Workplace Accommodations

Attention deficit-hyperactivity disorder (ADHD) is a neurobehavioral disorder that affects three to five percent of American children and adults. ADHD is usually diagnosed in childhood, and the condition can continue into the adult years. Many individuals with ADHD are undiagnosed until adulthood.

The common characteristics of ADHD are impulsivity, inattention, and/or over-activity. Failure to listen to instructions, inability to organize oneself and work tasks, fidgeting with hands and feet, talking too much, inability to stay on task, leaving projects, chores and work tasks unfinished, and having trouble paying attention to and responding to details are the primary symptoms of ADHD. Although individuals may have both inattention and hyperactivity symptoms, many individuals predominantly display one symptom more than another. There are three subtypes of ADHD:

• ADHD predominantly hyperactive-impulsive type: The major characteristics are fidgeting, talking excessively, interrupting others when talking, and impatience.
• ADHD predominantly inattentive type: The major characteristics are distractibility, organization problems, failure to give close attention to details, difficulty processing information quickly and accurately, and difficulty following through with instructions.
• ADHD combined type: The individual with combined type meets the criteria for both hyperactive-impulsive and inattentive type.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that is characterized by persistent deficits in social communication and social interaction across multiple contexts, including deficits in social reciprocity, nonverbal communicative behaviors used for social interaction, and skills in developing, maintaining, and understanding relationships. For the diagnosis, the presence of restricted, repetitive patterns of behavior, interests, or activities is required.

The brain can incur several different types of injuries depending on the type, amount, and position of force impacting the head. The impact may affect one functional area of the brain, several areas, or all areas of the brain. These factors determine what types of accommodations are effective. JAN’s Effective Accommodation Practices (EAP) Series: Executive Functioning Deficits is a publication detailing accommodations for individuals with limitations related to executive functioning. These ideas may be helpful in determining accommodations.

In order to receive a diagnosis of chronic fatigue syndrome (CFS), a patient must satisfy two criteria. First, an individual must have severe chronic fatigue of six months or longer duration with other known medical conditions excluded by clinical diagnosis. Second, an individual must concurrently have four or more of the following symptoms: substantial impairment in short-term memory or concentration; sore throat; tender lymph nodes; muscle pain; multi-joint pain without swelling or redness; headaches of a new type, pattern, or severity; erratic sleep; and malaise lasting more than 24 hours.

In addition to the primary defining symptoms of CFS, some CFS patients have reported a number of other symptoms. They include gastrointestinal, pain, nausea, photosensitivity, respiratory and skin issues, and weight changes. A majority of CFS patients also report mild to moderate symptoms of anxiety or depression. The treatment of CFS focuses on symptom management.  Chronic fatigue syndrome has also been called myalgic encephalomyelitis (ME) and post exertional fatigue syndrome.

An intellectual disability involves significant limitations both in intellectual functioning and in adaptive behavior. Adaptive behaviors include many everyday social and practical skills such as interpersonal and communication skills, social problem solving and responsibility, the use of time and money, as well as daily personal care and safety. Limitations in individuals often coexist with strengths, and will vary from individual to individual. This disability originates before the age of 18 and encompasses a wide range of conditions, types, and levels. Intellectual disability is caused by factors that can be physical, genetic, and/or social. Intellectual disabilities can also be caused by a head injury, stroke or illness.

Epilepsy is the tendency to have repeated seizures that originate in the brain. There are several types of possible seizures that range from losing consciousness and massive muscles jerks to blank stares.

Cancer develops when cells in a part of the body begin to grow out of control. Although there are many kinds of cancer, they all start because of out-of-control growth of abnormal cells. Normal body cells grow, divide, and die in an orderly fashion. During the early years of a person’s life, normal cells divide more rapidly until the person becomes an adult. After that, cells in most parts of the body divide only to replace worn-out or dying cells and to repair injuries. Because cancer cells continue to grow and divide, they are different from normal cells. Instead of dying, they outlive normal cells and continue to form new abnormal cells. Cancer cells often travel to other parts of the body where they begin to grow and replace normal tissue. This process, called metastasis, occurs as the cancer cells get into the bloodstream or lymph vessels of our body. Treatment options may include surgery, radiation, chemotherapy, hormone therapy, immunotherapy, and targeted therapy.

