People With and Without Disabilities: Interacting & Communicating
This publication was last revised July 2005
The following is an electronic version of the revised and expanded booklet "People With and Without Disabilities: Interacting and Communicating." This publication was prepared by the Equal Opportunity Programs Office, Code 120, NASA/Goddard Space Flight Center. This publication was prepared for all Goddard employees, especially those who have supervisors, managers, employees, or co-workers with disabilities. It is intended to provide general information and suggested behaviors that will increase the efficacy of interaction and communication.
For further information, please contact the author:
Michael J. Hartman
Disability Program Manager
Equal Opportunity Programs Office
Code 120
Goddard Space Flight Center
Greenbelt, MD 20771
E-Mail: Michael.J.Hartman@nasa.gov or Telephone: (301) 286-5715, voice/TTY
People With and Without Disabilities: Interacting & Communicating
INTRODUCTION
ALL PEOPLE WITH DISABILITIES
LANGUAGE CONSIDERATIONS
ACQUIRED BRAIN INJURIES
People with an Acquired Brain Injury
AMPUTATION
People Who Have Had an Amputation
ATTENTION DEFICIT DISORDER
People Who Have an Attention Deficit Disorder
People Who Have an Attention Deficit Hyperactivity Disorder
AUDITORY
People Who Are Deaf Or Hard of Hearing
COGNITIVE
People with Autism
People Who Have an Intellectual Disability
EPILEPSY
People with Epilepsy or Other Seizure Disorder
HIV/AIDS
People Who Have an HIV Infection/AIDS
LEARNING DISABILITIES
People with a Learning Disability
MOBILITY
People Who Have a Mobility Disability
People Who Had Polio or Have Post-Polio Syndrome
People Who Have Had a Spinal Cord Injury
People Who Use a Wheelchair
MUSCULAR/NEUROLOGICAL
People with Cerebral Palsy
People Who Have Multiple Sclerosis
People Who Have Muscular Dystrophy
People Who Have Had a Stroke
PSYCHIATRIC
People with, or Have a History of, a Psychiatric Disability
SPEECH
People Who Have a Speech Disability
TOURETTE
People with Tourette Syndrome
VISION
People Who Are Blind Or Have Low Vision
AFTERWORD
INTRODUCTION
NASA's Goddard Space Flight Center is dedicated to the principle of inclusion for people with disabilities. We have made great strides in making our physical environment convenient for all people. In recent years, Goddard has been proactive in recruiting people with disabilities as interns, and as participants in our cooperative education program, in addition to other student "pipelines." As always, we continue to recruit and hire individuals with disabilities into our permanent work force.
We recognize, however, that we need to do more than merely provide an accessible campus and invite people in. While there are legislative requirements and standards to guarantee physical access and to remove programmatic barriers, we have an additional goal. We strive to diminish attitudinal and communication barriers that are less obvious than physical barriers, but just as critical to ensure success for employees with disabilities.
This publication is written to suggest ways to promote effective communication between people with and without disabilities. In general, there is nothing extraordinary about such communication; however, using the suggested behaviors could bridge some of the perceived and real distinctions between co-workers. This booklet is not intended to address reasonable accommodation, unless an accommodation would promote more effective communication and interaction.
People with disabilities are just people who may happen to have difficulty with basic life activities, such as walking, moving, talking, learning, breathing, seeing, or hearing. It is important to understand, though, that not all conditions, illnesses, or diseases rise to the level of a disability as defined by law.
Some of the biggest barriers faced, and the hardest to remove, are stereotypical thinking about, and erroneous images of, people with disabilities, often resulting in feelings of pity, fear, paternalism, or disdain. People with disabilities are often wrongly perceived as helpless, confined, sick, needy, of limited intelligence or capacity, or as victims.
There is no particular personality type for people with disabilities in general, nor for individuals with the same disability. Furthermore, each person has his or her unique strengths and weaknesses, likes and dislikes. Therefore, it is important to remember that the suggestions in this booklet are designed to facilitate the interactions, but they will not automatically improve the quality of relationships, among co-workers with and without disabilities. Once the communication barriers are diminished, it is up to the individuals involved to create their own mutually acceptable relationship. It is important to note also that what is appropriate for one person might not be appropriate for another person, even if the two people have the same disability. So, when in doubt, ask your colleague what he or she prefers.
There are some people who, because of fear or discomfort, will avoid interacting with people with disabilities. Other people simply do not know what appropriate behavior is when around a person with a disability. Learning that people with disabilities are fundamentally no different from people without disabilities helps reduce fear and avoidance. People with disabilities, like all other large groups of people, represent a full range of personalities. Put simply, some are nice, some are not; some are easy to work with as colleagues, some are not; some you would like as friends, some you would not.
This booklet is arranged into broad disability groups. It does not attempt to discuss every disability or condition, only those where specific behaviors might be preferred when interacting and communicating.
Within each segment, there are two sections. "General Information" provides an introduction and basic overview of the disability. "Suggested Behaviors" provides a variety of options that will be appropriate in most situations.
Finally, it is important to recognize that there are many people with hidden disabilities or conditions which may not be immediately apparent. These include, but are not limited to, alcohol or other addictions, allergies, asthma, arthritis, cancer, chronic fatigue, chronic pain, diabetes, environmental illness, fibromyalgia, lung disease, kidney failure, hemophilia, hypertension, fragrance sensitivity, as well as the early stages of Multiple Sclerosis, Muscular Dystrophy, Amyotrophic Lateral Sclerosis, Parkinson's Disease, heart disease, and other conditions or disabilities.
People are very often affected by these hidden disabilities and conditions in ways that are less obvious than visible disabilities, but no less severe. Though there are usually no special communication needs, it should be noted that they are, nonetheless, bona fide disabilities. As such, they may require reasonable accommodations but are not included in this booklet, which will focus only on interaction and communication.
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FOR ALL PEOPLE WITH DISABILITIES
GENERAL INFORMATION
A person with a disability does not necessarily need help. Most people with disabilities try to be as independent as possible and will ask for assistance only if they need it. However, if you see a situation in where you think you might be of some assistance, ask, but do not insist that the person accept your aid.
If your offer for assistance is accepted or requested, ask how you can best be of help, and then try to do it with minimum attention drawn to the person with a disability, yourself, or your activities. Don't be embarrassed to admit that you don't know what to do or how to help. Simply ask the person for guidance, and he or she will instruct you.
SUGGESTED BEHAVIORS
When talking with a person with a disability, speak and ask questions directly to the person rather than to a companion, interpreter, or aide who might be accompanying that person.
Use first names only when socially appropriate, and when you extend the same familiarity to all others.
Ask questions when you are unsure of what to do.
Maintain eye contact without staring.
Use a natural tone of voice and body gestures.
If a person has a service dog or other assist animal, do not pet or otherwise distract the animal when it is working i.e., when the harness, jacket, special leash, or other designation is worn or displayed. If the person offers to let you interact with the assist animal, ask for direction in how to do so.
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LANGUAGE CONSIDERATIONS
The way we describe people with disabilities, like other stigmatized minorities, has changed so the words we now use are more accurate and appropriate. Words and phrases we have used in the past have been factually incorrect or hurtful and should be avoided. A sampling of these words and phrases include: cripple, crippled, invalid, retard, sick, victim, afflicted, deaf mute, mute, deaf and dumb, wheelchair-bound, or confined to a wheelchair.
The language we use, and the images that we create and promote through language, reflect the attitudes we have towards any particular group of people. Our language is picked up and emulated by others around us. The preferred words and phrases show respect for the dignity of people with disabilities.
We sometimes make the mistake of speaking as if all people with a certain disability, or all people with disabilities, share the same characteristics, have the same needs, or think and act the same. We also use adjectives as if they were nouns; we speak of "the deaf" or "the blind." Group designations such as "the blind," "the deaf," or "the disabled" are inappropriate because they do not reflect the individuality of people with disabilities.
