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What is the ADA? Basics and Definitions of the Americans with Disabilities Act

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When Is Anxiety Normal?

It's normal to feel anxious, nervous, or worried at times. Maybe you've felt anxious when you had to talk in front of a group. Or nervous before a tryout or a big test. Maybe you have felt anxious when you weren't sure your surroundings were safe. Or worried when a loved one was sick.

Most people have felt like this.

Anxious feelings can be uncomfortable - but they serve a purpose. They warn that something that matters to you is at stake. With anxious feelings, you might think, "I need to do well here." Or, "This counts - get ready." Or, "Be careful."

Anxiety sets off the body's fight-or-flight response. This is also called the stress response. It's a normal release of hormones that helps you gather the focus and energy you need for a challenge or possible threat. The fight-or-flight response causes the physical feelings that can happen with anxiety.

For example, when you're anxious, you might feel 'butterflies' in your stomach. Or you might have sweaty palms or shaky hands. You might notice your mouth is a little dry. Or your face feels a little warm. You might feel your breathing or heartbeat get faster. With anxiety, you might feel one - or a few - of these.

Feelings like these can help you do what you need to do. You can go ahead with the tryout or take the exam - even though you're nervous. You can check your surroundings to make sure you're safe. You can focus on what a loved one needs and plan how to help instead of getting caught up in the worry.

When you know that anxiety is normal for the situation, you can let go of focusing all your attention on the anxious thoughts and feelings. Instead, you can turn your attention to what you need to do. You don't need to do things to make anxiety 'go away.' You can take a breath and face the challenge. You'll find that anxiety fades on its own.

When Is Anxiety a Problem?

Some people feel anxiety that is too intense. It seems like more than they can cope with. Worries or fears take up too much of their time and energy. Some people might begin to avoid things that make them anxious. These things can be signs of an anxiety disorder.

If you feel like anxiety is too much, tell a parent, school counselor, or your doctor. There are treatments for anxiety disorders. The sooner you start getting help, the better you will feel.

Date reviewed: March 2022

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Anxiety is a natural part of life, and most of us experience it from time to time. Find out about normal anxiety and learn when anxiety can develop into a problem for some people.

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What Is Tourette Syndrome?

Tourette syndrome is a condition that affects a person's central nervous system and causes tics. Tics are movements or sounds that a person can't control and that they repeat over and over.

Tics are kind of like hiccups. You don't plan them, and you don't want them. Sometimes, a kid might be able to hold back a tic for a short time. But tension builds, and eventually the kid must let the tic out.

What Are the Symptoms of Tourette Syndrome?

People with Tourette syndrome have two kinds of tics - motor tics and vocal tics.

Motor tics are twitches or movements a person makes but can't control. They include eye blinking, head shaking, jerking of the arms, and shrugging.

Vocal tics are sounds a person makes but can't control. They can include throat clearing, grunting, and coughing.

A person with Tourette syndrome sometimes has more than one type of tic happening at once. Tics can happen throughout the day. But they often happen less or go away completely when a person is concentrating (like working on a computer) or relaxing (like listening to music).

The type of tics and how often they happen often change over time. They're usually worse when a person is under stress (like when studying for a big test) or excited or very energized about something (like at a birthday party or a sports activity).

Sometimes a person with Tourette syndrome might have other conditions, like ADHD, obsessive-compulsive disorder (OCD), or trouble learning.

How Is Tourette Syndrome Treated?

To have Tourette syndrome, a person must have at least two motor tics and one vocal tic. The person has to have the tics every day or off and on for over a year - and they have to start before the person turns 18.

There's no cure for Tourette syndrome, but most of the time no treatment is needed. A kid can deal with the tics and still do normal stuff, like go to school and play with friends. If tics are making it hard to do normal stuff, a doctor may suggest medicine.

Stress or being upset can make the tics worse, and kids might feel upset because of the tics and the problems that go with them. Talking to a psychologist or psychiatrist can help. A therapist can teach coping and relaxation skills, and help kids learn how to explain tics to others. They can also help kids with other problems that can be connected to Tourette syndrome, like ADHD and anxiety.

How Should I Act Around Someone Who Has It?

Kids who have Tourette syndrome want to be treated like everybody else. They can do regular stuff, just like other kids.

Many kids with Tourette syndrome get better as they get older. Some people will always live with Tourette syndrome, but they can enjoy themselves and pursue their dreams and goals just as their friends do.

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Tourette Syndrome (for Kids) - Nemours KidsHealth

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Tourette syndrome is a condition that causes tics -- movements or sounds that are repeated over and over. Learn more about Tourette syndrome in this article for kids.

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OCD causes kids to have stressful worry thoughts and worry habits. Therapy helps kids get over these stressful thoughts and habits. Kids who have worries and fears should let a parent know so they can help.

What Is OCD?

OCD causes kids to have worry thoughts (called obsessions).

Kids who have OCD can't stop worrying about things like these:

someone might get sick, hurt, or die

things might be germy or dirty

something has to be straight, even, or exactly right

something is lucky or unlucky, bad or good, safe or harmful

bad thoughts might come true

OCD also causes worry habits (called rituals). To kids with OCD, these habits seem like a way to make sure bad things don't happen. Kids with OCD might feel like they to:

wash and clean over and over

erase, rewrite, or re-do things over and over

repeat a word, phrase, or question (in their head or out loud)

check and re-check things

touch, tap, or step in an unusual way

put things in just the right order

What's It Like for Kids With OCD?

Kids with OCD get stuck in worry thoughts and worry habits. For example, OCD can cause a kid to think something like this: "I need to touch all four corners of my desk. If I don't, my mom will get sick and die." Often, kids can tell this idea doesn't make sense. But the worry feels so strong that they do the habit (ritual), just to make sure. At first, doing the habit seems to make them feel better.

But with OCD, worry habits multiply. They start to take more time and energy. Instead of helping kids feel better, they cause stress. Kids don't want to think or do these things. But OCD makes them feel they can't stop.

Kids may wonder why they are thinking and doing these things. They may not know that something called OCD can cause it.

What Should I Do if I Have Worry Thoughts or Worry Habits?

If you have worry thoughts or worry habits like these, talk to your parent about it. They can take you to your doctor to find out if OCD is causing the thoughts and worries.

Why Do Some People Get OCD?

Scientists are not yet sure what causes OCD to happen. They believe genes explain why some kids have worry thoughts that get 'stuck,' and do worry habits to feel better. But one thing is for sure. OCD is not caused by anything a child or parent did.

Luckily, there's therapy that can help. When kids do this therapy, they can get past the stuck thoughts and rituals that OCD causes. This can be a big relief.

What Is the Therapy for Kids With OCD?

The therapy for kids with OCD is called CBT. In this therapy, kids (and their parent) will meet with a therapist to talk and learn.

The therapist will teach kids more about OCD. For example, they might explain that stuck thoughts and fears are like brain 'hiccups' or 'tricks' that make it seem like bad things could happen if you don't do a ritual. Kids and parents will learn that doing rituals (worry habits) keeps OCD going strong. They'll learn that by not doing rituals, they can make OCD weaker.

That sounds easy. But for kids with OCD, not doing rituals can be hard at first. That's why therapy includes skills to learn how. In therapy, kids learn skills like these:

ways to cope with worry and anxiety

calming skills

what to do when a worry thought comes to mind

how to outsmart OCD's 'tricks'

how to face fears safely

how to stop a worry habit (ritual)

how to gain confidence over OCD

As kids practice these new skills, OCD problems start to weaken and go away. Kids learn they can let go of the worry thoughts without doing rituals. They feel back in charge of their own thoughts, feelings, and behavior.

Along with therapy, some kids take medicine for OCD.

When kids with OCD do therapy, they can feel better. They can get past worry thoughts and worry habits. This lets kids get back to doing all the things they enjoy.

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OCD (Obsessive-Compulsive Disorder) (for Kids)

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OCD causes kids to have stressful worry thoughts and worry habits. Therapy helps kids get over these stressful thoughts and habits. Kids who have worries and fears should let a parent know so they can help.

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Newsela | "Wonder" movie gives two Kansas girls hope

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Makayla Hainline identifies with the character in the new movie "Wonder." Both have Treacher Collins syndrome, which affects the way the face develops.

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Newsela | Inability to hear doesn't mean an inability to own a business

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Newsela | Instructional Content Platform

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Newsela is an Instructional Content Platform that supercharges reading engagement and learning in every subject.

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Disability and Health Disability Barriers

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Disability and Health Disability Barriers

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Centers for Disease Control and Prevention

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Nearly everyone faces hardships and difficulties at one time or another. But for people with disabilities, barriers can be more frequent and have greater impact. The World Health Organization (WHO) describes barriers as being more than just physical obstacles. Here is the WHO definition of barriers:

"Factors in a person's environment that, through their absence or presence, limit functioning and create disability. These include aspects such as:

a physical environment that is not accessible,

lack of relevant assistive technology (assistive, adaptive, and rehabilitative devices),

negative attitudes of people towards disability,

services, systems and policies that are either nonexistent or that hinder the involvement of all people with a health condition in all areas of life."

Often there are multiple barriers that can make it extremely difficult or even impossible for people with disabilities to function. Here are the seven most common barriers. Often, more than one barrier occurs at a time.

Attitudinal barriers

Attitudinal barriers are the most basic and contribute to other barriers. For example, some people may not be aware that difficulties in getting to or into a place can limit a person with a disability from participating in everyday life and common daily activities. Examples of attitudinal barriers include:

Stereotyping: People sometimes stereotype those with disabilities, assuming their quality of life is poor or that they are unhealthy because of their impairments.

Stigma, prejudice, and discrimination: Within society, these attitudes may come from people's ideas related to disability-People may see disability as a personal tragedy, as something that needs to be cured or prevented, as a punishment for wrongdoing, or as an indication of the lack of ability to behave as expected in society.

Today, society's understanding of disability is improving as we recognize "disability" as what occurs when a person's functional needs are not addressed in his or her physical and social environment. By not considering disability a personal deficit or shortcoming, and instead thinking of it as a social responsibility in which all people can be supported to live independent and full lives, it becomes easier to recognize and address challenges that all people-including those with disabilities-experience.

Communication Barriers

Communication barriers are experienced by people who have disabilities that affect hearing, speaking, reading, writing, and or understanding, and who use different ways to communicate than people who do not have these disabilities. Examples of communication barriers include:

Written health promotion messages with barriers that prevent people with vision impairments from receiving the message. These include

Use of small print or no large-print versions of material, and

No Braille or versions for people who use screen readers.

Auditory health messages may be inaccessible to people with hearing impairments, including

Videos that do not include captioning, and

Oral communications without accompanying manual interpretation (such as, American Sign Language).

The use of technical language, long sentences, and words with many syllables may be significant barriers to understanding for people with cognitive impairments.

Physical barriers

Physical barriers are structural obstacles in natural or manmade environments that prevent or block mobility (moving around in the environment) or access. Examples of physical barriers include:

Steps and curbs that block a person with mobility impairment from entering a building or using a sidewalk;

Mammography equipment that requires a woman with mobility impairment to stand; and

Absence of a weight scale that accommodates wheelchairs or others who have difficulty stepping up.

Policy Barriers

Policy barriers are frequently related to a lack of awareness or enforcement of existing laws and regulationsexternal icon that require programs and activities be accessible to people with disabilities. Examples of policy barriers include:

Denying qualified individuals with disabilities the opportunity to participate in or benefit from federally funded programs, services, or other benefits;

Denying individuals with disabilities access to programs, services, benefits, or opportunities to participate as a result of physical barriers; and

Denying reasonable accommodations to qualified individuals with disabilities, so they can perform the essential functions of the job for which they have applied or have been hired to perform.

Programmatic Barriers

Programmatic barriers limit the effective delivery of a public health or healthcare program for people with different types of impairments. Examples of programmatic barriers include:

Inconvenient scheduling;

Lack of accessible equipment (such as mammography screening equipment);

Insufficient time set aside for medical examination and procedures;

Little or no communication with patients or participants; and

Provider's attitudes, knowledge, and understanding of people with disabilities.

Social Barriers

Social barriers are related to the conditions in which people are born, grow, live, learn, work and age - or social determinants of health - that can contribute to decreased functioning among people with disabilities. Here are examples of social barriers:

People with disabilities are far less likely to be employed. In 2017, 35.5% of people with disabilities, ages 18 to 64 years, were employed, while 76.5% of people without disabilities were employed, about double that of people with disabilities.²

Adults age 18 years and older with disabilities are less likely to have completed high school compared to their peers without disabilities (22.3% compared to 10.1%).

People with disabilities are more likely to have income of less than $15,000 compared to people without disabilities (22.3% compare to 7.3%).

Children with disabilities are almost four times more likely to experience violence than children without disabilities.

Transportation barriers

Transportation barriers are due to a lack of adequate transportation that interferes with a person's ability to be independent and to function in society. Examples of transportation barriers include:

Lack of access to accessible or convenient transportation for people who are not able to drive because of vision or cognitive impairments, and

Public transportation may be unavailable or at inconvenient distances or locations.

References

1. World Health Organization, International classification of functioning, disability and health. Geneva:2001, WHO. p. 214.

2. Houtenville, A. and Boege, S. (2019). Annual Report on People with Disabilities in America: 2018. Durham, NH: University of New Hampshire, Institute on Disability. Available at https://disabilitycompendium.org/sites/default/files/user-uploads/Annual_Report_2018_Accessible_AdobeReaderFriendly.pdfpdf icon external icon

3. Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Division of Human Development and Disability. Disability and Health Data System (DHDS) Data [online]. [Accessed August 6, 2019].

Source: World Health Organization; available at https://www.who.int/mediacentre/news/notes/2012/child_disabilities_violence_20120712/en/external icon

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Disability and Health Disability Barriers | CDC

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For people with disabilities, barriers can be more frequent and have greater impact. Learn about what these barriers are for the disabled.

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What Is Type 1 Diabetes?

People who have type 1 diabetes can't use

glucose(the body's main type of sugar) for energy. That's because their body stopped making the hormone insulin. Normally, after we eat, the amount of glucose in the blood (blood sugar) goes up. When it does, the pancreas sends insulin into the blood. Insulin works like a key that opens the doors of the body's cells to let the glucose in, giving the cells the energy they need.

In type 1 diabetes, the pancreas doesn't make insulin. Without insulin, glucose can't get into the cells. It stays in the blood, which leads to high blood sugar. Having too much sugar in the blood isn't healthy and can cause problems. Some problems happen quickly and need treatment right away, while others develop over time and show up later in life.

90-Second Summary: Type 1 Diabetes

Learn the basics in 90 seconds.

What Happens in Type 1 Diabetes?

In type 1 diabetes, the body's immune system attacks and destroys the cells in the pancreas that make insulin. So the body can't make

insulin anymore.

This is different from type 2 diabetes, where the body still makes insulin, but the insulin doesn't work as it should.

Why Do Some People Get Type 1 Diabetes?

No one knows for sure why some people get type 1 diabetes. Doctors and scientists think a person's genes make them more likely to get it. But just having the genes for diabetes probably isn't enough. It's likely that something else needs to happen. Scientists are studying if other things - like some viral infections, a person's birth weight, or their diet - might make someone who already has the genes for type 1 diabetes more likely to get it.

