Atlas of Disabilities & Accommodations
When you think of disabilities, do you first consider a wheelchair or a white cane? There are many different types of disabilities, which can feel overwhelming at first, but once you know what they are and some common accommodations you might use to support team members with these disabilities, you will realize that inclusion is actually less complicated than you think. Remember, these are just ideas. It is always best to ask the person what accommodations they would prefer.
Chronic Illness:
A chronic illness is an illness that is present for a year or more and can have an ongoing effect on the physical and mental health of the person experiencing it. Examples of chronic illnesses include Ehlers Danlos Syndrome (EDS), Fibromyalgia, Rheumatoid Arthritis, Crohn's Disease, Multiple Sclerosis (MS), and Lupus. It is important to note, that many of these conditions can also impact other conditions listed here, for example, people with MS may also struggle with mobility.
Accommodation Considerations: Some people with a chronic illness will deal with bouts of fatigue or flare-ups of their symptoms. To help them to manage this there are many different accommodations that might be helpful. Flexible working hours are often really beneficial as some people can feel worse at different times of the day. If you are having them come into work, you’ll want to work with them to create spaces that ergonomically work for their body’s needs - this could be an optional stool to sit down on, an ergonomic chair, alternative keyboard setups, anti-fatigue matting to stand on, noise-canceling earphones for people with noise sensitivity or mobility aides should their work require movement throughout the day. If remote work is not an option, another accommodation that could be supportive would be a space where they can rest and a modified break schedule that allows them to work and rest at the times that work best for their bodies.
Communication Disability:
A communication disability refers to a condition where there is difficulty in understanding, expressing, or processing information through various forms of communication, including spoken words, gestures, or written symbols. This disorder can affect hearing, language, and speech abilities to varying degrees, ranging from mild to severe impairments. There are many different ways this can show up. For example, a speech disorder, which includes disorders such as stuttering, apraxia, and dysarthria, can affect someone’s ability to produce sounds. Whereas Language Disorders hinder an individual's capacity to understand or utilize spoken, written, or other symbolic systems for communication. Examples of speech disorders are dyslexia or dysgraphia.
Accommodation Considerations: There is a very large range of communication disorders, so we are not going to cover every accommodation here, but let’s talk through a few different scenarios. For someone who stutters, they are often met with well-meaning people who, in their own discomfort, try to complete the person’s thought for them. Avoid this. Be patient, and listen to the person. Communicate normally. Stutters are often exacerbated by anxiety so your visible discomfort with their speed of communication does not help the situation. When accommodating for a person with a stutter on the job, ask them what might be helpful. Generally, if they are being asked to present in a meeting, it is best practice to give them the information ahead of time so that they can prepare. They also may advocate for more of their communication to be written such as via email or messages. In some cases, people may not be able to speak at all. This can happen with dysarthria or aphasia, which can be caused when the muscles you use for speech are weak or your brain may have difficulty controlling those muscles, which can sometimes happen in people with Cerebral Palsy. The ability to control muscles has very little to do with your ability to contribute meaningfully, so it is important to know that there are a lot of different assistive technologies that can support people without speech to join the workforce. The good news for you as an employer is most people with this condition already know the assistive technology that they need to participate. For people who do not have other motor impairments, they can use communicate and do work via a computer. Some may have devices that can speak on their behalf. For people who have disabilities that do not just affect their speech but also their mobility, many communicate and work via AAC devices. AAC stands for Augmentative and Alternative Communication. They may use boards with letters or pictures to communicate, or they may use eye-gaze technology that allows them to use their eyes to control a computer screen that will talk on their behalf. While this process makes it possible for them to participate, it can also be quite fatiguing to do this, so within the limitations of the current technology, it is important to be patient and to allow for breaks throughout the workday. Additionally, if you would like them to present on a particular topic, providing the information ahead of time allows them to create their presentation ahead of time, allowing their AAC device to present at the time of the meeting fluently.
Generally, with speech and communication disabilities, it is important to welcome using the many different forms of communication as the default. With work becoming increasingly digital, allowing people to lean on written communication such as email, PowerPoint presentations, or messages as the primary communication method can be helpful. These days, even customer service is predominantly done via chat or email, so the previous expectation of speaking to someone is not common anymore. It can also be helpful to get them the information they will be expected to present on ahead of time so they can prepare for meetings. Believe it or not, this accommodation will support all of your employees. Not everyone likes to be put on the spot, and you may find that when sending the meeting agenda ahead of time or letting folks know what they might want to prepare, you begin to hear more diverse voices start to speak up.
