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 Disability Information - Cognitive Impairment


General Information

Education & Classroom Accommodations

Michigan Resources, Support Groups, Listservs & Websites

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Articles Related to this Disability

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 General Information

A cognitive impairment is characterized by lack of development in the cognitive domain, Impairment of adaptive behavior, manifested during the developmental period, and adversely affects educational performance.


Cognitively impaired persons are defined as having either a psychiatric disorder (e.g., psychosis, neurosis, personality or behavior disorders), an organic impairment (e.g., dementia), or a developmental disorder (e.g., mental retardation) that affects cognitive or emotional functions to the extent that capacity for judgment and reasoning is significantly diminished.


Types of Cognitive Disabilities (from

The concept of cognitive disabilities is extremely broad, and not always well-defined. In loose terms, a person with a cognitive disability has greater difficulty with one or more types of mental tasks than the "average" person. There are too many types of cognitive disabilities to list here, but we will cover some of the major categories. Most cognitive disabilities have some sort of basis in the biology or physiology of the individual. The connection between a person's biology and mental processes is most obvious in the case of traumatic brain injury and genetic diseases, but even the more subtle cognitive disabilities often have a basis in the structure or chemistry of the brain.

A person with profound cognitive disabilities will need assistance with nearly every aspect of daily living. Someone with a minor learning disorder may be able to function adequately despite the disorder, perhaps even to the extent that the disorder is never discovered or diagnosed. Admittedly, the wide variance among the mental capabilities of those with cognitive disabilities complicates matters somewhat. In fact, one may reasonably argue that a great deal of Web content cannot be made accessible to individuals with profound cognitive disabilities, no matter how hard the developer tries. Some content will always be too complex for certain audiences. This is unavoidable.

Nevertheless, there are still some things that designers can do to increase the accessibility of Web content to people with less severe cognitive disabilities.

Learning Disabilities
Learning disabilities affect a person's ability to process information. In some cases, the individual has difficulties interpreting what is seen or heard. In other cases, the individual can interpret the information but has difficulties making mental connections--or links--between different pieces of information. The person's written or spoken language may be affected, or the ability to read or do math. It is tempting to think that people with learning disabilities have below average intelligence. This is not always the case. Sometimes individuals with learning disabilities excel in areas where they do not have the learning disability. For example, an individual with dyscalculia (math learning disability) may be an excellent writer, artist, linguist, or whatever else. The learning disability might manifest itself only when that person is performing mathematical activities. In other cases, the individual has multiple learning disabilities, or learning disabilities of a broader nature, thus affecting more than one area of learning.

"Dyslexia is one of several distinct learning disabilities. It is a specific language-based disorder of constitutional origin characterized by difficulties in single word decoding, usually reflecting insufficient phonological processing abilities. These difficulties in single word decoding are often unexpected in relation to age and other cognitive and academic abilities; they are not the result of generalized developmental disability or sensory impairment. Dyslexia is manifest by variable difficulty with different forms of language, often including, in addition to problems reading, a conspicuous problem with acquiring proficiency in writing and spelling."
-The Definition of Dyslexia as adopted by the Research Committee of the International Dyslexia Association - external link, May 11, 1994 and by the National Institutes of Health, 1994.
Reading disabilities, such as dyslexia, are the most common type of learning disability. In fact, an estimated 15-20% of the population has some sort of language-based learning disability. Among these, dyslexia is the most common. Evidence suggests that dyslexia is an inherited condition found among both males and females of all ethnic backgrounds.

Attention Deficit Hyperactivity Disorder (ADHD)
Some people mistakenly think of ADHD as a learning disability. It is true that some people with ADHD have difficulties learning, but oftentimes this is due to their distractibility, rather than to any kind of inability to process information. People with ADHD can be impulsive, easily distracted, and inattentive. On a positive note, some people with ADHD are highly creative and very productive in short bursts, with an abundance of energy and enthusiasm. On a less positive note, it can be difficult for people with ADHD to stick to a task for a long period of time. On the Web, flashing banner ads can be distracting, as well as anything that draws a person's attention away from the main content.

