier. According to this viewpoint, some persons with a communication disorder such as hearing loss, could experience a situation of handicap if they were required to use a phone set to perform their work, whereas other persons with the same functional limitation could feel hey are fully participating in the work environment if they were able to use e-mail. The objective of this research is twofold; (1) to describe barriers to the workplace integration of persons with a communication disorder, and (2) to identify which accommodation strategies could be implemented by the employer in order to facilitate the workplace integration of such persons.

Six areas of communication disorders were considered as part of the study: (1) speech disorders (e.g., dysarthria) include problems associated with speech clarity and may be evidenced through a nasal voice, monotonous speech, difficulty in producing clear sounds, long sentences and in some cases the need to use an electronic communication device; (2) stuttering is a disorder affecting speech fluency and may take various forms such as the repetition of portions of words, the lengthening of sounds, the insertion of sounds, syllables or phrases; (3) total laryngectomy involves the absence of vocal cords and the use of an alternative method for communicating (e.g., artificial larynx); (4) aphasia is a language disorder associated with a brain lesion, further to a stroke for example, and may lead to problems such as a difficulty to find words, word substitution, telegraphic speech, reading and writing problems; (5) hearing disorders refer to problems with receiving an auditory message, which may result mainly in a difficulty to hear certain sounds, to understand speech surrounded with noise or to locate sound sources, and may be accompanied by buzzing in the ears; (6) voice disorders include problems related with voice quality such as a hoarseness, excessive aspiration, voice loss or a voice which does not match either the age or the sex of the person speaking (excessively high or low pitch).


This project involved interviewing 22 employers (13 women, 9 men) from the private and public sectors in 4 small groups of which two groups came from the manufacturing sector and two from the services sector. Eleven participants were 41-50 years old, six were 31-41 and five were 51-60. Twelve of them were from the service industry and ten from the manufacturing industry. Participants from the manufacturing sector were interviewed separately from participants in the services sector. All the participants have held positions with management responsibilities within their Human Resources Department. Their average experience was 15 years. Employers were identified through the local business community and a Montreal-based consultant. These employers were selected based on the following criteria: (a) their size, i.e. more than 400 employees, in order to ensure a minimum staff turnover within the organization, (b) the almost equal representation of the manufacturing and service industries with a view to obtain a sufficiently broad range of reference jobs, (c) the presence of a Human Resources professional with at least 5 years of experience in the field in order to get a perception based on a variety of experiences from each participant.


Data collection combined the focus group approach aimed at retrieving perceptions (Brotherson, 1994; Morgan, 1988) with the nominal group approach aimed at selecting and weighing the major barriers (Brunelle, Drouin, Godbout & Tousignant, 1988). As employers could be unfamiliar with communication disorders, they were shown a video on the various communication disorders. This session was followed by a question period. During the session, posters describing the features of each communication disorder provided participants with a practical reference, as needed. In line with the project objectives, the first task asked of participants was to identify, based on their actual experience, the workplace barriers which they perceived as being likely to generate difficult communication situations and prevent the hiring or integration of persons with communication disorders. In focus groups, participants identified numerous barriers that hinder or prevent workplace integration or reinstatement, as well a wide range of strategies or concrete means to bypass or lessen those barriers.

Upon arriving, participants, who were seated around the table in-groups of 4 to 7, were invited to read an information letter on the project, and to complete a consent form and a biographical questionnaire. Each 3-hour session was recorded on an audio tape (Sony Conference, Model BM-246) to enable researchers to return to the source at a later time, if needed, in order to check the understanding of certain barriers and strategies, the meaning of which may not have been fully understood. Participants were informed of the purpose of the recording and told that the tapes would be destroyed once the project had been completed. The permission to record and use only their first name was obtained after these explanations were given.