Some generalized symptoms and signs such as unexplained weight loss, fever, fatigue, or lumps may be seen in several types of cancer; however, other signs and symptoms are relatively specific to a particular type of cancer. Staging is the process of finding out how much cancer there is in the body and where it is located. Doctors use this information to plan treatment and to help determine a person’s outlook (prognosis). Cancers with the same stage usually have similar outlooks and are often treated the same way. Staging is also a way doctors can communicate with each other about a person’s case. For most cancers, the stage is based on three main factors: the original (primary) tumor’s size and whether the tumor has grown into other nearby areas, whether the cancer has spread to the nearby lymph nodes, and whether the cancer has spread to distant areas of the body.

The term “deaf” refers to individuals who are not able to hear well enough to rely on hearing as a means for processing information. The term “hard of hearing” refers to individuals who have some hearing loss but are able to use hearing to communicate.

Osteoarthritis (OA) is the most common type of arthritis and typically worsens with age. Rheumatoid arthritis (RA), although not as common, can cause significant limitations in individuals of all ages. With RA, one’s immune system attacks the joints and inflammation can affect the entire body.

RA affects joints in a way that limits both sides of the body. RA is termed as a bilateral condition, meaning if a worker has RA in one hand, they will have it in the other. Because it is an autoimmune disorder, RA can also affect the lungs, heart, skin, blood, nerves, and eyes. The most common issues are from limitations due to joint pain and stiffness in the upper and lower body, fatigue, and temperature sensitivity.

Anxiety disorders affect millions of people and these disorders include generalized anxiety disorder, acute stress disorder, substance-induced anxiety disorder, anxiety disorder due to a general medical condition, anxiety disorder not otherwise specified, panic disorder with or without agoraphobia, post-traumatic stress disorder, obsessive-compulsive disorder, social phobia, and specific phobias.

Anxiety disorders are clinically distinct from transitional anxiety experienced during events such as a wedding, moving into a new home, dealing with the illness or death of a loved one, or beginning a new job. Individuals with anxiety disorders may experience feelings of panic; extreme physical, mental, or emotional stress; and intense fear. Due to the highly individualized nature of mental health impairments, symptoms can present in numerous ways and significantly impact the functionality of individuals with Anxiety Disorders.

Depression is an illness that involves feelings of sadness lasting for two weeks or longer, often accompanied by a loss of interest in life, hopelessness, and decreased energy. Such distressing feelings can affect one’s ability to perform the usual tasks and activities of daily living. This is considered to be clinical depression. It is very different from a temporary case of “the blues” triggered by an unhappy event or stressful situation. Depression affects the mind, but this does not mean “it’s all in your head.”

Depression is a medical illness linked to changes in the biochemistry of the brain. Depression is not a weakness of character. Being depressed does not mean a person is inadequate. It means the person has a medical illness that is just as real as diabetes or ulcers. Like other medical disorders, clinical depression should not be ignored or dismissed. A clinically depressed person cannot simply “snap out of it” any more than a person with an ulcer could simply will it away.

Approximately one in four adults experience a mental health impairment. The DSM-5, the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the American Psychiatric Association (APA), provides diagnostic criteria for mental health impairments. According to the DSM-5, a mental health impairment is:

• a mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.

The National Alliance on Mental Illness (NAMI) (n.d.a) defines a mental health impairment as:

• a medical condition that disrupt a person’s thinking, feeling, mood, ability to relate to others, and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life.

