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  • Sexuality, Gender Identity, and Disability, Part 2

    Sexuality, Gender Identity, and Disability, Part 2

    Psychology & Healthcare

    According to the Gay, Lesbian, and Straight Education Network (GLSEN), gender is “a set of cultural identities, expressions, and roles… assigned to people, based upon the interpretation of their bodies.” This means that while a person’s sex is male, female, or intersex, their gender can be male, female, neither, or both. Because gender is a social construction, gender can be rejected or modified. It may also be the same as a person’s sex assigned at birth (SAAB), known as cisgender, or different from it, known as transgender (Slayter & Johnson, 2023).

    Further, a person’s gender identity may also differ from their gender expression, the intentional presentation of gender identity. Some people, like myself, identify as non-binary, a gender identity that exists somewhere between or outside of the male-female gender binary. Some other, related terms and subgroups include genderqueer, agender, and bigender (Slayter & Johnson, 2023). But these only scratch the surface.

    The discrimination, judgment, and stigma that stem from ignorance can easily discourage LGBTQ+ people with disabilities from disclosing their identities to medical professionals. A well-documented pattern across many minority groups shows that patients who are believed to be exaggerating or inventing symptoms are far less likely to disclose in the first place. When disabled LGBTQ+ patients do disclose and are met with misjudgments and assumptions, their confidence in healthcare in general is further eroded, limiting their ability to understand and advocate for their own bodies. Health literature actually confirms that a disproportionate number of LGBTQ+ people with disabilities, particularly those with ASD, have unmet healthcare needs, inadequate support networks, and documented cases of refused medical services (Mulcahy et al., 2024).

    One study drawing on qualitative data from 197 LGBTQ+ US participants with varying disabilities showed that 72.2% had avoided talking about their gender identity and/or sexuality with healthcare providers, and 9.8% never disclosed their LGBTQ+ identities at all. More research is definitely needed to identify potential causes behind these high rates of negative experiences. Though contributing factors are likely related to a lack of healthcare provider understanding and the all too common desexualization of disabled people (Mulcahy et al., 2024).

    In addition to these healthcare barriers, people with disabilities often have to contend with inaccessible transportation, limited or denied insurance, mobility challenges, high care costs, and more. Many LGBTQ+ people face their own barriers in employment, housing, healthcare, and legislation. However, LGBTQ+ people with disabilities frequently navigate all of these barriers simultaneously. Study participants have also reported lower overall health status and increased physical and mental symptoms. For those who identify as gender diverse, wholly unaddressed healthcare needs are also a major concern (Mulcahy et al., 2024). 

    In the 20th century alone, medical responses to disclosure included public shaming, coerced therapy, institutionalization, and lobotomies. Some minority groups responded to these feigned solutions by opening clinics. The Black Panthers’ Sickle Cell Anemia clinics and independent LGBTQ+ friendly services like the Haight Ashbury Medical Clinics are notable examples. Countless protests have also been mounted against the inclusion of homosexuality and gender identity disorder in the DSM, Medicaid funding cuts, threats to the Affordable Care Act, and other important causes (Health Right 360, 2026; American Psychiatric Association, 2025; Mulcahy et al., 2024).

    Concepts like crip theory, queer crip theory, and critical disability studies help explain how LGBTQ+ people are often perceived as inherently disabled and disabled people are often seen as inherently LGBTQ+ or asexual. However, the idea that both identities can coexist is rarely considered. In fact, the term crip has historically been used to stigmatize disabled people. Combined with the misconception that disabled people experience time and space differently than “able-bodyminded” people, and with Descartes’ idea that the body and mind can be experienced separately, these ideas likely laid the groundwork for crip theory (Mulcahy et al., 2024; Critical Disability Studies Collective, 2026).

    The largely unacknowledged intersection of LGBTQ+ identity and disability, and the resulting empathy gap, is likely a major contributing factor to patients regularly withholding parts of their identities. LGBTQ+ people with disabilities are routinely treated as though they have no specific sexuality or gender identity, even in medical settings. In some cases, they are even told outright that their disability makes a differing sexuality or gender identity impossible, a concerning conflation of causation and correlation. Society clearly needs to improve not only accessibility but also education on disability, sexuality, and gender identity (Mulcahy et al., 2024).

    For all these reasons, and the additional financial insecurity many LGBTQ+ people with disabilities face, supportive family, friends, and community are especially important. For those without a readily available support system, support groups and similar settings can provide information, emotional support, and rehabilitation resources. However, many support centers are only equipped to serve specific types of conditions or LGBTQ+ groups. In those cases, coming out socially and/or online may be a more manageable first step. Informal online support may help fill gaps left by formal support systems and unsupportive family, and can reduce social isolation in the process. All too often, others “see the disability and not the person,” dismissing a disabled person’s sexuality entirely, or even fetishizing their disability. While some disabled people may not object to this, it’s usually seen as dehumanizing. Often, all that’s needed is a little creativity, experimentation, and communication (Green et al., 2023).