Type 1 diabetes can't be prevented, and can happen in people of any age.

What Are the Signs & Symptoms of Type 1 Diabetes?

People can have diabetes without knowing it because the symptoms aren't always obvious and they can take a long time to develop. Type 1 diabetes may come on gradually or suddenly.

When a person first has type 1 diabetes, they may:

pee a lot because the body tries to get rid of the extra blood sugar by passing it out of the body in the urine

drink a lot to make up for all that peeing

eat a lot because the body is hungry for the energy it can't get from sugar

lose weight because the body starts to use fat and muscle for fuel

feel tired a lot

If these early symptoms of diabetes aren't recognized and treatment isn't started, chemicals can build up in the blood and cause stomach pain, nausea, vomiting, breathing problems, and even loss of consciousness. Doctors call this diabetic ketoacidosis, or DKA.

There's good news, though - getting treatment can control or stop these diabetes symptoms from happening and reduce the risk of long-term problems.

How Is Type 1 Diabetes Diagnosed?

Doctors use a blood test that measures the amount of sugar (glucose) in the blood. High blood sugars show that a person has diabetes. Then, the doctor will do more blood tests to find out what type it is.

Teens with type 1 diabetes often go to a pediatric endocrinologist. This is a doctor who specializes in diagnosing and treating kids and teens living with diseases of the endocrine system, such as diabetes and growth problems.

How Is Type 1 Diabetes Treated?

People with type 1 diabetes have to pay a little more attention to what they eat and do than people who don't have diabetes.

They need to:

check blood sugar levels as prescribed

give themselves insulin injections or use an insulin pump as prescribed

eat a healthy, balanced diet with accurate carbohydrate counts

get regular exercise

have regular checkups with doctors and other people on their diabetes health care team so they can stay healthy and get treatment for any diabetes problems

What Can Help Me Manage Type 1 Diabetes?

Sometimes people who have diabetes feel different from their friends because they need to take insulin, think about how they eat, and control their blood sugar levels every day. They may feel angry or depressed, or think that their parents are constantly worrying about their diabetes management.

Diabetes brings challenges, but people who have it play sports, travel, date, go to school, and work just like their friends.

Managing your diabetes might feel overwhelming at times, but you're not alone. Reach out to your diabetes health care team. They can answer questions and help with all kinds of issues. Don't hesitate to ask your doctors, dietitian, and others on the team for advice and tips. You might want to find a support group where you can talk about your feelings and find out how other people cope.

You also can get more information and support online at:

Date reviewed: September 2021

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Diabetes affects how the body uses glucose, a sugar that is the body's main source of fuel. In type 1 diabetes, glucose can't get into the body's cells where it's needed.

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Newsela | Children who are autistic discover through the iPad that they have a voice

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Nonverbal children have trouble communicating, but by learning to put their thoughts and words together on an iPad, the world around them is not such a strange place.

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Have you ever put on a blindfold and pretended that you couldn't see? You probably bumped into things and got confused about which way you were going. But if you had to, you could get adjusted and learn to live without your sight.

Lots of people have done just that. They have found ways to learn, play, and work, even though they have trouble seeing or can't see at all.

How Seeing Happens

Your eyes and your brain work together to see. The eye is made up of many different parts, including the cornea, iris, lens, and retina. These parts all work together to focus on light and images. Your eyes then use special nerves to send what you see to your brain, so your brain can process and recognize what you're seeing. In eyes that work correctly, this process happens almost instantly.

When this doesn't work the way it should, a person may be visually impaired, or blind. The problem may affect one eye or both eyes.

When you think of being blind, you might imagine total darkness. But most people who are blind can still see a little light or shadows. They just can't see things clearly. People who have some sight, but still need a lot of help, are sometimes called "legally blind."

What Causes Blindness?

Vision problems can develop before a baby is born. Sometimes, parts of the eyes don't form the way they should. A kid's eyes might look fine, but the brain has trouble processing the information they send. The optic nerve sends pictures to the brain, so if the nerve doesn't form correctly, the baby's brain won't receive the messages needed for sight.

Blindness can be genetic (or inherited), which means that this problem gets passed down to a kid from parents through genes.

Blindness also can be caused by an accident, if something hurts the eye. That's why it's so important to protect your eyes when you play certain sports, such as hockey.

Some illnesses, such as diabetes, can damage a person's vision over time. Other eye diseases, such as cataracts (say: KAH-tuh-rakts), can cause vision problems or blindness, but they usually affect older people.

Page 1

What Does the Doctor Do?

A kid who has serious trouble with vision might see an ophthalmologist (say: af-thal-MAH-luh-jist), a doctor who specializes in eye problems. Even babies might see an ophthalmologist if their parents think they might be having trouble seeing.

At the doctor visit, the doctor will talk with the parents and the kid (if the kid is old enough to describe what's going on). A doctor might use an eye chart to find out how well the kid can see. You've probably seen these charts that contain letters of different sizes. It's a way of testing how well a person can see. Someone with really good vision would be able to read certain letters from 20 feet (6 meters) away.

Eyesight this good is called 20/20 vision, although some people can see even better than that. The numbers change depending on how clearly a person can see. The larger or closer something needs to be in order for it to be seen, the worse a person's vision is.

Many times, glasses or contact lenses are all that's needed to help kids see better. But if glasses and contact lenses can't make someone's vision any better - and the person needs to get really close to something to see it - he or she may be considered blind. For instance, someone with good vision might be able to see an object from 200 feet (61 meters) away, but someone is considered blind if he or she needs to be 20 feet (6 meters) away to see the same object.

Babies and little kids won't be able to use the eye chart, but doctors can check their vision by doing special vision tests or something as simple as putting a toy in front of the child to see if he or she can focus on it.

The ophthalmologist also will examine the kid's eyes using special medication and lighting that allows him or her to see into the eyeballs. The ophthalmologist will look at each part of the eye to check for problems, such as a cataract (cloudiness of the eye's lens). Once the doctor knows what's causing the vision problem, he or she can begin planning how to treat it.

In some cases, an operation can help improve a kid's vision. For example, if a kid has a cataract, doctors may do surgery to remove it.

Page 2

Is Learning Different?

A baby who is blind can still learn and develop normally. But the baby's parents will need the help of specialists who know how to help blind children. It's often a great idea for the child to attend special learning programs designed just for little kids who have trouble seeing. These programs would make the most of the senses that the kid does have, such as touch, hearing, smell, and taste.

Touch comes in handy when a child is older and wants to read books. Kids who are visually impaired can learn to read by using a special system called braille. Braille is a way of expressing letters, words, and thoughts. To read braille, a person feels a series of little bumps that are associated with letters in the alphabet. For instance, "A" is represented as one bump. Computer programs and other devices that can "see" turn the words on a page into braille.

Hearing is another important sense if a kid has vision problems. Some devices can read out loud what's written on a page. With special equipment, a visually impaired kid can read almost anything. These kinds of technologies can be helpful in learning. Kids who are blind might attend a special school, or they might attend regular classes, aided by special devices and specialists.

Hot Dog!

Kids who have vision problems will get help from their parents, doctors, and teachers. When they are older, some of them may get a hand - or should we say a paw? - from a guide dog. These helper dogs are trained to be a blind person's eyes. That means the dog learns to be very alert to surroundings so he or she can be a good guide for the person.

Not only are these dogs great friends, they give blind people independence, so they can accomplish what they want to accomplish.

Many blind people have gone on to do amazing things in many different fields, including music, the arts, and even sports. Serious vision problems didn't stop runner Marla Runyan. She was the first legally blind person to ever qualify for the Olympics!

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Kids who can't see, or can't see well, learn to live without using their eyes. To learn more about visual impairment and what causes it, read our article for kids.

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What Is ADHD?

At times, all kids have trouble paying attention, listening, sitting still, or waiting their turn. But kids with ADHD have trouble with these things almost all the time.

Kids with ADHD aren't being this way on purpose. ADHD is a medical condition that affects their attention and self-control. Because of ADHD, they have a harder time staying focused. ADHD can also make kids more fidgety than other kids their age.

Kids with ADHD might have a tough time controlling their behavior and get into trouble more. This can make it hard to do things like pay attention in class or get along with others.

ADHD stands for attention deficit hyperactivity disorder. That's the medical term for difficulties with attention and self-control that can make kids fidget and move a lot.

What Are the Signs of ADHD?

Kids with ADHD might:

have trouble listening and paying attention

need lots of reminders to do things

get distracted easily

seem absent-minded

be disorganized and lose things

not sit still, wait their turn, or be patient

rush through homework or other tasks or make careless mistakes

interrupt a lot, and talk or call out in class when they shouldn't

do things they shouldn't, even though they know better

feel restless, fidgety, frustrated, and bored

If a kid has a lot of these signs, and these problems happen most of the time, it might be ADHD.

How Do Doctors Tell if a Kid Has ADHD?

If parents think their child might have ADHD, they can talk with the doctor about it. There are no lab tests or blood tests for ADHD. But doctors are trained to know what signs to look for.

If your parents take you to get checked out for ADHD, the doctor will ask you questions about what's going on in your life and at school. The doctor will ask things like if you have trouble doing homework, sitting still, slowing down, or listening - and how long that's been going on.

The doctor will check to make sure another health or learning issue is not the cause. The doctor will probably ask your parents and teachers to fill out checklists.

How Is ADHD Treated?

If a doctor finds that you have ADHD, you will get treatment to help. This can be a big relief. It can be hard to feel like you're always struggling with things that other kids seem to have no trouble doing.

To help kids with ADHD, doctors might:

Prescribe medicine. Doctors can give kids medicine that boosts the brain's ability to pay attention, slow down, and be more patient.

Provide therapy. Therapists can help kids learn to be more patient, cope with feelings, and gain self-control. They can help kids see the best in themselves and figure out what they're good at and how to use their strengths.

Help parents learn what to do. Parents can do things to help kids listen better, like telling kids one thing at a time. They can help kids organize their things at home. They can give encouragement, love, and support.

It's not just doctors and parents who help kids with ADHD. Sometimes schools give kids a learning plan called an IEP that's designed just for them.

Teachers can also do these things to help kids with ADHD do well in class:

Break schoolwork into parts.

Help kids organize their things.

Make sure kids sit where they are less likely to be distracted, like away from a window or door.

Give kids quick breaks to get up and move during class.

There are things that kids with ADHD can do to help themselves too, like:

Eat healthy food.

Get enough sleep.

Be active every day.

Practice mindfulness exercises and breathing exercises.

What Causes ADHD?

ADHD is caused by differences in the brain's ability to pay attention, slow down, and be patient. It's not clear what causes these brain differences, but doctors know that ADHD is in a person's genes. Most kids who have ADHD have a parent or relative with ADHD.

ADHD is not caused by eating too much sugar. And it's not something a kid does on purpose.

What's It Like for Kids With ADHD?

Having ADHD can be difficult sometimes. Kids may get scolded for things they can't help - like not listening, losing their temper, or doing things too fast. That can make them feel bad about themselves. At times, they may mistakenly blame themselves for ADHD. But ADHD is not a kid's fault.

Parents, teachers, and therapists can help kids get better at paying attention, slowing down, and gaining self-control. They can teach kids to use their strengths and energy in good ways. Kids with ADHD can improve their attention and self-control, do well in school and activities they enjoy, and feel good about themselves.

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ADHD is a medical condition that makes it harder for kids to stay focused. Kids with ADHD can also be more fidgety than other kids their age. This article for kids explains how doctors decide a kid has ADHD and what they can do about it.

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Newsela | Best practices in reading instruction for students with dyslexia

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When teaching kids with dyslexia to read, a systematic, explicit approach focused on phonological awareness, phonics, and ongoing skills diagnostics is key.

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Anxiety is another word for feeling worried or scared. It's normal for children and teens to feel anxious sometimes, like before a big test at school or talking in front of a group of people. But if your child's anxiety gets in the way of normal activities, such as sleeping alone at night, playing outside or going to school, they may need extra support.

The good news is that there are things you can do to help prevent your child from feeling anxious and help them handle worries when they happen. Talk with your pediatrician to discuss strategies and tips that can help.

What are some common signs of anxiety in children?

If your child is feeling anxious, they may not be able to tell you. Your child may feel bad or sick without knowing why, or you may notice they seem restless or tired.

Feeling as if their heart is racing

Sweating or blushing

Shaking or feeling sick to their stomach

Feeling very cold or hot

Trouble paying attention or sitting still

Touching the crotch area (for young boys)

How can I help my child manage anxiety at home?

These tips are helpful for all children, but they can be especially helpful for children with anxiety. Parenting is a busy job, so use your judgment about which tips make the most sense for your family.

Connect with your child

Set aside one-on-one time every day without TV or other media. Even just 10 minutes each day can make a big difference. Try gardening or taking care of houseplants, drawing or going for a bike ride.

Praise your child and make them feel good about themselves. For example, "You did a great job on that homework assignment!" or "Thank you for helping me with the laundry. I'm so lucky to have your help."

Find out what's worrying your child, because stress can make them feel anxious. Things such as being bullied at school, divorce, or a death in the family can make a child feel anxious. Your child may need extra help to handle issues such as these.

Help your child learn to manage fears

When your child is calm, start a conversation about things they can do to manage fears and worries when they happen. For example, let them know that they can

Practice deep breathing and muscle relaxation.

Use positive self-talk (for example, "I can try this" instead of "I can't do this").

Think of a safe place, such as their bedroom or favorite place outdoors.

Build healthy habits

Healthy lifestyle habits can help reduce stress and support a positive mood.

Get active! Encourage your child to be active for at least an hour every day. This activity can include playing outside, joining a sports team or an activity at the YMCA, biking or walking to school, or dancing at home to favorite music.

Eat healthy. Eat healthy meals every day, including fruits and vegetables, whole grains, and protein foods. Remember to eat breakfast!

Get plenty of sleep. School-aged children need 9 to 12 hours of sleep every night, and teens need 8 to 10 hours.

Build a family media plan to set healthy guidelines around entertainment screen time. Avoid scary or violent TV shows, video games, and movies.

Set up family routines. Follow a regular schedule for playtime, mealtime, and bedtime. Knowing what to expect can help your child feel safe and secure.

How can I help my child manage school anxiety?

Children may find it hard to focus on or even go to school when they're feeling worried. If your child is having trouble in school, try these ways to help.

Gently but firmly tell your child why it's important to go to school.

Talk with your child's teachers and the guidance counselor about what to do if your child asks to go home from school early.

If you think your child may be upset by family stress or pressure to do well in school, let them know they are doing a good job and you're proud of them.

Help your child set realistic goals for school. If they set goals that are too hard to meet, they may feel worse about themselves.

Remind your child that they can take steps to control their worries. For example, they can think about what to do ahead of time to handle a stressful situation.

Reward your child's brave behaviors at school. Spending time doing fun activities with a parent is a very powerful reward.

Remember, you know your child best.

Whether it's at school or the doctor's office, you are your child's biggest advocate. Don't hesitate to speak up on behalf of your child.

When do I need to go back to the doctor?