JAN receives numerous accommodation questions related to individuals with mental health impairments working successfully. Although there are various definitions and lists of impairments, this document covers those that are received the most by JAN. NAMI provides useful definitions of mental health impairments and statistics on their prevalence. The following (NAMI (n.d.b.)) is a summary of these:

• Bipolar disorder, sometimes referred to as manic depression, “is a medical illness that causes extreme shifts in mood, energy, and functioning. Bipolar disorder is a chronic and generally life-long condition with recurring episodes of mania and depression that can last from days to months that often begin in adolescence or early adulthood, and occasionally even in children.”
• Borderline personality disorder (BPD) is “an often misunderstood, serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self image, and behavior. It is a disorder of emotional dysregulation. This instability often disrupts family and work, long-term planning, and the individual’s sense of self-identity.”
• Major depression is “persistent and can significantly interfere with an individual’s thoughts, behavior, mood, activity, and physical health. Among all medical illnesses, major depression is the leading cause of disability in the United States and many other developed countries.”
• Obsessive compulsive disorder (OCD) “occurs when an individual experiences obsessions and compulsions for more than an hour each day, in a way that interferes with his or her life.”
• Panic disorder occurs when a person “experiences recurrent panic attacks, at least one of which leads to at least a month of increased anxiety or avoidant behavior. Panic disorder may also be indicated if a person experiences fewer than four panic episodes but has recurrent or constant fears of having another panic attack.”
• Post-traumatic stress disorder (PTSD) is “an anxiety disorder that can occur after someone experiences a traumatic event that caused intense fear, helplessness, or horror. While it is common to experience a brief state of anxiety or depression after such occurrences, people with PTSD continually re-experience the traumatic event; avoid individuals, thoughts, or situations associated with the event; and have symptoms of excessive emotions. People with this disorder have these symptoms for longer than one month and cannot function as well as they did before the traumatic event. PTSD symptoms usually appear within three months of the traumatic experience; however, they sometimes occur months or even years later.”
• Schizophrenia “often interferes with a person’s ability to think clearly; to distinguish reality from fantasy; and to manage emotions, make decisions, and relate to others.”
• Seasonal affective disorder (SAD) is “characterized by recurrent episodes of depression – usually in late fall and winter – alternating with periods of normal or high mood the rest of the year.” SAD is not regarded as a separate disorder by the DSM-5, but it is an added descriptor for the pattern of depressive episodes in patients with major depression or bipolar disorder.

Schizophrenia is a chronic and severe mental disorder that interferes with a person’s ability to think clearly, manage emotions, make decisions and relate to others. People with schizophrenia may seem like they have lost touch with reality. Although schizophrenia is not as common as other mental disorders, the symptoms can be incapacitating.

The symptoms of schizophrenia, include:

• Hallucinations include a person hearing voices, seeing things, or smelling things others can’t perceive. The hallucination is very real to the person experiencing it, and it may be very confusing for someone else to witness. The voices in the hallucination can be critical or threatening. Voices may involve people that are known or unknown to the person hearing them.
• Delusions are false beliefs that don’t change even when the person who holds them is presented with new ideas or facts. People who have delusions often also have problems concentrating, confused thinking, or the sense that their thoughts are blocked.
• Negative symptoms diminish a person’s abilities, and include being emotionally flat or speaking in a dull, disconnected way. People with the negative symptoms may be unable to start or follow through with activities, show little interest in life, or sustain relationships. Negative symptoms are sometimes confused with clinical depression.
• Cognitive issues/disorganized thinking involve struggling to remember things, organize thoughts, or complete tasks. Commonly, the individual with schizophrenia is unaware that he has the illness, which can make treating or working with him much more challenging.

Conditions related to schizophrenia include substance abuse, posttraumatic stress disorder, obsessive-compulsive disorder, and major depression.

Gastrointestinal (GI) disorders affect millions of people of all ages – men, women, and children. Examples of GI disorders include Crohn’s disease, gastroparesis, ulcerative colitis, irritable bowel syndrome, spastic colon, and diverticulitis. Symptoms of GI disorders range from very mild to debilitating. Just as symptoms may vary from person to person, so may the need for job accommodation.