When writing or speaking about people with disabilities, it is important to put the person first. Often, the focus is wrongly placed on the disability instead of on the person by naming the disability first. We refer to "blind people" or "a deaf accountant." Some people describe this concept as "people-first" language where the individual is recognized as a person first, and then further defined in terms of his or her characteristic, disability, or functional limitation. Although this is sometimes verbally cumbersome or awkward and lengthy to write, you will not be wrong in speaking and writing thus. However, as with all other things, check with the person with whom you are interacting to see if he or she has a preference.
Some examples of "people first" language:
A person with... a physical disability, muscular dystrophy
A person who uses...a wheelchair, an interpreter, an assistive device
A person who is...Deaf, blind, autistic
A person who has... multiple sclerosis, cerebral palsy
Likewise, services and programs do not have disabilities, but they are provided for people who do. So we should not write or speak about "disabled services" and "handicapped parking." A better way to convey these ideas would be "services for people who are disabled" and "parking spaces designated for people with disabilities."
Do not feel guilty or embarrassed you can do something that he or she cannot. You can talk about things that a person may not be literally able to do. You can say to a person who is blind, "You have got to see that play," an individual who is Deaf, "Did you hear about John?" or a person who uses a wheelchair or has a mobility disability, "Why don't we run over to the market."
Our attitudes towards people with disabilities are revealed when talking about people who are not disabled. When we say "able-bodied" or "normal," we must be aware of the implication and subtle message we are sending that says we feel people with disabilities are not "able" or "healthy" or are "abnormal." A more appropriate way to say this would be "people without disabilities" or "people who are not disabled." This also applies to programs or services provided for people who are not necessarily disabled that are described as, for example, "regular" with the implication that services provided to people with disabilities are "irregular." Instead, you might say, "typical" programs.
Not all people with disabilities agree on which language or terminology is preferred. Like any other large, diverse, yet identifiable group of people, individuals will vary as to how they refer to themselves and how they prefer others to refer to them. The suggestions given above will apply to most people and be correct in most situations. Some examples of other terminology that some people with disabilities have chosen to identify themselves as are "physically or mentally challenged" and "handicappers," while others still talk about themselves as "handicapped." It is important to remember that when talking to a person, ask what he or she prefers.
Here are some examples that exemplify these language principles:
USE: person with an intellectual, cognitive, or developmental disability
NOT: retard or retarded, mentally defective
USE: person who is Deaf or hard of hearing, chooses to not speak, or uses synthesized speech
NOT: the deaf; deaf and dumb, suffers a hearing loss, dumb, mute
USE: person who uses a wheelchair
NOT: confined or restricted to a wheelchair or wheelchair-bound
USE: person who has muscular dystrophy
NOT: stricken, afflicted, suffers from, or victimized by muscular dystrophy
USE: person with a physical disability or a person who has functional limitations
NOT: crippled, lame, deformed, the walking wounded
USE: person with psychiatric disability
NOT: crazy, nuts, "gone Postal"
USE: person who is successful, productive
NOT: has overcome his/her disability; is courageous (when it implies the person has courage because of having a disability), in spite of a disability
USE: person who is seeking accommodations or working accommodation issues
NOT: person who is having employment problems
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ACQUIRED BRAIN INJURIES
People with an Acquired Brain Injury
GENERAL INFORMATION
Acquired brain injury (ABI) can be caused by direct injury, external physical forces applied to the head, hemorrhage, swelling or may occur suddenly in the course of normal development. Other conditions that can result in a brain injury include heart attacks, aneurysms, chemical and drug reactions, breathing difficulties, infections, a car or other accident, and lack of oxygen to the brain. The injury may affect several areas of the brain and may be either closed or open head in nature.
In many cases, an ABI will result in an increased need for support in one or more of the following areas: physical capacities (i.e., the way we move and manipulate things); cognitive capacities (i.e., the way we think and process information); and behavioral and emotional capacities (i.e., the way we act, tolerate, and feel).
People who acquire brain injuries typically experience a variety of symptoms. These symptoms can vary in intensity over time, and could interact in unpredictable ways.
Physical Symptoms may include persistent headaches, fatigue, seizures, lack of motor coordination, weakness or involuntary muscle activity, double vision, partial loss of vision or hearing, delayed or difficult speech, sleeping disorders, and communication disabilities.
Cognitive Symptoms may include short and long-term memory loss, confusion, limited attention span, delayed response time, inability to make decisions, gaps in knowledge and skill, and difficulty managing two or more tasks simultaneously.
Behavioral/Emotional Symptoms may include inappropriate behavior, "disinhibition" (lack of inhibitions or appropriate boundaries), mood swings, depression, irritability, impulsivity, and denial of the disability. It should be noted that many individuals who have had an ABI experience some form of agitation during recovery.
With reasonable accommodations, though, all of these symptoms can, for the most part, be mitigated.
SUGGESTED BEHAVIORS
If the person's memory is affected, provide written information and instructions.
Break tasks into smaller sequential steps that are clear, consistent, and concise to increase understanding and remembering.
Verbally explain and demonstrate how to do a task.
Provide frequent feedback and recognize successes especially as new skills or gains are acquired.
Redirect a conversation that has gotten off track by using appropriate cues and reinforcers. For example, repeat important information about the purpose, duration, and guidelines of a meeting, or other type of gathering; summarize previous progress and review where previous meetings left off.
Follow-up spoken communications with a written communication (such as an e-mail or memo) to assist a person who may have memory support needs.
When asked to repeat a statement, use the same words and then paraphrase it for greater comprehension.
Provide only as much information or feedback as the person is capable of receiving and processing at any one time.
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AMPUTATION
People Who Have Had an Amputation
GENERAL INFORMATION
Amputation is the removal of all or part of a limb. An amputation may occur as the result of an accident or as a surgical intervention for a medical condition. Most amputations are for people who have wounds that do not heal properly due to vascular disease, atherosclerosis, and blood clots. Amputation may also be carried out to prevent the spread of cancer in the lower end of a limb.
"Phantom pain" is a sensation felt by a person who has had a limb amputated. The sensation has been described as one of a compressing, contracting, or a bent feeling in the absent body part. Some individuals may also feel an aching or burning pain, where the extremity was. The sensation is caused by stimulation along a nerve pathway, where the sensory ending has been severed in the amputated body part. The pain usually lasts between 2 to 3 months after the amputation, although some individuals experience phantom pain for years.
Some persons who have had an amputation replace the missing limb with a prosthetic. Prosthetics vary greatly in appearance and function. Some are made to look like biological limbs, while others do not. Some prosthetic hands have a grasping device that looks much like a hook to manipulate objects. Prosthetic hands, arms, legs, and feet function much the same as natural limbs with similar flexibility, strength, range of motion, and function.
SUGGESTED BEHAVIORS
Think of the prosthetic limb or device as you would a biological hand, arm, or leg.
When introduced to a person with metal grasping device or an artificial hand, it is appropriate to offer to shake the device or artificial hand.
Some people who have nonfunctioning or missing right hands prefer to shake hands with their left hand. Take your cue from the individual.
If the person does not have arms, it is appropriate to gently grasp his or her shoulder in a collegial manner in lieu of shaking hands.
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ATTENTION DEFICIT DISORDER
People Who Have an Attention Deficit Disorder or an Attention Deficit Hyperactivity Disorder
GENERAL INFORMATION
Attention Deficit Disorder (ADD) is defined as a persistent pattern of inattention that is more frequent and severe than behavior seen in individuals of a similar age. Add hyperactivity and impulsiveness to this condition, and you get an individual with Attention Deficit Hyperactivity Disorder (ADHD). This section will focus primarily on individuals with ADHD because that is the more severe of the two conditions. There are many more factors involved with ADHD than ADD. So, while this section will focus mainly on ADHD, the information does, for the most part, apply to and individual with ADD as well. Both conditions generally have an onset prior to the age of seven, but symptoms may be diagnosed at an earlier age, or not until the individual is an adult.
The exact cause of ADD and ADHD is not known at this time, but researchers have found that they are neurologically based. The conditions lie in a person's neurotransmitters -- the chemicals that regulate brain behavior.