Identification of Barriers and Strategies

Phase 1: Exploring Barriers. Once the purpose of the research was explained to participants, they were invited to share their perceptions with respect to workplace barriers that generate difficult communication situations and may prevent persons with a communication disorder from being hired or integrated. These employers were encouraged to reflect on the existing barriers in their own work environment. Each barrier was written down on a flip chart as soon as it was mentioned, and we regularly ensured that the words matched the ideas being expressed. This process continued until no more ideas were found (approximately 1 hour). In order to trigger the discovery of additional barriers, 2 job descriptions, taken from the Canadian Classification and Dictionary of Occupations (CCDO 1989), (e.g., police officer and travel agent) were presented and read aloud. This was followed by the collection of barriers perceived on the basis of these descriptions. During this exercise, participants had to imagine themselves as employers for these jobs. These descriptions were selected based on the variety of the communication tasks required and the fact they were easy for everyone to understand. Once the barriers had been described and numbered, the facilitator eliminated, with agreement from the group, all the redundant barriers. The employers produced a final list containing 27 to 34 barriers, depending on the groups.

Phase 2: Identifying Major Barriers. The second task was to identify the major barriers among all those listed. The nominal group procedure was used to select and weigh the most important barriers. With respect to the nominal group technique, Brunelle et al., (1988) indicate that the number of final elements to be selected, barriers in this case, depends on the number of distinct statements provided by the group, i.e. 9 elements when more than 22 statements have been identified. In order to perform this task, each subject received a number of cards equal to the number of barriers to be selected, and had to individually write down the number of the barrier selected and its rank (e.g., 9, most important, to 1, least important). Each participant selected their own subset of barriers and ranked them from 1 to 9. In this way, each participant had a say in both the chosen barriers and their importance. Afterwards, the results were compiled for all the participants within the group and the barriers that received the highest scores were retained.

Phase 3: Identifying Strategies. The third task was to identify the strategies or means that could be implemented in order to help overcome the barriers retained during Phase 2. Each barrier was listed in the upper part of the flip chart and the strategies were noted down under the relevant barrier as they were mentioned. Participants were encouraged to suggest strategies for all the persons concerned (employees, employers, professional practitioners).

Barrier Classification

A four-step classification process was used to extract the major points that attracted the attention of participants and to turn the information into interpretable data.

Step I: The goal of the first step was to extract from the data a list of preliminary categories under which the barriers could be grouped (e.g., interview process). A first list was produced based on the preliminary definitions originating in part from Fougeyrollas et al., (1999) environmental factors. Afterwards, fifty barriers among those that were not retained at the previous stage were selected randomly and classified by three evaluators familiar with the research project. These 50 barriers represented a sampling of the range of possible different environmental obstacles to integration. When a barrier could not be classified in a category or was disputed, it was noted and the category was reworked by research group members who were not involved in the previous evaluations. This step allowed us to verify to which extent the preliminary categories (e.g., electronic tools, interview process, etc.) were operational before classifying the final obstacles selected by the respondents. Once these categories were identified and improved, classification of the chosen barriers was much more systematic.

Step II: At this stage, the classification system obtained at Step I was checked once again by the same three evaluators, who reclassified the same 50 barriers, presented randomly this time.

Step III: Afterwards, the new classification was adjusted based on the results of Step II, and all barriers (n= 33) selected as the most important were then classified by 4 evaluators familiar with this research. Any barrier that was not classified under the same category by 3 out of 4 evaluators was reclassified by 2 additional evaluators whose final decision had to bring a consensus.

While this long classification process was taking place, Fougeyrollas and his associates (1999) published an experimental questionnaire concerning the measurement of environmental factors. It then became clear that the data extracted from this study could be more useful if the barriers were classified under neutral environmental factor categories. This made it possible to contribute to the enhancement of the model developed by Fougeyrollas et al., (1999) through the identification of other environmental factors that include barriers affecting persons with communication disorders but also possibly person with other types of functional limitations. Thus, the use of this neutral classification enabled us to incorporate our results into a model with greater potential of being generalised. For example, several barriers mentioned by the employers were related to their expectations regarding employee performance (e.g., high employer expectations, increased work productivity, increased expectations related to speed, etc.). These types of barriers were grouped under a factor called "expectations related to productivity". By grouping the barriers belonging to the same type under a single neutral label, it became possible to evaluate the factors on a barrier to facilitator continuum. This entire set of neutral factors forms what we call the neutral final classification.