Developmental Disabilities:
Developmental disabilities are a collection of conditions that typically arise either at birth or in early childhood and can affect a child's physical, cognitive, or behavioral capabilities. The primary categories of developmental disabilities encompass Autism Spectrum Disorder, Cerebral Palsy, Fetal Alcohol Spectrum Disorders, Down Syndrome, and Attention Deficit Hyperactivity Disorder (ADHD).
Accommodations Considerations: Developmental disabilities cover a wide spectrum and may include Autism Spectrum Disorder, Cerebral Palsy, Fetal Alcohol Spectrum Disorders, Down Syndrome, and Attention Deficit Hyperactivity Disorder (ADHD). If you are accommodating for people with neurodiversity, such as ADHD or Autism, there may be some similarities in how you might support them. As someone who has ADHD but didn’t know it until my mid-30s, I can say confidently that ADHD is not just the hyperactive boy we have cemented in our minds. In fact, people with ADHD may be quite calm. One commonality in people with ADHD and Autism is our ability to hyperfocus. When we get excited about a task, we can spend hours focusing on it, sometimes forgetting to eat. This ability can make us exceptional at some of the deeper thinking aspects of our jobs. While everyone with ADHD is different, this overview provided by the Job Accommodation Network hit home for me, “Individuals with AD/HD are often perfectionists and are hard on themselves. They have trouble setting personal boundaries like knowing when to stop working and they set unrealistic expectations for themselves. Someone who takes work home or stays late to finish work is often given more responsibility or a heavier workload because they appear to be able to get their work done.” But with that, you also are at a higher risk of burning out your neurodiverse employees.
People with ADHD may struggle to take feedback in stride because one of the symptoms of ADHD is rejection sensitivity. Delivering feedback in a way that lets the person know that you see the good things they are doing and are on their team to support the growth areas will make a big difference. Autistic people on the other hand generally prefer straightforward communication. Some autistic people may not be attuned to social cues the same way that neurotypical people are, and therefore, it is better to not assume that something is implied - just say what you mean and mean what you say. This is also an accommodation that can be helpful for diverse teams; many of the social cues that we have decided to be true and universally understood are actually cultural. Being straightforward and identifying where you may have implied but not said something can help everyone on the team to be more successful.
People with ADHD may not be great at details - such as answering emails on time or remembering to do the duller parts of their job. This is because the ADHD brain has a deficit of dopamine, which means that if we are not interested in a task, we have to psych ourselves up or create a stressful situation, such as an impending deadline or fear of getting in trouble to get us motivated enough to answer our email or clean our house. If you are hiring someone with ADHD, know that you are getting someone who will excel at some of the hardest parts of the job, but finding ways to accommodate them on some of the more boring parts of the role could free them up to do more deep work.
People with Autism and ADHD also tend to be very sensitive to sensory input such as loud noises, bright fluorescent lights or strong fragrances such as perfume. Personally, I do my best work at home where I can control these factors, and over the last decade, for the most part, no one has asked me to spend five days a week in an office, and I think that I have achieved so much because of that. If you require office time, ask the employee what would be helpful. Perhaps you provide noise-cancelling headphones or let them bring in their own desk lamp. If you have office space, your neurodiverse employees would benefit more from having their own office. Open offices, while in theory promoting collaboration, are a nightmare for me. When I used to be required to go into the office two days a week, I mentally prepared to get nothing done. I would spend the whole time hearing everyone talk, annoyed at the lighting situation or getting distracted by talking to coworkers.
Hearing Impaired & d/Deaf:
These refer to disabilities that make it hard for someone to hear, making them either partially or completely deaf. A hearing disability can be temporary due to an ear infection or a build-up of earwax or it can be permanent due to a ruptured eardrum, continued exposure to loud noise, or reactions to medicine or infection. Deafness can also be genetic, meaning that some children are born deaf. There are also different ways that people who are deaf might identify. You may have seen d/Deaf written with a lowercase “d” or an uppercase “D” - these actually mean different things for the community. People who are Deaf with a capital D view themselves as culturally Deaf. There is a very rich Deaf community who take real pride in being a part of that community. People who identify as capital-D Deaf are often born Deaf and learn sign language as their primary language. People who identify as deaf, with a lowercase d, are usually hard of hearing or users of hearing aids or cochlear implants. People who are deaf generally function predominately in a hearing world, can communicate orally and are usually adept at lip reading. They are generally less tied to Deaf culture. Much like many different aspects of identity, it can be hard to make assumptions about how people identify without asking them, that is why you may see deaf written as d/Deaf which encompasses for both identities. If someone tells you their preference, it is good etiquette to use their preference moving forward.
