The New Disability Landscape: Why Our Frameworks No Longer Fit

Cognitive, Behavioral, and Anxiety-Based Disabilities Have Transformed Higher Education—But Our Models Haven’t Caught Up

For most of the past fifty years, disability policy focused on blindness, deafness, paralysis, chronic illness, and developmental disabilities—impairments that were visible, stable, and clearly defined.

The Americans with Disabilities Act (ADA) was written for this world: one where exclusion stemmed from architectural barriers, inaccessible materials, and discriminatory attitudes.

But the disability landscape of the 21st century looks entirely different.

Today the fastest-growing disabilities on college campuses—and in American life—are cognitive, behavioral, and psychological: ADHD, autism spectrum conditions, dyslexia, anxiety and mood disorders, executive-function impairments, and sensory-processing differences.

These conditions are real and often profoundly disabling. But they differ so sharply from traditional impairments that the frameworks we inherited—medical diagnosis, civil-rights accommodation law, and the social model—no longer map neatly onto contemporary needs.

We now operate within two disability regimes, and higher education sits at the fault line between them.

Two Disability Regimes—And a Growing Mismatch

For decades, disability meant conditions such as paralysis, blindness, deafness, cerebral palsy, traumatic brain injury, chronic illness, or age-related decline. These shared features made accommodation relatively straightforward:

Clear diagnoses: Impairments were medically verifiable and stable.

Predictable limitations: Needs did not fluctuate dramatically day to day.

Obvious barriers: Stairs excluded wheelchair users; print excluded blind readers.

Straightforward accommodations: Ramps, interpreters, screen readers.

This was the world the ADA was designed to address. Advocates could point to a staircase and say, “The problem is the stairs, not the wheelchair.”

The conditions reshaping today’s campuses—ADHD, autism spectrum conditions, dyslexia, anxiety, depression, OCD, panic disorders, sensory sensitivity, chronic attentional challenges—operate very differently.

They’re invisible: There is no visible markers of impairment, complicating trust, verification, and institutional response.

They fluctuate: Symptoms vary with stress, sleep, environment, workload, or medication. A student may function well one day and be overwhelmed the next.

They’re expectation-dependent: Impairment emerges under institutional demands—dense readings, tight deadlines, high-stakes exams, group work—not in all settings.

They’re context-contingent: The same condition can be disabling in one course format and manageable in another. Disability arises in the interaction between the person and the environment.

They’re stratified by class and race: Diagnosis requires time, money, and advocacy. Affluent families obtain evaluations far more readily, creating a system where disability status correlates with privilege, not need.

The social model’s central analogy—the idea that accommodations simply “remove barriers” like ramps—breaks down here. In many cognitive-spectrum conditions, accommodations alter the demands of the task itself, not just access to it.

This is precisely where friction emerges in schools and universities, where faculty experience the consequences directly and where the old frameworks offer little guidance.

The Faculty Perspective

Faculty genuinely want to support students with disabilities and meet legal obligations. Most chose academia because they care about teaching and believe in inclusive education. But many now feel caught in a system designed for a different era—one that increasingly feels detached from pedagogical reality.

The challenges they face are not abstract. They are recurring, concrete, and often impossible to resolve within current frameworks:

Accommodations that change the task, not just access. A history seminar depends on weekly participation and shared interpretation. If a student attends only half the sessions, the barrier is removed—but so is the core activity the course is built to teach.

Accommodations that relieve pressure but impede development. Unlimited extensions help a student with executive-function difficulties avoid paralysis, but they also prevent the student from practicing planning, pacing, and follow-through—central goals of a college education.

Last-minute requests that unravel course design. A scaffolded course depends on sequencing and timely feedback. When accommodations arrive late in the term requesting broad extensions, instructors must choose between honoring the accommodation or preserving the educational structure.

Flexibility that collapses pacing and coherence. In lab sciences or mathematically sequenced courses, delays compound quickly. A student who is weeks behind due to open-ended extensions ends up completing an entirely different course—lacking the original class structure, context, and progression.

Extended time that alters what an exam measures. A two-hour exam designed to assess real-time synthesis and pressured decision-making becomes something quite different when time is extended. The competencies measured are no longer the same.

Reduced workloads that reduce learning. A literature course built around a sequence of five novels cannot simply be reduced to three without altering the interpretive and comparative capacities students are supposed to develop.

Alternative assignments that bypass essential skills. If a public speaking requirement is replaced with written work, or a group project with solo assignments, the student avoids distress—but also misses the opportunity to build the very skills the course is meant to teach.

These scenarios are routine across disciplines. Faculty rarely voice concerns publicly because doing so risks appearing unsympathetic or ableist. The result is widespread confusion, quiet resentment, inconsistent expectations, and erosion of standards—none of which serves students well.

