Employing People with Cognitive Disabilities

Background

"Cognition" refers to the mental process involved in understanding, knowing and learning. A cognitive disability can affect a person's ability to learn and process information; communicate through spoken or written language; and infer information correctly from social cues and body language.

Millions of people have cognitive impairments, which include developmental and intellectual disabilities; those with traumatic brain injuries; and persons with learning disabilities such as dyslexia and autism. Cognitive impairments can arise from a genetic disorder, a brain injury, the chemistry of the brain or some other circumstance.

Individuals with cognitive impairments may experience limitations in learning, motor skills or social abilities, which can affect workplace performance. Such functional limitations can include:

• Short or long-term memory loss.
  
• Difficulty with orientation.
• Distractibility or diminished attention span.
• Difficulty processing logical thoughts.
• Inability to solve problems.
• Difficulty with reading, writing and speaking.
• Difficulty expressing oneself, such as finding the right words to use in a conversation.

Cognitive impairments range from more serious conditions such as genetic disabilities and brain injuries to less severe impairments such as dyslexia and attention deficit disorder. These impairments can include:

Genetic disabilities including Down syndrome, autism, Asperger's syndrome and dementia. Some persons with these disabilities can function in the workplace at relatively high levels, whereas others may require assistance with everyday tasks.

Traumatic brain injuries as well as brain illnesses such as certain strokes, tumors and meningitis can affect a person's cognitive abilities. Because each brain is unique, however, there is no way to forecast with certainty how a person will be affected by a brain illness or injury.

Dyslexia is primarily a reading disability involving difficulty in word decoding. The person may have trouble with various language forms or with reading, spelling or writing.

Attention deficit/hyperactivity disorder (ADHD) affects a person's ability to focus, sit still and pay attention. The person may have difficulty in concentrating on tasks or subjects or may act impulsively. Persons with ADHD may have trouble following instructions or finishing assignments. They may make careless mistakes or pay insufficient attention to details.

HR's Role

There is a growing trend toward fostering neurodiversity in the workplace—recognizing and respecting neurological differences that include autism, dyslexia, ADHD and others. Autism at work programs are developing worldwide, including Microsoft's Autism Hiring Program, which adjusts the interview process to be better suited for applicants with autism. Organizations looking to improve their neurodiversity will need to adapt their recruitment, selection and development strategies to meet the needs of this talent pool.

See:

Why Your Autism Awareness Efforts May Be Excluding Autistic People

People with Autism Can Be an "Untapped Reservoir of Talent"

How to Attract and Support Neurodiverse Talent

Accepting Autism

Attracting and Retaining Workers with Disabilities

All employees require some types of support to perform their jobs effectively. Those with cognitive impairments, however, may need more daily support from HR, supervisors and co-workers than other employees require.

HR can play a critical role in providing such support by implementing specific accommodations or by adjusting a job's processes so that employees with cognitive impairments can confidently and competently meet the requirements of their jobs. Examples of actions that HR professionals can take for employees with cognitive disabilities include the following:

• Provide technical aids such as software or equipment to enable communication with and by the employee.
• Encourage support by co-workers and supervisors.
• Enlist the services of an employment support agency.

HR can lead the way in creating a welcoming culture for people with disabilities.

Ideas include:

• Volunteer your building space as a community resource for groups representing people with disabilities.
• Host or sponsor an event on behalf of a population that represents people with a disability.
• Be mindful of your organization's work space. Include Braille signage; have height-adjustable workstations and cafeteria tables; provide video phones in break areas; and color-code certain areas of the building, such as using a specific color on bathroom signage for those with cognitive disabilities.
• Emphasize and commit to a culture where people feel comfortable disclosing a disability and seeking accommodation, if needed.
• Identify and address any barriers people with disabilities may face and consider having a centralized accommodation fund in your budget.
• Offer counseling, such as support groups, vocational coaching and employee assistance programs.

To accommodate individuals' strengths and preferences effectively, an employer should be communicative and flexible. See 'Soft' Costs Can Help Manage Employees with Mental Disabilities.

