Barriers to correct pronoun usage in healthcare settings.

BACKGROUND: Using correct pronouns is an impactful way to establish affirming environments for transgender and nonbinary (TGNB) patients. However, physicians often report struggling with this. OBJECTIVE: This study set out to conduct an initial root cause analysis of factors contributing to medical students and physicians failing to use TGNB patients' correct pronouns. METHODS: A 10-item Qualtrics survey was sent to medical students, residents, and physicians practicing in Central Ohio. Participants were asked to describe perceived challenges or barriers colleagues have regarding correctly using TGNB patients' correct pronouns. A directed content analysis of participant responses was performed utilizing a fishbone diagram root cause analysis tool as a basis for conceptualizing and categorizing barriers. All coding was completed by independent reviewers utilizing a consensus reconciliation methodology. RESULTS: Of 928 survey respondents, 763 met the study inclusion criteria, of which 453 provided analyzable responses. Of these 453, attendings with five or more years of practice (32.5%) and medical students (27.4%) made up the two largest demographic categories. 1.7% of respondents identified as transgender, nonbinary, and/or genderqueer, and 64% identified as heterosexual/straight. Five core barrier categories were identified: documentation, patient care, environment, knowledge, and individuals. Sub-categories were also identified, including lack of documentation, discomfort, medical culture, lack of standardization, prejudice, and assumptions. CONCLUSION: The study identifies important barriers to medical professionals correctly using TGNB patients' pronouns. The root cause analysis conducted as part of this study demonstrates the necessity of multi-pronged, system-level interventions to support ensuring TGNB patients are addressed using the correct pronouns.

Comprehension priming in Chinese EFL learners' reflexive pronoun interpretation.

Reflexive interpretation is a pivotal aspect of discourse comprehension, which usually reveals consistent challenges for Chinese EFL learners. These learners often breach the locality constraint of reflexive pronouns, exhibiting a persistent tendency towards optional reflexive comprehension. Recent research has demonstrated the effectiveness of the priming technique in altering biases among L2 learners in anaphora resolution. However, no existing studies have investigated comprehension priming in the context of reflexive interpretation among Chinese EFL learners. This study addresses this gap by conducting a sentence comprehension experiment with 36 high school students to explore the potential of comprehension priming in modifying L2 learners' reflexive interpretation biases and examining the persistence of the priming effect. The findings reveal immediate and cumulative priming effects, with no discernible effect observed after 1 week. The results suggest that comprehension priming can occur universally, even without lexical overlap, previously assumed to be a prerequisite. While the priming effect lacks statistical significance after 1 week, there is a numerical increase in participants consistently interpreting the target structure correctly. Thus, comprehension priming emerges as an effective method for L2 learners to internalize more abstract linguistic rules. Further research on comprehension priming across diverse L2 populations and language structures is warranted.

"What do they mean?" a systematic review on the interpretation, usage and acceptability of "they".

The rise of feminist and LGBTQIA+ movements paved the way for many equality reforms. These include language reforms, which facilitate inclusion of multiple groups in society. For example, the shift from the generic "he" to "he or she" and "they" allows for the inclusion of women, transgender, and non-binary individuals in many narratives. For this reason, many institutions worldwide encourage neutral language. It remains unclear how individuals interpret neutral language. One case of neutral language is the pronoun "they," which has been assigned multiple definitions from the 1970s to 2022. We examine how the pronoun "they" has been interpreted, used, and accepted over time. We discuss trends in the findings and make suggestions for future research directions, including the need for better methods to investigate pronouns and clarification on what the focus of neutral language should be. This timely commentary has implications for action on equality, diversity, and inclusion.

Notes from the Underground: Seeking the top personality correlates of self-referencing.

OBJECTIVE: Self-focused language use has been frequently assumed to reflect narcissism; however, research indicates that the association between first-person singular pronouns (i.e., "I-talk") and grandiose narcissism is negligible. METHOD: To extend this literature, we progressively identify vulnerable narcissism and rumination as positive correlates of I-talk in five studies (valid Ns = 211, 475, 1253, 289, 1113). RESULTS: The first study revealed positive correlates of I-talk suggestive of vulnerable narcissism. The second study showed more directly that vulnerable narcissism was a positive correlate but that this association was attributable to shared variance with neuroticism. The third study, a preregistered effort, replicated and extended the results of the second study. The fourth and fifth studies focused on rumination in a preregistered manner. CONCLUSIONS: All the studies point to a clear distinction: While grandiose narcissism is negligibly related to I-talk, vulnerable narcissism is positively related to I-talk; moreover, rumination is a robust predictor of I-talk. A research synthesis revealed the following constructs significantly capture I-talk: depression (r = 0.10), neuroticism (r = 0.15), rumination (r = 0.14), and vulnerable narcissism (r = 0.12). The association between I-talk and neuroticism was partially mediated by rumination, providing a testable candidate mechanism for neuroticism interventions.