If your child's anxiety doesn't go away or gets worse, get back in touch with the doctor. You and the doctor can make a plan to try new approaches or strategies with your child.

It's especially important to talk with your child's doctor if:

Your child starts to experience other behavior problems, such as shyness.

Something scary happens in your child's life that may make their anxiety worse, such as an injury or death in the family.

You suspect your child's anxiety is affecting another medical condition (for example, if your child's asthma gets worse with anxiety).

The doctor can also help you decide whether visiting a specialist may help. For example, a type of therapy called cognitive behavioral therapy can be helpful for children with anxiety.

Make time to care for yourself, too.

Parenting can be stressful. If you're feeling overwhelmed, don't be afraid to ask for support from family, close friends, social services, or your faith community. Children pick up on the stress and worries of adults, so getting support for yourself can help your child too.

More information

Adapted from Addressing Mental Health Concerns in Pediatrics: A Practical Resource Toolkit for Clinicians, 2nd edition (Copyright © 2021 American Academy of Pediatrics)

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anxiety; fear; childhood fears; stress; mental health; media; positive parenting; school; self-care

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Help Your Child Manage Anxiety: Tips for Home & School

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​Anxiety is another word for feeling worried or scared. It's normal for children at any age to feel anxious sometimes, such as if they need to take a big test at school or talk in front of a group of people.

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What Is Tourette Syndrome?

Tourette syndrome is a condition that affects a person's central nervous system and causes tics. Tics are movements or sounds that a person can't control and that they repeat over and over.

Tics are kind of like hiccups. You don't plan them, and you don't want them. Sometimes, a kid might be able to hold back a tic for a short time. But tension builds, and eventually the kid must let the tic out.

What Are the Symptoms of Tourette Syndrome?

People with Tourette syndrome have two kinds of tics - motor tics and vocal tics.

Motor tics are twitches or movements a person makes but can't control. They include eye blinking, head shaking, jerking of the arms, and shrugging.

Vocal tics are sounds a person makes but can't control. They can include throat clearing, grunting, and coughing.

A person with Tourette syndrome sometimes has more than one type of tic happening at once. Tics can happen throughout the day. But they often happen less or go away completely when a person is concentrating (like working on a computer) or relaxing (like listening to music).

The type of tics and how often they happen often change over time. They're usually worse when a person is under stress (like when studying for a big test) or excited or very energized about something (like at a birthday party or a sports activity).

Sometimes a person with Tourette syndrome might have other conditions, like ADHD, obsessive-compulsive disorder (OCD), or trouble learning.

How Is Tourette Syndrome Treated?

To have Tourette syndrome, a person must have at least two motor tics and one vocal tic. The person has to have the tics every day or off and on for over a year - and they have to start before the person turns 18.

There's no cure for Tourette syndrome, but most of the time no treatment is needed. A kid can deal with the tics and still do normal stuff, like go to school and play with friends. If tics are making it hard to do normal stuff, a doctor may suggest medicine.

Stress or being upset can make the tics worse, and kids might feel upset because of the tics and the problems that go with them. Talking to a psychologist or psychiatrist can help. A therapist can teach coping and relaxation skills, and help kids learn how to explain tics to others. They can also help kids with other problems that can be connected to Tourette syndrome, like ADHD and anxiety.

How Should I Act Around Someone Who Has It?

Kids who have Tourette syndrome want to be treated like everybody else. They can do regular stuff, just like other kids.

Many kids with Tourette syndrome get better as they get older. Some people will always live with Tourette syndrome, but they can enjoy themselves and pursue their dreams and goals just as their friends do.

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Tourette Syndrome (for Kids) - Nemours KidsHealth

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Tourette syndrome is a condition that causes tics -- movements or sounds that are repeated over and over. Learn more about Tourette syndrome in this article for kids.

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What Is OCD?

OCD is a mental health condition. It causes thoughts called obsessions, anxiety, and actions called compulsions (also called rituals). People with OCD feel stuck in a stressful cycle of these thoughts and actions.

Cognitive behavioral therapy helps people get past the cycle of OCD. They learn to deal with bothersome thoughts, calm anxiety, and face fears safely without doing rituals. Some people also take medicine for OCD.

If you think you have OCD, talk to a parent or adult in your life. Ask them to help you see a doctor or mental health provider to find out more. If you do have OCD, work with your doctor or therapist to learn and practice the skills that are proven to help OCD get better.

What Are Obsessions?

Obsessions are thoughts that cause anxiety. They can be fear thoughts about bad things that could happen. Or thoughts about how things have to be. They can be nagging doubts about whether things are OK. Or images or ideas about things that seem scary, bad, or wrong.

OCD causes these stressful thoughts to come to mind over and over. They can be about anything, but for many people with OCD, they are thoughts about:

germs, injury, harm, or illness

things that seem bad, rude, or wrong

whether things are even, straight, or placed just as they 'should' be

colors or numbers that seem bad, unlucky, or have special meaning

whether something might come true

What Are Compulsions?

Compulsions are behaviors people with OCD feel a strong urge to do. They are also called rituals. To someone with OCD, rituals seem like the way to stop the thoughts, fix things, be safe, or make sure bad things won't happen. Rituals can be actions, or they can be things people say in their head.

Here are some examples of rituals. Someone with OCD might feel like they have to:

wash and clean over and over

erase, rewrite, or start over a lot

repeat words, phrases, or questions

check and re-check if something is closed, locked, clean, right, or finished

touch, tap, or step in an unusual way or a set number of times

put things in just the right order, do things a set way

avoid things, such as numbers or colors that seem unlucky

What's It Like for Someone With OCD?

Most people with OCD can tell that the thoughts and rituals don't make sense. But OCD leads them to feel unsure. They feel a strong urge to do the ritual. They feel if they don't, something bad could happen. At first, rituals give some relief from the bad thoughts and feelings.

But rituals multiply. They take more time and energy. And the worry thoughts keep coming back. This is how OCD becomes a stressful cycle. Instead of stopping OCD, the rituals keep it going.

Someone with OCD will spend more than an hour a day bothered by worry thoughts and rituals. They may check, arrange, fix, erase, count, or start over many times, just to feel that things are OK. They don't want to think about these things. But OCD makes the thoughts hard to ignore. They don't want to do rituals. But OCD makes them feel they have to.

OCD can show up in many parts of their life. Things like getting dressed, having breakfast, or doing schoolwork seem full of stressful choices. OCD can make it seem like one choice might prevent a bad thing. Or that another choice might make a bad thing happen.

Someone with OCD may not know why they think, feel, and do these things. They may try to hide their fears and rituals. They may worry what others will think. They may even think they are going 'crazy' - but they're not. OCD can cause this to happen.

Why Do Some People Get OCD but Others Don't?

Like in many health conditions, a person's

genesplay a role in whether they get OCD. That's why OCD often runs in families. Genes can affect the chemistry, structure, and activity in different parts of the brain. With OCD, these differences lead unwanted thoughts to get 'stuck' instead of move on. OCD gets started because someone has genes that make it more likely.

But OCD keeps going because of rituals. The more people do rituals, the stronger OCD gets. This happens because our brains learn to do more of what we practice. Our brains also learn to do more of what gets rewarded. In OCD, rituals 'reward' the brain with a feeling of relief.

What Is the Treatment for OCD?

The treatment for OCD is a type of cognitive behavioral therapy (CBT). In therapy, people meet with a therapist to talk, learn, and practice skills. Along with therapy, some people may take medicine for OCD.

In therapy, people might learn:

how thoughts, feelings, and behaviors affect each other

how OCD is like a brain 'trick' making it seem like bad things will happen unless people do rituals

that doing rituals keeps OCD going strong

that not doing rituals weakens OCD

But even when someone with OCD knows this, it's not easy to just stop doing rituals. That's why therapy teaches skills like:

coping and calming skills for anxiety

how to deal with worry thoughts

how to face fears safely

how to resist doing rituals

In therapy, people practice using these skills. One by one, they face fears without doing rituals. This can feel uncomfortable at first, but it quickly gets easier with practice. The more people with OCD resist rituals, the more worry thoughts can fade. As the person practices their skills, the brain's activity can change for the better.

Therapy takes time - how long depends on the person. Most people work with their therapist each week for a few months or more. Some people have therapy more often.

The therapist will teach, support, and encourage along the way. Often, the therapist will work with a parent, too. Parents want to know how to best help when OCD fears or rituals happen at home.

What Should I Do if I Think I Have OCD?

If you think you might have OCD:

Tell a parent or adult in your life what you're going through. They can take you to your doctor or mental health provider to find out if you have OCD. It can be a relief to know what's causing the symptoms. And to find out there's therapy that works for OCD.

If you find out you have OCD:

Go to therapy. Learn about OCD. The more you learn, the better you'll understand it.

Practice the skills you learn in therapy. The more you practice, the better and sooner you'll be able to overcome OCD.

Get support from people who care. Let a parent help you practice what you learn in therapy. Share your success and progress along the way.

Be patient with yourself. Dealing with OCD is tiring and stressful. And therapy takes time and practice. But many people like you have overcome OCD. You can, too.

Make time for good things. Find a little time to relax and do things you enjoy. Be with people who make you laugh and feel good. This helps you through the tough moments and gives you energy to overcome OCD.

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OCD is a mental health condition. It causes thoughts called obsessions, anxiety, and actions called compulsions (also called rituals). People with OCD feel stuck in a stressful cycle of these thoughts and actions. Cognitive behavioral therapy helps people get past the cycle of OCD.

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Newsela | Sign language interpreters share spotlight at pandemic news briefings

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As the only certified deaf interpreter in Ohio, Marla Berkowitz uses American Sign Language to translate the governor's daily COVID-12 update for the deaf community.

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Newsela | Parents, nonprofits unite to create more inclusive playgrounds

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Newsela - Making video games accessible to those with disabilities

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Newsela - Program finds fit in tech jobs for people with autism

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Data entry is repetitive and hard to do well; that is, quickly and accurately. Shane Foley is great at it.

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The human eye is like a camera that collects, focuses, and transmits light through a lens to create an image of its surroundings. In a camera, the image is created on film or an image sensor. In the eye, the image is created on the retina, a thin layer of light-sensitive tissue at the back of the eye.

Like a camera, the human eye controls the amount of light that enters the eye. The iris (the colored circular part of the eye) controls the amount of light passing through the pupil. It closes up the pupil in bright light and opens it wider in dim light. The cornea is the transparent, protective surface of the eye. It helps focus light, as does the lens, which sits just behind the iris.

When light enters the eye, the retina changes the light into nerve signals. The retina then sends these signals along the optic nerve (a cable of more than 1,000,000 nerve fibers) to the brain. Without a retina or optic nerve, the eye can't communicate with the brain, making vision impossible.

What Is Visual Impairment?

Many people have some type of visual problem at some point in their lives. Some can no longer see objects far away. Others have problems reading small print. These types of conditions are often easily treated with eyeglasses or contact lenses.

But when one or more parts of the eye or brain that are needed to process images become diseased or damaged, severe or total loss of vision can occur. In these cases, vision can't be fully restored with medical treatment, surgery, or corrective lenses like glasses or contacts.

The American Foundation for the Blind estimates that 10 million people in the United States are visually impaired. Visual impairment is a term experts use to describe any kind of vision loss, whether it's someone who cannot see at all or someone who has partial vision loss.

Some people are completely blind, but many others have what's called legal blindness. They haven't lost their sight completely but have lost enough vision that they'd have to stand 20 feet from an object to see it as well as someone with perfect vision could from 200 feet away.

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What Causes Visual Impairment?

People rarely lose their eyesight during their teen years. When they do, it's usually caused by an injury like getting hit in the eye or head with a baseball or having an automobile or motorcycle accident.

Some babies have congenital blindness, which means they are visually impaired at birth. Congenital blindness can be caused by a number of things - it can be inherited, for instance, or caused by an infection (like German measles) that's transmitted from the mother to the developing fetus during pregnancy.

Conditions that may cause vision loss after birth include:

Amblyopia (pronounced: am-blee-OH-pee-uh) is reduced vision in an eye caused by lack of use of that eye in early childhood. Some conditions cause a child's eyes to send different messages to the brain (for example, one eye might focus better than the other). The brain may then turn off or suppress images from the weaker eye and vision from that eye then stops developing normally. This is also known as a "lazy eye." Strabismus (misaligned or crossed eyes) is a common cause of amblyopia, since the brain will start to ignore messages sent by one of the misaligned eyes.

Cataracts are cloudy areas in part or all of the lens of the eye. In people without cataracts, the lens is crystal clear and allows light to pass through and focus on the retina. Cataracts prevent light from easily passing through the lens, and this causes loss of vision. Cataracts often form slowly and usually affect people in their 60s and 70s, but sometimes babies are born with congenital cataracts. Symptoms include double vision, cloudy or blurry vision, difficulty seeing in poorly lit spaces, and colors that seem faded.

Diabetic retinopathy (pronounced: reh-ton-AH-pa-thee) occurs when the tiny blood vessels in the retina are damaged due to diabetes. People with retinopathy may not have any problems seeing at first. But if the condition gets worse, they can become blind. Teens who have diabetes should be sure to get regular eye exams because there are no early warning signs for this condition. To help prevent retinopathy, people with diabetes should also avoid smoking, keep their blood pressure under control, and keep their blood sugar at an even level.

Glaucoma is an increase in pressure inside the eye. The increased pressure impairs vision by damaging the optic nerve. Glaucoma is mostly seen in older adults, although babies may be born with the condition and children and teens can sometimes develop it as well.

Macular (pronounced: MAH-kyoo-lur) degeneration is a gradual and progressive deterioration of the macula, the most sensitive region of the retina. The condition leads to progressive loss of central vision (the ability to see fine details directly in front). Macular degeneration is often age related (it occurs in older people, especially older than 60), but sometimes it can occur in younger people. Excessive exposure to sunlight and smoking can increase the risk for age-related macular degeneration. Symptoms may include increased difficulty reading or watching TV, or distorted vision in which straight lines appear wavy or objects look larger or smaller than normal.

Trachoma (pronounced: truh-KO-muh) occurs when a very contagious microorganism called Chlamydia trachomatis causes inflammation in the eye. It's often found in poor rural countries that have overcrowded living conditions and limited access to water and sanitation. Blindness due to trachoma has been virtually eliminated from the USA.

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What Do Doctors Do?

If you, your parent, or your doctor suspects a visual problem, you'll probably pay a visit to an ophthalmologist (pronounced: af-thal-MAH-luh-jist), a medical doctor who specializes in examining, diagnosing, and treating eyes and eye diseases. When someone goes for an examination, the ophthalmologist will look at the structure of that person's eye.

Other simple tests an ophthalmologist may perform include:

Visual acuity test. A person reads an eye chart to measure how well he or she sees at various distances.

Visual field test. Ophthalmologists use this test to measure side, or peripheral, vision.

Tonometry test. This test determines the fluid pressure inside the eye to evaluate for glaucoma.

If your doctor determines that you have an eye condition that is likely to cause visual impairment, many treatments are available. Options may include eyeglasses, contact lenses, and eye drops or other medicines.

In some cases, surgery may be required. For instance, cataracts are often treated by removing the clouded lens and replacing it with an intraocular lens (an artificial plastic lens that requires no special care and restores vision).