    References

    American Psychiatric Association (2025). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Psychiatry Online. https://psychiatryonline.org/dsm

    Health Right 360 (2026). Our Story. Health Right 360. https://www.healthright360.org/about/our-story/

    Mulcahy, A., Batza, K., Goddard, K., McMaughan, D.J., Kurth, N.K., Streed, C.G., Wallisch, A.M., Hall, J.P. (2024). Experiences of patients with disabilities and sexual or gender minority status during healthcare interactions. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC11404532/

    Slayter, E., & Johnson, L. (2023). Social Work Practice and Disability Communities: An intersextional anti-oppressive approach — Chapter 7. Salem State University. ROTEL Project. https://pressbooks.salemstate.edu/disabilitysocialwork/chapter/chapter-7-gender-gender-identity-and-gender-expression/

    Critical Disability Studies Collective (2026). Terminology. University of Minnesota. https://cdsc.umn.edu/cds/terms

    Green, A.K., Gomes, R.S.M., Heinze, N., Kempapidis, T. (2023). Queer and Disabled: Exploring the experiences of people who identify as LGBT and live with disabilities. MDPI.com. https://www.mdpi.com/2673-7272/4/1/4

  • Sexuality, Gender Identity, and Disability, Part 1

    Sexuality, Gender Identity, and Disability, Part 1

    Education

    Society often assumes that having a disability automatically means an individual either can’t or doesn’t have sex. Because of this, disabled people are often given inadequate sexual health resources and education. Data from the Centers for Disease Control (CDC) shows that around 22% of American adults have some form of disability. CDC data from 2015 also shows that 41% of high schoolers report being sexually active, often without using protection. Around 10 million new cases of sexually transmitted infections (STIs) were found in people 15 to 24 years old, and around 22% of new HIV diagnoses occurred in people 13 to 24 years old (Clarke, 2017).

    Of course, these are only the cases reported to the CDC. There’s also the question of why any of this is happening in the first place. Some of it comes down to simple teenage disregard for safety. But the societal disregard of sexuality in the disabled community, and the resulting lack of education, has to be taken into account. Accommodations such as ASL interpreters, alternative formatting, simplified language, and physical accommodations can address most of these barriers. In other words, barriers shouldn’t be used as an excuse to avoid proper education; they should be seen as a call for proper accommodations (Clarke, 2017).

    People with intellectual and developmental disabilities (IDDs), a category of cognitive disabilities, have increasingly influenced research on the connections between sexuality, gender identity, and disability. However, this influence has not reduced the level of layered discrimination, sexual abuse, and exploitation that can lead to mental health issues. Research from the Human Rights Campaign (HRC) has also shown that 36% of LGBTQ+ adults, and 52% of transgender adults specifically, also identify as disabled, with cognitive disabilities being the most common category of disability. Unfortunately, much of the research concerning disabled LGBTQ+ people focuses solely on the perspectives of caretakers and medical professionals. Fortunately, there’s a growing push to prioritize the anonymity of those with disabilities and to increase community-engaged research (CER) (Kammes, n.d.).

    In general, disabled people tend to have lower levels of education and employment, largely because of inadequate support and teaching. Sex education is often lacking for disabled students, and special education needs are often evaluated late or inadequately supported. Those who leave school early because of disability often struggle to find employment and the benefits that come with it. Students also often lack education on LGBTQ+ issues, and around a fifth of LGBTQ+ students are outed and/or harassed. However, most of these cases go unreported because they’re seen as “not serious enough”, a pattern that can lead students to believe that reporting won’t change anything (Green et al., 2023).

    To add to this, disabled LGBTQ+ students often miss out on education because of compounded fear: being harassed, assaulted, or expelled, with their disability making it harder for them to do anything about it. Compared to those without disabilities, disabled LGBTQ+ women are also significantly less likely to find full-time work and more likely to be unable to complete the work they do find. Disabled transgender adults are also more likely to be unemployed, let go from a job, experience employment discrimination, and fear discrimination if they quit. In fact, surveys have shown that gender identity was the most common reason given for being denied promotion, fired, or not hired in the first place. Annual household income was also found to be significantly higher in homes without disabilities than in those with one or more disability (Green et al., 2023).

    References

    Clarke, T. (2017). Disability Rights and Sexual Health. AMCHP. https://amchp.org/2017/12/15/disability-rights-and-sexual-health/

    Green, A.K., Gomes, R.S.M., Heinze, N., Kempapidis, T. (2023). Queer and Disabled: Exploring the experiences of people who identify as LGBT and live with disabilities. MDPI.com. https://www.mdpi.com/2673-7272/4/1/4

    Kammes, R. (n.d.). Belonging and Community: Trends in issues relating to sexuality and gender identity for people with disabilities. Institute on Community Integration, University of Minnesota. https://publications.ici.umn.edu/impact/36-2/belonging-and-community

  • Silver Linings — Assistive Technology

    Silver Linings — Assistive Technology

    FocusMate

    FocusMate is a virtual body doubling service, but let me back up. Body doubling is essentially parallel play for everyday tasks and chores. Many neurodiverse people, especially those with ADHD, have a hard time staying focused when alone, but work far more efficiently when someone else is there holding them accountable. Like most people, I sought this out for most of my life and only recently learned the name for it.