Emoji use in social media posts: relationships with personality traits and word usage.

Prior research has demonstrated relationships between personality traits of social media users and the language used in their posts. Few studies have examined whether there are relationships between personality traits of users and how they use emojis in their social media posts. Emojis are digital pictographs used to express ideas and emotions. There are thousands of emojis, which depict faces with expressions, objects, animals, and activities. We conducted a study with two samples (n = 76 and n = 245) in which we examined how emoji use on X (formerly Twitter) related to users' personality traits and language use in posts. Personality traits were assessed from participants in an online survey. With participants' consent, we analyzed word usage in posts. Word frequencies were calculated using the Linguistic Inquiry Word Count (LIWC). In both samples, the results showed that those who used the most emojis had the lowest levels of openness to experience. Emoji use was unrelated to the other personality traits. In sample 1, emoji use was also related to use of words related to family, positive emotion, and sadness and less frequent use of articles and words related to insight. In sample 2, more frequent use of emojis in posts was related to more frequent use of you pronouns, I pronouns, and more frequent use of negative function words and words related to time. The results support the view that social media users' characteristics may be gleaned from the content of their social media posts.

Disintegration at the Syntax-Semantics Interface in Prodromal Alzheimer's Disease: New Evidence from Complex Sentence Anaphora in Amnestic Mild Cognitive Impairment (aMCI).

Although diverse language deficits have been widely observed in prodromal Alzheimer's disease (AD), the underlying nature of such deficits and their explanation remains opaque. Consequently, both clinical applications and brain-language models are not well-defined. In this paper we report results from two experiments which test language production in a group of individuals with amnestic Mild Cognitive Impairment (aMCI) in contrast to healthy aging and healthy young. The experiments apply factorial designs informed by linguistic analysis to test two forms of complex sentences involving anaphora (relations between pronouns and their antecedents). Results show that aMCI individuals differentiate forms of anaphora depending on sentence structure, with selective impairment of sentences which involve construal with reference to context (anaphoric coreference). We argue that aMCI individuals maintain core structural knowledge while evidencing deficiency in syntax-semantics integration, thus locating the source of the deficit in the language-thought interface of the Language Faculty.

Fostering Belonging Beyond the Health Office Through Inclusive Language.

A sense of belonging in school is fostered when students feel included. School nurses can establish an inclusive school atmosphere where students feel safe, supported, accepted, and valued. The language choices of school nurses play a key role in fostering such an environment. Through consciously using language that promotes respect, acceptance, justice, and equity, nurses can support student well-being. Nurses may be using embedded terminologies and outdated language that promotes exclusion but can learn and model inclusive language practices such as cultural humility, calling in, and respecting pronouns. Making intentional choices to embrace and employ these practices is imperative to supporting student health today.

Personal pronouns and person perception - Do paired and nonbinary pronouns evoke a normative gender bias?

Research on gender-fair language aims to identify language inclusive to a multitude of individuals, for example, increasing the visibility of women by using paired pronouns (he/she) instead of generic masculine forms (he). However, binary presentations like he/she might come with unwanted side effects and evoke what we label as normative gender bias. A normative gender bias is defined as when words lead to stronger associations with individuals with normative gender expressions than with individuals with non-normative gender expressions, thus contributing to making non-normative individuals invisible. In three experiments, we compared the extent to which the paired pronoun he/she (Swedish and English), the neo-pronouns hen (Swedish), ze (English), and the generic pronoun singular they (English) evoked a normative gender bias. Swedish- (N = 219 and 268) and English- (N = 837, from the UK) speaking participants read about individuals referred to with the paired pronoun he/she or with hen, ze, or they. In Experiment 1 (Swedish), there was no main effect of condition on a normative bias, but in Experiment 2 (Swedish), the paired pronouns he/she evoked normative gender bias while hen did not. In Experiment 3 (English), both ze and singular they evoked normative gender bias, although normative associations were lower in these conditions compared to he/she. Furthermore, the normative bias was lower among participants who had knowledge about the use of ze as a nonbinary pronoun. Finally, neither ze nor they evoked a normative gender bias when their use was explicitly stated to be nonbinary. A potential explanation for why singular they did not generally result in less normative associations, despite almost all participants knowing about it, may include its more common use as a generic pronoun. Taken together, our results suggest that neo-pronouns, but not paired pronouns, have the potential to evoke less normative associations, but that they must be both (1) actively created new words and (2) well-known to language users as nonbinary pronouns.