Staffing Considerations

Employers' actions throughout the staffing process are important to ensuring fairness and preventing discrimination. Among the types of potential discrimination addressed by such rules are those arising from disability—whether physical, psychiatric or cognitive. For full discussions on legal requirements, see Accommodating Employees' Disabilities and Developing an Accessible Workplace.

In assisting applicants with cognitive disabilities, HR may consider the following suggestions for applications, recruiting and interviewing.

Employment Applications

To make the employment application process accessible to persons with cognitive impairments, the employer may have to adjust the organization's application forms and procedures. It may be necessary to:

• Simplify and minimize wording on the job application form, provide forms with large print, eliminate jargon and complicated language, and incorporate the use of pictures.
• Allow a candidate to apply on tape or to provide required information by telephone.
• Provide clarification and assistance as needed concerning information requested on the job application form.

An employment application should not include any questions for which answers would indicate an applicant's disability. Such inquiries could be used as evidence of an employer's intent to discriminate unless the questions asked can be justified by a business purpose of the employer. An employment application may ask if an applicant is able to perform the essential functions of the job for which they are applying, with or without reasonable accommodation. Employers should proceed with caution when designing application forms and have legal counsel review before distribution.

Recruiting

Opening the organization's recruitment processes to people with cognitive disabilities enables employers to tap into a valuable source of potential employees. Many people with in-demand workplace skills who need certain accommodations related to cognitive impairments are those who have suffered traumatic brain injury—people such as returning military veterans. Here are some of the ways an employer can effectively recruit workers with disabilities:

• Post open positions at job service or workforce employment centers.
• Contact college and university career centers.
• Partner with disability-related advocacy organizations.
• Include people with disabilities in diversity recruitment goals.
• Post open positions or host booths at disability-related job fairs.
• Establish summer internship and mentoring programs.
• Post open positions at independent living centers.

See:

Where can employers find qualified applicants with disabilities?

How can HR help introduce more people with disabilities into the workforce?

Interviewing

When it is known that applicants have a cognitive disability, you may ask them in advance of the interview what communication or support needs they may have and adjust accordingly. Changes might include providing written or visual interview materials, allowing more time for the interview, or simply ensuring that the applicant feels free to ask for clarification at any time.

Some employers are implementing interviewing programs designed specifically to attract people with cognitive disabilities such as Microsoft's Autism Hiring Program, which strives to make the process less stressful for applicants by expanding the interview over a period of days and providing the applicants with an environment to showcase their abilities.

If an applicant's disability is apparent or manifests during the interview process, concentrate on the individual, not the disability. Treat the individual with the respect you would accord any candidate. Ask only those job-related questions that relate to the functions of the job for which the applicant is applying. If the applicant has a known disability, either because it is obvious or because it was revealed by the applicant, you may ask him or her to describe how he or she would perform the job. 

Accommodations

Employers sometimes perceive an employee or a potential employee with cognitive disabilities as somewhat difficult to accommodate in the workplace. This common misperception is based not on cost figures but on insufficient information about the types of resources available for accommodating persons with such disabilities. In fact, many accommodations can be made with simple, low-cost adjustments to workstations or conference rooms or in work procedures.

See Accommodation and Compliance Series: Employees with Intellectual Impairment or Cognitive Impairment.

Although individuals who have cognitive disabilities may have accommodation needs specific to their condition, many face the same architectural and attitudinal barriers experienced by people with other disabilities. Some of the accommodations that can be helpful regardless of the type of disability are related to the use of voice equipment, communication boards and aids, signage, and other cues for facilitating spatial orientation and directions.

Other access needs for people who are cognitively impaired, however, are specific to the circumstances, such as the use of facilitators or augmented communication for people who would benefit from them.

People with cognitive disabilities may have difficulty reading, writing, spelling, listening, speaking, thinking, performing sequential tasks, performing mathematical calculations or responding to directions. Bear in mind, however, that many individuals with developmental and cognitive disabilities do not have limited intellectual functioning; in fact, they may have above-average intelligence but have difficulties receiving, processing or expressing information. Workplace accommodations should compensate for those functional limitations.