Other methods can compensate for vision loss. Guide dogs can help people get from place to place independently. Braille allows those with visual impairment to read and write. Special equipment such as microscopic and telescopic glasses and voice-recognition software can make school and homework easier.

What's It Like to Be Visually Impaired?

Just as you don't think about your eye color every day, people with visual impairment don't always think about their condition every day either.

Someone with sight problems can become isolated from others more easily, though. If a visually impaired person asks for assistance, don't hesitate to help. But someone who uses a cane or a guide dog is probably self-sufficient and may not need help.

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When one or more parts of the eye or brain that are needed to process images become diseased or damaged, severe or total loss of vision can occur. Read all about visual impairment.

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What Is Cerebral Palsy?

Cerebral palsy (CP) is a problem that affects muscle tone, movement, and coordination. It happens when the brain can't properly send messages to muscles about how to move in smooth or well-coordinated ways. CP can also affect other body functions that involve motor skills and muscles, like breathing, bladder and bowel control, eating, and talking.

There are different types of CP. Some people have one type, or a mix of:

1. spastic cerebral palsy, which causes stiffness and trouble moving

2. dyskinetic (athetoid) cerebral palsy, which causes uncontrolled movements

3. ataxic cerebral palsy, which causes a problem with balance and depth perception (judging the distance between two objects)

There is no cure for CP, but a child's quality of life can improve with:

Cerebral palsy does not get worse over time.

What Causes Cerebral Palsy?

The cause of CP isn't always known. But many cases happen when a child's brain is still developing, such as before birth or in early infancy. This may be due to:

infections or other medical problems during a woman's pregnancy

a stroke either in the womb or after birth

untreated jaundice (a yellowing of the skin and whites of eyes)

genetic disorders

In rare cases, CP happens because something goes wrong during a child's birth.

Premature babies (babies born early) have a higher chance of having CP than full-term babies. So do other low-birthweight babies and multiple births, such as twins and triplets.

Areas of the brain that affect learning can also be affected. This can lead to learning disabilities. Brain damage also can happen from:

In rare cases, CP happens after a problem during childbirth.

How Is Cerebral Palsy Diagnosed?

Babies who are born early or who have health problems that put them at risk for cerebral palsy are watched for signs of the condition. Doctors look for:

developmental delays, like not reaching for toys by 4 months or sitting up by 7 months

problems with motor skills, like being unable to crawl, walk, or move arms and legs in the usual way

uncoordinated movements

muscle tone that is too tight or too loose

infant reflexes (like the palmar grasp, or "hands in fists" reflex) that stay beyond the age at which they're usually gone

What Problems Does CP Cause?

A range of physical problems can happen with CP. Some kids have a lot of trouble with movement, while others don't. It depends on how much the brain was damaged. The damage can be partial, for example, affecting only the part of the brain that controls walking. Or it can affect a larger area, like the parts that control walking, talking, and understanding speech.

Brain damage that causes CP also can affect other brain functions and lead to problems like:

How Is Cerebral Palsy Treated?

There's no cure for cerebral palsy. But resources and therapies can help kids grow and develop to their greatest potential.

As soon as CP is diagnosed, a child can begin therapy for movement and other areas that need help, such as learning, speech, hearing, and social and emotional development. Many will need assistive devices like braces or wheelchairs.

Medicine helps kids who have a lot of muscle pain and stiffness. They can take medicine by mouth, G-tube, or get it through a pump (the baclofen pump) placed under the skin.

Surgery can help fix dislocated hips and scoliosis (curved spine), which are common in kids with CP. Leg braces help with walking.

Kids can improve their bone health by having a diet that's high in calcium, vitamin D, and phosphorus. These nutrients help keep bones strong. Doctors, dietitians, and speech-language therapists can work with families to make sure kids get enough of the right nutrients and suggest changes to their diets or mealtime routines, if needed.

What Else Should I Know?

Kids with CP often need to see many different medical specialists for care. That team may include doctors and surgeons, other providers like physical assistants, nurses, therapists, psychologists, educators, and social workers.

Even if many medical specialists are needed, it's still important to have a primary care provider or a medical home. This provider will take care of your child's routine health care and also help you coordinate care with other doctors.

Where Can Caregivers Get Help?

Taking care of a child with cerebral palsy can feel overwhelming at times. Not only do kids with CP need a lot of attention at home, they also need to go to many medical visits and therapies. Don't be afraid to say yes when someone asks, "Can I help?" Your family and friends really do want to be there for you.

To feel less alone and to connect with others who are facing the same challenges, find a local or online support group. You also can get information and support from CP organizations, such as:

Staying strong and healthy is not only good for you, but also for your child and your whole family.

Looking Ahead

Living with cerebral palsy is different for every child. To help your child move and learn as much as possible, work closely with your care team to develop a treatment plan. Then, as your child grows and their needs change, adjust the plan as needed.

These guides can help as you plan for each stage of childhood and early adulthood:

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Cerebral Palsy (CP) (for Parents) - Nemours KidsHealth

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Cerebral palsy (CP) affects a child’s muscle tone, movement, and more. This article explains causes, diagnosis, treatment, and coping.

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Newsela | Want to improve your reading skills? You might just need more space

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Students with and without dyslexia read better when letters have extra spacing between them.

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Kids Meet a Guy in a Wheelchair for the First Time

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Newsela | Instructional Content Platform

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Newsela is an Instructional Content Platform that supercharges reading engagement and learning in every subject.

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The Americans with Disabilities Act (ADA) is U.S. legislation that provides civil rights protection to individuals with physical or mental disabilities. It protects people with disabilities from discrimination in many areas, including employment, education, and public accommodations. It also mandates that buildings, public transportation systems, telecommunications systems, and other public services be made accessible to individuals with disabilities. President George H.W. Bush signed the ADA into law on July 26, 1990, with widespread bipartisan support. A landmark civil rights act, it initiated numerous changes to help address unfair practices and the unjust treatment of people with disabilities of all kinds. Disability activists had worked for many years to bring about such legislation.

The ADA was passed to help ensure that people with disabilities would have equal opportunities and equal access to facilities. The act defines a disability as a "physical or mental impairment that substantially limits one or more of the major life activities." The act's employment provisions apply to all employers with 15 or more employees. These provisions were phased in from 1992 to 1994. They made it illegal, for instance, for employers to fire people or to refuse to hire people solely because they have disabilities. Among other provisions, they also require employers to provide "reasonable accommodations" to employees with disabilities so that they can do their jobs. For example, an employee who uses a wheelchair might need a larger cubicle. An employee who uses a service animal might need the employer to make an exception to a policy prohibiting animals in the workplace.

The act's public-accommodations provisions generally went into effect in 1992. They require that necessary changes be made to all facilities used by the public so that people with disabilities can access them. Such facilities include schools, restaurants, theaters, day-care centers, doctor's offices, parks, institutional buildings, and hotels. For example, many buildings had to have ramps and elevators built, so that people in wheelchairs could access them. Likewise, curbs were cut, handicapped parking spaces were created, and some public bathroom stalls were widened to allow access. Elevator buttons were labeled in Braille so that blind people could read them. Television programs provided closed captioning, so that people who were deaf or hard of hearing could watch them.

The passage of the ADA resulted in a large number of discrimination lawsuits, many of which went before the U.S. Supreme Court. For resolution of these cases, the court was required to interpret the broad antidiscrimination provisions of the law in a variety of specific contexts. At the same time, it had to balance such questions as states' rights and the definition of disability.

A later act rejected certain Supreme Court decisions that had altered the original intent of the ADA. Called the ADA Amendments Act (ADAAA), it clarified and expanded several measures of the original legislation. President George W. Bush signed this amendment act into law in 2008. It went into effect at the beginning of 2009.

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The Americans with Disabilities Act (ADA) is U.S. legislation that provides civil rights protection to individuals with physical or mental disabilities. It protects people with disabilities from discrimination in many areas, including employment, education, and public accommodations. It also mandates that buildings, public transportation systems, telecommunications systems, and other public services be made accessible to individuals with disabilities.

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Newsela | Disability History: The disability rights movement

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Advocates have worked tirelessly for decades to improve the lives of people with disabilities

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Diabetes

Diabetes is a condition that happens when the body can't use glucose (a type of sugar) normally. Glucose comes from the carbohydrates we eat and is the main source of energy for all the cells in the body. A hormone called insulin (which is made in the pancreas) helps glucose get into the cells.

In diabetes, either the pancreas does not make enough insulin ( type 1 diabetes) or the body can't respond normally to the insulin that is made ( type 2 diabetes). In both types of diabetes, when glucose can't get into the cells, the glucose level in the blood rises. Symptoms of diabetes include extreme thirst, the need to pee more than usual, and feeling tired often.

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Diabetes is a condition that happens when the body can't use glucose (a type of sugar) normally.

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Newsela | Kids with autism relax in hug chair made by high school students

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Chloe and the Nurb take you on a tour of the eyes and how seeing happens. Watch this How the Body Works movie!

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Centers for Disease Control and Prevention

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Cerebral palsy (CP) is the most common motor disability in childhood. Learn more facts.

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Newsela | Newsom's struggles with dyslexia spur quest to fund early screening

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California Governor Newsom's lifelong struggle with dyslexia makes his proposal to screen infants and toddlers for developmental disorders a personal mission.

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Apraxia of Speech Factsheet (for Schools) (for Parents)

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What teachers should know about apraxia of speech and how to help students with the speech disorder do their best in school.

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Our Incredible Girl With No Arms | BORN DIFFERENT

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Daily Life Problems, Struggle and Challenges Faced by Blind People

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Problems that blind people face in their daily lives. Be it accessible places or availability of Braille, life is struggle and has challenges

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Kids Meet a Woman With Tourette's | Kids Meet | HiHo Kids

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Kids Describe Color to a Blind Person | Kids Describe | Cut

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Kids Meet a Guide Dog for the Blind | Kids Meet | HiHo

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What is apraxia of speech?

Apraxia of speech (AOS)-also known as acquired apraxia of speech, verbal apraxia, or childhood apraxia of speech (CAS) when diagnosed in children-is a speech sound disorder. Someone with AOS has trouble saying what he or she wants to say correctly and consistently. AOS is a neurological disorder that affects the brain pathways involved in planning the sequence of movements involved in producing speech. The brain knows what it wants to say, but cannot properly plan and sequence the required speech sound movements.

AOS is not caused by weakness or paralysis of the speech muscles (the muscles of the jaw, tongue, or lips). Weakness or paralysis of the speech muscles results in a separate speech disorder, known as dysarthria. Some people have both dysarthria and AOS, which can make diagnosis of the two conditions more difficult.

The severity of AOS varies from person to person. It can be so mild that it causes trouble with only a few speech sounds or with pronunciation of words that have many syllables. In the most severe cases, someone with AOS might not be able to communicate effectively by speaking, and may need the help of alternative communication methods.

What are the types and causes of apraxia of speech?

There are two main types of AOS: acquired apraxia of speech and childhood apraxia of speech.

Acquired AOS can affect someone at any age, although it most typically occurs in adults. Acquired AOS is caused by damage to the parts of the brain that are involved in speaking and involves the loss or impairment of existing speech abilities. It may result from a stroke, head injury, tumor, or other illness affecting the brain. Acquired AOS may occur together with other conditions that are caused by damage to the nervous system. One of these is dysarthria, as mentioned earlier. Another is aphasia, which is a language disorder. (For more information, see the NIDCD fact sheet Aphasia.)

Childhood AOS is present from birth. This condition is also known as developmental apraxia of speech, developmental verbal apraxia, or articulatory apraxia. Childhood AOS is not the same as developmental delays in speech, in which a child follows the typical path of speech development but does so more slowly than is typical. The causes of childhood AOS are not well understood. Imaging and other studies have not been able to find evidence of brain damage or differences in the brain structure of children with AOS. Children with AOS often have family members who have a history of a communication disorder or a learning disability. This observation and recent research findings suggest that genetic factors may play a role in the disorder. Childhood AOS appears to affect more boys than girls.

What are the symptoms of apraxia of speech?

People with either form of AOS may have a number of different speech characteristics, or symptoms:

Distorting sounds. People with AOS may have difficulty pronouncing words correctly. Sounds, especially vowels, are often distorted. Because the speaker may not place the speech structures (e.g., tongue, jaw) quite in the right place, the sound comes out wrong. Longer or more complex words are usually harder to say than shorter or simpler words. Sound substitutions might also occur when AOS is accompanied by aphasia.

Making inconsistent errors in speech. For example, someone with AOS may say a difficult word correctly but then have trouble repeating it, or may be able to say a particular sound one day and have trouble with the same sound the next day.

Groping for sounds. People with AOS often appear to be groping for the right sound or word, and may try saying a word several times before they say it correctly.

Making errors in tone, stress, or rhythm. Another common characteristic of AOS is the incorrect use of prosody. Prosody is the rhythm and inflection of speech that we use to help express meaning. Someone who has trouble with prosody might use equal stress, segment syllables in a word, omit syllables in words and phrases, or pause inappropriately while speaking.

Children with AOS generally understand language much better than they are able to use it. Some children with the disorder may also have other speech problems, expressive language problems, or motor-skill problems.

How is apraxia of speech diagnosed?

Professionals known as speech-language pathologists play a key role in diagnosing and treating AOS. Because there is no single symptom or test that can be used to diagnose AOS, the person making the diagnosis generally looks for the presence of several of a group of symptoms, including those described earlier. Ruling out other conditions, such as muscle weakness or language production problems (e.g., aphasia), can help with the diagnostic process.

In formal testing for both acquired and childhood AOS, a speech-language pathologist may ask the patient to perform speech tasks such as repeating a particular word several times or repeating a list of words of increasing length (for example, love, loving, lovingly). For acquired AOS, a speech-language pathologist may also examine the patient's ability to converse, read, write, and perform nonspeech movements. To diagnose childhood AOS, parents and professionals may need to observe a child's speech over a period of time.

How is apraxia of speech treated?

In some cases, people with acquired AOS recover some or all of their speech abilities on their own. This is called spontaneous recovery.

Children with AOS will not outgrow the problem on their own. They also do not acquire the basics of speech just by being around other children, such as in a classroom. Therefore, speech-language therapy is necessary for children with AOS as well as for people with acquired AOS who do not spontaneously recover all of their speech abilities.

Speech-language pathologists use different approaches to treat AOS, and no single approach has been proven to be the most effective. Therapy is tailored to the individual and is designed to treat other speech or language problems that may occur together with AOS. Frequent, intensive, one-on-one speech-language therapy sessions are needed for both children and adults with AOS. (The repetitive exercises and personal attention needed to improve AOS are difficult to deliver in group therapy.) Children with severe AOS may need intensive speech-language therapy for years, in parallel with normal schooling, to obtain adequate speech abilities.

In severe cases, adults and children with AOS may need to find other ways to express themselves. These might include formal or informal sign language; a notebook with pictures or written words that can be pointed to and shown to other people; or an electronic communication device-such as a smartphone, tablet, or laptop computer-that can be used to write or produce speech. Such assistive communication methods can also help children with AOS learn to read and better understand spoken language by stimulating areas of the brain involved in language and literacy.