    Kids doing homework while a parent works on something nearby and periodically checks; that’s body doubling. Working on your laptop at a library or café while others do the same; also, body doubling. In behavioral health, this is often described as modeled behavior. FocusMate applies this same concept through video calls and builds the Pomodoro Technique into its structure: a method traditionally using cycles of 25-minute bursts of focused work with 5-minute breaks in between, designed to boost productivity and prevent burnout.

    FocusMate’s pricing is also straightforward and reasonable. Their free plan allows users up to three sessions a week at no charge. Their Plus plan offers unlimited weekly sessions for $8 per month (billed annually) or $12 per month (billed monthly). Businesses can also sign up for $5 per user per month for teams of 10 or more, with a $50 monthly minimum.

    The site itself has a detailed, fully cited article on the science behind their method, along with an FAQ page and a page with detailed guidance on what users can do during sessions. Sessions can be prescheduled or started within minutes of logging in. To start a session, a user selects a length of time (25, 50, or 75 minutes), a task mode (Desk, Moving, or Anything), and whether they’d like to work in Quiet Mode. I personally prefer 50-minute sessions on the Anything task mode without setting Quiet Mode. I then introduce myself and my task, mute my microphone, and start working.

    My preferred settings let me stay focused on my task and listen to my Instrumental Study playlist with someone else helping to hold me accountable. What a difference! When I first heard about FocusMate, I assumed it was just another app for sensitive tech bros. But it has genuinely helped me improve my productivity, and I’m happy to be proven wrong by science.

    References

    Focusmate Inc. (2026). How It Works. FocusMate.com. https://www.focusmate.com/how-it-works/

    Health Essentials (2025). What is Body Doubling and Can It Help with ADHD?. Cleveland Clinic. https://health.clevelandclinic.org/body-doubling-for-adhd

  • Silver Linings — Stress & Anxiety Aids

    Silver Linings — Stress & Anxiety Aids

    The Woobles

    A few years ago, a therapist I was seeing suggested that I try to take up an offline hobby. Research has backed this up. Hobbies can help with the symptoms of stress, depression, and anxiety in several ways. Some can help us process emotions and ground us in the present. Others can create a sense of progress through small wins, which can help us strengthen our identities and build connections. They can also help us with routines and healthy habits. In fact, 45 minutes of working on visual art can reduce cortisol levels in 75% of people. Journaling can bring clarity in tough situations, and gardening can help ease depression (MHA, 2026).

    There were plenty of hobby options to choose from. I could even take up people-watching in the park, using snippets of overheard conversations as creative writing prompts. But fiber arts were starting their comeback, and I knew that my mom and sister both knew how to knit and crochet. Naturally, I wanted to learn too, but I didn’t want to take up their time. YouTube had some decent videos, but most were aimed at experienced crocheters.

    Then I saw an ad for The Woobles. That was it! Something felt perfectly suited to a detail-oriented, routine-obsessed mind like mine. I found the kit I wanted and got started. I started with the easy Woobles originals and quickly filled my wish list with favorites. They now offer a wide and growing range of options, including their original patterns. If you’re looking for something nerdy or fantastical, there are now crochet collaborations with franchises ranging from Peanuts and Hello Kitty to The Lord of the Rings and Harry Potter. Every kit comes with all the materials you’ll need, including a QR code for the video instructions, and the company’s YouTube channel has other helpful content (The Woobles, 2026). I can’t recommend The Woobles enough!

    References

    The Woobles (2026). Billy the Unicorn Crochet Kit. The Woobles. https://thewoobles.com/products/unicorn-crochet-kit?_pos=2&_psq=billy&_ss=e&_v=1.0

    MHA (2026). Why Hobbies Are Good for Your Mental Health. Mental Health America. https://mhanational.org/resources/why-hobbies-are-good-for-your-mental-health/

  • Silver Linings – Sensory & Figet Toys for Neurodivergent Adults

    Silver Linings – Sensory & Figet Toys for Neurodivergent Adults

    As I briefly touched on in my first posts, sensory tools can make a big difference for those of us with chronic anxiety and other neurodivergent conditions. For many on the autism spectrum, such as myself, stimming is almost as essential as eating. Sure, we can delay, minimize, and modify our stims, but it’s best for everyone when we find a safe outlet that meets our stimming needs. This is where sensory and fidget toys can be so beneficial, and you don’t even have to be neurodivergent to see these benefits.