Brain Injury
Some causes of brain injury include traumatic head injury, stroke, and illness (such as meningitis or brain tumors). Every brain injury is different, and there is no reliable way to predict how a person's brain will be affected. After a person receives an injury to the head, medical professionals perform a series of neurological and psychological examinations to determine what areas of the brain were damaged. Some brain injuries result in behaviors that are hardly noticeable at all, whereas others are immediately obvious. The severity of the damage will determine how effectively the person will be able to process information on Web pages.

Genetic Diseases
Genetic sources of cognitive disabilities include Down's syndrome, autism, and dementia, in order of least to most severe. Some individuals with Down's syndrome are able to function at a high level, while others are more limited in the cognitive capacity. The more severe the cognitive disability, the harder it is for the individual to comprehend Web content. If a developer wishes to use the Web to communicate to people with severe cognitive disabilities, it may be necessary to use little or no text at all. Graphics, audio, video, and animations may be the most effective way to communicate to this audience. That does not mean that all of your Web content must presented in a graphic-only format. Much of the content of the Internet in general is not even suited to people with severe cognitive disabilities. It is simply beyond their capacity to comprehend. However, if you are designing a site that is meant to communicate directly with such individuals, you should use as many meaningful graphics as possible.


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 Education & Classroom Accommodations

Michigan Special Education Rule 340.1705 Cognitive impairment; determination.

Rule 5. (1) Cognitive impairment shall be manifested during the developmental period and be determined through the demonstration of all of the following behavioral characteristics:

(a) Development at a rate at or below approximately 2 standard deviations below the mean as determined through intellectual assessment.

(b) Scores approximately within the lowest 6 percentiles on a standardized test in reading and arithmetic. This requirement will not apply if the student is not of an age, grade, or mental age appropriate for formal or standardized achievement tests.

(c) Lack of development primarily in the cognitive domain.

(d) Impairment of adaptive behavior.

(e) Adversely affects a student's educational performance.

(2) A determination of impairment shall be based upon a comprehensive evaluation by a multidisciplinary evaluation team, which shall include a psychologist.

R 340.1738 Programs for students with severe cognitive impairment.

Rule 38. Programs for students with severe cognitive impairment shall be operated as follows:
(a) There shall be 1 teacher and 2 instructional aides for a maximum of 12 students. The maximum number of students may be extended to 15 if an additional instructional aide is assigned with the placement of the thirteenth student. At least 1 full-time teacher and 1 fulltime aide shall be employed in every program for students with severe cognitive impairment.
(b) Programs for students with severe cognitive impairment shall consist of a minimum of 230 days and 1,150 clock hours of instruction. The first 5 days when pupil instruction is not provided because of conditions not within the control of school authorities, such as severe storms, fires, epidemics, or health conditions as defined by the city, county, or state health authorities, shall be counted as days of pupil instruction. Subsequent days shall not be counted as days of pupil instruction.
(c) Teachers shall be responsible for the instructional program and shall coordinate the activities of aides and supportive professional personnel.
(d) Instructional aides shall work under the supervision of the teacher and assist in the student’s daily training program.
(e) Program assistants may assist the teacher and the instructional aides in the feeding, lifting, and individualized care of students with severe cognitive impairment.
(f) A registered nurse shall be reasonably available.
R 340.1739 Programs for students with moderate cognitive impairment.
Rule 39. Programs for students with moderate cognitive impairment shall be operated as follows:
(a) There shall be 1 teacher and 1 teacher aide for a maximum of 15 students.
(b) There shall be 1 lead teacher and a maximum of 3 instructional aides for a maximum of 30 students, with not more than 10 students for each aide.
R 340.1740 Programs for students with mild cognitive impairment.
Rule 40. Programs for students with mild cognitive impairment shall be operated as follows:
(a) Elementary programs for students with mild cognitive impairment shall serve not more than 15 different students. When an elementary program for students with mild cognitive impairment has 12 or more students in the room at one time, an aide shall be assigned to the program.
(b) Secondary programs for students with mild cognitive impairment shall have not more than 15 different students in the classroom at any one time and the teacher shall be responsible for the educational programming for not more than 15 different students.