The point is not that accommodations are unnecessary. It is that the current accommodation regime is being asked to address developmental, psychological, and sociological problems it was never designed to solve. Accommodations were created to remove architectural barriers. They are now widely used to manage anxiety, compensate for executive-function deficits, buffer performance pressure, and supply developmental scaffolding—functions that require different institutional tools.

The Incentive Problem: When Diagnosis Becomes a Proxy for Performance Anxiety

A difficult truth in contemporary disability discourse is that when disability status confers real academic advantages—extended time, flexible deadlines, reduced workloads—demand for diagnosis rises.

This does not make underlying conditions less real. It means diagnosis now operates within powerful incentive structures that complicate institutional response and questions of equity.

Faculty often observe a predictable pattern: accommodations sometimes function less as supports for documented impairments and more as explanations for academic underperformance—especially when student or parental expectations are high.

A student raised in a high-achievement environment arrives at college, loses the scaffolding of intensive tutoring and parental oversight, and suddenly struggles. The gap between identity (“I’m gifted”) and performance becomes threatening. A diagnosis supplies both an explanation and a protective institutional framework—“I’m capable; I just have ADHD.”

This is a reasonable response to an educational culture that has left students with few tools for coping with difficulty.

And the incentives extend outward. Parents see diagnosis as responsible advocacy. Private evaluators know families expect actionable findings. Universities, wary of legal exposure, tend to approve requests. Some students see extended time as advantage, not simply access.

The result is diagnosis clustering among the affluent—those who can afford private testing, navigate bureaucracies, and understand institutional expectations. Meanwhile, first-generation and low-income students—who often face the greatest challenges—are least likely to obtain diagnoses and thus least likely to receive accommodations.

In this environment, accommodations meant to promote equity can end up reproducing inequality.

Let me be clear: many students genuinely need accommodations. Mental health conditions and learning differences are real and increasingly common. The decline in stigma around seeking help is a positive development. Earlier generations simply failed silently.

But the deeper issue is pedagogical. Many traditional course structures—large lectures, passive learning, high-stakes exams, rigid deadlines—are poorly suited to today’s student population. Accommodations often function as workarounds for a broader set of institutional and cultural failures.

Students are not manufacturing distress. They are responding to conditions we helped create.

Accommodations have become the institutionally sanctioned vocabulary for struggle—the only culturally acceptable way for many students to say, “I need help.”

The problem is as much sociological as psychological. We built a system that generates distress, medicalizes it, and then treats diagnosis as its primary solution—thereby reinforcing the cycle.

Accommodation vs. Development: The Missing Middle

The ADA was built on a straightforward principle: accommodations remove external barriers without altering essential requirements. A ramp grants entry but doesn’t change the course. An interpreter grants access but doesn’t change the content.

That logic made sense for the organic disability regime. But it fits poorly for today’s rapidly growing category of cognitive-spectrum disabilities, where the primary challenges are developmental or emotional, not purely environmental.

Many of the difficulties students face involve capacities that grow through practice, coaching, and repeated exposure—not traits that can be bypassed through accommodation:

Executive function: planning, organizing, initiating tasks, and managing time.

Emotional regulation: tolerating frustration, persisting through difficulty, and managing anxiety.

Sustained attention: focusing on challenging material for extended periods.

Planning and time management: breaking tasks down, estimating time, and balancing demands.

Social communication: navigating group dynamics, collaboration, and feedback.

Yet higher education often responds to these developmental needs with accommodations that provide relief rather than promote growth:

Deadline extensions ease pressure but do not teach planning or scheduling.

Reduced workloads make courses manageable but limit the practice needed to build reading stamina and analytical endurance.

Alternative assessments avoid stressful formats but eliminate opportunities to develop essential skills like real-time synthesis or public speaking.

Flexible attendance reduces anxiety but removes the repeated participation that builds confidence and interpersonal competence.

This is not an argument against accommodations. It is an argument that we are using the wrong tool for many of the challenges students face.

A student with executive-function difficulties does not simply need more time—they need guidance in structuring work and managing deadlines. A student with social anxiety does not simply need to avoid group projects—they need supported exposure that gradually builds collaborative capacity.

We have applied a framework designed for architectural barriers to developmental impairments. The result is a system that offers short-term relief but too often fails to cultivate the long-term skills students need to function independently in college—and far beyond it.

When Accommodations Alter the Task Itself

A core principle of disability rights is that accommodations should remove barriers without changing what is being assessed. An interpreter doesn’t change the lecture. The accommodation opens access; it doesn’t alter the standards.

But many cognitive-related accommodations do change the task—and therefore what is being measured.