ADHD and ADD are not learning disabilities. ADHD is a behavioral condition that is characterized by impulsiveness and an inability to pay attention for more than a set period of time. This attention span varies with each individual. The condition might cause some individuals to make mistakes on the job, but these mistakes are usually a result of their ADHD, not a reflection on their ability to learn. This differs from learning disabilities, which refer to specific developmental disorders associated with learning and the ability to process or interpret information.
While adults with ADHD might find it challenging to focus their attention for extended periods of time or to organize their offices, desks, and materials, most are able to effectively find coping mechanisms that help them to adapt to their disability, and they can and do thrive professionally. Thus, there should be no ADHD-related barriers to increased responsibilities and career development. As such, there is no need to restrict the nature or the amount of work that is assigned to a person with ADHD.
One effective, coping mechanism is to maintain a structured, consistent, predictable daily schedule. It may also be helpful if the employee is able to limit the number and kinds of distractions in his or her work area.
SUGGESTED BEHAVIORS
Communicate in direct, clear terms. Be patient, specific, and consistent. Apply structure whenever possible in communication and work tasks.
Ask clarifying questions throughout the conversation to ensure that the person is grasping the information provided. Repetition may be necessary.
For new employees, clearly state expectations, policies, and procedures, as well as both defined and "hidden" rules in the organization.
Allow for several short breaks during a long meeting or workshop rather than one long break. People with ADHD have the most difficulty in situations that require prolonged periods of attention.
If tasks are regularly performed, it is helpful to work with the employee to develop a book of procedures to assist you in communicating instructions for these tasks.
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AUDITORY
People Who Are Deaf or Hard Of Hearing
General Information
The term "deaf" refers to a profound loss of hearing. Persons are considered deaf if they are unable to hear or understand speech and must rely on vision for communication. The term "hard of hearing" refers to a hearing loss from mild (i.e., difficulty with or inability to hear soft sounds) to severe (i.e., difficulty with or inability to hear loud sounds). The severity of a person's hearing loss may be different at various frequencies. Also, the ability to hear a voice might be different from the ability to discriminate between sounds and to understand speech. Some people cannot hear voices but can hear environmental sounds.
Deafness is unlike other disabilities in that the same term is used to refer to two distinct groups of people. Those who consider themselves "deaf" (written with a lower-case "d") have a profound hearing loss but identify primarily with the hearing culture. Those who consider themselves "Deaf" (written with an upper-case "D") consider themselves to be a member of the Deaf Community, which generally perceives hearing loss to be a cultural and communication distinction rather than disability. These communities no longer commonly use the term "hearing impaired."
People who refer to themselves as "Deaf" often have Deaf parents and have attended state schools for children who are Deaf. For this population, American Sign Language (ASL) is the primary language. ASL is a linguistically recognized language with its own vocabulary, grammatical rules, and syntax that allows users to express themselves fully. It employs a subtle combination of hand, face, and body movements to convey messages. ASL is a completely separate language from English and follows neither the word order nor grammar rules of English. It is important to remember that, for people who use ASL as their primary language, English is a second language. Just as in the general population, the ease and competence with which someone learns a "second language" varies widely.
ASL is not a universal sign language. People who are Deaf from other countries use their own unique culturally determined Sign Language such as French Sign Language or Spanish Sign Language.
Some people who embrace their Deaf culture take pride in their deafness and do not necessarily seek to be integrated into the hearing world. They celebrate their Deaf experience through drama, poetry, storytelling, dance and other uniquely Deaf art forms that are passed down from one generation to the next.
People who refer to themselves as "deaf" often relate more easily with the hearing culture. Often these people have hearing parents and have attended public schools in mainstreamed classes. People who are deaf typically do not use ASL as their primary communication method. Instead, they use an English-based sign system to communicate with each other and with hearing people who know that communication method.
Persons who lose their hearing later in life, sometimes referred to as "late deafened," may have different communication preferences and rely on residual hearing, lipreading, captioning, or perhaps an English-based sign system.
The ability and facility to communicate orally often depends on when the individual became deaf. People who lost their hearing after the development of their speaking skills may have little difficulty speaking. In contrast people who were born without hearing, or who lost it at a very early age, may experience difficulty in learning to speak, though this is not always the case. Because speech develops as one listens to others and imitates the sounds heard, vocal communication can be more complicated for people who have never heard speech than for those whose hearing loss developed later in life. Many persons who have a hearing loss learn to use their voices in speech class and prefer to communicate vocally. Others choose to communicate in variety of other ways, including sign language, speechreading (also known as lipreading), cued speech, and writing.
People with a hearing loss communicate with people who are hearing in a variety of ways. Some do so with assistive technology, such as Assistive Listening Devices, Cochlear Implants, or reliance on various kinds of hearing aids. Assistive Listening Devices include large and small area amplification of spoken speech. Very simply stated, Cochlear Implants are surgically embedded devices that change the acoustic signal of sound into an electrical stimulus. Through both external and internal devices the auditory nerve is stimulated and that information is transmitted to the brain.
Assistive technology that presents a text rendition of spoken language includes CART (Computer Assisted Real Time Captioning) and another method called "C-Print Captioning." Both of these methods utilize a hearing person who listens to the speaker, inputs the spoken word into an electronic word processor, and produces written English onto a screen or other kind of display.
Individuals with a hearing loss sometimes use a telephone relay service. The relay service operator communicates with the person with a hearing loss through a TTY (a telecommunications device for people with a hearing loss or have speech disabilities) and with the person who is hearing through the telephone. The operator, who is not an interpreter, voices the TTY message and types the spoken message between the participants in the conversation.
A relatively new technology allows for Video Relay services where a qualified interpreter, in a remote location, communicates with the person with a hearing loss via the Internet with a web camera and the person who is hearing through the telephone and provides interpreting services between the two individuals.
Many people with a hearing loss prefer to use a qualified professional interpreter to facilitate communication. The need for an interpreter depends on the situation and the people involved. The term interpreter here is meant as a general term for both interpreters and transliterators.
A qualified interpreter facilitates and culturally mediates communication between people who do not share a common language or means of exchanging messages. Interpreters bridge this communication gap by rendering the message of one person to another in the most appropriate language for the participating consumers. This communication need is shared by all of the persons involved. Interpreters transmit messages using one or more of the following modes of communication: spoken English, ASL, an English based sign system, cued speech, or the oral method (utilizing lip movements, but no voice and no signs). The mode is fundamentally dependent on the preference of the individual with a hearing loss.
Professional certified interpreters all follow a Code of Ethics developed by their certifying organization. While there are some differences among various codes, which are reviewed and revised from time to time, virtually all of the codes share some basic concepts. These concepts most likely will include, but are not limited to, confidentiality, faithful rendering of the message, non-intervention, discretion when accepting assignments, competency, integrity, compensation, appropriate behavior, responsiveness to consumers, and professional development.
The two national certifying bodies for professional interpreters, the Registry of Interpreters for the Deaf (RID) and the National Association of the Deaf (NAD), have recently formed the National Council on Interpreting (NCI) to develop a National Interpreter Certification (NIC) test. This new test replaces certain RID and NAD certification testing. Certification will be awarded by the NIC.
If the person with a hearing loss chooses to use an interpreter, here are some guidelines that will facilitate the process.
COMMUNICATING THROUGH AN INTERPRETER:
When using an interpreter, communicate directly with the person with a hearing loss, rather than speaking as if he or she were not there. Avoid phrases such as, "tell him..." Ask questions directly of the person with a hearing loss, e.g., "How do you feel about that?" not, "How does she feel about that?" Talk to, not about, the person with a hearing loss. Talk through, not to, the interpreter.
Maintain eye contact with the person with a hearing loss, even as he or she is looking at the interpreter.
At times, the person with a hearing loss may prefer to have the interpreter voice the message that is communicated in sign. If this is the case, remember to respond to the person with the hearing loss, not the interpreter. Sometimes the gender of the person with a hearing loss is different from the interpreter. Do not be confused by this, especially on the telephone.