How and When to Accommodate Cognitive Disabilities Under the Americans with Disabilities Act
Written by Chuck Levin, Attorney; Revised by Kathy Wilde, Litigation Director, March 2002

I. Introduction:

The Americans with Disabilities Act (ADA) is a landmark law that prohibits discrimination based on disability in the areas of employment, governmental services, public accommodations offered by private entities, and telecommunications. This law protects people with either physical or mental disabilities.

This paper will tell consumers and those involved in consumers' lives how the ADA may apply to people with a cognitive disability. By "cognitive disability", we mean someone who has difficulty reading, writing and understanding, due to mental retardation, autism, traumatic brain injury, or other disability. Examples based upon real life situations illustrate the kinds of issues and considerations that may be involved with this population. We give examples of reasonable accommodations that employers, businesses and public agencies may need to provide to give people with cognitive disabilities equal opportunities under the law. Reasonable accommodations for a person with a cognitive disability may look quite different than those for a person with a physical disability.

If, after reading this pamphlet, you have questions concerning how your worksite, business or agency can accommodate people with cognitive disabilities, or if you want to learn more about people with developmental disabilities, please call The Arc-Multnomah, 223-7279. Legal questions concerning the ADA may be directed to the Oregon Advocacy Center, (503) 243-2081, or 1-800-452-1694 (voice), (503) 323-9161 (TTY) or 1-800-556-5351 (TTY).

This brochure does not, and is not meant to, explore all the provisions and protections within the ADA. Instead, it offers a broad overview. It is not a substitute for legal advice from an attorney. The particular facts of each situation will determine the existence of an ADA claim. To learn more about the existence of a possible ADA violation in a particular context, contact an attorney with relevant experience.

II. Title I Overview (Employment)
Title I of the ADA applies to employment in the private and public sector. All employers with more than 15 employees are currently covered by the Act. Title I makes it illegal for these employers to discriminate against persons with disabilities in any terms of employment, including the job interview, advancement opportunities, work conditions, salary, and benefits. Title I, though, does not require an employer to hire someone who cannot perform the essential functions of the job in question with reasonable accommodation. Nor does it require an employer to choose a qualified person with a disability over a qualified person without a disability. But it does require that people with disabilities be given the same chance as everyone else in the workplace.

Following is an analysis of a hypothetical fact situation which explores the legal process involving Title I.

III. Title I: Example and Analysis
Frank, whose IQ is 70, wants to apply for a job at a grocery store. Because of Frank's behavior, or his mannerisms, or his speech, or because Frank tells the manager, the manager knows that Frank has a cognitive disability.

The application procedure at the grocery store consists of two parts: a job application form and an interview. Frank picks up the application form, but has trouble understanding it and fills it out incorrectly and incompletely.

The manager calls him to schedule the interview.

ADA Implications and Issues

If the manager was not aware that Frank had a disability, and did not regard him as having a disability, then he and the grocery store could not be liable for any wrongdoing under the ADA, because under the ADA, an entity can only discriminate against an individual with a disability if it is aware of the disability, or, if the person does not actually have a disability, if it regards the person as having a disability.

Here, the manager knows about Frank's disability. The Manager must therefore determine if Frank can meet the "essential functions" of the job with or without reasonable accommodation. If he cannot meet the essential functions of the job, even with reasonable accommodation, the manager is not required to further consider him for the position.