▪ Extended time fundamentally changes exam conditions. A timed exam measures not only knowledge but the ability to retrieve information quickly, prioritize under pressure, and synthesize in real time. This matters in fields where rapid decision-making is essential—medicine, nursing, law, engineering.

▪ Reduced workload alters the learning arc. If a literature course assigns five novels, each builds interpretive stamina and comparative insight. Completing three instead of five doesn’t simply lighten the load—it produces a different educational experience.

▪ Flexible deadlines disrupt pacing and sequencing. Many courses scaffold assignments so that each prepares students for the next. When a student works on a separate timeline, the structure breaks down. They may complete all the work, but not within the designed learning progression.

▪ Alternative assessments change the skill being taught. A written report is not a substitute for an oral presentation in a public-speaking course. An individual paper does not recreate the learning of a collaborative project. In such cases, the accommodation alters—not just accesses—the intended outcome.

These are not minor adjustments. They transform what the course is. Yet universities have no shared criteria for identifying when an accommodation preserves learning outcomes and when it compromises them.

The legal framework doesn’t help much. The ADA requires “reasonable accommodations” that do not alter “essential requirements”—but what counts as essential?

Is time pressure essential? Is attendance? Is group work? Is real-time performance?

Faculty across the country are making these decisions alone, with no institutional guidance, producing inconsistencies students experience as unfair and faculty experience as legally risky.

Universities urgently need clear definitions of essential requirements—not to limit accommodations, but to ensure that access does not inadvertently erase the very skills a course exists to teach.

Why the Old Models Fail Us

We typically rely on three frameworks for thinking about disability. Each offers insight, but none is adequate for today’s rapidly changing landscape.

The medical model locates disability in the body or brain. It deliverstherapies and treatments that help many people, but it pathologizes difference and ignores environmental barriers.

The social model locates disability in exclusionary environments. It revolutionized public space and civil rights. But it falters when impairments involve internal states—pain, fatigue, cognitive fog—that remain disabling even in accessible settings.

The identity model understands disability as a cultural identity and source of pride. It empowered Deaf culture, neurodivergent communities, and crip theory. But it fits poorly for those with late-onset, degenerative, or episodic conditions who do not experience disability as identity at all.

Each model captures part of the truth. None captures the whole. They cannot explain:

▪ fluctuating impairments that shift with stress, sleep, or medication;

▪ conditions requiring developmental support, not just accommodation;

▪ diagnostic incentives that make disability status valuable in competitive environments;

▪ inequities in access to diagnosis that mirror class and racial privilege;

▪ tasks that rely on cognitive skills—attention, rapid synthesis, real-time performance—that accommodations can fundamentally change;

▪ late-life disability rooted in loss, dependence, and grief rather than community or pride.

Higher education now sits at the intersection of these tensions. A new framework must integrate the strengths of each model while addressing what they leave out.

Toward a New Framework for Disability in Higher Education

A 21st-century approach to disability in higher education must move beyond the old binaries—medical vs. social model, accommodation vs. exclusion, disability vs. ability. It must be:

Ecological: Disability arises not solely from bodies or environments but from their interaction—between neurological differences, institutional demands, cultural norms, technologies, and economic pressures.

An autistic student may struggle profoundly in a sensory-rich, highly social classroom yet thrive in a quiet, structured workspace. A student with ADHD may excel in project-based courses but falter in high-stakes timed exams. Impairment emerges in the mismatch, not in the person alone.

This ecological view reminds us that while environments can and should be changed, some academic tasks require specific cognitive capacities. Accommodations cannot infinitely reshape the activity without altering its fundamental nature.

Developmental: Accommodations remove barriers; development builds skills. Students need both.

A student with weak executive function may need extended deadlines and coaching in planning and time management. A student with social anxiety may need relief from group work and gradual, supported exposure to collaborative tasks.

Relying only on accommodations can foster dependence. Relying only on development can veer into coercion. A mature framework must hold both sides together.

Equity-Conscious: Support cannot depend exclusively on diagnosis. Diagnosis is stratified by class, race, geography, and parental advocacy. Students without resources often go without evaluation—and therefore without help.

Universities should offer universal academic supports—executive-function coaching, writing centers, study-skills workshops, anxiety-management sessions—available to everyone without requiring disclosure. This widens access, reduces stigma, and aligns help with need rather than documentation.

Integrity-Protecting: Faculty must be able to define which course components are truly essential.

If a course teaches public speaking, oral presentation is essential. If it teaches collaboration, group work is essential. If it teaches performance under pressure, timed assessment may be essential.

At the same time, institutions must scrutinize whether long-standing practices are genuinely pedagogical or simply inherited tradition. The boundary between integrity and rigidity must be examined openly, not assumed.