Be aware that the interpreter is there only to facilitate communication, not to participate in the conversation or activity.
The person with a hearing loss should be consulted about where to place the interpreter. This will usually be in a well-lit area near the speaker. The person with a hearing loss should have a clear view of the interpreter and any visual aids the speaker may use. Avoid bright lights or colors directly behind the interpreter.
Adequate lighting of the interpreter is necessary at all times, especially when the room is darkened.
Speak at a customary rate of speed, in a natural tone, and using usual speech patterns.
As the interpreter will be a few words behind the speaker, allow additional time for questions before continuing during a conversation, meeting, or workshop.
Be mindful that the person with a hearing loss cannot watch the interpreter and look at visuals simultaneously. Therefore, allow time for people to look in each direction.
The person watching the interpreter usually cannot take notes simultaneously so it is helpful to provide written instructions, directions, or notes when possible. In a meeting, a volunteer note-taker (perhaps a co-worker or clerical assistant) will be extremely helpful.
When planning a meeting or event, find out the preferred communication mode of the person with a hearing loss, if possible, in order to obtain the most appropriate interpreting services. In some specialized situations, a person with a hearing loss may prefer CART or C-Print captioning instead of a sign language interpreter.
Provide as much information about the meeting to participants, CART or C-Print Captioning providers, and sign language interpreters prior to the meeting time including acronyms, specialized vocabulary, correct spelling of names, agendas, and speakers' notes or prepared remarks.
SUGGESTED BEHAVIORS
To get the attention of a person with a hearing loss, vocalize a greeting, and if necessary, discreetly wave your hand or gently tap the person's shoulder. If you are entering his or her office and the person's back is to you, you could flicker the room lights. Wildly gesticulating, hitting the person, or throwing objects at the person is not appropriate.
When speaking to an individual with a hearing loss, use meaningful facial expressions and gestures to emphasize your intent and attitude. This helps to visually display your tone of voice. Try to find a quiet place away from computers, telephones, and other sources of noise that has adequate lighting.
Pen and paper are handy communication devices in some situations.
Although you want to avoid gross or exaggerated arm waving, pantomime is sometimes helpful.
Be aware that if you point to an object or area during a conversation with a person with a hearing loss, that person will most likely turn to look at where you are pointing. Wait to resume speaking until the person faces you again.
When talking to an individual with a hearing loss, position yourself so that any bright sunlight or other light is in front of you rather than in back of you. Keep your face out of shadows. Illuminate your face as much as possible.
Remove from your mouth objects such as pens, pencils, gum, or food. Keep your hands or any other objects from covering your mouth.
If a person is speaking for himself or herself and you do not understand that person's speech, it is appropriate for you to ask him or her to repeat, or even write down what was said.
If the person has difficulty understanding something you've said, try repeating the phrase. If your message is still not understood, try to rephrase your thought rather than repeating the same words. Do not raise your voice or yell because the essential barrier is not the person hearing you, it is the person understanding you. If needed, jot the phrase down on paper.
Not all individuals with a hearing loss can lipread, but many do and some do it quite well. Even good lipreaders, though, sometimes miss words. It is important to check with the person to make sure you are communicating effectively. When a person is lipreading you, enunciate clearly, but do not overenunciate your words, as you will distort your lip movements and make understanding more difficult. Use your voice when talking to the person so that your lip movements will be more natural and the person can use his or her residual hearing for better understanding.
Face the person when conversing so he or she can augment communication by lipreading.
Try to learn some elementary or "survival" sign language and fingerspelling from colleagues, coworkers, or managers who have a hearing loss. Secondary resources could include interpreters or other people skilled in sign language.
If you telephone a person who is hard of hearing, let the phone ring longer than usual. Speak clearly and be prepared to repeat who you are, and the reason for the call.
When talking with a person with a hearing loss, explain any interruption (such as a phone ringing or knock at the door) before attending to it.
Provide written notices of events that are usually announced orally. Arrange to have messages that are delivered by a public address system relayed in writing.
At meetings, strive to enforce the process of only one person speaking at a time. Some meeting facilitators use a small object such as a ball or gavel to indicate whose turn it is to speak. This allows the person with a hearing loss to easily identify who is speaking.
Provide paper and pencils at all tables to facilitate communication.
E-mail is a better way to communicate than voice mail. Make use of "Instant Messaging" (IM) technology.
In meetings or on conference calls, each individual should identify himself or herself by name to facilitate understanding, flow of ideas, and exchange of information.
Be aware that when using an interpreter, there may be a need to be more precise. For example, in English, there is a big difference between "I would" and "I will". Yet, the sign that the interpreter would most likely use is the same for both. Thus, it could be confusing unless the interpreter adds the concept of "if" to the first phrase, such as, "If I were you, I would..." compared with "I will..." The interpreter may not make the distinction that in the first instance, the speaker is suggesting that the listener do something, and in the second, the speaker is taking the action. This is especially critical in supervisor and employee conversations.
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COGNITIVE
People Who Have a Cognitive Disability
GENERAL INFORMATION
"Cognition" refers to the ability to comprehend what you see and hear, and to infer information from social cues and body language. People with impaired cognitive functions may have trouble learning new things, generalizing from one situation to another, and expressing themselves through spoken or written language. Cognitive disabilities are sometimes referred to as "developmental disabilities" because they are manifested before the person reaches adulthood and they affect cognitive development. As children, people with these kinds of impairments might have been classified in school with one of the following conditions: learning disability, mental retardation (now called intellectual disability), autism, multiple disabilities, having a head injury, or Down syndrome.
When working with someone whose cognitive functioning is different from yours, it is important to distinguish between learning and working style preferences and disabilities.
People with Autism have a complex neurological disability that affects the functioning of the brain, which typically appears during the first three years of life. Autism ranges from mild to severe. Typically, people with autism have some difficulties in verbal and non-verbal communication, processing information, social interactions, and leisure or play activities. They may exhibit repeated body movements (such as hand flapping or rocking), unusual responses to people or attachments to objects, and resistance to changes in routines. However, autism does not affect intelligence. Therefore, many people with autism function very well in the workplace and can perform the duties of virtually any job.
People with Intellectual Disabilities (formerly, mental retardation) may have average or superior abilities in some areas, while at the same time, are slower to learn or retain skills in other respects. Intellectual disability should not be confused with psychiatric disability, learning disability, or behavioral and emotional disability.
While it is true that some people with an intellectual disability are not able to think, reason, or remember as well as others, the effects of the disability can be lessened. Skills and abilities are increased through rehabilitation, education, and experience on the job.
Most people with an intellectual disability want to be independent and responsible for their own support. For them, success on the job often depends upon the willingness of coworkers to devote reasonable time and interest to helping these individuals adjust initially and meet new challenges as they arise.
To achieve workplace success, some people with an intellectual disability may utilize a "job coach" to facilitate and support their mastery over assigned tasks. This "supported employment" model helps the employee navigate the workplace.
SUGGESTED BEHAVIORS
Cognitive Disabilities -- in general
Be prepared to repeat what you say Ð orally, in writing, or using multiple formats -- to communicate with the person.
Offer assistance in understanding written instructions and in completing forms or documents.
Provide extra time for decision-making.
Be patient, flexible, and supportive. Take time to listen to, and understand the individual and make sure the individual understands you.
Adjust the length of conversations to maximize the individual's ability to remain attentive and decrease stress level.
Give instructions and have discussions in a quiet, informal, distraction-free environment.
Describe job tasks clearly, concisely, and simply. Break down large tasks into clearly defined small, sequential steps, keeping verbal descriptions short and direct. Use concrete terms and avoid abstract ideas
Establish tasks that include a set routine and consistent work.
People Who Have Autism
Remember that the person may have difficulty making eye contact and interpreting nonverbal cues, such as facial expression, gestures, and tone of voice in social settings
Be aware the person may be sensitive to touch, sounds, light, or color.