People use wheelchairs for a variety of reasons, the most common reason being paralysis from spinal cord injuries. Individuals who have had a stroke, muscular dystrophy, multiple sclerosis, polio, cerebral palsy, back condition, cancer, diabetes, traumatic brain injury, and dementia may also have limitations that result in paraplegia. Paraplegia is a condition that results from paralysis in the legs and potentially the trunk.

An individual with a vision impairment may be blind or have vision loss. These limitations vary depending on the individual. Vision impairment is a term that encompasses various limitations in eye function. This can include low vision, blindness, limited visual field, photosensitivity, color vision deficiency, or night blindness.

Blind

An individual who is blind has no vision, but may be able to see light and shadows. In other words, the individual has no useful sight. This limitation describes someone who is unable to see because of an injury, disease, or congenital condition. It may be temporary or permanent.

Blind – Total

The term blindness is sometimes used interchangeably with the term sightless.  However, individuals who identify as blind, are considered functionally blind, or who meet the legal definition of blindness vary in terms of what they are able to perceive using their eyes. Generally, however an individual who is considered or who identifies as blind has significantly limited vision in both eyes.  Depending on the age of onset, progression and underlying causes of blindness, individuals may use a variety of adaptive techniques and assistive technology to perform every day and workplace tasks.  Typical accommodations needs include accommodations related to: getting to and from work, on the job travel, getting around the workplace, accessing information, using computers and other equipment, working around vehicles or heavy machinery, emergency preparedness, and use of service animals.

https://askjan.org/limitations/Blind-Total.cfm

Blind – One Eye

Individuals who are blind in one eye, but have normal vision in the other eye can do many types of tasks without accommodation or adaptation.  However, they may have difficulty with tasks requiring depth perception and with tasks that require monitoring equipment or people on opposite sides of a room, or in situations where movement of the head is restricted, because they will have a limited field of vision on the affected side.

https://askjan.org/limitations/Blind-One-Eye.cfm

Vision Loss

An individual with vision loss could have a limited visual field, be unable to distinguish colors, have limitations after nightfall, be photosensitive, have low vision, or have progressive vision loss. Individuals with vision loss experience some degree of difficulty seeing even with the use of corrective lenses. Some individuals with vision loss may have usable vision remaining, while others may be unable to see at all. Vision loss is generally the result of errors of refraction, diseases of the eye, and other vision-related conditions. Accommodations may include the use of accessible materials, magnification, and text-to-speech technologies.

Limited Visual Field

Visual field deficits result in a limited visual field. These cannot usually be be fixed with glasses or surgery. Field loss can be described as a scotoma (a blind spot), hemanopsia (half of the field is missing in one or both eyes), or tunnel vision (the field is constricted to central vision). Visual field refers to the total area that is visible to a person while looking at a fixed central point. Individuals with conditions such as glaucoma, macular degeneration, retinitis pigmentosa, and cataracts may experience limited field of vision. This can impact both peripheral and central vision. Employees with visual field loss may have difficulty navigating around obstacles in the workplace, and may need accommodations to assist with wayfinding and mobility.

Color Vision Deficiency (Color Blindness)

Color Vision Deficiency (CVD) is the inability to distinguish between some colors and shades. Most people with this condition can identify some colors. Few people are totally “color blind.” Color filters, such as a special red contact lens worn on one eye or prescription glasses may be used to help some people with a color deficiency. In addition, talking products are available that will scan a color and announce a description of the color (originally designed for individuals who are blind).

Night Blindness

Individuals with night blindness do not see well at night or in areas with low levels of light such as dark rooms and or heavily shaded areas. Some individuals may also have a slower adjustment to a change in light conditions.  Nyctalopia is a medical term that may be used to describe night blindness. Driving at night, working outside at night and working in areas with low levels of light may prove challenging for an individual with night blindness.