Accommodation Considerations: Hearing disabilities have a wide spectrum; people can be completely d/Deaf, or they could be hard of hearing. Within hard of hearing, there is a spectrum, too, in terms of what tones people may struggle to hear or what decibels people can hear. Many accommodations can help people with all types of hearing disabilities succeed in your organization. One easy accommodation that you should have auto-enabled regardless of who you meet with is the ability for participants to turn on captions on video calls. This is just a checkbox in Zoom, but it can make a huge difference for people who are hard of hearing. For people who are Deaf, they may require an interpreter. For people who grew up Deaf, their language is really emotive, and that is often not captured just through captions. Captioning software is also not great yet which means that a person solely relying on that will miss a lot of being said. This is why when a hearing person assumes captions are enough, it can be very frustrating for a Deaf person because it prevents them from being fully included. If you are working with someone with an interpreter, speak to the person directly, not the interpreter. The interpreter is the voice of the Deaf individual. It is also helpful to speak at a conversational rate. If you are presenting slides, one additional helpful accommodation is to pause on the slide before talking so the Deaf individual can read the slide and then focus on the interpreter. This tends to be good practice for most employees because study after study has proven that the brain cannot listen to someone talk and read a slide simultaneously - so this can be a win-win. Ac
For people who are deaf or hard of hearing, many different assistive technologies help them work within a hearing world. There are assistive listening devices that help filter out background noise, enabling the most important noise to be sent directly into the individual’s ears via an earbud. There are hearing aides that can be hooked directly into your phone or computer. Some apps can adjust how you hear the sound through your computer. There are even name badges that provide real-time captioning that you could wear to help deaf and hard-of-hearing folks understand you better in a crowded room.
Intellectual Disabilities:
An intellectual disability affects someone's ability to access knowledge or skills, including social and practical skills that may be required for daily living. Examples of intellectual disabilities may include Down Syndrome, Fragile X Syndrome, and Huntington’s Disease or they may be caused by exposure to toxins in utero, alcoholism, maternal infection, or pre/postnatal brian infections.
Accommodation Considerations: An intellectual disability affects someone's ability to access knowledge or skills, including social and practical skills that may be required for daily living. As always, there is a wide range of different things someone with an intellectual disability might experience. Some may struggle with executive functions, and others may need support in simplifying the concepts and tasks. Some accommodations that can be helpful are providing written or picture instruction of the task, helping them plan and prioritize their time, and being clear and explicit about what they need to do in simple language.
Learning Disabilities:
Learning disabilities affect someone's ability to understand or process information in certain subjects. These can often overlap with many of the other disabilities described here but may include: Dyslexia, dyscalculia, dysgraphia, auditory processing disorder (APD), nonverbal learning disability (NVLD), attention-deficit/hyperactivity disorder (ADHD), specific language impairment (SLI), and executive functioning disorder (EFD)
Accommodations Considerations: People with dyslexia can struggle with fluency, reading rate, rhyming, spelling, vocabulary, comprehension and written expression. For some people with dyslexia, their reading rate can be much slower, which means they may need more time to read and comprehend information before responding to it. Providing materials ahead of time for review or allowing the person a minute or two to read the slide before jumping in can be helpful. People with dyslexia, like myself, can also struggle with grammar and spelling. I rely on tools such as Grammarly and read my important emails or documents out loud to listen for errors, but if I am moving too fast, I will make mistakes. For things that need to be done without error, it is important that you can provide a second set of eyes on a document if you are working with someone with dyslexia. It is not carelessness, it’s that they actually can’t see their mistakes even with all the tools around them to mitigate them.
Dyscalculia and Dysgraphia are similar. Dyscalculia affects how people perceive and use numbers, such as when studying math, problem-solving, or working within spreadsheets. People with dysgraphia struggle with the act of handwriting as well as language, syntax, and grammar. If you are working with someone with Dyscalculia and you are presenting things with graphs, charts, or spreadsheets, it can be helpful to give them a preview so that they have time to read and understand it before being asked to react to it. Taking the time to walk them through it 1:1 can also be really helpful. Similar to people with dyslexia, if they are doing work that requires math or spreadsheets, it can be helpful to have another colleague available to check on their work.
Mental Health Disabilities:
These are mental or emotional disabilities that substantially limit one or more life areas. Examples of this might include anxiety, depression, OCD, eating disorders, PTSD, Schizophrenia, Bipolar Disorder, or substance abuse.
