Demystifying Accommodations for People with Hidden Disabilities

Allen Smith, J.D. By Allen Smith, J.D. March 30, 2022

Marcia Lang, a social worker and psychologist, speaks at the SHRM Employment Law & Compliance Conference 2022 on March 29. Photo by Chris Williams.

​Hidden disabilities are more common than apparent ones and can be harder to accommodate on the job. Marcia Lang, a social worker and psychologist in Silver Spring, Md., shared ideas for accommodating individuals with psychiatric and neurodevelopmental disabilities at the SHRM Employment Law & Compliance Conference 2022 in Washington, D.C., on March 29.

The author of Hidden Disabilities in the Workplace (Palmetto Publishing, 2021), Lang noted that somewhere between 1 in 4 and 1 in 5 individuals have disabilities, most of the disabilities are hidden and many employees with hidden disabilities are afraid to disclose they have one. It's up to employers to create a safe environment for individuals with disabilities to step forward and request an accommodation, she said.

The Interactive Process

Accommodation requests don't have to include the phrase, "I need an accommodation," she stated. An employee may request accommodations more indirectly, such as, "I'm having trouble getting to work at my scheduled starting time because of medical treatments I'm undergoing." Managers need to be trained to be on the lookout to identify accommodation requests so they can be referred to HR.

Once an employee requests a reasonable accommodation, the employer needs to engage in a discussion with the employee about possible accommodations. This discussion is commonly referred to as the interactive process.

First ask, "How can I help you?" Lang recommended. The employee may suggest a quick fix that enables him or her to get back to performing essential job functions.

An office manager who has to report to work by 8 a.m. and requests getting in at noon is not asking for a reasonable accommodation, Lang noted. That would be an undue hardship, she explained.

The cost of an accommodation rarely will be a winning argument for employers that are maintaining that an accommodation poses an undue hardship, she cautioned.

The employee should provide documentation to show a hidden impairment is in fact a disability. Stress, for example, is not a disability, and a stress-free environment is not an accommodation, Lang said.

The supervisor and employee should be contacted about possible accommodations. Once an accommodation is selected, the employer should document the approved accommodation. The employer then should revise accommodations as needed by the employee with a disability, ensuring that it is meeting its obligations under the Americans with Disabilities Act without resorting to accommodations that result in an undue hardship.

Reassignment to a vacant position is an accommodation of last resort, Lang said. If an employee is no longer qualified to fill a position with or without a reasonable accommodation, the worker may be terminated.

Don't let employees use their disability as an excuse to miss deadlines, for example. They still can be required to meet the same performance standards as others and the essential job functions, which Lang said should be in their job descriptions.

Accommodating People with Psychiatric Disabilities

Although Lang noted that accommodations should be individually tailored, she made the following suggestions for accommodating individuals with psychiatric disabilities:

  • Provide work-focused feedback of what is going well and what needs improvement.
  • Allow for reasonable breaks.
  • Provide a workspace free of distractions.
  • Break tasks into smaller pieces but maintain same overall deadlines.
  • Provide written expectations of work tasks and performance.
  • Maintain routines in the office as much as possible.
  • Explain why expectations or routines have changed.
  • Refer individuals with psychiatric disabilities to the employee assistance program, as needed.

A leave of absence beyond time off under the Family and Medical Leave Act may be a reasonable accommodation in most jurisdictions, but only for a definite period. Indefinite leave is not a reasonable accommodation, she stated.

Accommodating Individuals with Neurodevelopmental Disabilities

Learning disabilities, attention deficit hyperactivity disorder and autism all are neurodevelopmental disabilities, Lang said.

Individuals with learning disabilities might need some of the same adjustments as people with psychiatric disabilities, she noted. For example, employers might:

  • Reduce distractions for them.
  • Break tasks into smaller segments but keep the same overall deadlines.
  • Put tasks in writing.

In addition, employers may need to give individuals with learning disabilities extra time to learn new tasks.

Individuals with attention deficit hyperactivity disorder might benefit from having a sit/stand desk if they're fidgety, she said. Software is available as well to help them organize their thoughts, Lang added.

People with autistic spectrum disorder may approach social interactions differently from their peers. Possible accommodations include:

  • Clear, concrete and specific wording. Avoid ambiguity.
  • Explain why when giving a direction or response.
  • Maintain routines and explain why a routine has changed.
  • Break tasks into smaller segments and put them in writing.
  • Address inappropriate behaviors or comments immediately and explain why they are inappropriate.


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