Be aware the person may tend to focus or fixate on particular objects or topics of discussion.
Be aware the person may quietly talk to himself or herself frequently throughout the day.
As the degree of impact of the disability varies tremendously with each individual, it helps to ask the person for advice and guidance in setting up his or her work environment. Things to consider would be the amount of noise, light, and other distractions in the person's work area.
Be aware the person may be socially awkward or shy.
As the person may have difficulty interpreting nonverbal cues, direct, specific, and clear communication is important.
People Who Have Intellectual Disabilities
Simplify and minimize wording in written and oral communications, but be sure to retain the original meaning.
Periodically, ask the person if he or she understands you. Have him or her paraphrase the meaning of your words and ideas to confirm this. Likewise, repeat information back to the individual to show that you understood what was said.
Routine and consistent job duties are usually the easiest to master. Add new responsibilities only after previous duties have been learned. Provide lists or checklists of job duties to help the person work independently.
Ask the person how he or she learns best and can stay on track.
Demonstrate what needs to be done, and then let the person practice with guidance and corrections from you.
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EPILEPSY
People with Epilepsy or Other Seizure Disorder
GENERAL INFORMATION
A seizure occurs when there is a sudden electrical discharge in the brain. Each individual is uniquely affected. A seizure can result in a relatively slight reaction, such as a short lapse in attention, to a more severe reaction, such as a loss of consciousness. Some seizure disorders can be controlled with medication; however, side effects of the medication may make the person lethargic or slow their reaction time to situations. When controlled by medication, seizure episodes in the workplace are rare. If a person discloses that he or she has such a disorder, ask what to do in case of a seizure. Be mindful, though, that some individuals may not disclose that they have epilepsy due to their experiences with other people and societal stigma.
SUGGESTED BEHAVIORS
If a person is having a seizure, stay calm.
If the seizure lasts beyond a few minutes, or if the person seems to pass from one seizure to another or does not regain consciousness after the seizure episode ends, call for emergency assistance.
When the seizure begins, help ease the person to the floor. Helping the person lie on one side often helps keep the airway open.
Do not try to stop the seizure. Do not try to "revive" the person during the seizure. Let the seizure run its course.
Do not move the person unless the environment in which the seizure occurring is clearly dangerous.
Remove hard, sharp, or hot objects from the vicinity of the person to avoid injuries, but do not interfere with the person's movements.
Loosen the person's tight clothing and remove his or her glasses.
Do not put your hand or any hard implement in the person's mouth to hold down the tongue. Contrary to popular belief, the tongue cannot be swallowed.
Make sure that breathing is unobstructed but do not be concerned if breathing is slightly irregular.
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HIV and AIDS
People Who Have an HIV Infection or AIDS
GENERAL INFORMATION
Medical and public health authorities have established that HIV infection cannot be transmitted through casual, social contact as exists in the vast majority of workplaces. Nor is HIV infection transmissible through food or food handling. As a result, HIV transmission in the workplace will rarely constitute a direct threat.
Workplace education emphasizing the fact that HIV and AIDS are not transmitted by casual contact affords an employee a supportive atmosphere in which to work. It will also serve to reassure co-workers that they are not at risk and help preserve workforce productivity.
It is important to maintain confidentiality about any individual, but our society has shown this to be particularly critical when considering a person with HIV or AIDS.
SUGGESTED BEHAVIORS
The Centers for Disease Control and Prevention has stated that you cannot contract HIV through casual contact. Your interaction should reflect this understanding.
Be mindful that close co-workers, friends, and family members might feel the stigma that is sometimes attached to persons with HIV or AIDS.
Do not pity, overreact, or be paternalistic to a person with AIDS or HIV.
Because HIV and AIDS may be contracted in various ways, do not presume to know the lifestyle of a person with AIDS or HIV.
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LEARNING DISABILITIES
People with a Learning Disability
GENERAL INFORMATION
The term "learning disability" is used to describe a variety of neurological disorders in acquiring, storing, retrieving, or expressing information. In other words, learning disabilities involve speaking, writing, or understanding in persons who have average or above average intelligence. Manifestations include difficulty in oral expression, listening comprehension, thinking, interpreting information, reading skills, reading comprehension, written expression, spelling, reasoning, organization skills, problem solving, or doing mathematical calculations. A learning disability can also affect the social aspects of a person's life such as team participation and interpersonal relationships.
Although its impact can be lessened somewhat as a person develops and learns adaptive techniques, a learning disability is a life-long condition. A person is very likely to have a combination of two or more learning disabilities in varying degrees rather than only one type. Also, the instance of learning disabilities with Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder being present at the same time is quite common.
It is not always apparent that a person has a learning disability. A possible indication that a person has a learning disability is when he or she performs in a way that seems inconsistent with his or her intelligence or personality. For example, employees with unrecognized learning disabilities may be perceived as clumsy, inefficient, accident-prone, unmotivated, careless, slow, distracted, or inattentive. In addition, they may seem to lack social skills or emotional maturity.
People with learning disabilities must discover their own personal coping mechanisms to accommodate their specific learning disability. Just as learning disabilities are unique, so too, are coping mechanisms. Alternative work strategies can help people with learning disabilities adapt. Once they learn new skills in an appropriate manner, they generally perform to their maximum capability.
Some common types of specific learning disabilities that have been identified are academic, perceptual, and motor. These types often overlap in the way they are manifested.
The academic learning disabilities and the difficulties they present include Dyslexia, reading; Dysgraphia, writing; Dysphasia, speaking; and Dyscalculia, math.
The employee who has severe dyslexia, for example, often reads printed matter by using computers and calculators with artificial speech. They may ask another individual to read to them or they use audiotapes to gather information. They usually prefer verbal rather than written instructions.
Coping mechanisms for other learning disabilities follow similar patterns of identifying the disability, and finding ways to work around the barriers imposed by the disability.
People who have a perceptual learning disability have difficulty receiving information through their senses. This includes auditory, tactile and visual perception.
People with motor learning disabilities experience difficulty when their muscles react differently than expected to brain signals, resulting in a lack of coordination.
Other learning disabilities involve attention deficit, balance, crossing the midline (going from the one side of the body to the other side of the body), directionality, lack of inhibition, short-term memory, and social skills.
SUGGESTED BEHAVIORS
Explain the organization's unique culture or "politics" and the relationship between organizations and individuals, including the "hidden" rules by which organizations or individuals operate. Openly discuss the rules of "turf" and "territory" that other employees might instinctively perceive and understand.
Recognize that some people with learning disabilities, especially when not diagnosed, experience feelings of frustration, anger, inadequacy, and low self-esteem. Once diagnosed, it is important to recognize these feelings as being a result of the learning disability and to address them openly and honestly.
Be firm about any limits that are set.
If inappropriate behavior is observed or reported, tell the person exactly what behavior is inappropriate and what changes need to be made.
Reduce distractions and unnecessary visual and auditory stimulation.
Be thorough, direct, and specific in communication. Ask questions to insure understanding. Allow adequate time for a response.
When giving instructions or directions, break large tasks into small and clearly defined sequential steps.
Demonstrate how to do a task in addition to explaining it verbally.
Give frequent and constructive feedback.
Allow adequate time to learn certain skills.
Whenever possible, notify the person of changes well in advance.
Decide together the preferred way to communicate. This may be in writing, verbally, or even by telephone.
For the employee who has difficulty with visual perception, it is important to have neat and well-organized surroundings.
For people who read slowly, give advance notice of reading materials, allow extra time, and prioritize the work. Audiotape written communications. Provide graphic presentations such as diagrams and flow charts when appropriate.
For people with auditory perception difficulties, catch their eye before beginning a conversation. Talk in a quiet place. Ask them to repeat what you said. If they take notes, allow them to finish writing before you continue talking.