Accommodation Considerations: People with mental health conditions can benefit from many of the same accommodations you might provide others with a disability, such as flexible schedules, the ability to take breaks, or a quiet space in the office that they can go to when they need a break. Some conditions, such as PTSD, may have identifiable triggers that can exacerbate symptoms, such as certain noises, light, or periods of high stress. This can also be true for people with neurodiversity and chronic conditions such as migraines. If a person is able to identify some of their triggers, working to try and limit them in the office and/or giving them a warning if it may occur is good practice. For example, you may know that there is a scheduled test of the fire alarm that is happening that week or perhaps there will be loud construction - letting people know ahead of time and giving them the option to work from home on those days or to leave the building during the time of the fire alarm is best practice.
Similarly, people who struggle with their mental health may have periods where they require accommodation that can support tasks involving executive functions such as prioritizing, planning, and time management. Being able to work with a manager to manage their workload and stress triggers during particularly rough periods can help.
Mobility Disabilities:
These are conditions that affect movement or fine motor skills. Examples may include paralysis (partial or complete), limb loss or limb difference, muscular dystrophy, multiple sclerosis (MS), spinal cord injuries, cerebral palsy, arthritis, and post-polio syndrome. A mobility disability may affect someone’s ability to get into a building or their ability to use a typical work setup without accommodations.
Accommodations Considerations: Many different conditions may fall under having a mobility disability, such as paralysis (partial or complete), limb loss or limb difference, muscular dystrophy, multiple sclerosis (MS), spinal cord injuries, cerebral palsy, and arthritis. This means there will be many different ways people with a mobility disability might request to be accommodated. Two important elements of supporting someone with mobility issues are access and energy. Access can compromise many different elements, such as whether they can get access to the building, do they have a work set up that allows them to access their computer, or the tools of work that work most comfortably and effectively for their body. Similarly, for people with a mobility disability, the energy required to move their body is often significantly more taxing than people who are able-bodied so ensuring that this is being factored into decisions about where they work, how they work, when and if they travel for work or how many days they need to be in person will make a big difference.
Working from home is a huge benefit to people who get fatigued easily getting to and from the office or for people whose workplace isn’t accessible for people with wheelchairs or mobility-related issues. As a manager, you should always try to make sure that every event you ask the person to attend, or any event that your company expects people to come, is accessible, including wheelchair access, accessible bathrooms, and accessible parking. There are also lots of different software or ergonomic office setups the office can provide that can make it easier for people to interact with their devices however is best for their body. I work with a startup now that allows you to interact with any device however you want to including facial expressions, voice commands, gestures - you name it, they can do it. The world is opening up more and more for people with remote work and more and more accessible ways to interact with devices.
People with mobility impairments may also have issues holding or grasping certain items, lifting things, or working at jobs that require standing all day. There are tools that can make this process less fatiguing for people, and it is important for the manager to work with the employee to figure out the right setup and role that will allow them to do their best work. It is important to remember that just because something has been done that way forever - such as standing all day if you work behind a counter - doesn’t mean that it is the only way it can or should be done.
Neurological Disabilities:
Neurological disabilities encompass illnesses that affect the central and peripheral nervous systems, which include the brain, spinal cord, cranial nerves, peripheral nerves, nerve roots, autonomic nervous system, neuromuscular junction, and muscles. In simpler terms, they are conditions that impact the body's communication network, from the brain down to the muscles. These may include Alzheimer's, Parkinson's disease, Epilepsy, migraines, Multiple Sclerosis, and stroke
Accommodation Considerations: Neurological disorders include Alzheimer's, Parkinson's disease, Epilepsy, migraines, Multiple Sclerosis, and stroke. This is a quite wide range of things and many will overlap with accommodations for mobility and communication.
If you are working with someone with Epilepsy, it is important to know how to support them if they are having a seizure. Some people with Epilepsy have service dogs that can alert them when they are likely to have one and ensure that they are on the ground and in a safe place where they won’t get hurt. While the person will likely tell you what they will need in the event that a seizure happens, it is helpful to know the following:
Emergency contact information for the person
Visual or audible warning signs that might occur just before a seizure
How and when to provide on-site medical assistance
When to call 911
Providing environmental support
Designating emergency responders
Knowing who to go to for help
Educating co-workers about epilepsy
Other neurological conditions, such as stroke, may have many overlapping accommodations with other disabilities - or require no accommodations at all. People who have had a stroke may have weakness on one side of their body and struggle with activities such as walking, standing, balancing, climbing, grasping, or gripping objects for precision. For those who struggle with walking or balancing, there are a variety of mobility aids that can be utilized, or their work setup can be adjusted to a space that is better suited to their condition. Additionally, there are many grasping devices on the market that can aid - my favorite is one of our Remarkable Tech startups, HominidX, which really improves upon the existing solutions for holding and grasping. Other people who have had a stroke may have vision loss and would benefit from accommodations for those with vision-related disabilities. Stroke may also impede communication in which case they would benefit from accommodations created for people with communication-related disabilities. Other things to consider when supporting a stroke survivor in the office are the increased fatigue they might experience as well as potential increased support for working memory and planning tasks. Ensuring in the beginning, especially as they return to work, that they get adequate breaks and that you are helping them prioritize and plan may help be helpful.