Title I requires employers to make reasonable accommodations to known disabilities of employees and applicants when necessary to afford them the same opportunity as others. Reasonable accommodations may be creatively developed and tailored to allow one to obtain and retain a job. The regulations state that whether an accommodation is considered "reasonable" will depend upon:

The nature and net cost of the accommodation (taking into account the availability of tax credits and deductions, and/or outside funding);

The overall financial resources of the facility involved in the provision of the reasonable accommodation, the number of persons employed there, and the effect on expenses and resources;

The overall financial resources of the covered entity, the overall size of the business of the covered entity with respect to the number of its employees, and the number, type and location of its facilities;

The type of workplace of the covered entity, including the composition, structure and functions of the workforce of such entity, and the geographic separateness and administrative or fiscal relationship of the facility or facilities in question to the covered entity; and The impact of the accommodation upon the operation of the facility, including the impact on the ability of other employees to perform their duties and the impact on the facility's ability to conduct business.

If the accommodation is not reasonable, then it is an "undue burden" and the employer is not required to provide it. In our example, as a practical matter, the Manager may first have to provide reasonable accommodations to Frank in the application process in order to find out whether Frank can meet essential job functions. Accommodations may include:

providing an assistant to help Frank complete the job application form;

explaining to Frank how to fill out the job application form in language he can understand;

waiving the requirement that he fill out the job application sheet, in favor of the interview (unless the job would require that he be able to fill out similar types of forms or paperwork);

enlisting the support, if necessary, of known case managers or of Frank's advocates to get Frank to the interview.

The ADA prohibits employers asking applicants about any disability. They can inquire only about their ability to do the job. Thus, the employer may ask questions designed to find out whether Frank can meet the essential functions of the job. The following questions are probably not permissible:

"Has your IQ ever been measured: What is it?"

"Do you have any disabilities?"

"Do you take any medications?"

"Have you ever lived in a group home?"
The following questions are probably permissible:

"Where do you live?"

"Can you add and subtract (if the job requires this)?"

"Can you lift 40 pounds at a time (if the job requires this)?

"Do you have any case managers or advocates?" (would you mind if I contact them?)
Note: although this question may seem disability-related and therefore impermissible, in those instances where an applicant's disability is readily apparent, the employer's knowledge of this information will allow him to communicate with those key players in the applicant's life that will be knowledgeable about the kinds of reasonable accommodations that may be required in order for the person to remain on the job successfully. Also, such persons may be in a position to provide required counseling or training to the individual which the employer may not be required to provide, which could mean the difference between the person's ability to hold the job and getting fired.

Even if Frank is qualified to perform the essential functions of the job, the Manager is not required to hire him. The ADA is not an "affirmative action" law. However, if the Manager chooses to hire someone else instead of Frank, the reason for his doing so may not be related to Frank's disability, unless the disability precludes Frank from performing the essential functions of the job.

Assume Frank is hired for the job, but he cannot do it without reasonable accommodations. Depending on the nature of the job and Frank's precise limitations, such accommodations could include:

(However, if Frank cannot meet work standards or quotas set by the employer, than he is not "qualified" for the job and the employer need not hire or retain him.)

providing a reader

providing other auxiliary aides or services

first consulting with Frank's advocate or case manager if Frank is having problems on the job which would ordinarily lead to termination, and giving such people the opportunity to work with Frank to cure the identified problem.

If the employer does not know that Frank has a disability, but is suspicious that he does, may he ask him? No. An employer may not ask disability-based questions of applicants.
If Frank asks for a reasonable accommodation but the employer doubts whether he has a disability, the employer may ask Frank to produce some sort of evidence, like a doctor's letter or evaluation.

During the application process, can the grocery store insist that Frank take a drug test?
Yes. Drug tests are permitted under the ADA, so long as they test only for illegal drugs, and not prescription drugs. If a drug test shows that the applicant is taking an authorized drug, the employer may not act against the employee or applicant for such use, and in any court proceeding, the applicant may defend that such use is occurring under the supervision of a licensed medical practitioner.

Current illegal drug users, though, are not considered people with disabilities under the ADA. A person who uses drugs illicitly cannot claim any protection under the act if their drug use is discovered as a result of a drug test.