Some adults and children will make more progress during treatment than others. Support and encouragement from family members and friends and extra practice in the home environment are important.

What research is being done to better understand apraxia of speech?

Researchers are searching for the causes of childhood AOS, including the possible role of abnormalities in the brain or other parts of the nervous system. They are also looking for genetic factors that may play a role in childhood AOS. Other research on childhood AOS aims to identify more specific criteria and new techniques to diagnose the disorder and to distinguish it from other communication disorders.

Research on acquired AOS includes studies to pinpoint the specific areas of the brain that are involved in the disorder. In addition, researchers are studying the effectiveness of various treatment approaches for both acquired and childhood AOS.

Where can I find additional information about apraxia of speech?

The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language.

For more information, contact us at:

NIDCD Information Clearinghouse
1 Communication Avenue
Bethesda, MD 20892-3456
Toll-free voice: (800) 241-1044
Toll-free TTY: (800) 241-1055
Email: nidcdinfo@nidcd.nih.gov

NIH Pub. No. 13-7466
September 2016

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Apraxia of speech (AOS)-also known as acquired apraxia of speech, verbal apraxia, or childhood apraxia of speech (CAS) when diagnosed in children-is a speech sound disorder. Someone with AOS has trouble saying what he or she wants to say correctly and consistently.

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The Americans with Disabilities Act (ADA) was signed into law on July 26, 1990. The law provides civil rights protections to people with mental and physical disabilities.

The ADA helps people with disabilities in several ways. It says that employers cannot refuse to hire someone just because that person is disabled. Employers also have to make sure that people with disabilities can do their job. For example, a blind person may need access to a special keyboard and software to be able to use a computer.

The law also says that public buildings and services have to be accessible to people with disabilities. That means that people have to be able to enter a building and use services. For example, buildings, sidewalks, and buses and trains all have to have ramps to allow people who use wheelchairs to get around easily. Elevator buttons are now labeled in Braille so that blind people can read them. Television programs provide captions that appear on the screen. With the captions, people who are deaf or hard of hearing can watch the programs.

In 2008 another law, the ADA Amendments Act, broadened the definition of the word disability. It added new protections and applied to more people.

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The Americans with Disabilities Act (ADA) was signed into law on July 26, 1990. The law provides civil rights protections to people with mental and physical disabilities. The ADA helps people with disabilities in several ways. It says that employers cannot refuse to hire someone just because that person is disabled.

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Hearing loss happens when there is a problem with the ear, nerves connected to the ear, or the part of the brain that controls hearing. Someone who has hearing loss may be able to hear some sounds or nothing at all. To learn more, read this article for kids.

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Newsela | The first college goalball team lets blind student-athletes compete

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Players wear blinders and find the ball by listening for bells inside it. The University of California, Berkeley, has the first college goalball team, and hopes other schools will want to play too.

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What Is Diabetes?

Diabetes happens when a person's body can't use sugar normally.

Learn More

Type 1 Diabetes

In type 1 diabetes, the pancreas can't make insulin well. Without insulin, cells can't get the energy they need.
What is it? Treatment Chandler's story

Type 2 Diabetes

A person with type 2 diabetes still makes insulin, but their body doesn't respond to it normally.
What is it? Treatment

Staying Healthy When You Have Diabetes

Learn ways to keep yourself healthy and fit.

Do You Take Insulin or Other Medicines?

Learn about insulin and other medicines that kids with diabetes often take. Find out why kids need them and how to take them safely.

Medicines

Why Should I Care About Carbohydrates?

It's a little easier for people to control their diabetes if they eat about the same amount of carbs at about the same times each day. Find out how to do it.
Carbohydrates and diabetes All about carbs

Understanding Diabetes

Find out what diabetes is, how it's treated, and what to expect.

Can diabetes be prevented?

What does the endocrine system do?

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Diabetes happens when a person's body can't use sugar normally. Learn More In type 1 diabetes, the pancreas can't make insulin well. Without insulin, cells can't get the energy they need. What is it? Treatment Chandler's story A person with type 2 diabetes still makes insulin, but their body doesn't respond to it normally.

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Newsela - Airports design special sensory spaces for passengers with autism

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Newsela | Instructional Content Platform

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Newsela is an Instructional Content Platform that supercharges reading engagement and learning in every subject.

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Making Playgrounds Accessible and Inclusive for All

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Making Playgrounds Accessible and Inclusive for All

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Making Playgrounds Accessible & Inclusive for All
(Last Updated On: May 3, 2021)
Do you remember spending afternoons swinging high into the sky, dreaming of life's possibilities? Or speeding down the slide to catch up with a friend? Many of us look back fondly to the days when life revolved around the playground. It's heartbreaking to think some kids don't know what it's like to swing, slide and climb at the park with friends. At Miracle® Recreation, we want to help bring playtime to all kids.

Playing at the playground is an essential part of childhood. It helps kids get the physical exercise they need to stay healthy, and it helps them develop critical cognitive, emotional and social skills. Every kid deserves the chance to learn, have fun and create joyful memories on the playground.

An accessible playground is not necessarily inclusive, and both elements are essential for a playground to benefit everyone. In this post, we'll explore the differences between accessibility and inclusivity, the advantages of both and how you can make a difference as a playground owner. There is nothing more rewarding than building a playground that welcomes kids of all abilities. Sometimes, just a few small changes can make a playground more inclusive, and you don't need a limitless budget to make it happen.

Read the full article or skip to a specific section:

What Is an Accessible Playground?

An accessible playground allows kids with or without disabilities to access and use a variety of playground equipment. It also invites parents, caregivers or older siblings with disabilities into the play area to supervise children or take part in the fun. In 2018, 14% of students attending public school received special education services. These included specific learning disabilities, speech or language impairments, autism, developmental delays, intellectual disabilities, emotional disturbances, hearing impairment and orthopedic impairments.

The accessibility guidelines in the Americans with Disabilities Act (ADA) require most new playgrounds to comply with the standards they set forth. They also require existing playgrounds undergoing alterations to comply. A few ADA compliance standards include:

An accessible playground must have available, unobstructed routes to the playground and connecting play equipment.

The playground must include at least one of each type of ground-level play component on an accessible route.

At least 50% of the playground's elevated play components must be on an accessible route.

Ramps must have handrails on both sides.

Playgrounds must use specific safety surfacing that has met ADA criteria. Additionally, this surfacing should receive regular inspections and maintenance to ensure compliance.

All kids should be able to travel freely on smooth pathways and ramps, use grab bars with ease and be able to move from one piece of equipment to the next safely.

What Is an Inclusive Playground?

In addition to being accessible, your playground should be inclusive. An inclusive playground allows children of all abilities and developmental stages to play in the same space and creates a nurturing environment for all.

No one deserves to feel left out. An inclusive playground considers the needs of all kids and incorporates play equipment that addresses those needs and promotes growth and joy. For example, children with autism spectrum disorder (ASD) or sensory processing disorder sometimes need to regroup in a quiet, cozy space. To build an inclusive playground, you might incorporate a comfortable, quiet area for kids with ASD to escape the commotion without feeling isolated. Experts estimate one in 59 children has ASD. An inclusive playground sends kids with ASD and other disorders the message that they shouldn't have to play alone.

Why Make Your Playground Accessible and Inclusive?

Children with disabilities benefit from free, unstructured play just as other children do, and they have a right to equal opportunities. An inclusive playground removes barriers between kids, despite any differences, and gives them the chance to play and grow together as they should. The benefits of an inclusive and accessible playground seem endless, but here are a few to consider.
View Inclusive Playground Equipment

Help kids gain understanding: When all kids get to play together, they gain a better understanding of the world and learn to appreciate and accept differences and similarities. They get to learn new perspectives and develop empathy, which they can carry with them through life.

Create a stimulating play environment: An accessible playground offers a wide variety of exciting inclusive play activities all kids can enjoy. From exploring a range of sensory-stimulating activities to using equipment that challenges their physical abilities without causing fatigue or stress, kids won't get bored on a correctly designed inclusive playground.

Help kids build self-esteem: A positive, enriching playground helps kids develop a sense of identity, and boosts their confidence and self-esteem as they learn new skills and make friends.

Help families spend time together: Adults with disabilities can spend time with their kids or grandchildren in an accessible and inclusive playground.

Build a better future: Inclusive and accessible playgrounds teach kids to value equality and fairness, which has long-lasting positive effects on the community and helps create an inclusive society where everyone enjoys equal opportunities.

Overall, an inclusive and accessible playground makes everyone happier, healthier and more connected to one another.

How to Make a Playground Accessible and Inclusive

Making a playground accessible and inclusive does not have to be complicated or unaffordable. There are plenty of resources available to provide guidance and funding assistance. Also, many playground structures already have inclusivity and accessibility in mind. Nevertheless, it's understandable if you feel overwhelmed by all the options and regulations. Rest assured, you don't need an enormous budget or space to make your playground fun for everyone. Let us help you start the process.

1. Evaluate Your Playground

The first step to design an accessible playground is to evaluate your playground and ask yourself the following questions:

Can kids and adults who use wheelchairs or mobility devices easily access the playground and equipment?

Are there deterrents such as slopes or narrow paths making accessibility difficult?

Can kids of all abilities use playground equipment such as slides, swings and climbers?

Can all kids play side by side?

Are paths level and smooth, so kids in wheelchairs can easily move about?

Is there enough shade to protect kids and their caregivers from the sun?

Are there rest areas for parents and guardians?

Are there activities that engage the senses in an interesting mix of shapes, textures and sounds?

How many elevated inclusive play activities do you have?

Do you have ramps, berms or other ways to make it more accessible?

Can all playground users enter the playground using the same route, so no one feels excluded?

To make sure your playground is ADA-compliant, consult the 2010 ADA Standards for Accessible Design published by the Department of Justice. Need more tips for playground planning? Check out our Ultimate Guide to Planning Your Playground.

2. Determine Needs

Your top priority is to make your playground safe, fun and challenging for everyone, all in the same play space. That means considering the unique needs of all kids. For example, you might take the following into account.

Adding sensory activities: Children with ASD often feel over- or understimulated, and either need a quiet place to escape to or the option to engage in activities that stimulate their senses. Make sure to include a mix of both calmer areas and sensory-rich activities that may involve music, lights or spinning motions.

Boosting accessibility: Think about how children will access play equipment. You might need to add ramps or transfer systems so all children can enjoy slides, bridges and other pieces. Consider activities that will engage all children physically and help them build strength and coordination. Also, consider how much effort a child will have to put into reaching equipment. It should never be exhausting to play!

Creating social space: Make sure to include inclusive play activities and equipment all children can use at the same time, so they get the chance to interact and socialize.

The entire playground should offer many opportunities for kids to develop cognitive, physical, social and sensory skills. Consider where your playground needs the most improvement and set realistic goals. Step by step, you can design an accessible and inclusive playground all the kids in your community will enjoy.

Accessible and Inclusive Equipment to Include in Your Playground

You can easily make any playground more accessible and inclusive. It may be a matter of adding a few new pieces of equipment to make a playground for everyone. We'll show you inclusive and ADA-compliant playground equipment to demonstrate it's all within your reach.

1. Ramps

Ramps allow all children to reach elevated play components and enjoy the view up high. They should also provide a space to turn around in a wheelchair. Handrails on both sides of ramps allow kids to effortlessly pull themselves along. Ramps are perfect for kids who are unable or do not want to use transfer systems.

2. Inclusive Slides

Slides add a lot of fun to a playground and promote the development of social skills and coordination. All children should be able to enjoy the freeing feeling of riding a slide at the playground. An accessible and inclusive slide makes it easy for children of all abilities to reach the top of the slide. For example, our Avalanche Inclusive Slide, suitable for ages 5 to 12, offers a lower transfer point so kids can access the slide from ground level and pull themselves up by gripping the side rail. Once they reach the top, they can zoom down the spacious slide alongside siblings or friends.

3. Ground-Level Play Activities

Ground-level activities allow children to enter and exit equipment or structures at the ground level. When equipment is in the same play area, children get to interact and play regardless of developmental or ability levels. For example, our Ten Spin accommodates up to 10 kids at once, allowing them all to whirl and play together. You can easily add this freestanding piece of equipment to any playground to make it more inclusive.

4. Sensory Activities

Sensory activities not only help meet the needs of children with ASD, but they are also enjoyable for all kids and often easy to add to any playground. You might install a piece of musical equipment like our Concerto Chimes, so kids can explore different sounds and jam out to their unique tune.Our Clover Leaf Sandbox offers multiple access points at the perfect height, so kids can enjoy tactile play together, while still feeling comfortable in their personal space. To add excitement to your playground for everyone, consider our colorful Sensory Maze, which makes rainbows on the sidewalk as the sun shines through. Explore our sensory stimulation guide to learn more.

5. Inclusive Swings

There's nothing more freeing than gliding through the air on a swing, and you can make it possible for all your playground users. Swinging helps autistic children process sensory information with soothing, repetitive motions. For all children, swinging helps improve motor skills and coordination. For example, our Accelerator Swing is a group swing ideal for stimulating the vestibular sense and making friends. Our ADA-compliant Inclusive Swing Seat offers extra support and security for a snug ride into the sky that kids can enjoy side by side. We even have an accessible zip line that uses the Inclusive Swing Seat, allowing everyone to fly from one area of the playground to the other.

6. Wheelchair-Accessible Equipment

Some children can't transfer out of their wheelchairs, but they still want to play alongside their friends. Movement experiences are essential for them to develop coordination and balance. Choose a piece of equipment that a person in a wheelchair can easily roll onto, such as our Inclusive Whirl which is a wheelchair-accessible merry-go-round. Also, consider our Alta Glide Flex - an accessible glider.

As you can see, there are many simple ways to make a new or existing playground accessible and inclusive, as well as plenty of fun!

Grants for Accessible and Inclusive Playground Equipment

If you're concerned about budget, know there is plenty of financial assistance available to help you make your dream a reality. Many organizations support inclusive and accessible playgrounds and are happy to help and contribute some of their resources. For example, KaBOOM! is a nonprofit organization that offers several grant opportunities and resources to help build safe playgrounds. Feel free to explore our Playground Grant Resource Guide to learn more ways you can fund your inclusive and accessible playground.

View Inclusive Playground Equipment From Miracle Recreation

At Miracle Recreation, we offer high-quality, durable, safe and innovative playground equipment for kids of all abilities to enjoy. We take pride in finding solutions and making sure all kids get equal opportunities to grow and reach their potential. We design and build our equipment to meet or exceed safety standards while providing unique, thrilling and unforgettable play experiences for all. If you can't find what you're looking for, our custom design team is happy to create inclusive playground equipment straight from your imagination.

Need help with the next step? Our representatives are well-versed in ADA requirements and inclusive play design and are excited to assist you. View our inclusive and accessible playground equipment, and contact us today!

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How to Make Playgrounds Accessible & Inclusive for All

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(Last Updated On: May 3, 2021) Do you remember spending afternoons swinging high into the sky, dreaming of life's possibilities? Or speeding down the slide to catch up with a friend? Many of us look back fondly to the days when life revolved around the playground.