Step IV: At this step, the barriers judged most important were classified by the three authors according to the neutral final classification. The classification process led to the creation of two major categories (organizational and social factors). Table 1 lists the barriers for each category of factors.

The participants identified 136 strategies to eliminate or bypass barriers, i.e. 53 for the manufacturing sector and 83 for the service sector, which were then classified on the basis of the neutral final classification. The results of this study present the barriers identified under each factor by all participants as well as the major strategies suggested.

Table 1: Most important obstacles mentioned by the groups of employers


American Speech-Language-Hearing Association. (1995). ASHA's consumer conscience. ASHA Reports, May, 14.18.

Barrette, J. & Haccoun, R. (1995). La precision de l'evaluation du rendement: une vérification de la theorie de Wherry. Revue canadienne des sciences de l'administration, 12(4), 325-339.

Beukelman, D.R., Kraft, G.H. & Freal, J. (1985). Expressive communication disorders in persons with multiple sclerosis: A survey. Archives of Physical Medicine and Rehabilitation, 66, 675-677.

Black-Schaffer, R.M. & Osberg, J.S. (1990). Return to work after stroke: Development of a predictive model. Archives of Physical Medicine and Rehabilitation, 71, 285-290.

Brotherson, M.J. (1994). Interactive focus group interviewing: a qualitative research method in early intervention. Topics in Early Childhood Special Education, 14 (1), 101-118.

Brunelle, J., Drouin, D., Godbout, P. & Tousignant, M. (1988). La supervision de l'intervention en activité physique. Montréal : Gaetan Morin.

Canadian Classification and Dictionary of Occupations (C.C.D.O) (1989). Gouvernement du Canada, Ministere des Approvisionnements et Services. Classification Canadienne des Professions, 9 th. Ed. Ottawa, Canada, Canadian Government Publishing Center.

Canadian Human Rights Commission. (1997). Employeur sans obstacles. Internet: /barrier/index.htm.

Carey, M.L. & Franklin, J.C. (1992). Outlook - 1990-2005. BLS Bulletin 2402. (Washington, D.C.: US) Department of labour, Bureau of labour statistics.

Carriero, M.R., Faglia, Z. & Vignolo, L.A. (1987). Resumption of gainful employment in aphasics: preliminary findings. Cortex, 26, 667-672.

Ezrachi, O., Ben-Yishay, Y., Kay, T., Diller, L. & Rattock, J. (1991). Predicting employment in traumatic brain injury following neuropsychological rehabilitation. Journal of Head Trauma Rehabilitation, 6(3), 71-84.

Felsenfeld, S., Broen, P.A. & Mcgue, M. (1994). A 28-year follow-up of adults with a history of moderate phonological disorder: Educational and occupational results. Journal of Speech and Hearing Research, 37, 1341-1353.

Fougeyrollas, P., Cloutier, R., Bergeron, H., St. Michel, G., Cote, J., Cote, M., Boucher, N., Roy, K., & Remillard, M.B. (1999). The Quebec Classification: Disability Creation Process. Lac St-Charles, P.Q.: International Network on the Handicap Creation Process. Fougeyrollas, P., Noreau, L. & St Michel, G. (1997b), Measure of the quality of the environment, ICIDH Environmental Factors International Network, 9(1), 32-39.

Garcia, L.J., Barrette, J. & Laroche, C. (1999). Towards a social model on the integration of persons with human communications disorders into the work place. International Journal of Practical Approaches to Disability, 23(3), 14-23.