Acquisition of demonstratives in cross-linguistic perspective.

This paper examines the acquisition of demonstratives (e.g., that, there) from a cross-linguistic perspective. Although demonstratives are often said to play a crucial role in L1 acquisition, there is little systematic research on this topic. Using extensive corpus data of spontaneous child speech, the paper investigates the emergence and development of demonstratives in three European (English, French, Spanish) and four non-European languages (Japanese, Chinese, Hebrew, Indonesian) between age 1;0 and 6;0. The data show that, across languages, demonstratives are among the earliest and most frequent child words, but their frequency decreases with age and MLU. As children grow older, they tend to use other types of referring terms (e.g., anaphoric pronouns) and other types of spatial expressions (e.g., adpositions). Considering these results, we hypothesize that children shift from using a body-oriented strategy of deictic communication to more abstract and disembodied strategies of encoding reference and space during the preschool years.

Antecedents and consequences of open and closed questions in intake sessions of psychodynamic psychotherapy.

To investigate whether there are different antecedents and consequences of different types of therapist questions as this has implications for conducting psychotherapy and for training therapists.We examined the antecedents and consequences of questions for 88 clients working with 33 doctoral student therapists in psychodynamic psychotherapy. Questions were coded into open questions for thoughts (OQT), open questions for feelings (OQF), closed questions for facts (CQF), and closed questions other (CQO). The antecedents and consequences were assessed in terms of self-referring pronouns (SRP), self-referring emotion words (SRE), and number of words.In terms of antecedents, when clients were using a high number of SRP, therapists were more likely to ask OQT and CQO than CQF. When clients were using a high number of SRE, therapists were more likely to ask OQF than CQF. In terms of consequences, clients spoke less after CQF than the other three skills, used fewer SRP after CQF than after CQO, and used more SRE after OQF than CQF.CQO were more similar in terms of antecedents and consequences to OQT and OQF than to CQF.

How do parents refer to their children while playing? A cross-linguistic comparison of parental input to Bulgarian- and English-speaking children with ASD.

Instances of person-reference, in the form of personal pronouns, names, or terms of endearment, are frequently used in child-directed speech. Examining this aspect of parental input is especially relevant to children with autism, who experience difficulties with person-reference. In this study, we compared the person-reference during parent-child interactions of Bulgarian (N=37) and English-speaking (N=37) parents of children with autism, who were matched on the language ability of their child. English-speaking parents used significantly more personal pronouns to refer to their children, while Bulgarian-speaking parents used the child's name more along with kinship terms. Furthermore, Bulgarian-speaking parents used significantly more different ways to refer to their child. These group differences were interpreted in the context of structural differences in the pronominal systems of Bulgarian and English, and in terms of culturally different discourse practices.

Children's memory for gender-neutral pronouns.

Are there disparities in children's memory for gender-neutral pronouns compared with gendered pronouns? We explored this question in two preregistered studies with 4- to 10-year-old children (N = 168; 79 boys, 89 girls, 0 gender-diverse). Participants were presented with a memory task. An experimenter read an illustrated story about a target character. Participants were asked to verbally repeat the story to measure spontaneous pronoun use and then to explicitly recall the characters' pronouns. In Study 1 the story characters had typically feminine or typically masculine appearances (determined by independent raters), whereas in Study 2 the characters had gender-neutral appearances. In both studies, targets were referred to with gendered or gender-neutral pronouns. In both studies, children more accurately recalled gendered pronouns than gender-neutral pronouns. However, on most tasks, children only used "they" if a character had gender-neutral pronouns, and almost never used "they" if a character had gendered pronouns. We also found some evidence suggesting that older children more accurately recall gender-neutral pronouns compared with younger children.

Are palm reversals the pronoun reversals of sign language? Evidence from a fingerspelling task.