Physical exams are not permitted at all in the application process, until an offer of employment is made. An offer of employment may be made contingent upon the passing of a physical examination, so long as:

all job applicants are required to take the same exam;

all information acquired in the course of the exam is kept confidential; and

if, as a result of the exam, the applicant is denied employment, that the exam is consistent with business necessity and does not discriminate or tend to discriminate against people with disabilities.

IV. Title II Overview
Title II of the ADA pertains to all public entities, which the Act defines as:

Any State or local government;

Any department, agency, special purpose district, or other instrumentality of a State or States or local government; and

The National Railroad Passenger Corporation, and any commuter authority (as defined in section 103(8) of the Rail Passenger Service Act).

Title II imposes almost identical requirements upon public entities as Section 504 of the Rehabilitation Act imposes on entities receiving federal financial assistance. That is, public entities cannot discriminate against "qualified individuals" in their administration of services, programs, benefits, privileges, or opportunities. A person is a "qualified individual" if she meets the "essential eligibility requirements" of the program in question. If a person is a "qualified individual", then the public entity must make reasonable accommodations or provide auxiliary aids in order to make its programs or activities accessible.

V. Title II Example and Analysis
Jill, who has moderate mental retardation, goes to Senior and Disabled Services Division (SDSD) to find out about possible benefits and programs she may be eligible for. The receptionist gives her a brochure with the descriptions of the programs and benefits. Jill does not readily understand it, as the language is often technical and complex.

ADA Implications and Issues

SDSD is a public entity and is therefore covered by Title II of ADA.

As a Title II entity, SDSD must make its programs accessible to people with disabilities. Program accessibility means more than just physical access. It also includes making application and program information readily understandable.

Therefore, SDSD must make the application forms and program descriptions accessible to Jill. Options may include:

providing a staff person to explain the materials to Jill so that they are meaningful and comprehensible to her; or assist in filling out necessary paperwork.

developing new, or supplementary materials geared towards people who do not read, write, or comprehend written information easily.
These are reasonable accommodations which would allow Jill access to SDSD's programs. The agency's refusal to provide them, or similar accommodations, will likely constitute a violation of ADA.

As one of SDSD's target groups is people with disabilities, it should have people and procedures set up to identify prospective clients with disabilities. Standard questions that might be asked at intake for this purpose include whether the person has a history of special education; has a case manager, or has been hospitalized.

VI. Title III Overview (Public Accommodations)
Title III prohibits discrimination by private entities that offer public accommodations. Public accommodations include inns, hotels, motels, restaurants, bars, movie theaters, concert halls, stadiums, auditoriums, bakeries, grocery stores, shopping centers, laundromats, dry cleaners, banks, hair salons, lawyers' offices, museums, libraries, parks, zoos, private schools, day care centers, gymnasiums, spas, hospitals, doctor's offices, and other such places where the public is invited.

Title III prohibits public accommodations from discriminating against an individual on the basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations that the public accommodations offers.

Public accommodations must make reasonable modifications in policies, practices, or procedures when to do so is necessary to afford goods, services, facilities, privileges, advantages, or accommodations to individuals with disabilities, unless the modifications would "fundamentally alter" the nature of what is being provided, or result in an "undue burden" to the public accommodation.

Public entities must further take steps to ensure that individuals with disabilities are not excluded, denied services, segregated or otherwise treated differently than other individuals because of the absence of auxiliary aids and services, unless such auxiliary aids and services would create an undue burden or fundamentally alter the nature of what is being offered. "Auxiliary aides" include such things as interpreters, notetakers, transcription services, written materials, telephone handset amplifiers, assistive listening devices, assistive listening systems, telephones compatible with hearing aids, closed cation decoders, open and closed captioning, TTYs, videotext displays, readers, taped texts, audio recordings, brailled materials, large print materials, and the acquisition or modification of equipment or devices.

Title III Examples and Analysis
Example 1:

John enters a restaurant to eat dinner. John is cognitively impaired and non-verbal. The manager comes by John's table and asks John to prove to him that he is carrying enough money to pay for a meal at the restaurant.