    Little Ouchies

    Like many autistic adults, I have unconsciously relied on something called pain stimming for most of my life. Pain stimming refers to any number of self-stimulatory behaviors that produce low-grade pain or mild discomfort as a way of self-regulating overwhelming emotions. This can include skin picking, nail biting, hair pulling, digging fingernails into one’s own skin, or even hitting oneself. Pain stimming is not inherently harmful, but it can become so when the stimming escalates. Often, the best solution is not to try to stop the behaviors entirely, but rather to redirect them (The Sensory Store, 2025).

    When I start to feel overwhelmed or completely out of control of a situation, I need to ground myself. Without my fidget toys, I dig my nails into my arm or bite my lip or tongue until I feel a painful sensation that I can control. When I was younger, I would hit myself on the shoulder, leg, or head. This can get dangerous for anyone when they are unable to self-regulate. This is exactly why I have my Little Ouchies pain stim spinner. The spikes on its surface let me safely experience a small, controlled pain sensation, while the spinner allows me to fidget in place when I need to move (Little Ouchies, 2025). If you’re interested in buying one for yourself or a loved one, please find the link in my references below.

    References

    Little Ouchies (2025). What is Pain Stimming? A Guide to Neurodivergent Sensory Tools & Self-Regulation. Little Ouchies. https://littleouchies.com/blogs/news/what-is-pain-stimming-a-guide-to-neurodivergent-sensory-tools-self-regulation

    The Sensory Store (2025). Pain Stimming and Harm Reduction Supports. The Sensory Store. https://www.sensorystore.co.nz/blogs/news/pain-stimming-and-harm-reduction-supports

  • Silver Linings

    Silver Linings

    I started my blog with research posts discussing specific issues that members of the disability community face regularly. I research each topic thoroughly and provide references at the end for anyone who wants to explore further. However, I felt there was more I could do for holistically-minded members of the disability community, like myself. So, from time to time, I’ll be posting what I like to call Silver Linings.

    Silver Linings posts will include reviews of products, services, and businesses, along with the occasional interview, all focused on things that can help to brighten your day. I welcome suggestions on products, places, goods, and services worth looking into. I love hearing from other members of this community about what has helped you. I’m only one person with my own experiences, and I firmly believe that a community benefits most when we work together. After all, who better to vouch for a product or service than real people who really use it?

    If you’d like to contribute or just send me a message, feel free to comment below or email me at UnicornRootsHolistic@gmail.com. And as I like to say: eat chocolate, pet puppies, and have a great day!

  • Assistive Technology, Part 2

    Access

    Assistive Technology (AT) can take many forms: high-tech, low-tech, products, systems, and services. In fact, most people who use ATs regularly use more than one type, which shows just how important integration and integrative services are. More than 2.5 billion people worldwide use AT, and that number is expected to reach 3.5 billion by 2050. However, in many parts of the world, the majority of people who need the independence that AT provides have no access to the technology that could help improve their hearing, vision, mobility, self-care, cognition, communication, and much more. Greater access could help not only AT users; it could improve the well-being and inclusion of communities, enabling greater participation in the political, economic, and social life (World Health Organization, 2024).

    Most people will need some form of AT as they age, and the majority of AT users are seniors, disabled people, and those with long-term health conditions. However, AT has the potential to help everyone. Research shows that early access to appropriate AT can support language and communication development, improve access to education and employment, help prevent secondary complications, and support a greater sense of independence and safety. Still, the gaps in access globally are shocking. Nearly 80 million people require a wheelchair, while only up 35% of them have access to one. Around 1.5 billion people are deaf or hard of hearing, but fewer than 10% have access to a hearing aid (World Health Organization, 2024).

    It’s easy to assume that these numbers are disproportionate solely because of costs, and funding is certainly a factor. But other barriers play a significant role as well. A general lack of awareness, issues with physical access, limited product range, procurement challenges, workforce issues, and inadequate policy-making are just a few examples. The 2030 Agenda for Sustainable Development emphasizes universal health coverage (UHC) as a path toward universal access to health services, including the rights established by the Convention on the Rights of Persons with Disabilities. In 2022, the WHO and UNICEF Global Report on Assistive Technology provided recommendations for governments and stakeholders to work towards universal AT access for all. Examples of these recommendations include improving AT access across development sectors, involving AT users and their families in development processes, increasing public awareness to combat stigma, investing in data-driven policy, and supporting research and innovation (World Health Organization, 2024).

    To better understand what specific ATs are needed for any given group, it’s important to understand how different disabilities affect those living with them. Understanding this can help us understand what types of AT will benefit which individuals. This is where classification and categorization systems are truly valuable.

    The International Classification of Functioning, Disability, and Health (ICF) defines disability as encompassing activity limitations, impairments, and restrictions in participation. The purpose of AT is to decrease these limitations while promoting participation in society. As I covered in part 1, AT helps by aiding body structure and function, activity performance, and environmental modifications. Some options require insurance, prescriptions, or detailed documentation, while other options are readily available, such as touch lamps and electric toothbrushes. Some AT options may also require services to help with specialized customization, maintenance, and repair. Because the effects of an individual’s disability can also change with their environment, ideally, AT should be considered part of an adaptable environment rather than a standalone solution (Gray et al., n.d.).