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Newsela | In these classrooms, fidgeting, moving around and bouncing are encouraged

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Peter works so hard at reading, but it just never gets easier. He knows he's smart, so why can't he read like the other kids? Peter has a problem called dyslexia.

Dyslexia (say: dis-LEK-see-uh) is a learning problem some kids have. Dyslexia makes it tough to read and spell. The problem is inside the brain, but it doesn't mean the person is dumb. Plenty of smart and talented people struggle with dyslexia.

But dyslexia doesn't have to keep a kid down. With some help and a lot of hard work, a kid who has dyslexia can learn to read and spell.

How Does Reading Happen?

To understand dyslexia, it helps to understand reading. Reading is a real workout for your brain. You need to do the following steps - and all at once:

1. Understand the way speech sounds make up words.

2. Focus on printed marks (letters and words).

3. Connect speech sounds to letters.

4. Blend letter sounds smoothly into words.

5. Control eye movements across the page.

6. Build images and ideas.

7. Compare new ideas with what is already known.

8. Store the ideas in memory.

Phew! Kids who have dyslexia struggle with the beginning steps, so that makes doing the rest of the steps even harder. It's no surprise, then, that trying to read and dealing with dyslexia makes a kid's brain really tired really fast.

How Kids Become Readers

Most kids start learning to read by learning how speech sounds make up words. Then they connect those sounds to alphabet letters. For example, they learn that the letter "b" makes a "buh" sound.

Then kids learn to blend those sounds into words. They learn that "b" and "at" makes "bat." Eventually, most kids don't have to sound words out and can instantly recognize words they've seen many times before.

But it's tougher for kids who have dyslexia. They may struggle to remember simple words they have seen many times and to sound out longer words. Why is it so hard?

Dyslexia means that a person's brain has trouble processing letters and sounds. That makes it tough to break words into separate speech sounds, like b-a-t for bat. When it's hard to do that, it's really hard to connect speech sounds to different letters, like "buh" for b, and blend them into new words.

So a kid who has dyslexia will read slowly and might make a lot of mistakes. Sometimes they will mix up letters in a word, such as reading the word "was" as "saw." Words may blend together wrong.

What's It Like to Have Dyslexia?

Even before kindergarten, a kid who has dyslexia usually has trouble with letters and sounds. Later, a teacher might say that the kid is smart, but doesn't seem to be getting the hang of reading. Other times, it's a parent who notices the kid is struggling. The best thing to do is to go to a specialist who can help figure out what's wrong.

A specialist in learning disabilities knows a lot about learning problems that kids have and what to do about them. During a visit with a specialist, a kid might take some tests. But the idea isn't to get a good grade; it's to spot problems. Discovering a learning disability is the first step toward getting help that will make it easier for the kid to learn.

Making Reading Easier

Most kids with dyslexia can learn to read with the right kind of teaching. They might learn new ways for remembering sounds. For example, "p" and "b" are called brother sounds because they're both "lip poppers." You have to press your lips together to make the sound.

Thinking about the way the mouth needs to move to make sounds can help kids read more easily. Learning specialists know lots of special activities like this to teach reading to kids who have dyslexia.

Kids with dyslexia also might use flash cards or tape classroom lessons and homework assignments instead of taking notes about them. They may need parents and tutors to help them stay caught up.

Extra time for tests is really important, so kids with dyslexia have enough time to finish and show their teacher how much they have learned. Computers help a lot too. You can get programs that "read" books out loud.

How Do Kids With Dyslexia Feel?

Kids who have dyslexia might get frustrated, angry, or sad because reading and spelling are so hard. They may not like being in a different reading group from their friends or having to see a special reading tutor.

But getting this help is so important and will help them go on to do great things in life. Some of the most creative and successful people have dyslexia, but it didn't stop them from chasing their dreams!

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Peter works so hard at reading, but it just never gets easier. He knows he's smart, so why can't he read like the other kids? Peter has a problem called dyslexia. Dyslexia (say: dis-LEK-see-uh) is a learning problem some kids have. Dyslexia makes it tough to read and spell.

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DYSLEXIA | What Is Dyslexia? | Learning Disability | The Dr Binocs Show | Peekaboo Kidz

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How to Help a Child with Dyslexia at Home

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How Can Hearing Aids Help?

Hearing loss affects people of all ages - even babies. Hearing aids can help those who have a type of permanent hearing loss called sensorineural hearing loss.

The inner ear is made up of a snail-shaped chamber called the cochlea (pronounced: KOE-klee-uh), which is filled with fluid and lined with thousands of tiny hair cells (outer and inner rows). When the vibrations move through this fluid, the tiny outer hair cells react first by amplifying sounds. Then the inner hair cells translate them into electrical nerve impulses and send them to the auditory nerve, which connects the inner ear to the brain.

Hearing aids intensify sound vibrations that the damaged outer hair cells have trouble amplifying. The more a person's outer hair cells are damaged, the higher the hearing aid is turned on.

What Are the Types of Hearing Aids?

Types of hearing aids include:

Behind-the-ear (BTE) hearing aids. These have two main parts:

A small hard plastic case that goes behind the ear. This holds the electronics that make up the actual hearing aid and the battery.

An earmold that fits inside the outermost part of the ear. A plastic tube connects the earmold to the hearing aid. Sound travels from the hearing aid through the earmold and into the ear.

In-the-ear (ITE) hearing aids. These fit completely inside the outer ear. As with BTEs, there is a hard plastic case that holds the electronic components, but it's shaped to fit in the ear, so it's all one piece. There are different size ITE. The size depends on the person and their amount of hearing loss.

An

audiologistspecializes in testing and helping people with hearing loss. They will help find the right hearing aid for someone who needs it. Ear molds are specially fit to a person's ear.

Some ITEs have something called a telecoil installed. A telecoil is a small magnetic coil that allows people to receive sound through the circuitry of the hearing aid, rather than through its microphone. Telecoils can make it easier to hear conversations over the telephone. They also help people hear in public places that have installed special sound systems, called induction loop systems. Churches, schools, airports, and auditoriums often use loop induction systems.

Sometimes the audiologist might want to add an FM system to a hearing aid. An FM system is a great help in a classroom as it lets students hear the teacher's voice above any background classroom noise. The teacher will wear a small microphone and transmitter that sends sound directly to the hearing aid and receiver using a wireless FM transmission.

Canal hearing aids. These fit directly in the ear canal and come in two slightly different styles. The first, an in-the-canal (ITC) hearing aid, is custom made to fit the size and shape of a person's ear canal. The second, a completely-in-canal (CIC) hearing aid, is slightly different from the ITC and is nearly hidden in the ear canal. Both canal hearing aids are used to treat mild to moderately severe hearing loss.

No single style of hearing aid or manufacturer is best - hearing aid selection is based on a person's individual needs.

Other programs can be added to hearing aids as well. For example, if you want to play music, ask your audiologist about a program designed for amplifying music. Also, you can use wireless accessories with hearing aids to listen to TV or your music player, play videogames, or use your phone. Talk to your audiologist about your hobbies and interests so they can recommend programs for your specific needs.

Let your audiologist know when something is not working well. It might take several tries to adjust your hearing aid. This means you may have to visit your audiologist several times, but it's worth the benefit of being able to hear your friends and what is happening around you.

How Do I Care for a Hearing Aid?

Hearing aids should be comfortable. As your ear grows, your audiologist may need to change the earmold part of the hearing aid. If a hearing aid is really irritating your ear, contact your audiologist as soon as possible. The audiologist can adjust it and make sure you get the most comfortable hearing aid possible. Being able to hear well shouldn't hurt!

Earmolds are available in fun colors or ones that match your skin so you can pick a color you prefer. Cleaning makes a difference in hearing aid comfort. A perfectly comfortable hearing aid can become uncomfortable over time if earwax builds up and is not taken care of every day. A dirty hearing aid not only can be uncomfortable, but also can lead to infections.

Most hearing aids come with cleaning instructions for that specific model. In general, though, try to look over your hearing aid every night. After you take it out, check to make sure there is no fresh earwax building up on it. If you see any wax, wipe it off with a soft cloth or tissue. Avoid wiping a hearing aid with anything rough as it might affect its structure and effectiveness.

It's true that hearing aids aren't known as a fashion item. But if you wear hearing aids, you're probably more conscious of them than other people are. Most people won't even notice that someone is wearing a hearing aid.

It can take a little time to get used to the idea (and the feeling) of wearing hearing aids. But stay focused on how much more you can hear with them. By wearing a barely noticeable device, you'll be able to hear the world around you.

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Hearing loss affects people of all ages - even babies. Hearing aids can help those who have a type of permanent hearing loss called sensorineural hearing loss. The inner ear is made up of a snail-shaped chamber called the cochlea (pronounced: KOE-klee-uh), which is filled with fluid and lined with thousands of tiny hair cells (outer and inner rows).

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Paraplegia is paralysis of the legs and lower half of the body. It happens when the spinal cord is damaged. Sometimes, they are kept alive by a life-support machine. It sometimes happens to people because they get a disease.

Superior paraplegia is a type of paraplegia where people cannot use their arms and the top of their body.

A person who has paraplegia is sometimes called a paraplegic.

In Spanish: Paraplejía para niños

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What Is Autism Spectrum Disorder?

Autism (say: AW-tiz-um) spectrum disorder is a difference in the way a kid's brain develops. Kids with autism may have trouble understanding the world around them.

What's It Like to Have Autism Spectrum Disorder?

A kid with autism might have trouble:

talking and learning the meaning of words

making friends or fitting in

dealing with changes (like trying new foods, having a substitute teacher, or having toys moved from their normal places)

dealing with loud noises, bright lights, or crowds

Kids also might move in an unusual way (like flapping their hands) or do the same thing over and over (like saying the same word).

A kid with autism may have a little trouble with these things, or a lot. Some kids need only a little bit of help, and others might need a lot of help with learning and doing everyday stuff.

What Causes Autism?

Autism is something people are born with. No one knows exactly what causes it. It probably has something to do with a kid's genes and other things that change the way the brain develops.

How Is Autism Diagnosed?

Doctors check babies and little kids for signs of autism at every checkup. A parent may think that something is wrong and tell the doctor. Maybe the child is old enough to speak but doesn't. Or a kid doesn't seem interested in people or plays in unusual ways.

When a doctor thinks a kid might have autism, he or she will work with a team of experts to see if it is autism or something else.

How Is Autism Spectrum Disorder Treated?

There is no cure for autism, but treatment can make a big difference. The younger kids are when they start treatment, the better.

Doctors, therapists, and special education teachers can help kids learn to talk, play, and learn. Therapists also help kids learn about making friends, taking turns, and getting along.

What if My Friend Has Autism Spectrum Disorder?

Some people with ASD do not feel that they have a disorder and don't want to change. They're proud of who they are and they want to be accepted, even though they may have different strengths and weaknesses than most other people.

All people deserve respect. But kids with ASD may be teased, bullied, or left out because they're different. Bullying and teasing are never the right way to treat other people, but it may be hard to be a friend with someone who has ASD.

Kids with ASD often don't understand playful jokes. You may need to be very clear when you communicate with someone who has ASD.

Try to be patient and kind. Remember how hard it might be for the person with ASD to understand how to be a friend. Stand up for classmates who are bullied. Tell adults, so they can help protect kids who are bullied.

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Autism (say: AW-tiz-um) spectrum disorder is a difference in the way a kid's brain develops. Kids with autism may have trouble understanding the world around them.

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Learn about this group of conditions that affect movement. It’s caused by damage to the developing brain, usually before birth.

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Understanding ADA Access On Your Playground....What is Required??

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Understanding ADA Access On Your Playground....What is Required??

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Play It Safe Playgrounds & Park Equipment

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The Importance Of Access
The Americans with Disabilities Act of 1990 (ADA) is a wide-ranging civil-rights law prohibiting, under certain circumstances, discrimination based on disability, which is defined by the ADA as "a physical or mental impairment that substantially limits a major life activity."

The ADA establishes standards by which public facilities, including public play spaces, must comply to ensure opportunities for people of all abilities.

Complying with ADA standards is the law, but it's also advantageous to the mission of encouraging more free play for kids.

Free play on playgrounds has been scientifically proven to have a variety of physical, mental, emotional, and cognitive benefits for children and parents of all ages, and can be an important activity to promote family interaction and relationship-building.

Making sure a public play space is accessible to all-not only for children of varying abilities, but for parents, grandparents, and caregivers with different physical conditions-helps ensure a play space that is a healthy community gathering spot.

Playground equipment and surfacing materials are both subject to ADA standards. Specific guidelines for play components-both ground and elevated-and surfacing materials and access routes are listed below.

But having compliant materials and designs isn't enough. Vigilance with regard to proper installation and maintenance procedures is the key to upholding compliance. Working with certified experts on installation and maintenance is recommended to safeguard the investment made in a compliant facility.

Understanding The Standards
Because there can be some confusion about the standards for new or existing public play facilities, the International Play Equipment Manufacturers Association (IPEMA)-the industry's membership association that provides third-party validation and certification for playground equipment and surfacing safety standards-has compiled a toolkit designed to help those in charge of play facilities with compliance.

The Checklist for Access summarizes 12 key steps for compliance. It is intended to help owners of public play areas understand how to use the Department of Justice's 2010 Standards for Accessible Design.

Newly constructed and altered play areas must comply with the 2010 Standards for Accessible Design (includes the play-area guidelines) on or after March 15, 2012.

Requirements And Key Considerations For Existing Playgrounds
Existing play areas are not required to meet the 2010 Standards by March 15, 2012.

March 15, 2012, is the Department of Justice's compliance date for all entities covered by Title II, and Title III must begin using the new (2010) accessibility standards. This means all new construction and alterations to existing facilities should begin utilizing these standards.

It is important to understand that playgrounds built prior to March 15, 2012, are subject to review if they are undergoing alteration, or if physical or communication barriers exist to the programs, goods, services, or activities offered at the facility.

The new Department of Justice's 2010 Standards for Accessible Design trigger access if one is building a new playground or making an alteration to an existing playground. In both cases, owners need to provide a primary means of access.

Here is the "real" consideration: If there is an existing playground and no alterations are planned, the question becomes "Are there any barriers to participation by people with disabilities?"
Can a person with a disability gain entry into the playground by an accessible route?

Providers of public playgrounds have the responsibility under the Program Access standard to remove barriers and make their programs, services, and activities accessible. So if the facility doesn't currently provide access, barriers should be identified in an official transition plan. This should include a prioritized action plan for accessibility improvements.

One of the most important playground-access activities is to complete an audit of the facilities and create a realistic transition plan to remove all physical and communication barriers to programs, services, and activities for people with disabilities.
Public Playground Accessibility Checklist
1. Public playgrounds must have an accessible route at least 60 inches wide, a maximum running slope of 1:20, and a maximum cross slope of 1:50. The route to the play area is an accessible route. Minimum width is 36 inches, and the maximum slope is 1:12. Any running slope over 1:20 or 5 percent is treated as a ramp with handrails and landings.

2. Within the play area, the safety surfacing must comply with ASTM F 1292-99 or -04 Standard Specification for Impact Attenuation of Surface Systems Under and Around Playground Equipment when located within the use zone for proper impact attenuation. All accessible routes within the play area, clear floor, or ground spaces at play components required to be accessible and turning spaces must comply with ASTM 1951-99 Standard Specification for Determination of Accessibility of Surface Systems Under and Around Playground Equipment.