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MOBILITY
People Who Have a Mobility Disability
GENERAL INFORMATION
Mobility disabilities include a broad range of disabilities that affect a person's independent movement. Mobility disabilities may result from cerebral palsy, spinal cord injury, stroke, Parkinson's Disease, arthritis, muscular dystrophy, multiple sclerosis, amputation, polio, or other conditions resulting in paralysis, muscle weakness, nerve damage, stiffness of the joints, strength and endurance, short stature, conditions like Osteogenesis Imperfecta ("brittle bones"), or lack of balance or coordination.
Some people with mobility disabilities use manual or power wheelchairs, while others use a variety of mobility aides, such as crutches, canes, walkers, or scooters. Not every person who uses a wheelchair or other mobility device is unable to walk; many use these devices to conserve their energy, or to cover long distances. Prosthetic devices, such as artificial arms or legs, and body braces might also be used. Some people with mobility disabilities use service animals to assist them with carrying or retrieving items and opening doors in order to achieve greater independence.
The conditions that cause mobility disabilities have their own distinct characteristics. Some mobility disabilities are acquired at birth, while others are caused by accidents, illnesses, or the natural process of aging. People with mobility disabilities have highly diverse levels of physical ability and range of motion.
A major cause of mobility disability is spinal cord injury and disease. Causes include motor vehicle accidents, falls, and sports injuries, such as diving accidents. Other causes of damage to the spinal cord include conditions such as polio and spina bifida.
Spinal cord injuries can be either complete, meaning that there is no sensation or voluntary movement below the injury, or incomplete, meaning that there is some functioning below the injury. In addition to a lack of muscle control and/or sensation, people with a spinal cord injury may experience loss of involuntary functions such as unassisted breathing or body temperature control, as well as chronic pain.
Although many people who are paralyzed cannot experience certain sensations, there are many forms of spinal cord injuries resulting in varying levels of movement and sensation. For example, it is possible for someone with a spinal cord injury to have no muscle control of his or her lower extremities, but to have sensation to touch.
People with a mobility disability who use a wheelchair do so for a variety of reasons. Each person may have different needs and physical abilities.
Some people with a mobility disability, including paraplegia (commonly, paralysis of the lower body), who use a wheelchair will need to stretch and relieve pressure from time to time by slightly lifting themselves off the chair with their arms. This is done to stimulate circulation.
Do not be surprised if the person transfers from a wheelchair to a ergonomically superior stationary chair or gets out of the wheelchair to move about. Many people who use wheelchairs can walk with or without the aid of canes, braces, or crutches, but their speed, range, and convenience of movement is enhanced by the use of wheelchairs and scooters. People who use wheelchairs participate in many different physical activities such as swimming, skiing, driving and other activities both in and out of their wheelchair.
Mobility is also an issue for individuals with short stature. There are literally hundreds of medical or genetic conditions that cause short stature, that is, a person who is approximately 4 feet 10 inches or shorter. The most common is Achondroplasia. A person with this condition has arms and legs that are short when compared to the trunk length. This shortness is particularly noticeable in the upper arms and thighs. Other persons with short stature have proportional arms and legs when compared with the trunk of the body. Mobility issues include walking and climbing steps with a shorter stride, while communication issues involve face-to-face interactions.
Schedule meetings at convenient accessible locations so the person doesn't have to take a long and indirect route to get there. Give clear instructions on how to reach a destination, using the shortest and most accessible route. Make sure there are accessible bathrooms near meeting locations. Floor or ground surfaces should be free of obstacles that would inhibit the movements of people with a mobility disability. Provide convenient places to sit at meetings or other group activities.
SUGGESTED BEHAVIORS
If a person uses crutches, a walker, a cane, or some other assistive equipment, offer assistance with coats, bags, or other belongings.
If you call a person with a mobility disability, allow the phone to ring longer than usual to allow extra time for her or him to reach the telephone.
The use of touch with a person using a wheelchair (e.g., a pat on the shoulder or arm to show support) adheres to the same rules as when touching a person not using a wheelchair. In short, use common sense and be respectful.
When walking with a person who walks slower than you, walk alongside and not in front of the person.
If a person falls or is off balance, simply offer assistance. A natural tendency is to overreact, but you need not be overprotective of a person with a mobility disability.
Offer to shake hands even if the person appears to have little hand strength or movement.
Do not hold on to a person's wheelchair. It is a part of the person's body space and holding on is both inappropriate and dangerous.
Talk directly to the person using the wheelchair, not to a companion or other third party.
It is appropriate to offer to assist with a particular task such as opening a door, loading a wheelchair into a car, or pushing it up a steep hill, but do not be offended if your help is not accepted. Never assume the person needs your assistance and start grabbing or pushing his or her wheelchair.
If the person uses a cane or crutches, the person will want to keep them within reach. If, however, they are in the way or pose a tripping danger, it's fine to ask the person to move them under the chair or desk.
As the person may have decreased physical stamina and endurance, finding a place to sit and talk is preferable to standing during the entire interaction.
When conversing, place yourself at eye level with the person. Some ways to accomplish this without drawing attention to yourself are kneeling, sitting on a chair, or standing a little farther away to reduce the steep angle of the sightline. This is effective when interacting with all people who are sitting as well as persons with short stature.
If the person's speech is difficult to understand, do not hesitate to ask him or her to repeat what was said. Never pretend to understand when you do not.
If a person chooses to communicate using assistive technology, such as an augmentative communication device, be patient with the speed of the technology. Though not generally done, some individuals may not mind having his or her sentences finished by you in order to ease communication. Absolutely confirm this, though, before doing it.
Some people with paraplegia, quadriplegia, or other disabilities may have difficulty in holding a pen or in writing. Although you should not assume so, the individual may want or need your assistance in this task and ask for it. If this is the case, ask how you can best assist him or her. For example say, "If you would like assistance, I am available to help you fill out the form."
Do not physically lift or manipulate a person with a mobility disability in any manner against his or her will.
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MUSCULAR/NEUROLOGICAL
People Who Have a Muscular/Neurological Condition
GENERAL INFORMATION
Muscular or neurological disabilities can affect motor ability and/or speech. A person with such a disability may exhibit some involuntary or halting movement or limitation of movement in one or more than one appendage, as well as some lisping, indistinct speech, lack of saliva control, or flatness of tone due to lack of fine motor control of the tongue and lips. The severity and functional effects of the disability vary from person to person.
Cerebral Palsy is a condition caused by damage to the brain, usually occurring before, during, or shortly after birth. Cerebral palsy is characterized by an inability to fully control motor functions. This may include stiff or difficult movements; involuntary and uncontrolled movements; involuntary spasms; impairments in sight, hearing or speech; a disturbed sense of balance and depth perception; difficulty in maintaining balance; unsteady or irregular gait, or mobility impairments. Because of these traits, some people with cerebral palsy might appear to be under the influence of alcohol or drugs when they are not. Cerebral palsy does not affect intelligence, though it may co-exist with a intellectual disability.
Some people who have significant cerebral palsy or other muscular or neurological disabilities may communicate with the aid of assistive technology, such as typing, or using a communication board or other electronic device.
Multiple Sclerosis (MS) is a condition of the brain and spinal cord (Central Nervous System) in which the covering of the nerves is destroyed. This condition impedes the communication between the brain and spinal cord, thus creating a multitude of different symptoms.
Although each case of MS is unique, typical symptoms include difficulty with balance and coordination, fatigue, tremors and spasms, pain, weakness, numbness, tingling, and weakness or other reactions to hot or cold weather conditions or room temperature. Vision, hearing, and/or speech might also be affected. In some cases, the symptoms become gradually more severe, while in others there may be a pattern of exacerbation followed by complete or partial remission.
Muscular Dystrophy (MD) is the common name for several progressive hereditary conditions, including Amyotrophic Lateral Sclerosis (ALS), which cause muscles to weaken and degenerate. MD is caused by altered genes, which prevent the body from manufacturing essential substances in adequate amounts to maintain and fuel the muscles.
Since MD encompasses many conditions, the symptoms will vary with the type. However, some symptoms are prevalent in many of the conditions. These symptoms include, but are not limited to, generalized weakness, muscle atrophy, or paralysis affecting limb and trunk muscles, as well as a person's face, feet, hands, or neck. Sometimes respiratory muscles are also affected.