    AT classification systems, such as the National Classification System for Assistive Technology Devices and Services used in the US and the International Organization for Standardization (ISO) and ICF-based classifications used internationally, organize AT into classes and subclasses for ease of access. The US system divides AT into classes, including architectural elements, sensory elements, computers, controls, independent living, mobility, orthotics and prosthetics, recreation and leisure, and modified furnishings, each with a unique numeric code. Europe uses a similar ISO-9999 and 3-tiered system. Both systems support efficient information retrieval, inventory management, and appropriate acquisition. These systems also specify hard technologies (tangible devices that can be assembled), soft technologies (human decision-making elements), as well as strategy and training materials. Within these systems, AT that requires specific skill is classified as a tool requiring additional soft technology, while AT that does not require specific skill is classified as an appliance (Gray et al., n.d.).

    Unsurprisingly, the majority of AT users are seniors relying on low-tech supportive appliances like walkers, canes, and glasses. Children and young adults more commonly use AT tools such as braces, prosthetics, and adaptive keyboards. However, mobility aids are the most widely used AT category. All of this classification and categorization also helps to determine costs and payment systems. Payment may be made in full or in part by individuals and families, or by insurance, rehabilitation centers, employers, veterans organizations, charities, or other third parties. Some AT can even be donated or loaned. In some US jurisdictions, businesses may be offered tax deductions for making their buildings fully accessible (Gray et al., n.d.).

    Two key tools used for measuring AT effectiveness are the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) and the Psychosocial Impact of Assistive Devices Scale (PIADS) questionnaires. Both of these questionnaires collect data on AT benefits and user satisfaction using criteria such as environment, expectations, perceptions, psychological factors, adaptability, competence, self-esteem, and specific AT characteristics. While some important factors like changes in satisfaction, self-esteem, adaptability, safety, and continued competence haven’t been adequately studied, current evidence shows that AT users have seen significant improvement in their ability to complete ADLs and in their overall quality of life (Gray et al., n.d.).

    It’s also easy to see how AT advancement is closely connected to overall technological advancement and the growth of the internet. This relationship has made it easier for disabled people to access AT and paved the way for new innovations. At the same time, the rise in graphics-rich and audio-dependent content has contributed to existing challenges that AT was initially created to help prevent (Gray et al., n.d.).

    References

    World Health Organization (2024). Assistive Technology. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/assistive-technology

    Cook, A.M. (n.d.). Assistive Technology. Britannica. https://www.britannica.com/science/assistive-technology

  • Assistive Technology, Part 1

    Definitions

    When I was younger, I used to wonder why none of the characters in fantasy stories and period dramas ever seemed to need glasses or wheelchairs. It seemed strange to me that disabled characters were virtually nonexistent. Of course, these stories were fiction, and I now know more about history and artistic licence. But representation matters. So what changed? The continued expansion of Assistive Technologies has played a major role in the growing visibility of the disabled community.

    Assistive Technology (AT) is an umbrella term for products, systems, and services designed to help those with disabilities and health conditions complete activities of daily living (ADLs) that would otherwise be difficult or impossible. This may include physical devices like shower chairs, canes, or prescription footwear; digital services and software like speech recognition or screen readers; and even widely available features like curb cutouts, accessible bathrooms, elevators, and widened hallways. While most ATs are designed specifically for those with disabilities, many can benefit everyone. For example, curb cuts help wheelchair users and people pushing strollers. ATs also help people with arthritis, amyotrophic lateral sclerosis (ALS), Attention Deficit Hyperactivity Disorder (ADHD), autism, vision and hearing loss, Ehlers-Danlos Syndrome (EDS), and many other conditions with ADLs like bathing and dressing, eating, communication, learning and remembering, symptom management, and much more (Office of Disability Services, 2026; World Health Organization, 2024; Cleveland Clinic, 2025).

    At their core, ATs are intended to promote independence and accessibility. They address a wide range of needs, including communication, mobility, vision and hearing loss, learning and cognitive disabilities, neurodiversity, and dexterity and fine motor skills. Many ATs are also very versatile, and more are created every day. For example, augmentative and alternative communication (AAC), mouth sticks, eye-tracking devices, and other speech-generating tools are typically used for communication needs, but they can also support mobility, learning, and cognitive needs. ATs such as adapted keyboards and joysticks, typically used to support mobility needs, can also support cognitive needs. AT systems and services like screen magnification and high-contrast displays, screen readers, audiobooks, captioning software, visual and haptic alerts, speech-to-text (STT) and text-to-speech (TTS) tools, as well as products like assistive listening and note-taking devices, can all support many needs (Office of Disability Services, 2026).