The waiter then comes to take his order. Upon discovering that John cannot communicate what he wants, the waiter ignores him or asks him to leave.

ADA Implications and Issues

The restaurant is a public accommodation operated by a private entity, and is therefore covered under Title III of ADA.

The restaurant cannot exclude John because he is cognitively impaired and non-verbal.

A restaurant would typically have the authority to question customers for the purpose of insuring that they have the capability of paying for their meals and service. However, restaurants do not question everyone about this, they are selective. The way they select whom to question may be suspect. If they are questioning all people with disabilities because of their fear, prejudice, or stereotype that people with disabilities are unlikely to be able to pay, this may violate the ADA. On the other hand, if they question a particular individual with a disability for reasons which may relate to the disability tangentially, but which are the same reasons that they would question anyone else, such as dirty or disheveled appearance, such questioning may pass muster under ADA because they are not disability-based.

John may require auxiliary aids to read or understand the menu. The waiter could easily serve in this capacity by reading and explaining the menu to him. John may then point to items on the menu to convey his wishes. By simply ignoring him, as in the example, the restaurant would be violating ADA by failing to take such steps necessary to ensure that he is not denied services or otherwise treated differently than other individuals because of the absence of auxiliary aids and services. If auxiliary aids and services are unsuccessful at bridging the communication gap, the waiter would have justification for not serving John.
Example 2:

John, an individual with a cognitive impairment, and who has some challenging behaviors, visits a shopping mall. He is in the central area of the mall, shouting loud and rude remarks at passersby, including some obscenities. Some shoppers complain to mall authorities, who order John to leave the mall and not come back.

Nonetheless, John later returns to the mall, and hangs out in a jewelry store there. The owner of the store, seeing that John is not a customer who is likely to be able to afford to buy jewelry from him, orders him to leave.

ADA Implications and Issues

The mall as a whole is covered under Title III.

The mall may impose neutral rules concerning conduct expected of those who visit the mall. Such rules can prohibit violent or disruptive behavior, to enable the mall to conduct it's business in an orderly manner.
In any event, the mall may require John to leave if he constitutes a direct threat to the health or safety of others in the mall. "Direct threat" means a "significant risk to the health or safety of others that cannot be eliminated by a modification of policies, practices, or procedures, or by the provision of auxiliary aids or services." While John's conduct likely does not constitute a "direct threat," John could still be excluded from the mall if he does not meet the mall's neutral rules concerning conduct of shoppers.

If John wants to return to the mall, against the mall's order that he not come back, he should be able to, if he meets the mall's neutral conduct rules. Even if the mall has neutral rules which allow it to keep disruptive people off the mall grounds for some unspecified time in the future, it must modify such rules or policies to accommodate John's disability.

If John is not being disruptive in the jewelry store, the owner cannot order him to leave his store, unless he also orders everyone else to leave who he believes is not likely to purchase jewelry from him,. whether or not disabled. Many shoppers go to malls to browse, and this is commonly accepted. John has the same right to browse in mall stores as anyone else.


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 Articles Related to this Disability

MI Students With Cognitive Impairment Score Well on Alternate Assessments - A majority of Michigan students with cognitive impairment "Surpassed" or "Attained" set performance standards on the state's alternate assessment, known as MI-Access.


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 Medical Information

Research Involving Cognitively Impaired Persons

The principal concern in reviewing research involving individuals with psychiatric, cognitive or developmental disorders or involving individuals who are substance abusers is that their disorders may compromise their capacity to understand the information presented and their ability to make a reasoned decision about participation in research.


Child-Based Risk Factors - Children with severe cognitive deficiencies usually develop very low, if any, reading achievement. Other factors that are associated with developmental delays in cognitive abilities include severe nutritional deficiency, very low birthweight, fetal alcohol syndrome, lead poisoning, and severe psychopathological conditions that emerge in early childhood.


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