Stroke is a brain injury caused by a sudden interruption of blood flow to the brain. When an area of the brain is damaged by stroke, functions controlled by that area no longer work as they previously did. There are four areas of brain function that can be affected by stroke: motor control, sensation, communication/cognition, and personality. People who survive a stroke often have weakness on one side of the body. They also might experience a variety of disabling effects such as partial or full paralysis of the body, memory loss, or speech difficulties.
Many of the conditions caused by stroke can be significantly improved with rehabilitation. Through physical, occupational, recreational, speech, and other therapies, people who have had a stroke can enhance their functional abilities and live and work independently.
SUGGESTED BEHAVIORS
If the person's speech is difficult to understand, ask him or her to repeat what was said. Never pretend to understand when you do not.
If a person chooses to communicate using assistive technology, such as an augmentative communication device, be patient with the speed of the technology. Though not generally done, some individuals may not mind having his or her sentences finished by you in order to ease communication. Absolutely confirm this, though, before doing it.
Some people with muscular or neurological disabilities may have difficulty holding a pen or writing. If this is the case, do not assume anything, but rather ask how you can be of assistance. For example say, "If you would like assistance, I am available to help you fill out the form." Do not say, "Oh, you cannot do that, I will do it for you."
When introduced to a person with a disability, it is appropriate to offer to shake hands. People with limited hand use can usually shake hands. Shaking hands with the left hand is an acceptable greeting.
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PSYCHIATRIC
People with, or a History of, a Psychiatric Disability
GENERAL INFORMATION
Psychiatric disabilities cover a wide range of behavioral, emotional, or psychological conditions. These include anxiety disorders, major depression, bi-polar disorders, (formerly called manic-depressive illness), schizophrenia, as well as, personality, disassociative and post-traumatic stress disorders.
Not all causes of psychiatric disabilities are known, but it is generally believed that these disorders are due to a combination of biochemical, psychological, and environmental factors. They can interfere with a person's ability to think, feel, and interact with or relate to other people and the environment. Many of these conditions can be treated successfully with medication and treatment.
Psychiatric disabilities are often not apparent. Supervisors will probably not know whether an employee has a psychiatric disability unless he or she chooses to disclose it. Supervisors should be aware, though, that a noticeable change in a person's work habits, level of accomplishment, quality of work, or interpersonal relationships with colleagues and managers, may be an indication of a psychiatric disability. Supervisors and managers are encouraged to seek guidance and assistance from the Employee Assistance Program (EAP) and the Equal Opportunity Programs Office (EOPO) if they notice these changes.
The symptoms of psychiatric disabilities manifest themselves differently depending on the type of disorder and the unique traits and support systems of the individual. For example, some workers with psychiatric disabilities find it difficult to concentrate while workers who take medications to control their psychiatric symptoms may experience side effects such as hand tremors, excessive thirst, or blurred vision. Some individuals report difficulty in focusing on multiple tasks simultaneously, particularly amid noise and distractions. Other employees find it difficult or impossible just to get out of bed and come to work.
While it is not unusual for many people to feel anxious during times of stress, people with anxiety disorders experience feelings of excessive anxiety and overwhelming fears that interfere with their usual daily activities. Anxiety disorders include generalized anxiety disorder, panic disorder, post-traumatic stress disorder, obsessive-compulsive disorder, as well as social and other phobias.
Depression is probably the most commonly diagnosed psychiatric disability. Clinical depression is characterized by a loss of energy, sleep disturbances, changes in appetite, and feelings of hopelessness that are experienced continually for more than two weeks. Depressive illnesses include major depression, dysthymic disorder, atypical depression, and manic depression/bi-polar disorder.
Schizophrenia is among the more severe forms of psychiatirc disability. It generally refers to a psychotic disorder characterized by a loss of contact with the environment and a disintegration of personality. Even though this condition cannot be cured, it can be controlled with medication and psychotherapy.
Psychiatric disability does not affect a person's intelligence. However, sometimes during adjustment periods to medications, people with psychiatric disabilities may appear lethargic. Some people with psychiatric disabilities may experience difficulties with their attention span or discussing topics that produce anxiety. Some individuals may have difficulty processing or expressing emotions or might overreact to emotionally charged topics. All of these behaviors can result in miscommunication.
Although some psychiatric disabilities include symptoms of aggressive behavior, people with these disabilities are generally no more violent than anyone else. If violent behaviors are part of a person's specific condition, they can usually be controlled with medication and psychotherapy.
Applicants and employees are often deterred from discussing their psychiatric disabilities with employers because of the stigma often associated with these disorders. Disclosure is a personal decision on the part of the worker that involves many factors including trust, comfort with others in the workplace, job security, and the perceived open-mindedness and support of the immediate supervisor.
Sometimes it is difficult to share an office if you have a psychiatric disability because of the communication and interpersonal dynamics of having an office mate. Therefore, if possible, it might be better for an employee with a psychiatric disability to have his or her own office.
SUGGESTED BEHAVIORS
Be sensitive to requests for a flexible work schedule to allow the person to attend medical appointments and therapy sessions and to deal with medication issues, insomnia, fatigue, or other conditions that often accompany psychiatric disabilities.
Through your own behavior and demeanor, show that you trust the individual's ability to control his or her behavior.
Integrate the person fully into office activities.
If the person makes an occasional odd statement, try to just agree or let the comment pass. Simply help redirect the person to the topic or task.
Minimize stress for the employee as much as possible.
Approach each employee with an open mind about his or her strengths and abilities.
Convey important information objectively and avoid using sarcasm and giving mixed messages. Talk to the individual in a calm and relaxed manner. Make sure that any instructions are defined carefully and clearly. Repeat or summarize information and write it down for the person's reference when needed. Explain things even though they may seem obvious to you.
Clearly express expectations for performance. Maintain continuous communication with the individual, providing timely feedback on a regular basis. Do not assume the employee knows when he or she is doing either well or poorly.
Be firm, fair, flexible, and consistent, especially in administering policies and work assignments.
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SPEECH
People Who Have a Speech Disability Including People Who Stutter
GENERAL INFORMATION
Speech disabilities vary greatly, and may be related to another condition such as cerebral palsy, brain injury, stroke, or hearing loss. Stuttering is one type of a speech disability. Sometimes, involuntary body and facial movement associated with the effort to speak accompany speech disabilities.
Individuals with a speech disability sometimes use a telephone relay service. The relay service operator communicates with the person with a speech disability through a TTY (a telecommunications device for people with a hearing loss or have speech disabilities) and with the other person through the telephone. The operator, who is not an interpreter, voices the TTY message and the other person can respond by voice.
SUGGESTED BEHAVIORS
Be patient. Wait for the person to finish his or her thought rather than interrupting or finishing it for the person, unless that person expressly gives you permission to do so.
Do not pretend to understand when you do not. This will hinder communication, not enhance it. Ask the person to rephrase the thought or spell out a particular word to facilitate your understanding.
Repeat back what you do understand so the other person may fill in or correct your understanding where needed.
If you are having difficulty understanding what the person is saying, let the person know. "I didn't understand that last part. Could you please repeat it?" "I'm not sure if I understood correctly. Did you say...?"
Do not make unsolicited suggestions, such as "relax" or "take your time"
Allow the communication to take as much time as necessary. Hurrying through the interaction can make the situation worse.
If you continue to have difficulty, offer pen and paper if the person is physically able to write, but first ask the individual if this is acceptable.
Concentrate on the words the individual is saying rather than how they are being said.
If no solution to the communication barrier can be worked out between you and the individual, ask if there is someone who could facilitate the conversation.
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TOURETTE
People with Tourette Syndrome
GENERAL INFORMATION
Tourette Syndrome is a neurological disorder with two basic features: involuntary motor tics and involuntary vocal tics. The symptoms come and go, vary in intensity, and change over time. Many individuals with Tourette Syndrome have Attention Deficit Disorder (i.e., difficulty with attention and impulse control) and Obsessive-Compulsive Disorder (i.e., controlling urges) and/or some form of learning disability.