Many people with disabilities, cognitive or otherwise, do not have functional limitations and will not require an accommodation. The duty to accommodate is an individual remedy. There is no list of required accommodations; they are determined by the employer and employee.

Accommodation ideas

Two major categories of assistance that employers can offer employees with cognitive disabilities are assistive technology and individualized work environments.

Assistive technology includes devices such as voice recognition systems, self-operated audio systems, telephone recorders, cassette recorders and audio signage.

Individualized work environments include workstations and work processes that are adapted to accommodate a person's needs. If it can be done, it should be done. A work environment that is adapted for the needs of a person with a disability—whether cognitive or of another type—can be safer and more efficient for that person.

Accommodating the individual strengths of a person with a cognitive disability requires communication, flexibility and a variety of work method options. Using ergonomics and common sense as a basis for the design of individualized workstations is important. For example, for a person who has difficulty sequencing, color-coding frequently used forms may be helpful, or have daily job tasks outlined on a single sheet of paper posted at the workstation. Other people with cognitive impairments may prefer to hear information rather than to read it. See A-Z of Disabilities and Accommodations (by Limitation) for information on various accommodations.

Following are workplace modifications that may benefit people who are cognitively impaired:

Workstations: Avoid isolating workstations. Minimize surrounding distractions such as clutter and noise. Provide adjacent space for the employee's instructor, job-sharing partner or job coach. Arrange materials and equipment in the order of their use.

Computers: Cover or shield unneeded keys. Provide editing software and voice output with optical character recognition to "read" documents.

Information displays: Clarify messages by using pictures, numbers and familiar symbols rather than words. Place labels and instructions as close as possible to the referred items. Provide digital clocks.

Communication devices: Provide a continuous-loop tape recorder for short messages and a telephone with auto-dialer, headset and large buttons.

Controls: Provide simple, logically arranged, clearly labeled controls. Avoid those with complex or multiple functions, and place shields or lockouts on controls not to be used.

Seating: Provide clear instructions and, when necessary, assistance for adjusting the employee's chair.

Storage: Keep labels clear and simple, and consider using familiar symbols in place of words. Avoid frequent reorganization of storage areas. Mark hazardous materials with a yellow-and-black striped warning tape.

Safety

At all times, but especially during emergencies, people must be able to find their way to their destinations with a minimum of help. Employees with cognitive impairments may have difficulty orienting themselves and navigating toward exits. To help make the environment accessible for such employees, consider modifications such as these:

• Use varying architectural materials and styles so that spaces do not all look the same. This makes identifying landmarks easier for everyone and is especially beneficial to people who have difficulty interpreting information.
• At points where a direction decision must be made, avoid similar-appearing choices. Instead, provide changes in lighting, texture, color and acoustics at transition points to differentiate direction options.
• Provide appropriate signage where it is needed. Graphics, especially international or other standard symbols, should be used whenever possible, and they should be accompanied by textual descriptions. Use familiar graphics and clear, simple language.

Mark emergency equipment and evacuation routes conspicuously. Have plans in place for the evacuation of people with disabilities.

Supervision

A separate category of accommodations centers on supervisory procedures. Employers should ensure that their employees with cognitive impairments have easy access to supervisors. It would be worthwhile for the employer to provide guidelines for feedback on problem areas and to develop ways to deal with problems in their earliest stages.

In addition, try to have an employee with cognitive disabilities work with a supervisor who is supportive and understanding. Also, consider identifying other employees who are willing to provide help and support for an employee with a cognitive disability.

Other methods of helping an employee with a cognitive impairment to do well in the workplace include recognition and positive reinforcement, as well as the availability of the services of an employee assistance program to help the person cope with matters such as stress and family issues.

Management Considerations

An individual's disability should not define the person any more than should age, gender, race or other personal characteristic. Current employees should be introduced to a new hire who has a cognitive impairment just as they would be introduced to any other new employee. An employee's disability—if it has been accommodated properly—is irrelevant to the person's function in the workplace. Following are discussions of onboarding and performance management as they affect employees with cognitive disabilities.