    Other ATs are designed for more specialized needs. Braille displays, hearing aids, and cochlear implants are largely unhelpful for those without vision and/or hearing loss. Similarly, wheelchairs, canes, and some highly specialized devices are primarily designed for those with mobility disabilities. On the other hand, some readily available tools, such as noise-canceling headphones, white noise apps, organizational apps, memory aids, and daily routine aids, can be especially helpful for those with learning and cognitive disabilities, even though they are simple conveniences to most people. In fact, Princeton University’s ODS site maintains a list of AT options organized by need, linked in the references below (Office of Disability Services, 2026).

    When considering all the ADLs that may need to be accommodated for, the list continues. Fall detection devices, vibrating alarms, grab bars, reaching and dressing aids, ramps, shower seats, ergonomic utensils, stair lifts, collapsible stools, eyeglasses, fidget toys, and that’s just the beginning. AT devices can be high-tech, like a touchscreen communication device, or low-tech, like a cardboard communication board. They can be physical hardware, like prosthetics, or computer hardware, like specialized keyboards. Some AT can include special software. Some can be found easily and independently, while others need to be carefully chosen by a team of professionals or consultants. This is partly because some AT requires a prescription, even when it’s covered by insurance or a government program. Cost and coverage are often significant barriers, as they often depend on the device or system, the reason or reasons that it is needed, the individual’s insurance coverage, and even the disabled individual’s employer (Cleveland Clinic, 2025; ATiA, 2026).

    Portability can also be an issue, making rental services a practical choice for some. Luckily, there are organizations like ATiA whose members can help their clients connect with AT providers. Online message boards and social media can also be a great place to start looking for information or to find less specialized AT (Cleveland Clinic, 2025; ATiA, 2026).

    Finally, when talking about AT, it’s important to acknowledge the ableism that often accompanies it. As with any form of discrimination, the discrimination against those with a disability is not always intentional, and it can come from within the disabled community as well. The modern concept of ableism, which likely emerged in the 1960s and 1970s, can be seen in almost every setting, personal, societal, cultural, and institutional. It can manifest in the unnecessary labeling and altered expectations of an innocent peer, or in more obvious judgments rooted in eugenics-based thinking. In almost every case, these judgments are based on what is perceived as “normal” (Britannica Editors, 2025).

    References

    Office of Disability Services (2026). Assistive Technology. Princeton University. https://ods.princeton.edu/assistive-technology

    Cleveland Clinic (2025). Assistive Technology. Health Library. https://my.clevelandclinic.org/health/articles/assistive-technology

    ATiA (2026). What is AT?. Assistive Technology Industry Association. https://www.atia.org/home/at-resources/what-is-at/

    World Health Organization (2024). Assistive Technology. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/assistive-technology

    Britannica Editors (2025). Ableism. Encyclopedia Britannica. https://www.britannica.com/topic/ableism

  • Service Animals, Part 3

    Service Animals, Part 3

    Part 3: Legallities

    In “Service Animals, Part 2,” I explained what a service animal was. Of course, legal definitions and legalities in general are often more complex than they appear. Generally, any establishment open to the public must allow service dogs to accompany their handlers, even where there’s a no pets policy. In the US, service dogs are not required to be certified or trained by a professional, nor are they required to wear a harness, vest, or tag to identify them as a service dog (US Department of Justice, n.d.).

    I also mentioned briefly in “Service Animals, Part 2,” that a service animal is generally a dog. However, miniature horses — typically up to three feet tall and weighing up to 100 pounds — may also qualify where reasonable. If the horse is house-broken, under the handler’s control, and the facility can accommodate the horse’s general type and size without compromising legitimate safety requirements, it is considered a reasonable service animal (US Department of Justice, 2020). For time and clarity, though, I’ll continue to focus on service dogs.

    Legally speaking, a service dog is one specifically trained to help their disabled handler with tasks directly related to their disability. While service dogs may also provide comfort and emotional support, these skills are not considered service dog tasks. Other working dogs, such as facility dogs, therapy dogs, and Emotional Support Animals (ESAs), provide comfort and emotional support primarily to non-disabled individuals. Though these dogs are often highly trained, they are still considered pets. For example, facility dogs are trained to assist professionals working in healthcare, rehabilitation centers, criminal justice settings, and similar establishments. Therapy dogs are certified to visit and comfort certain therapy patients. ESAs, while not specially trained, help to comfort and calm their handlers. However, these working dogs are only allowed where pets are and where their specific jobs take them (Canine Companions, 2026).

    To identify service dogs, establishments may ask a handler whether their dog is required due to their disability and what specific tasks the dog has been trained to perform. However, regardless of the handler’s response to this, they can not ask for proof of this disability or of the service dog’s qualifications. If the dog can not be kept under reasonable control, or if the service dog’s presence will fundamentally alter the nature of goods, services, programs, or activities provided, those in charge are allowed to refuse entry or service, or ask the handler to remove their service dog. For example, a sterile hospital setting may require the removal of a service dog. If a service dog must be removed, the handler must be provided with an alternative opportunity to receive their goods or services without their service dog (US Department of Justice, n.d.; US Department of Justice, 2020).