Motor tics caused by Tourette Syndrome include eye blinking, shoulder shrugging, facial grimaces, and arm waving. Vocal tics include production of noises such as throat clearing, tongue clicking, and barking sounds, as well as vocalization of socially unacceptable words such as cursing and insulting comments.
Tourette Syndrome is exacerbated by both positive and negative stress, anxiety or worry. Therefore, the symptoms could be manifested differently or more repeatedly each day depending on the circumstances of that particular day. To reduce the symptoms, the individual is advised to rest or temporarily leave the stressful situation.
SUGGESTED BEHAVIORS
If someone is exhibiting the symptoms of Tourette Syndrome, it is best to ignore the symptoms.
If the symptom is bothersome or intrusive and cannot be ignored, bring it to the attention of the person in a non-judgmental and non-threatening way.
If the symptom is a physical one, move out of the way.
Do not react with anger or annoyance if the person displays motor or vocal tics. Remember the person cannot control the tics and behaviors.
Be patient.
Several short breaks are often more effective than one long break.
It may help to allow the person to briefly go to a private place where the person is comfortable to relax and release tics. Short time-outs are very helpful.
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VISION
People Who Are Blind or Have Low Vision
GENERAL INFORMATION
People who have congenital blindness have been without sight since early childhood or birth. People who have adventitious blindness lost their sight later in life often as a result of disease, aging, or a sudden injury. It is important to differentiate between these two conditions because of the diversity in education, employment, and attitudes among people with these two different types of blindness.
An individual who has congenital blindness most likely formed his or her identity as a person who is blind. People with congenital blindness probably received special education services throughout school and learned to use Braille and assistive devices at a young age.
Someone with adventitious blindness most likely formed his or her identity as a person who is sighted. When people lose their sight later in life, they often experience a period of tremendous shock. They need to learn the skills to help them adapt to a life without vision. Very often, these individuals do not know Braille
The terms "blindness" and "low vision" mean either a complete or partial loss of vision. What a person is able to see depends upon the age of onset, degree of visual memory, and degree of usable vision regarding light, shape, color, and other factors. For some persons, only the edges or a part of the visual field might be obscured. Others might have no central vision although side or peripheral vision still exists.
Vision disabilities also include tunnel vision and color blindness. Tunnel vision has been described as seeing the world through a small tube. It is often accompanied by night blindness. This means that the person with tunnel vision may function very well in good light but not when the light gets below a certain level. The most common causes of tunnel vision are glaucoma and retinitis pigmentosa (RP). Color blindness describes a number of difficulties in identifying various colors and shades. The severity of the condition ranges from only a slight difficulty distinguishing among different shades of the same color to the rare inability to distinguish any colors.
"Low vision" generally refers to a severe vision disability, not necessarily limited to distance vision. Low vision applies to all individuals with sight who are unable to read the newspaper at a normal viewing distance, even with the aid of eyeglasses or contact lenses. This includes individuals who are legally blind.
There is a large range of behaviors that are common for some people who are blind. For example, a person who is blind may or may not look directly at you. An individual might rock back and forth or move his or her head around. In a room with a public address system, the person who is blind might face the nearest electronic speaker rather than the podium because that is from where he or she hears the voice of the person who is speaking.
Some people who are blind use an assist animal or cane to get around independently while others do not use these mobility aids.
SUGGESTED BEHAVIORS
Announce your presence by name because your voice may not be recognizable. When you leave a person's presence, say so.
Speak directly to the person in a normal speed and tone of voice. Shouting or speaking overly slow is not helpful.
When conversing with a group of people, identify the person to whom you are speaking. If a person who is blind or has low vision does not respond to you, it may be because he or she thinks you are talking to someone else.
In meetings, ask each person to identify himself or herself by name before they speak. Continue this until people's voices become familiar and recognizable.
Offer assistance in filling out forms, and be prepared to read aloud any information that is written, if requested. Many people with a vision disability can fill out forms and sign their names if the designated spaces are indicated to them.
When giving directions, use a relevant reference. "Two steps to your left" is a better way to describe a location than a vague expression such as, "over there." Some individuals like to refer to positions in terms of clock hands: "The chair is at your 2 o'clock."
Use directional words with the other person's orientation. For example, when you are facing someone, the door that is on your "left" is the same door that is on that person's "right."
If a person asks you for assistance in going from one location to another, put out your arm and tell him or her that your arm is there. He or she will then take your arm and you can proceed. Do not just grab the person's arm.
Walk at a comfortable pace when guiding a person who is blind. There is no need to walk slowly. Let the person know if you are approaching a step or other obstacle, and how you plan to navigate it.
When guiding a person into a new or strange surrounding, describe special features or physical characteristics of the area. When going into a room, orient the person to the surroundings: describe where furniture is, where the door is, and where the person is in relation to these objects.
When speaking to a person with low vision, position yourself so that the sun or any other bright lights are in front of, not behind, you. Your face will be illuminated and, at the same time, glare or blinding light in the eyes of the other person will be eliminated.
Petting or touching a dog guide or other service animal (usually indicated by a harness) while it is "on duty" is not appropriate. When the animal is not on duty, it is up to the animal's human to decide if play is permitted.
If you are offering a seat, physically indicate the back or arm of the chair or give a verbal cue as to the seat's location, e.g., "The chair is one step to your right" or "The chair is two steps behind you." Then the person will be able to sit down by him or herself. Neither force the person into the chair, nor move the chair without telling the person.
Be aware that the person may need to use a tape recorder or Braille device to note information.
When a person who is blind or has low vision is meeting many people, introduce each person individually. This helps the person to better associate names and voices for subsequent encounters.
Be precise and thorough when you describe people, places, or things. Use descriptive language. If the person has visual memories, references to colors, patterns, designs and shapes are perfectly acceptable. If not, try to attach other descriptive words and ideas to colors. For example, red is often associated with hot, blue with cool, green with calm, yellow with cheery.
Use alternative formats for written materials, such as Braille, large print, computer disk, and audio. Also, increase the frequency of oral announcements, provide audiotapes or Braille transcripts of frequently requested information, and read aloud brochures or important information.
Many people who are blind or have low vision are quite comfortable reading documents and messages from a computer utilizing a screen reader, magnification software, or other assistive technology, so electronic mail with or without text attachments is an excellent way to communicate on a regular basis.
When interviewing or meeting with people with vision disabilities, ask whether they would prefer a well-lit area. Avoid sharp contrasts of light and dark areas.
Ask the employee whether he or she learns best from oral instruction or a combination of hands-on, written, and aural learning.
At a meeting, read and describe all information that is included in a visual presentation so that everyone understands it.
When preparing visual presentations, keep font sizes large and use contrasting colors to ensure ease in reading. You might also provide the materials in alternate formats.
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AFTERWORD
This document is meant to provide a quick guide to facilitate communication and ease interactions between people with and without disabilities. It is an expansion and revision of a publication that was originally published in 1994 by the Equal Opportunity Programs Office at NASA's Goddard Space Flight Center. It had its roots in materials I originally developed for the inauguration of President Jimmy Carter in 1977 and expanded for the Office of the Assistant Secretary for Personnel Administration at the U.S. Department of Health and Human Services.
It is the hope and desire of the Equal Opportunity Programs Office that this information will be especially useful to new managers and supervisors. We cannot stress enough the importance of training and education in this area. This booklet is designed to augment training, not to replace it.
Most of the material was developed from over 30 years of professional experience in the field of disability. Some was taken from reading and discussions with colleagues and other professionals. This current revision could not have been done without the support and review of several individuals, primarily in the fields of communication, disability, and diversity. This was truly a collaborative effort.
As such, if you have any comments, concerns, or suggestions on how to improve this document, please contact me at Michael.J.Hartman@nasa.gov or call me at (301) 286-5715, voice and TTY.
Michael J. Hartman, March 2004
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