Onboarding

The onboarding process can be made more accessible to a new employee with a cognitive impairment in numerous ways. If an employment support service has been used in the recruitment process, a professional from that service may be enlisted to come into the workplace to provide guidance on helping the employee move into the job. Another approach—one that seems to work well for people with cognitive impairments—is to have the new employee shadow or be supported by a more experienced employee.

If the onboarding process for an employee with cognitive impairments requires off-the-job training and assessment, the employer may want to consider adjustments such as:

• Putting people in groups that are smaller than usual.
• Asking questions orally rather than on written tests.
• Giving the new employee extra time to go through a training manual.
• Putting training materials in formats more accessible for the employee.
• Allowing a support worker to attend the training.

Similarly, implementing some of the following suggestions may help employees with cognitive impairments feel more comfortable in the workplace:

• When speaking to someone who has a cognitive disability, be alert to the person's responses, and adjust the method of communication if necessary. Keep in mind that some people may benefit more from simple, direct sentences or from supplementary visual forms of communication, such as gestures, diagrams or demonstrations.
• Repeat information by using different wording or a different communication approach if necessary and allow sufficient time for the information to be fully processed and understood.
• Do not pretend to understand the person if you do not. Ask the person to repeat what he or she said.
• In conversation, people with some types of cognitive impairments may respond more slowly; remain patient, flexible and supportive by giving them additional time to process information and respond accordingly.
  
• Do not expect all people to read well; some may not read at all.
• Be selective in job placement; try to match each person with work that best suits his or her individual skills, strengths and limitations.
• People with visual-perception problems may prefer spoken directions and may need extra time to complete assignments.
• People with auditory or perceptual problems may need to have directions repeated and may take notes to help them remember directions or a sequence of tasks. They may benefit most from watching a demonstration of a task. They may also require a longer training period than other employees.

Performance management

Employees with cognitive disabilities are usually held to the same performance appraisal and performance management standards and procedures as those applied to other employees. However, to enable an employee with a cognitive impairment to achieve certain job performance goals, the employer may want to make certain modifications in the organization's policies and procedures on evaluation and performance monitoring.

Such modifications to organizational performance management policies and procedures may include:

• Asking a support agency or other organization to help recast and further simplify the language of current forms or to make such forms accessible in other formats.
• Allowing an employee with a cognitive impairment to have a support worker or a colleague who acts as a "natural support" with them during performance-related meetings.
• Allowing extra time for performance-related meetings.
• Considering possible adjustments to enable a person with cognitive disabilities to achieve specific targets.

Employee Relations

The success of an employee with a cognitive disability may depend on how well the employee gets along with supervisors and co-workers. Employers' first step in providing a supportive and welcoming workplace is to educate themselves and their employees about cognitive impairments and brain injuries. This does not require a big budget; several resources are available for this purpose.

After the onboarding period, the attitudes and behaviors of co-workers and supervisors regarding an employee with a cognitive impairment can be crucial to whether the person remains employed. Negative and unhelpful attitudes can undermine an employee's confidence and make it difficult for the person to demonstrate competence in the job.

Support from supervisors may take the form of giving instructions more than once, checking with the employee to make sure he or she has understood an instruction, and checking more frequently than usual that the employee is carrying out the task correctly.

Following are suggestions from experts on ways that employers can help employees learn about cognitive impairments and treat their co-workers equitably:

• Create a self-help library of resources on cognitive impairments; materials could include online resources, books and CDs.
• Provide training on cognitive impairments and brain injuries to dispel common misconceptions.
• Send employees monthly e-mails containing helpful tips on various mental and physical health topics.
• Provide policies and guidelines on appropriate workplace conduct, including statements on discrimination, harassment and workplace bullying, and schedule regular sessions with employees to discuss those topics.
• Enlist the aid of a subject-matter expert to discuss cognitive impairments and brain injuries with employees.
• Designate an individual or a group to be responsible for ensuring ownership and accountability for employment equity initiatives in each department or division.
• Provide sensitivity training for co-workers.
• Facilitate open discussions with workers, both those with and without disabilities, to encourage them to express their thoughts on cognitive-impairment issues and to develop strategies to deal with such issues.