3. Within the play area, the accessible route must be at least 60 inches wide, with a maximum running slope of 1:16, a maximum cross slope of 1:48, and a minimum of 80 inches overhead clearance. For small play areas of less than 1,000 square feet in total size, the accessible route must be at least 44 inches wide, with a maximum running slope of 1:16, a maximum cross slope of 1:48, and a minimum of 80 inches overhead clearance.

4. Composite play structures that include a transfer system as a means of access must meet the following criteria:

* Transfer platform height must be between 11 and 18 inches with a clear minimum width of 24 inches and a depth of 14 inches

* Transfer steps are a maximum of 8 inches high, and include handholds to aid movement.

* Minimum 30-inch by 48-inch transfer space must be provided adjacent to the transfer platform. The 48-inch-long minimum dimension of the transfer space shall be centered on and parallel to the 24-inch-long minimum side of the transfer platform. The side of the transfer platform serving the transfer space shall be unobstructed.

5. Composite play structures that include ramps connecting elevated play components as a means of access must meet the following criteria:

* Elevated ramps must be at least 36 inches wide, with a maximum running slope of 1:12, and a maximum length of 144 inches (12 feet) before providing a landing.

* Elevated ramps must include handrails on both sides, meeting hand-gripping criteria, and with a height between 20 and 28 inches. Elevated ramps with handrails, barriers beyond the ramp edge, and barriers not extending within 1 inch of the ramp surface must have edge-curbing at least 2 inches high for the entire ramp length. No handrail extensions are required.

* When elevated ramps change in direction, a 60-inch by 60-inch minimum level landing must be provided at both the top and the bottom of each run.

6. Elevated ramps and accessible platforms attached at ramp levels shall have no openings on a surface greater than ½ inch, and a vertical change in level less than ¼ inch or up to ½ inch with a 2:1 beveled edge.

7. Openings on elevated-ramp accessible platforms for access/egress play opportunities must be narrowed to 15 inches or less.

8. Advisory reach-ranges for accessible manipulative and interactive sensory and communicative components must have reach-range heights between 18 and 44 inches for the 5- to 12-year-old user group and between 20 and 36 inches for the 2- to 5-year-old user group.

9. Ground-level upper-body equipment intended for use by a person using a mobility device must be less than 48 inches above protective surfacing.

10. Ground-level play tables and components must have a minimum vertical-knee clearance of at least 24 inches high, a minimum depth of at least 17 inches, and a minimum width of at least 30 inches. The maximum top of a playing surface shall not exceed 31 inches.

11. Composite play structures must have elevated accessible routes by ramp and/or transfer systems to connect at least 50 percent of the elevated play components. Large composite play structures with more than 20 elevated play components must have at least 25 percent of the elevated play components connected by elevated ramps.

12. Play areas must have the minimum number of accessible play components and types on the accessible routes per the following criteria: One of each type at ground level and 50 percent elevated must be accessible. The trigger to use the table is for additional numbers and types. Where elevated play components are provided, ground-level play components shall be provided in accordance with Table 240.2.1.2, and shall comply with 1008.4. EXCEPTION: If at least 50 percent of the elevated play components are connected by a ramp and at least three of the elevated play components connected by the ramp are different types of play components, the play area shall not be required to comply with F240.2.1.2.

Confused? Play It Safe Playgrounds and Park Equipment, Inc. offers free consultation. If you need a little guidance about the ADA standards on your new or existing playground, gives us a call...we'll figure it out together!

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Understanding ADA Access On Your Playground....What is Required??

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The Importance Of Access The Americans with Disabilities Act of 1990 (ADA) is a wide-ranging civil-rights law prohibiting, under certain circumstances, discrimination based on disability, which is defined by the ADA as "a physical or mental impairment that substantially limits a major life activity."

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Newsela | "Groundskeeper" video game tests for attention deficit disorders

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A husband-and-wife team, a game developer and a child psychiatrist, have come up with a game to help diagnose brain disorders like Attention Deficit Hyperactivity Disorder (ADHD).

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What is dyslexia? - Kelli Sandman-Hurley

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Kids Meet A Deaf Person | Kids Meet | HiHo Kids

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A comprehensive suite of e-learning resources designed for all ages and abilities with articles, videos, educator tools, eBooks, research guides and more.

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Title 42 - The Public Health and Welfare

Chapter 126 - Equal Opportunity for Individuals with Disabilities

Sec. 12101. Findings and purpose

(a) Findings

The Congress finds that-

(1) physical or mental disabilities in no way diminish a person's right to fully participate in all aspects of society, yet many people with physical or mental disabilities have been precluded from doing so because of discrimination; others who have a record of a disability or are regarded as having a disability also have been subjected to discrimination;

(2) historically, society has tended to isolate and segregate individuals with disabilities, and, despite some improvements, such forms of discrimination against individuals with disabilities continue to be a serious and pervasive social problem;

(3) discrimination against individuals with disabilities persists in such critical areas as employment, housing, public accommodations, education, transportation, communication, recreation, institutionalization, health services, voting, and access to public services;

(4) unlike individuals who have experienced discrimination on the basis of race, color, sex, national origin, religion, or age, individuals who have experienced discrimination on the basis of disability have often had no legal recourse to redress such discrimination;

(5) individuals with disabilities continually encounter various forms of discrimination, including outright intentional exclusion, the discriminatory effects of architectural, transportation, and communication barriers, overprotective rules and policies, failure to make modifications to existing facilities and practices, exclusionary qualification standards and criteria, segregation, and relegation to lesser services, programs, activities, benefits, jobs, or other opportunities;

(6) census data, national polls, and other studies have documented that people with disabilities, as a group, occupy an inferior status in our society, and are severely disadvantaged socially, vocationally, economically, and educationally;

(7) the Nation's proper goals regarding individuals with disabilities are to assure equality of opportunity, full participation, independent living, and economic self-sufficiency for such individuals; and

(8) the continuing existence of unfair and unnecessary discrimination and prejudice denies people with disabilities the opportunity to compete on an equal basis and to pursue those opportunities for which our free society is justifiably famous, and costs the United States billions of dollars in unnecessary expenses resulting from dependency and nonproductivity.

(b) Purpose

It is the purpose of this chapter-

(1) to provide a clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities;

(2) to provide clear, strong, consistent, enforceable standards addressing discrimination against individuals with disabilities;

(3) to ensure that the Federal Government plays a central role in enforcing the standards established in this chapter on behalf of individuals with disabilities; and

(4) to invoke the sweep of congressional authority, including the power to enforce the fourteenth amendment and to regulate commerce, in order to address the major areas of discrimination faced day-to-day by people with disabilities.

Sec. 12101 note: Findings and Purposes of ADA Amendments Act of 2008, Pub. L. 110-325, §2, Sept. 25, 2008, 122 Stat. 3553, provided that:

(a) Findings

Congress finds that-

(1) in enacting the Americans with Disabilities Act of 1990 (ADA), Congress intended that the Act "provide a clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities" and provide broad coverage;

(2) in enacting the ADA, Congress recognized that physical and mental disabilities in no way diminish a person's right to fully participate in all aspects of society, but that people with physical or mental disabilities are frequently precluded from doing so because of prejudice, antiquated attitudes, or the failure to remove societal and institutional barriers;

(3) while Congress expected that the definition of disability under the ADA would be interpreted consistently with how courts had applied the definition of a handicapped individual under the Rehabilitation Act of 1973, that expectation has not been fulfilled;

(4) the holdings of the Supreme Court in Sutton v. United Air Lines, Inc., 527 U.S. 471 (1999) and its companion cases have narrowed the broad scope of protection intended to be afforded by the ADA, thus eliminating protection for many individuals whom Congress intended to protect;

(5) the holding of the Supreme Court in Toyota Motor Manufacturing, Kentucky, Inc. v. Williams, 534 U.S. 184 (2002) further narrowed the broad scope of protection intended to be afforded by the ADA;

(6) as a result of these Supreme Court cases, lower courts have incorrectly found in individual cases that people with a range of substantially limiting impairments are not people with disabilities;

(7) in particular, the Supreme Court, in the case of Toyota Motor Manufacturing, Kentucky, Inc. v. Williams, 534 U.S. 184 (2002), interpreted the term "substantially limits" to require a greater degree of limitation than was intended by Congress; and

(8) Congress finds that the current Equal Employment Opportunity Commission ADA regulations defining the term "substantially limits" as "significantly restricted" are inconsistent with congressional intent, by expressing too high a standard.

(b) Purposes

The purposes of this Act are-

(1) to carry out the ADA's objectives of providing "a clear and comprehensive national mandate for the elimination of discrimination" and "clear, strong, consistent, enforceable standards addressing discrimination" by reinstating a broad scope of protection to be available under the ADA;

(2) to reject the requirement enunciated by the Supreme Court in Sutton v. United Air Lines, Inc., 527 U.S. 471 (1999) and its companion cases that whether an impairment substantially limits a major life activity is to be determined with reference to the ameliorative effects of mitigating measures;

(3) to reject the Supreme Court's reasoning in Sutton v. United Air Lines, Inc., 527 U.S. 471 (1999) with regard to coverage under the third prong of the definition of disability and to reinstate the reasoning of the Supreme Court in School Board of Nassau County v. Arline, 480 U.S. 273 (1987) which set forth a broad view of the third prong of the definition of handicap under the Rehabilitation Act of 1973;

(4) to reject the standards enunciated by the Supreme Court in Toyota Motor Manufacturing, Kentucky, Inc. v. Williams, 534 U.S. 184 (2002), that the terms "substantially" and "major" in the definition of disability under the ADA "need to be interpreted strictly to create a demanding standard for qualifying as disabled," and that to be substantially limited in performing a major life activity under the ADA "an individual must have an impairment that prevents or severely restricts the individual from doing activities that are of central importance to most people's daily lives";

(5) to convey congressional intent that the standard created by the Supreme Court in the case of Toyota Motor Manufacturing, Kentucky, Inc. v. Williams, 534 U.S. 184 (2002) for "substantially limits", and applied by lower courts in numerous decisions, has created an inappropriately high level of limitation necessary to obtain coverage under the ADA, to convey that it is the intent of Congress that the primary object of attention in cases brought under the ADA should be whether entities covered under the ADA have complied with their obligations, and to convey that the question of whether an individual's impairment is a disability under the ADA should not demand extensive analysis; and

(6) to express Congress' expectation that the Equal Employment Opportunity Commission will revise that portion of its current regulations that defines the term "substantially limits" as "significantly restricted" to be consistent with this Act, including the amendments made by this Act.

Sec. 12102. Definition of disability

As used in this chapter:

(1) Disability

The term "disability" means, with respect to an individual-

(A) a physical or mental impairment that substantially limits one or more major life activities of such individual;

(B) a record of such an impairment; or

(C) being regarded as having such an impairment (as described in paragraph (3)).

(2) Major Life Activities

(A) In general

For purposes of paragraph (1), major life activities include, but are not limited to, caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, and working.

(B) Major bodily functions

For purposes of paragraph (1), a major life activity also includes the operation of a major bodily function, including but not limited to, functions of the immune system, normal cell growth, digestive, bowel, bladder, neurological, brain, respiratory, circulatory, endocrine, and reproductive functions.

(3) Regarded as having such an impairment

For purposes of paragraph (1)(C):

(A) An individual meets the requirement of "being regarded as having such an impairment" if the individual establishes that he or she has been subjected to an action prohibited under this chapter because of an actual or perceived physical or mental impairment whether or not the impairment limits or is perceived to limit a major life activity.

(B) Paragraph (1)(C) shall not apply to impairments that are transitory and minor. A transitory impairment is an impairment with an actual or expected duration of 6 months or less.

(4) Rules of construction regarding the definition of disability

The definition of "disability" in paragraph (1) shall be construed in accordance with the following:

(A) The definition of disability in this chapter shall be construed in favor of broad coverage of individuals under this chapter, to the maximum extent permitted by the terms of this chapter.

(B) The term "substantially limits" shall be interpreted consistently with the findings and purposes of the ADA Amendments Act of 2008.

(C) An impairment that substantially limits one major life activity need not limit other major life activities in order to be considered a disability.

(D) An impairment that is episodic or in remission is a disability if it would substantially limit a major life activity when active.

(E)

(i) The determination of whether an impairment substantially limits a major life activity shall be made without regard to the ameliorative effects of mitigating measures such as-

(I) medication, medical supplies, equipment, or appliances, low-vision devices (which do not include ordinary eyeglasses or contact lenses), prosthetics including limbs and devices, hearing aids and cochlear implants or other implantable hearing devices, mobility devices, or oxygen therapy equipment and supplies;

(II) use of assistive technology;

(III) reasonable accommodations or auxiliary aids or services; or

(IV) learned behavioral or adaptive neurological modifications.

(ii) The ameliorative effects of the mitigating measures of ordinary eyeglasses or contact lenses shall be considered in determining whether an impairment substantially limits a major life activity.

(iii) As used in this subparagraph-

(I) the term "ordinary eyeglasses or contact lenses" means lenses that are intended to fully correct visual acuity or eliminate refractive error; and

(II) the term "low-vision devices" means devices that magnify, enhance, or otherwise augment a visual image.

Sec. 12103. Additional definitions

As used in this chapter:

(1) Auxiliary aids and services

The term "auxiliary aids and services" includes-

(A) qualified interpreters or other effective methods of making aurally delivered materials available to individuals with hearing impairments;

(B) qualified readers, taped texts, or other effective methods of making visually delivered materials available to individuals with visual impairments;

(C) acquisition or modification of equipment or devices; and

(D) other similar services and actions.

(2) State

The term "State" means each of the several States, the District of Columbia, the Commonwealth of Puerto Rico, Guam, American Samoa, the Virgin Islands of the United States, the Trust Territory of the Pacific Islands, and the Commonwealth of the Northern Mariana Islands.

Subchapter I - Employment [Title I]

Sec. 12111. Definitions

As used in this subchapter:

(1) Commission

The term "Commission" means the Equal Employment Opportunity Commission established by section 2000e-4 of this title.

(2) Covered entity

The term "covered entity" means an employer, employment agency, labor organization, or joint labor-management committee.

(3) Direct threat

The term "direct threat" means a significant risk to the health or safety of others that cannot be eliminated by reasonable accommodation.

(4) Employee

The term "employee" means an individual employed by an employer. With respect to employment in a foreign country, such term includes an individual who is a citizen of the United States.

(5) Employer

(A) In general

The term "employer" means a person engaged in an industry affecting commerce who has 15 or more employees for each working day in each of 20 or more calendar weeks in the current or preceding calendar year, and any agent of such person, except that, for two years following the effective date of this subchapter, an employer means a person engaged in an industry affecting commerce who has 25 or more employees for each working day in each of 20 or more calendar weeks in the current or preceding year, and any agent of such person.

(B) Exceptions

The term "employer" does not include-

(i) the United States, a corporation wholly owned by the government of the United States, or an Indian tribe; or

(ii) a bona fide private membership club (other than a labor organization) that is exempt from taxation under section 501(c) of title 26.