    Legally speaking, service animals are not pets, as their tasks directly relate to their handlers’ disabilities. For this reason, service dog handlers are not required to answer questions about their disability, documentation, proof of necessary accommodations, or to demonstrate their service dog’s training. They can’t be segregated, given lower-quality service, or charged more solely because of their service dog. A business can charge handlers for damages that they or their service dog cause, if other non-disabled customers would also be charged for damages. However, if a service dog handler needs alternative accommodations, the business is not responsible for the service dog’s care or supervision (US Department of Justice, 2020).

    To add to this, a customer or employee’s allergies and/or fear of dogs is not considered a valid reason to deny a service dog handler access to goods and services. These fears and allergies will not fundamentally alter the nature of goods or services provided. This means that if someone is allergic to pet dander, the business must accommodate both the disabled handler and the allergic customer separately (US Department of Justice, 2020).

    It’s important to note here that rules and regulations are often updated as needs evolve. For instance, the most recent update of the Americans with Disabilities Act (ADA) Title II and Title III regulations, published by the US Department of Justice (DOJ) in September 2010, modified specific requirements for the regulation of public and commercial accommodations, including the 2010 Standards for Accessible Design (2010 Standards). That said, state and local laws may differ from federal regulations. So it’s important to check your state attorney general’s office for all applicable laws (US Department of Justice, 2020).

    Regardless of these local and federal variations, all housing, schools, emergency shelters, and businesses must comply with ADA regulations. State and local governments may also require licensing and vaccination for service dogs, but only if these conditions apply to all dogs. They can not require specific service dog certifications or registrations, or discriminate against service dogs based on breed. Notably, airplanes are not subject to ADA’s regulations. Instead, they are required to comply with the Air Carrier Access Act. Similarly, the Equal Employment Opportunity Commission (EEOC) is responsible for enforcing ADA regulations in employment settings (US Department of Justice, n.d.). Simply put, if your well-behaved service dog helps you manage your disability, you can take them with you.

    References

    Canine Companions (2026). Know the Differences: Service Dogs, Emotional Support Animals, and More. Canine Companions. https://canine.org/service-dogs/service-dog-month/service-dog-differences/

    US Department of Justice (n.d.). Service Animals. ADA.gov. https://www.ada.gov/topics/service-animals/

    US Department of Justice (2020). ADA Requirements: Service Animals. ADA.gov. https://www.ada.gov/resources/service-animals-2010-requirements/#miniature-horses

  • Service Animals, Part 2

    Service Animals, Part 2

    Part 2: Job Titles

    Dogs have been working with people for a very long time, far longer than they’ve been our pets, and with good reason. They can sense things that we just can’t. In fact, dogs have around 300 million olfactory receptors in their noses, compared to humans, who have around six million. And that’s just their nose! The first known guide dogs were working with people in the first century AD, and standardized guide dog training began in the 18th century (Mueller, 2025). However, this is just one job that a service dog can do.

    A service animal may be a miniature horse in some special situations, but these situations are very rare. For this reason, this article will focus on service dogs. Regardless of terminology, service dogs are specially trained to help with tasks that their handlers struggle to perform independently. For example, mobility service dogs may press access buttons or brace an unsteady handler. Guide dogs identify and maneuver around obstacles using a specialized harness. Hearing dogs alert their deaf handlers to specific sounds and lead them to safety when necessary. Medical alert dogs detect significant hormonal changes or the presence of dangerous allergens. Some alert dogs are even trained to get help when necessary (US Service Animals, 2023).

    The Americans with Disabilities Act (ADA) defines a service dog as “any guide dog, signal dog, or other dog that has been trained to provide assistance to an individual with a disability” (Stull, 2025a). Unfortunately, service dogs are often confused with therapy dogs and emotional support animals (ESAs). While these types of assistance dogs definitely play important roles, they have distinctly different job descriptions. It’s often easier to distinguish service dogs from therapy dogs and ESAs when you understand the variety of jobs that service dogs can do. These jobs can include guiding, hearing, mobility tasks, medical alert, psychiatric, or a combination of these.

    In the US alone, there are more than 500,000 working service dogs. All of these service dogs are legally allowed to enter any public space, even where pets are not allowed. While guide dogs are the most widely known type of service dog, even their jobs are not as simple as some may think. They do more than just take their blind or visually impaired handlers from point A to point B. These amazing dogs stop at curbs to alert their handler to a crossing, avoid obstacles that could harm their handler, and actively ignore potentially dangerous commands (a technique called “selective disobedience”). They are generally trained for around a year to a year and a half, beginning with puppy raisers who work on basic obedience training and socialization. After this, the dogs move on to be trained by professional guide dog trainers before they’re paired with their handler. Finally, the dog and their new handler work together in a 2-4 week training program (Mueller, 2025; Stull, 2025a).

    Similarly, hearing ear dogs are raised like guide dogs. However, these dogs are trained to alert their deaf and hard-of-hearing handlers to specific sounds (e.g., oncoming cars, alarms, door bells, and knocking) and lead them to or away when necessary. Once paired with their new handler, they work on a 2-4 week training program that may also include additional, specialized alert skills (Stull, 2025a; Mueller, 2025).