Life-Course Based: Disability is not confined to young adults seeking neurodiversity-affirming support. It spans the entire lifespan: children with learning differences, undergraduates managing mental health conditions, midlife adults developing chronic illness, older adults facing sensory loss, mobility decline, or cognitive change, and anyone dealing with grief, trauma, or temporary impairment. Each stage brings different needs—and often requires a different kind of response.

Practical Steps for Colleges and Universities

Updating disability frameworks will require significant institutional changes.

1. Create Universal Academic Supports

Offer executive-function coaching, study-skills workshops, writing support, and anxiety-management resources to all students. This reduces reliance on diagnosis and ensures support reaches those who need it but lack access to evaluation.

2. Clarify Essential Course Requirements

Departments should specify what learning outcomes truly require and why. This clarity enables accommodations that preserve academic integrity while removing barriers.

3. Build a Tiered Support System

Not every challenge requires formal accommodations. A three-tier approach—universal supports, targeted interventions, and individualized accommodations—ensures help matches need rather than documentation.

4. Require Proactive Communication

Students using accommodations should be expected (and supported) to communicate with instructors early and regularly. This is not punitive; it teaches skills in self-advocacy and collaborative problem-solving that matter beyond college.

5. Reform Assessment Practices

Universities should examine what exams and assignments actually measure and whether alternative formats could measure the same competencies. Rigor must be preserved, but so must fairness and clarity.

6. Address Diagnostic Inequity

Partner with clinics for low-cost evaluations. Offer screenings for struggling students. Provide psychoeducational testing through university services. Support should not depend on a family’s financial or bureaucratic resources.

Aging: The Test of a Mature Disability Framework

Within twenty years, older adults will be the nation’s largest disabled population. As the Baby Boom generation ages, tens of millions will experience declining mobility, hearing and vision loss, cognitive slowing or dementia, chronic pain, and increasing dependence.

Yet aging is largely absent from contemporary disability discourse. Frameworks built around neurodiversity, youth activism, and identity politics fit poorly here.

Most older adults do not embrace disability as an identity. They are not seeking pride in impairment or community organized around diagnosis. What they want is straightforward: dignity, as much autonomy as possible, good care when needed, accessible housing and transportation, humane medical systems, and a social order that does not treat aging as a personal failure.

Their disabilities are acquired rather than lifelong, often degenerative rather than stable. Their experience is framed less by empowerment than by grief, adaptation, and the need for sustained support. Accommodation helps, but it is not enough. Aging requires care, interdependence, and new forms of social infrastructure, not just better ramps and captioning.

The social model is right to insist that environments disable. But aging exposes its limits. No ramp cures dementia. No design principle erases chronic pain. Late-life disability shows that disability is at once embodied, social, emotional, and existential.

If our frameworks cannot encompass aging, they cannot encompass disability. Aging is the most common form of disability. Any account that treats it as peripheral has not yet faced what disability really is.

The Future We Are Building

We are in the midst of a major shift in what disability means, who claims it, and what institutions are expected to do in response.

The older frameworks are not wrong—the ADA was a breakthrough, the social model a liberation, disability identity movements transformative. But they were built for a world centered on visible, stable impairments and clear external barriers. Today’s landscape—cognitive-spectrum conditions, diagnostic expansion, unequal access to evaluation, and the looming wave of age-related disability—demands more.

Higher education sits at the center of this transition. Colleges and universities are where many cognitive and mental health conditions are first diagnosed, where accommodations are requested and granted, and where tensions between access and standards are felt most acutely.

If we fail to update our concepts and practices, we will:

▪ Undermine equity by tying support to diagnoses that affluent families can secure more easily.

▪ Erode academic integrity by granting accommodations that silently change what learning and mastery mean.

▪ Fuel resentment among students and faculty who see the system as opaque or unfair.

▪ Fail students who need developmental support and coaching, not only extensions and pressure relief.

▪ Reproduce inequality under the banner of inclusion.

If, instead, we build systems grounded in ecological thinking (disability as an interaction, not a label), developmental support (skills as well as rights), pedagogical integrity, equity-conscious design, and a life-course perspective, we can create institutions that genuinely support human variation in all its forms.

Disability is not “their” story; it is everyone’s story. How we define it, accommodate it, and support people across the lifespan will shape not only the lives of disabled students but the character of higher education itself.

Designing a disability framework fit for this century—one that honors rights while reckoning with incentives, that protects access while preserving academic integrity, that respects identity while acknowledging suffering, and that serves both a neurodivergent 20-year-old and a declining 80-year-old—is one of the defining challenges facing American universities.

It is time to meet that challenge directly.