Acquisition of pronominal forms by children with autism spectrum disorder (ASD) continues to garner significant attention due to the unusual ways that such children produce and comprehend them. In particular, pronoun reversal errors (e.g., using the 2nd-person pronoun "you" to refer to oneself) have been noted in the speech of children with ASD since the very first report of the disorder. In more recent years, investigations of the signing of deaf children with ASD have documented a different phenomenon: palm orientation reversals, such that signs typically produced with an outward-facing palm are produced with the palm towards the signer, or vice versa. At the same time, true pronoun reversals have yet to be documented in the signing of deaf children on the autism spectrum. These two curious facts have led us to ask if there is evidence that palm orientation reversals in signed languages and pronoun reversals in spoken languages could be surface manifestations of the same underlying differences present in ASD. In this paper we seek to establish whether there is evidence for such an analogy, by comparing the ages at which the two phenomena appear in both typically-developing (TD) children and those with ASD, the frequency and consistency with which they appear, and their relationships with other linguistic and cognitive skills. Data are presented from a fingerspelling task given to a sample of 17 native-signing children with ASD and 24 native-signing TD children. We conclude that there are provocative parallels between pronoun reversals in spoken languages and palm reversals in signed languages, though more research is needed to definitively answer these questions.

The role of grammatical role and thematic role predictability in reference form production in Mandarin Chinese.

Evidence suggests that English speakers use pronouns when referring to the grammatical subject and predictable thematic role. We tested how grammatical role and thematic role predictability affect different types of referential forms, namely, overt pronouns and null pronouns in Mandarin Chinese. We found that both overt and null pronouns were sensitive to grammatical role. However, we did not find any evidence that overt and null pronouns were sensitive to thematic role predictability. Although null pronouns were influenced by grammatical role, the rate of null pronouns for subject reference was very low compared to that of overt pronouns. Given the frequent occurrence of null pronouns in Mandarin, our results suggest that the use of null pronouns may not be explained by a simple grammatical role mechanism.

Effects of Including Gender Pronoun Questions in Surveys.

This research examines whether the mere presence of asking about gender pronouns (e.g., she/her, he/him, they/them, and ze/zir) in a survey enhances participants' attitudes and satisfaction of answering the questions. A large sample (N = 1,511) of heterosexual, cisgender, and LGBTQIA+ participants across the United States (US) were surveyed an online "personality test" (as a deception), with the real purpose of examining whether asking a pronoun question enhanced their perceptions of the survey. Three demographic groups were included: (i) heterosexual-cisgender (n = 503), (ii) gay-cisgender (n = 509), and (iii) genderqueer (trans, non-conforming, other, n = 499). Half of each group were randomly given either a survey that included a gender pronoun question (test) or not (control), and then all rated their perceptions of the survey questions. For participants who identified as heterosexual or gay, no major differences were found between survey conditions. However, participants who identified as genderqueer experienced significant increases of satisfaction, comfort level, and perceived relevance of the questions when given a survey that asked their gender pronouns versus the survey that did not. These findings have implications for any surveys that ask about personal demographics, and suggest that any form of written communication should include clarity about gender pronouns.

Morphosyntactic Skills Influence the Written Decoding Accuracy of Italian Children With and Without Developmental Dyslexia.

Some types of developmental dyslexia (DD) are associated with morphology. Deep DD leads to morphological and semantic errors, and possible comorbidity with syntactic deficits; phonological-output-buffer DD causes problems in decoding longer morphologically complex words. In addition, cross-linguistic studies highlight the effects of morphological awareness on reading accuracy and fluency. The role of morphosyntactic abilities on reading is, however, not clear. This study explores the influence of morphosyntactic competence on reading in Italian children with and without DD. A total of 14 children with DD and 28 with Typical Development (TD) attending the Italian primary school were tested on written decoding, syntactic comprehension of different grammatical structures, and syntactic production of direct object clitic pronouns. DD children were significantly less accurate and slower in reading than TD children. Syntactic skills of the two groups did not differ significantly, but some differences in their acquisitional pace emerged. Syntactic comprehension and production of direct-object-clitic pronouns predicted reading accuracy standard scores, thus suggesting that morphosyntactic abilities, beyond clitics' weak phonological status, affect decoding accuracy. Decoding accuracy was influenced by reading errors related to morphology (morphological, semantic, and phonological-output-buffer errors). Decoding speed was a specific weakness of DD children and was rather affected by multi-letter combinations. Consistent with a dual-route approach to orthographic processing, we argue that accuracy depends on fine-grained decoding strategies maximizing the precise ordering of letters, thus it is more sensitive to morphosyntactic skills. Morphological reading errors were associated with phonologically weak (determiners, clitic pronouns, and prepositions) and salient words (verbs). This suggests that the decoding of function words and morphologically complex words is particularly demanding and related to both phonological and morphosyntactic skills. Age had a negative predictive effect on semantic errors, compatible with the gradual acquisition of lexical decoding strategies, which seemed to be slowed down by DD. We conclude that oral morphosyntactic skills play a role in reading accuracy in the Italian shallow orthography for both DD and TD children. It is then advisable to assess children's linguistic profile during DD diagnoses to establish whether some reading errors are related to morphosyntactic weakness. In this case, ad hoc morphosyntactic training might support reading accuracy.