    Mobility assistance is another important type of service dog job. These dogs can help pull a wheelchair over uneven or challenging terrain, or help handlers with less well-known mobility disabilities like arthritis, Cerebral Palsy, muscular dystrophy, spinal cord injuries, and more. Their tasks can also include retrieving items that their handler drops, helping to open and close doors, pushing access buttons, and providing physical support to a handler with difficulty balancing, using stairs, and/or moving between sitting and standing (Stull, 2025a; Mueller, 2025).

    Seizure response dogs are a type of medical assistance dog trained to remain with their handler during a seizure and to alert or retrieve help if needed. In contrast, seizure alert dogs are trained to alert their handler to chemical changes that precede a seizure, allowing their handler get to a safe place before the seizure occurs. While there’s no conclusive proof as to how seizure alert dogs do it, there is significant evidence supporting their effectiveness (Stull, 2025a; Mueller, 2025).

    Other alert dogs, such as allergy detection and diabetic alert dogs, are also trained to alert their handlers to the presence of allergens or to changes in insulin levels that could be fatal if not handled appropriately. However, contrary to popular belief, alert dogs cannot be trained to recognize the scent they alert to. These dogs are chosen and trained for their jobs because of their innate ability to detect these scents (Stull, 2025a).

    Psychiatric service dogs are actually a category of medical assistance dogs trained to help their handlers with mental health conditions such as PTSD, OCD, severe social anxiety, self-harm, autism spectrum disorder (ASD), and more. These dogs can be trained to walk ahead of their handler, turn lights on in a new room, interrupt an anxiety or panic attack, create a physical barrier to distance known triggers, or even alert their handler in a way that creates an excuse to leave. Autism support dogs, one type of psychiatric service dog, also help their handlers (often children) navigate difficult social settings, prevent eloping, mediate the symptoms of sensory overload, and provide companionship when others can’t. However, one common misconception is that psychiatric service dogs and ESAs are the same. The major difference here is that emotional support isn’t a disability task. In fact, ESAs don’t need any specialized training (Stull, 2025a; Mueller, 2025; US Service Animals, 2023).

    Clearly, service dogs can do a lot. This is exactly why it’s so important to differentiate between the different categories of assistance animals. While there is no clear definition of “assistance animal,” a common consensus seems to define this term as an umbrella term including all service animals, therapy animals, and emotional support animals. So, it’s important to clearly differentiate between the other two categories as well.

    According to the ADA, an ESA (also called an emotional support dog or ESD) is “an animal [which] provides companionship, relieves loneliness, and sometimes helps with depression, anxiety, or certain phobias, but do not have special training to perform tasks that assist people with disabilities.” ESAs are pets and are not permitted into places that don’t already allow pets without a letter from a medical or mental health provider. However, it’s also important to remember that no matter the certification or qualification, an aggressive dog can be denied entry or asked to leave any establishment. That said, service dogs are the only type of assistance animal with full access to public areas (Stull, 2025b).

    Therapy dogs (and sometimes other animals) are pets whose handler brings them somewhere to offer therapeutic care to others. These dogs have to be certified nationally, locally, or occasionally through the facilities providing animal therapy. There are three main types of therapy dogs: therapeutic visitation dogs, animal-assisted therapy dogs, and facility therapy dogs. Therapeutic visitation dogs are part of a team visiting hospitals, retirement facilities, and similar facilities in order to lift spirits and/or distract the patients receiving treatment. Animal-assisted therapy dogs work with health professionals in facilities like rehabilitation centers to help with injury recovery or heightened anxiety levels, allowing patients to relax and open up more. Facility therapy dogs typically live where they work with the residents, in places like nursing homes. They can be trained to comfort residents, alert staff when needed, and perform other related tasks (Stull, 2025b).

    All in all, dogs are amazing. Service dogs, ESAs, and therapy dogs do amazing jobs that are as varied as the disabilities and conditions that they help their humans with. However, it’s important to remember to respect these assistance dog teams. Wanting to bring your dog everywhere isn’t a reason to pretend that they’re a service dog. And most importantly, ask before you pet that adorable puppy; they may be working.

    References

    Mueller, L. (2025). 8 Types of Service Dogs and What They Do. Title of source. https://www.thesprucepets.com/types-of-service-dogs-4587180

    Stull, E. (2025a). The 10 Most Common Types of Service Dogs. The Academy of Pet Careers. https://www.theacademyofpetcareers.com/blog/10-types-of-service-dogs/

    Stull, E. (2025b). Therapy Dogs vs Emotional Support Dogs: What is the difference?. The Academy of Pet Careers. https://www.theacademyofpetcareers.com/blog/therapy-dogs-vs-emotional-support-dogs/

    US Service Animals (2023). The Different Types of Service Animals & How They Can Help. US Service Animals. https://usserviceanimals.org/blog/types-of-service-animals/