Accommodating Children with Physical Disabilities

The Americans with Disabilities Act and Sec. 504 prohibit discrimination against a child with a physical or mental impairment that “limits one or more major life activities.” In general, a facility must make “reasonable modifications” to its programs to accommodate a child’s disability. There are three important exceptions, namely that a program (1) can exclude children who pose a direct threat to the health or safety of others, (2) need not make accommodations that would fundamentally alter the program, and (3) need not take steps that place an undue burden on the program.

How the general rule and exceptions play out depends entirely on the specifics of the program and the disability. Furthermore, your program must individually assess each situation, and cannot consider hypothetical concerns such as “what if everyone asks for this” or “the other parents will be upset.”

At one end of the spectrum are the easy exclusions. A youth program can expel a violent child, and an adventure camp need not accommodate wheelchairs. At the other end are the clear accommodations. A camp cannot exclude children with HIV or epilepsy, and a child care center must accommodate a child’s anxiety disorder. The vexing problems are the ones in between.

Chronic Illnesses

Children with chronic medical conditions require a nuanced calculation. Most organizations can accommodate allergies, for example, with moderate changes in their programs. Children with compromised immune systems will need more proactive plans, such as added protection from children with colds or flu symptoms.

Diabetes is another common situation that caregivers face. Because the treatment involves sharp, pointy objects, most youth programs are not comfortable dealing with it. Lay people, however, are perfectly capable of learning to monitor blood sugar for and dispense medicine (even insulin), so the ADA requires that you provide those services. Note that the American Diabetes Association encourages older children to learn self-care and urges programs to allow them to do so.

Other illnesses may require more specialized medical care. The law does not require you to perform medical procedures, or to hire a nurse to provide advanced care. If a lay person cannot be trained to safely provide a service, then your program need not provide it.

Communicable Diseases

You can exclude children who pose a direct threat of passing on a communicable disease, such as measles. Some communicable diseases, however, you can accommodate. For example, Methicillin Resistant Staphylococcus Aureus (MRSA) is contagious, but the CDC counsels against excluding children from day care or schools if you can keep the infected area clean and covered.

Service & Emotional Support Animals

A very contentious area currently is whether programs must accommodate service animals and emotional service animals. Modern media confuses the two, but the law treats them very differently. A service animal is a dog trained to do a specific task related to the child’s disability. The task can be as simple as reminding them to take medication, or as complicated as detecting an oncoming seizure and protecting the child during the seizure. The dog can be trained either professionally or by the family.

Your program must make accommodations for service animals consistent with the principles set out above. For example, if a service dog poses a danger to the other children or is not housebroken, you can exclude it. If other children are allergic to dogs, then you must make an effort to segregate them and care for everyone. If your program is too small for that accommodation to work, then the presence of the service animal would fundamentally alter your program and you can exclude it. In a camping program, a blind child with a guide dog might able to participate in a hike, but not a ropes course. You can require that a service animal be leashed, as long as it can perform the tasks that the child needs and the child’s disability does not preclude a leash.

Emotional support animals, by contrast, are not trained for a task and have no legal status under federal law. You can exclude these animals without running afoul of the ADA. As always, local or state laws vary, so check with your local attorney about those requirements.

Conclusion

Every program that serves young people wants to do the right thing for them. Both morality and the law require that attitude. But even federal law must bow to the laws of physics and economics, and only require that your program do what it reasonably can to accommodate disabilities.