Greater entropy leads to more explicit referential forms during language production.

Speakers can refer to previously-mentioned words (e.g., the actor) using attenuated referring expressions such as pronouns (he), or elaborated referential forms such as repeating the original word (the actor). Predictability is theorized to influence form of reference during language production: More attenuated forms may be used to refer to more predictable words, presumably because predictable words are already active in memory, and therefore require less linguistic signal during subsequent reference. However, the reported results are mixed. The current study examines the effect of entropy, an information-theoretic metric that captures the predictability of all, not just one, referential candidate, on the production of referential forms. A meta-analysis combining data from multiple experiments (492 participants, 405 items) revealed that greater entropy leads to more explicit referential forms, suggesting that entropy might intensify the competition between referential candidates during language production, reducing total memory activation.

Youth-specific sexual and gender minority state-level policies: Implications for pronoun, name, and bathroom/locker room use among gender minority youth.

While research that investigates the importance of school-level promotive factors (e.g., teacher support) for sexual and gender minority youth (SGMY) well-being has proliferated, less research has focused on state-level climate and policy implications for gender minority youth-specific experiences. This study investigated the impact of two youth-specific SGM state-level laws (i.e., "anti-LGBT laws" and conversion therapy bans) on social transition experiences (i.e., name/pronoun use and using desired bathroom/locker rooms) of GMY (n = 4000) aged 13-17. Through a series of multivariable regression models, it was determined that the absence of laws that restricted rights for sexual and gender minority people was associated with greater use of the correct name and correct pronouns for transgender youth. These differences were further explained by binary gender identity (transgender binary or nonbinary) status, region, and age in multivariable models. Findings highlight the importance of enacting more uniform protections for SGMY, especially to protect transgender youth that live in the southern region of the U.S.

The Effects of Semantic Role Predictability on the Production of Overt Pronouns in Spanish.

In order to refer in any language, speakers must choose between explicit forms of expression, such as names or descriptions, or more ambiguous forms like pronouns. Current models suggest that reference form is driven by subjecthood, where speakers in English choose pronouns for the subject, and speakers of null pronoun languages like Spanish or Italian use null pronouns. We test this generalization by examining the effect of a different factor, thematic role predictability, on reference production in Spanish. In stories about transfer events (e.g., Ana gave a ball to Liz), speakers prefer to use pronouns more for reference to goals (Liz) than sources (Rosa and Arnold, Journal of Memory and Language 94:43-60, 2017). However, this has not been examined for null pronoun languages. In two experiments, we demonstrate that Spanish speakers are also sensitive to thematic role, but it primarily affects the rate of overt pronouns (ella, el) rather than null pronouns. These results highlight the need to include semantic constraints in models of reference production for null-pronoun languages.

Revealing traces of depression through personal statements analysis in social media.

Depression is a common and very important health issue with serious effects in the daily life of people. Recently, several researchers have explored the analysis of user-generated data in social media to detect and diagnose signs of this mental disorder in individuals. In this regard, we tackled the depression detection task in social media considering the idea that terms located in phrases exposing personal statements (i.e., phrases characterized by the use of singular first person pronouns) have a special value for revealing signs of depression. First, we assessed the value of the personal statements for depression detection in social media. Second, we adapted an automatic approach that emphasizes the personal statements by means of a feature selection method and a term weighting scheme. Finally, we addressed the task in hand as an early detection problem, where the aim is to detect traces of depression with as much anticipation as possible. For evaluating these ideas, benchmark Reddit data for depression detection was used. The obtained results indicate that the personal statements have high relevance for revealing traces of depression. Furthermore, the results on early scenarios demonstrated that the proposed approach achieves high competitiveness compared with state-of-the-art methods, while maintaining its simplicity and interpretability.