Vision Disabilities/Blindness:
A vision impairment, including blindness, is something that makes it hard or impossible to see. In nations where access to eyecare is easy, many vision impairments can be corrected through a very common assistive technology - glasses. However, in nations where access to eye care is difficult, vision impairment is a huge issue… I mean, think of how many people you know wear glasses or contacts! Being legally blind is also a spectrum. When someone says they are blind, it does not mean that they do not have any vision it means that they have visual acuity of less than 20/200. Within blindness, there is also a spectrum of how people see the world. Some have complete blindness, which is what we traditionally think of, but what might surprise you is that only 15% of blind people are completely blind. Here are a few examples of other ways people may experience blindness: CVI, or cortical/cerebral visual impairment, is a brain-based disorder that co-occurring with visual impairment. People with CVI would see the world as a swirling mass of color. People with Retinitis Pigmentosa will have trouble seeing at night. They often will lose their peripheral vision resulting in them seeing the world via a small circle directly in front of them. Macular Degeneration results in a similar experience as Stargardt Syndrome and it causes most people to lose their central vision, so they might see the world as a ring with a black dot in the center. Retinopathy of Prematurity is an eye disease that can affect babies born prematurely. Children who experience this often end up with no vision.
Accommodation Considerations: As we mentioned before, having a disability that affects your vision can mean many different things, and therefore, accommodations could encompass a variety of things based on each person’s individual needs. If a person is legally blind, it is important that when you create presentations and documents that you do so in a way that is accessible, meaning a screen reader can read it. For any images or charts provided, you should check that the alternative text is available and that it represents what is being shown. Many programs such as PPT, use AI to do this now, but it often is not accurate enough to be considered accessible. It is very easy to change these, and to make sure that you are providing accessibility. This should be best practice for all your public-facing documents, presentations, and websites. If their role encompasses working with external organizations documents that may or may not arrive accessibly, giving them access to an OCR device, such as Seeing AI by Microsoft can help read inaccessible printed documents out loud. If you are giving a presentation or having an event where a presenter will be presenting, it is best practice to have the presenter describe the slides and to have any video shown to have audio descriptions.
For people who read braille, there are assistive devices such as refreshing braille keyboards that, while can be expensive, are helpful. For people who have some vision, they may benefit from a large print keyboard or one with a braille overlay. If you have having an event or want to make your workplace accessible, you might consider having it mapped by an organization such as Goodmaps or XR Navigation, which allows blind people to preview and navigate new places. It is also helpful to ensure that offices and doors to rooms such as bathrooms have braille lettering so they can be distinguished easily. For people with other vision disabilities, providing large print documents can be helpful. Generally, a font any smaller than 12pt is way too small - ideally, the font would be between 12-16pt. For people with color blindness, it is also important to consider the contrast between the text and the background. The best practice is a ratio of 7:1 for normal text and 4.5:1 for large text. This can easily be checked via tools us as webaim.org. It also is pretty obvious when the text does not have the right contrast. If you look at something and wonder, does that text stand out enough? The answer is probably it doesn’t.
Other things to keep in mind:
Travel: In general, travel for people with disabilities can be challenging for a variety of reasons. For people with wheelchairs, they may rightfully be worried that airplane travel will damage their wheelchairs. A wheelchair for a disabled person is an extension of their body, think of it as their legs, if you had a high chance of having your legs broken every trip would you readily get on a plane? If they do get on the plane, they may only be able to sit in a certain type of seat such as first-class or the aisle, because of the way their body moves, or they may not be able to walk easily down the aisle so they may need to get a seat as close to the front as possible. For people with chronic illness or chronic pain flying can be fatiguing and even painful. They may need to limit layovers or get an aisle seat to move their body when they feel pain.
Many disabled people have to play the energy game in their mind. The energy game is a game where you look at all the things that require your energy and you figure out how you will save your energy reserves for the most important activities. For example, if you know that you need to give a big presentation, you may opt to fly in early so you can get a good night's sleep. Or you may opt for a flight that doesn’t include a layover, or pay a little extra to stay at the event venue. In general, when asking disabled employees to travel for work, you should always let them dictate their travel arrangements and preferences. It may cost a little bit more, but it will make a huge difference.