Photosensitivity

There are many individuals who are sensitive to light, commonly referred to as photosensitivity. There are many different medical conditions or medications that can trigger photosensitivity, and problematic types of lighting may differ depending on the individual and their medical condition. Regardless of the cause of the reaction, individuals who experience photosensitivity may need accommodations to maintain or increase their productivity at work. Accommodations come in a variety of solutions for a specific limitation. See below for some ideas to help you get started.

• Performing Outdoor Tasks: When individuals who are photosensitive need to perform essential functions outdoors, accommodations that employers may consider include: providing flexible schedules to avoid peak sun hours; providing UV protection clothing/accessories; allowing frequent rest breaks indoors or in shaded areas; combining tasks to limit exposures; limiting exposure to water, ice, and other highly reflective surfaces; and allowing flexible leave around low-ozone and sun-flare events.
• Performing Driving Tasks: Whether an individual spends the entire work day in a vehicle or just part of the day, this UV exposure can prove problematic for individuals with photosensitivity. To address this issue, an employer may consider providing the following accommodations: allowing telework or flexible work schedules to avoid peak sun exposure, providing window tinting and shades on work vehicles, allowing frequent breaks indoors, and modifying dress code policies to allow UV protection clothing/accessories.
• Performing Indoor Tasks: While it may seem like individuals who are photosensitive would be able to easily work indoors, there are many hidden UV light sources that may need to be eliminated or avoided. Examples of accommodations that may help include: providing alternate lighting, UV light filters, sheltered work spaces, UV protection clothing/accessories, and UV filtered computer screens; allowing telework or flexible work schedules to avoid peak sun exposure; and avoiding water, ice, and highly reflective surfaces around unavoidable UV sources.
• Office Setting:
  • Consider allowing telework for some or all of the week so that the employee may work in a setting where he or she can more easily control lighting.
  • Consider use of floor to ceiling cubicle walls so that fluorescent light is blocked from reaching the employee’s work station.  Other options to block out overhead lighting include an office with a door, a cubicle roof or even a patio umbrella installed over one’s desk.
  • Consider installing filters in fluorescent light fixtures to reduce the negative effects of fluorescent lights. Turning off overhead lights and using lamps may allow more control over lighting especially for employees who need to work in dim light.
  • Consider use of full spectrum lighting to supplement natural light near employee’s workstation if the individual does better with natural or full spectrum light.  If the individual is sensitive to full spectrum, natural light, or UV, consider other options.
  • For individuals who are sensitive to flickering, consider use of alternative lighting such as incandescent or LED lighting.
  • Consider modifying dress code to allow employee to wear items that may be helpful in reducing the effects of fluorescent light such as sunglasses or hats with brims.
  • Explore accommodations to enhance concentration such as reducing background noise or allowing employee to listen to music through headphones while working.
  • If the person does better with natural light, try to place them near a window.
  • If the person needs more control over the light in their workspace or is sensitive to UV, windows can be problematic.  Consider moving the person away from windows or installing appropriate window coverings.

Low Vision

The term “low vision” is usually used to describe the experience of having a vision impairment that cannot be corrected and which interferes with daily activities. Individuals who meet that standard for legal blindness sometimes identify as having low vision.  Individuals with low vision typically use a variety of strategies and assistive technologies to access information and to perform daily tasks.  Magnification is often beneficial to individuals with low vision, but the degree of magnification needed varies.  Individuals with low vision may also use many of the technologies used by or designed for individuals who are blind.

Progressive Vision Loss

Progressive vision loss is a term used to describe vision loss that gets worse over time. As the vision loss progresses, different solutions may be needed. Magnification may be replaced with text-to-speech or Braille solutions as vision declines. Depending on the individual’s preferences and the nature and degree of their vision loss, solutions designed for individuals who are blind may be appropriate. It is usually painless, but can be central or peripheral and may be worse for far or near sightedness. It is usually bilateral, but this differs depending on the individual.