Garcia, L.J., Barrette, J. & Laroche, C. (2000). Perceptions of the obstacles to work reintegration for persons with aphasia. Aphasiology, 14, (3), 269-290.

Getkate, M., Hausdorf, P. & Cronshaw, S.F. (1992). Transnational validity generalization of employment tests from the United States to Canada. Canadian Journal of Administrative Sciences, 9(4), 324-335.

Hétu, R., Getty, L. & Waridel, S. (1994). Attitudes towards co-workers affected by occupational hearing loss II: focus group interviews. British Journal of Audiology, 28, 313-325.

Jackson, D.N., Peacock C.P. & Smith J.P. (1980). Impressions of personality in the employment interview. Journal of Personality and Social Psychology , 39(2), 294-307.

Johnson, R. (1987). Return to work after severe head injury. International Disability Studies, 9, 49-54.

Kalinowski, J., Stuart, A., Armson, J.,. & Lerman, J.W. (1996). Speech clinicians and the general public's perceptions of self and stutterers. Journal of Speech-Language Pathology and Audiology, 7(2), 79-85.

Kutscher, R.E. (1992). Outlook 1990-2005: major trends and issues. Occupational Outlook Quarterly, 36(1), 2-5.

Macleod-Gallinger, J.E. (1992). The career status of deaf women: a comparative look. American Annals of the Deaf, 137, 315-325.

Mckinnon, S.L., Hess, C.W. & Landry, R.G. (1986). Reactions of college students to speech disorders. Journal of Communication Disorders, 19, 75-82.

Morgan, D.L. (1988). Focus groups as qualitative research. Qualitative research methods. Volume 16. New Park, California: Sage Publications.

Nester, M.A. (1984). Employment testing for handicapped persons. Public Personnel Management Journal, 13, 417-434.

Rice, M. & Kroll, R. (1994). A survey of stutterer's perceptions of challenges and discrimination in the work place. Proceedings of the First World Congress on Fluency Disorders, 2, 559-562.

Rice, M. (1995). Work place experiences of people who stutter. Paper presented at the meeting of the World Conference of the International Fluency Association, Linkoping, Sweden.

Rolland, J. & Belin, C. (1991). L¹aphasique et le monde du travail. In J. Ponzio, D. Lafond, R. Degiovani & Y. Joanette (Eds.) L'aphasique (pp. 195-211). Montréal: Edisem, Inc.

Shrey, D.E. & Lacerte, M. (1997). Principles and practice of disability management in industry. GR Florida, Press Inc.

Statistics Canada. (1990). Highlights: Disabled Persons in Canada. The Health and Activity Limitation Survey, Ottawa, Catalogue # 82-602.

Submitted by

Jacques Barrette, Ph.D.
University of Ottawa
School of Management
136 Jean Jacques Lussier
Ottawa, Ontario
Canada K1N 6N5

Linda J. Garcia, Ph.D.
Associate Professor
Audiology and Speech-language Pathology Program
University of Ottawa
University of Ottawa Institute on Health of the Elderly

Chantal Laroche, Ph.D.
Associate Professor
Audiology and Speech-Language Pathology Program
School of Rehabilitation Sciences
Faculty of Health Sciences
University of Ottawa
45 Smyth road, # 3062
Ottawa, Ontario
Canada, K1H 8M5
tel: (613) 562-5800 #3066
fax: (613) 562-5428


This project was funded by the Social Sciences and Humanities Research Council of Canada and the Status of Disabled Persons Secretariat, Grants No. 817-95-1004. This project was also supported by and carried out in partnership with the following organizations: Quebec Telephone, The National Bank, The Canadian Human Rights Commission, the Montreal Association of Laryngectomees, Canadian Voice Care Foundation, Canadian Hard of Hearing Association, the Canadian Hearing Society, the Canadian Association for People who Stutter, Canadian Association of Speech-Language Pathologists and Audiologists.


International Journal of Disability, Community & Rehabilitation
Volume 1, No. 1 Canada
ISSN 1703-3381