Privacy

Employers must respect an employee's right to confidentiality about his or her impairment and any needs relating to it. Everyone is entitled to having their personal information kept private. People with learning disabilities often have bad experiences in which personal information about them is not kept confidential, with such breaches sometimes resulting in harassment and abuse.

Harassment

Many people with cognitive disabilities are victims of harassment or bullying, and unfortunately this sometimes occurs in the workplace. The employer must clearly, emphatically and unequivocally communicate to all employees that harassment and bullying are unacceptable and will not be tolerated.

Under the ADA, it is illegal to harass an applicant or employee because he or she has a disability, had a disability in the past, or is believed—whether correctly or incorrectly—to have a physical or mental impairment that is not transitory. Harassment can include offensive remarks about a person's disability, and it may be perpetrated by co-workers, a supervisor or even a nonemployee such as a client or a customer of the employer.

Although the law does not prohibit simple teasing, offhand comments or isolated incidents that are not serious, harassment is illegal when it is so frequent or severe that it creates a hostile or offensive work environment or when it results in an adverse employment decision such as demotion or firing of the victim.

Legal Considerations

The principal standards for employers regarding disabilities are detailed in the following federal laws:

• The Americans with Disabilities Act (ADA), which prohibits employers with 15 or more employees from discriminating against qualified individuals with disabilities in job application procedures, hiring, firing, advancement, compensation, job training and other employment matters.
• The Americans with Disabilities Act Amendments Act (ADAAA), a 2008 law that instituted changes in the definition of "disability," making it easier for those seeking protection under the ADA to establish that they have a disability within the meaning of the ADA. The law took effect in 2009.
• The Rehabilitation Act of 1973, which requires employers with federal contracts exceeding $10,000 to take steps to hire, retain and promote qualified individuals with disabilities. The regulations implementing Section 503 of the law make clear that employers are to refrain from employment discrimination against qualified individuals with disabilities.

In addition to the these laws there are other employment-related legal protections for people with disabilities, including cognitive impairments:

The Mental Health Parity and Addiction Equity Act of 2008 mandates that group health plans provide benefits for mental health and substance-related disorders. Such benefits must be at least equivalent to benefits offered for medical and surgical procedures. The legislation renews and expands provisions of the Mental Health Parity Act of 1996.

All mental health and addiction disorders—including cognitive impairments—listed in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders would be subject to the act's parity requirement.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) medical privacy rule allows covered entities—employers—to release personal health information externally and to use the information internally only under limited circumstances. Employee permission is needed when the use of personal health information falls outside the circumstances permitted by the privacy rule.

With the Developmental Disabilities Assistance and Bill of Rights Act (DD Act) of 2000, Congress observed that national policy for people with disabilities should be characterized by independence, productivity and integration. This legislation built on the 1984 Developmental Disabilities Act, which for the first time focused on employment as an important hallmark of services for people with developmental disabilities.

See A Guide to Disability Rights Laws for additional information.

Tools and Samples

Forms

ADA: Accommodation Approval Letter

ADA: Accommodation Denial Letter

ADA: Accommodation Medical Certification

ADA: Reasonable Accommodation Checklist

Policies

ADA/ADAAA Policy

EEO Policy and Procedures

EEO Policy Detailed

Nondiscrimination/Anti-Harassment Policy and Complaint Procedure

Service Animal Policy

Telecommuting: Telecommuting Policy and Procedure

Additional Sources

Building an Inclusive Workforce: A Four-Step Reference Guide to Recruiting, Hiring, and Retaining Employees with Disabilities (PDF)

Business Strategies that Work: A Framework for Disability Inclusion (PDF)— Identifies promising employment policies and practices for recruiting, hiring, retaining and advancing qualified individuals with disabilities.