(6) Illegal use of drugs

(A) In general

The term "illegal use of drugs" means the use of drugs, the possession or distribution of which is unlawful under the Controlled Substances Act [21 U.S.C. 801 et seq.]. Such term does not include the use of a drug taken under supervision by a licensed health care professional, or other uses authorized by the Controlled Substances Act or other provisions of Federal law.

(B) Drugs

The term "drug" means a controlled substance, as defined in schedules I through V of section 202 of the Controlled Substances Act [21 U.S.C. 812].

(7) Person, etc.

The terms "person", "labor organization", "employment agency", "commerce", and "industry affecting commerce", shall have the same meaning given such terms in section 2000e of this title.

(8) Qualified individual

The term "qualified individual " means an individual who, with or without reasonable accommodation, can perform the essential functions of the employment position that such individual holds or desires. For the purposes of this subchapter, consideration shall be given to the employer's judgment as to what functions of a job are essential, and if an employer has prepared a written description before advertising or interviewing applicants for the job, this description shall be considered evidence of the essential functions of the job.

(9) Reasonable accommodation

The term "reasonable accommodation" may include

(A) making existing facilities used by employees readily accessible to and usable by individuals with disabilities; and

(B) job restructuring, part-time or modified work schedules, reassignment to a vacant position, acquisition or modification of equipment or devices, appropriate adjustment or modifications of examinations, training materials or policies, the provision of qualified readers or interpreters, and other similar accommodations for individuals with disabilities.

(10) Undue hardship

(A) In general

The term "undue hardship" means an action requiring significant difficulty or expense, when considered in light of the factors set forth in subparagraph (B).

(B) Factors to be considered

In determining whether an accommodation would impose an undue hardship on a covered entity, factors to be considered include-

(i) the nature and cost of the accommodation needed under this chapter;

(ii) the overall financial resources of the facility or facilities involved in the provision of the reasonable accommodation; the number of persons employed at such facility; the effect on expenses and resources, or the impact otherwise of such accommodation upon the operation of the facility;

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

(iv) the type of operation or operations of the covered entity, including the composition, structure, and functions of the workforce of such entity; the geographic separateness, administrative, or fiscal relationship of the facility or facilities in question to the covered entity.

Sec. 12112. Discrimination

(a) General rule

No covered entity shall discriminate against a qualified individual on the basis of disability in regard to job application procedures, the hiring, advancement, or discharge of employees, employee compensation, job training, and other terms, conditions, and privileges of employment.

(b) Construction

As used in subsection (a) of this section, the term "discriminate against a qualified individual on the basis of disability" includes-

(1) limiting, segregating, or classifying a job applicant or employee in a way that adversely affects the opportunities or status of such applicant or employee because of the disability of such applicant or employee;

(2) participating in a contractual or other arrangement or relationship that has the effect of subjecting a covered entity's qualified applicant or employee with a disability to the discrimination prohibited by this subchapter (such relationship includes a relationship with an employment or referral agency, labor union, an organization providing fringe benefits to an employee of the covered entity, or an organization providing training and apprenticeship programs);

(3) utilizing standards, criteria, or methods of administration-

(A) that have the effect of discrimination on the basis of disability; or

(B) that perpetuate the discrimination of others who are subject to common administrative control;

(4) excluding or otherwise denying equal jobs or benefits to a qualified individual because of the known disability of an individual with whom the qualified individual is known to have a relationship or association;

(5)

(A) not making reasonable accommodations to the known physical or mental limitations of an otherwise qualified individual with a disability who is an applicant or employee, unless such covered entity can demonstrate that the accommodation would impose an undue hardship on the operation of the business of such covered entity; or

(B) denying employment opportunities to a job applicant or employee who is an otherwise qualified individual with a disability, if such denial is based on the need of such covered entity to make reasonable accommodation to the physical or mental impairments of the employee or applicant;

(6) using qualification standards, employment tests or other selection criteria that screen out or tend to screen out an individual with a disability or a class of individuals with disabilities unless the standard, test or other selection criteria, as used by the covered entity, is shown to be job-related for the position in question and is consistent with business necessity; and

(7) failing to select and administer tests concerning employment in the most effective manner to ensure that, when such test is administered to a job applicant or employee who has a disability that impairs sensory, manual, or speaking skills, such test results accurately reflect the skills, aptitude, or whatever other factor of such applicant or employee that such test purports to measure, rather than reflecting the impaired sensory, manual, or speaking skills of such employee or applicant (except where such skills are the factors that the test purports to measure).

(c) Covered entities in foreign countries

(1) In general

It shall not be unlawful under this section for a covered entity to take any action that constitutes discrimination under this section with respect to an employee in a workplace in a foreign country if compliance with this section would cause such covered entity to violate the law of the foreign country in which such workplace is located.

(2) Control of corporation

(A) Presumption

If an employer controls a corporation whose place of incorporation is a foreign country, any practice that constitutes discrimination under this section and is engaged in by such corporation shall be presumed to be engaged in by such employer.

(B) Exception

This section shall not apply with respect to the foreign operations of an employer that is a foreign person not controlled by an American employer.

(C) Determination

For purposes of this paragraph, the determination of whether an employer controls a corporation shall be based on-

(i) the interrelation of operations;

(ii) the common management;

(iii) the centralized control of labor relations; and

(iv) the common ownership or financial control, of the employer and the corporation.

(d) Medical examinations and inquiries

(1) In general

The prohibition against discrimination as referred to in subsection (a) of this section shall include medical examinations and inquiries.

(2) Preemployment

(A) Prohibited examination or inquiry

Except as provided in paragraph (3), a covered entity shall not conduct a medical examination or make inquiries of a job applicant as to whether such applicant is an individual with a disability or as to the nature or severity of such disability.

(B) Acceptable inquiry

A covered entity may make preemployment inquiries into the ability of an applicant to perform job-related functions.

(3) Employment entrance examination

A covered entity may require a medical examination after an offer of employment has been made to a job applicant and prior to the commencement of the employment duties of such applicant, and may condition an offer of employment on the results of such examination, if-

(A) all entering employees are subjected to such an examination regardless of disability;

(B) information obtained regarding the medical condition or history of the applicant is collected and maintained on separate forms and in separate medical files and is treated as a confidential medical record, except that-

(i) supervisors and managers may be informed regarding necessary restrictions on the work or duties of the employee and necessary accommodations;

(ii) first aid and safety personnel may be informed, when appropriate, if the disability might require emergency treatment; and

(iii) government officials investigating compliance with this chapter shall be provided relevant information on request; and

(C) the results of such examination are used only in accordance with this subchapter.

(4) Examination and inquiry

(A) Prohibited examinations and inquiries

A covered entity shall not require a medical examination and shall not make inquiries of an employee as to whether such employee is an individual with a disability or as to the nature or severity of the disability, unless such examination or inquiry is shown to be job-related and consistent with business necessity.

(B) Acceptable examinations and inquiries

A covered entity may conduct voluntary medical examinations, including voluntary medical histories, which are part of an employee health program available to employees at that work site. A covered entity may make inquiries into the ability of an employee to perform job-related functions.

(C) Requirement

Information obtained under subparagraph (B) regarding the medical condition or history of any employee are subject to the requirements of subparagraphs (B) and (C) of paragraph (3).

Sec. 12113. Defenses

(a) In general

It may be a defense to a charge of discrimination under this chapter that an alleged application of qualification standards, tests, or selection criteria that screen out or tend to screen out or otherwise deny a job or benefit to an individual with a disability has been shown to be job- related and consistent with business necessity, and such performance cannot be accomplished by reasonable accommodation, as required under this subchapter.

(b) Qualification standards

The term "qualification standards" may include a requirement that an individual shall not pose a direct threat to the health or safety of other individuals in the workplace.

(c) Qualification standards and tests related to uncorrected vision

Notwithstanding section 12102(4)(E)(ii), a covered entity shall not use qualification standards, employment tests, or other selection criteria based on an individual's uncorrected vision unless the standard, test, or other selection criteria, as used by the covered entity, is shown to be job-related for the position in question and consistent with business necessity.

(d) Religious entities

(1) In general

This subchapter shall not prohibit a religious corporation, association, educational institution, or society from giving preference in employment to individuals of a particular religion to perform work connected with the carrying on by such corporation, association, educational institution, or society of its activities.

(2) Religious tenets requirement

Under this subchapter, a religious organization may require that all applicants and employees conform to the religious tenets of such organization.

(e) List of infectious and communicable diseases

(1) In general

The Secretary of Health and Human Services, not later than 6 months after July 26, 1990, shall-

(A) review all infectious and communicable diseases which may be transmitted through handling the food supply;

(B) publish a list of infectious and communicable diseases which are transmitted through handling the food supply;

(C) publish the methods by which such diseases are transmitted; and

(D) widely disseminate such information regarding the list of diseases and their modes of transmissibility to the general public.

Such list shall be updated annually.

(2) Applications

In any case in which an individual has an infectious or communicable disease that is transmitted to others through the handling of food, that is included on the list developed by the Secretary of Health and Human Services under paragraph (1), and which cannot be eliminated by reasonable accommodation, a covered entity may refuse to assign or continue to assign such individual to a job involving food handling.

(3) Construction

Nothing in this chapter shall be construed to preempt, modify, or amend any State, county, or local law, ordinance, or regulation applicable to food handling which is designed to protect the public health from individuals who pose a significant risk to the health or safety of others, which cannot be eliminated by reasonable accommodation, pursuant to the list of infectious or communicable diseases and the modes of transmissibility published by the Secretary of Health and Human Services.

Sec. 12114. Illegal use of drugs and alcohol

(a) Qualified individual with a disability

For purposes of this subchapter, a qualified individual with a disability shall not include any employee or applicant who is currently engaging in the illegal use of drugs, when the covered entity acts on the basis of such use.

(b) Rules of construction

Nothing in subsection (a) of this section shall be construed to exclude as a qualified individual with a disability an individual who-

(1) has successfully completed a supervised drug rehabilitation program and is no longer engaging in the illegal use of drugs, or has otherwise been rehabilitated successfully and is no longer engaging in such use;

(2) is participating in a supervised rehabilitation program and is no longer engaging in such use; or

(3) is erroneously regarded as engaging in such use, but is not engaging in such use;

except that it shall not be a violation of this chapter for a covered entity to adopt or administer reasonable policies or procedures, including but not limited to drug testing, designed to ensure that an individual described in paragraph (1) or (2) is no longer engaging in the illegal use of drugs.

(c) Authority of covered entity

A covered entity-

(1) may prohibit the illegal use of drugs and the use of alcohol at the workplace by all employees;

(2) may require that employees shall not be under the influence of alcohol or be engaging in the illegal use of drugs at the workplace;

(3) may require that employees behave in conformance with the requirements established under the Drug-Free Workplace Act of 1988 (41 U.S.C. 701 et seq.);

(4) may hold an employee who engages in the illegal use of drugs or who is an alcoholic to the same qualification standards for employment or job performance and behavior that such entity holds other employees, even if any unsatisfactory performance or behavior is related to the drug use or alcoholism of such employee; and

(5) may, with respect to Federal regulations regarding alcohol and the illegal use of drugs, require that-

(A) employees comply with the standards established in such regulations of the Department of Defense, if the employees of the covered entity are employed in an industry subject to such regulations, including complying with regulations (if any) that apply to employment in sensitive positions in such an industry, in the case of employees of the covered entity who are employed in such positions (as defined in the regulations of the Department of Defense);

(B) employees comply with the standards established in such regulations of the Nuclear Regulatory Commission, if the employees of the covered entity are employed in an industry subject to such regulations, including complying with regulations (if any) that apply to employment in sensitive positions in such an industry, in the case of employees of the covered entity who are employed in such positions (as defined in the regulations of the Nuclear Regulatory Commission); and

(C) employees comply with the standards established in such regulations of the Department of Transportation, if the employees of the covered entity are employed in a transportation industry subject to such regulations, including complying with such regulations (if any) that apply to employment in sensitive positions in such an industry, in the case of employees of the covered entity who are employed in such positions (as defined in the regulations of the Department of Transportation).

(d) Drug testing

(1) In general

For purposes of this subchapter, a test to determine the illegal use of drugs shall not be considered a medical examination.

(2) Construction

Nothing in this subchapter shall be construed to encourage, prohibit, or authorize the conducting of drug testing for the illegal use of drugs by job applicants or employees or making employment decisions based on such test results.

(e) Transportation employees

Nothing in this subchapter shall be construed to encourage, prohibit, restrict, or authorize the otherwise lawful exercise by entities subject to the jurisdiction of the Department of Transportation of authority to-

(1) test employees of such entities in, and applicants for, positions involving safety-sensitive duties for the illegal use of drugs and for on-duty impairment by alcohol; and

(2) remove such persons who test positive for illegal use of drugs and on-duty impairment by alcohol pursuant to paragraph (1) from safety-sensitive duties in implementing subsection (c).

Sec. 12115. Posting notices

Every employer, employment agency, labor organization, or joint labor-management committee covered under this subchapter shall post notices in an accessible format to applicants, employees, and members describing the applicable provisions of this chapter, in the manner prescribed by section 2000e-10 of this title.

Sec. 12116. Regulations

Not later than 1 year after July 26, 1990, the Commission shall issue regulations in an accessible format to carry out this subchapter in accordance with subchapter II of chapter 5 of title 5.

Sec. 12117. Enforcement

(a) Powers, remedies, and procedures

The powers, remedies, and procedures set forth in sections 2000e-4, 2000e-5, 2000e-6, 2000e-8, and 2000e-9 of this title shall be the powers, remedies, and procedures this subchapter provides to the Commission, to the Attorney General, or to any person alleging discrimination on the basis of disability in violation of any provision of this chapter, or regulations promulgated under section 12116 of this title, concerning employment.

(b) Coordination

The agencies with enforcement authority for actions which allege employment discrimination under this subchapter and under the Rehabilitation Act of 1973 [29 U.S.C. 701 et seq.] shall develop procedures to ensure that administrative complaints filed under this subchapter and under the Rehabilitation Act of 1973 are dealt with in a manner that avoids duplication of effort and prevents imposition of inconsistent or conflicting standards for the same requirements under this subchapter and the Rehabilitation Act of 1973. The Commission, the Attorney General, and the Office of Federal Contract Compliance Programs shall establish such coordinating mechanisms (similar to provisions contained in the joint regulations promulgated by the Commission and the Attorney General at part 42 of title 28 and part 1691 of title 29, Code of Federal Regulations, and the Memorandum of Understanding between the Commission and the Office of Federal Contract Compliance Programs dated January 16, 1981 (46 Fed. Reg. 7435, January 23, 1981)) in regulations implementing this subchapter and Rehabilitation Act of 1973 not later than 18 months after July 26, 1990.

Subchapter II - Public Services [Title II]

Part A - Prohibition Against Discrimination and Other Generally Applicable Provisions

Sec. 12131. Definitions

As used in this subchapter:

(1) Public entity

The term "public entity" means

(A) any State or local government;

(B) any department, agency, special purpose district, or other instrumentality of a State or States or local government; and

(C) the National Railroad Passenger Corporation, and any commuter authority (as defined in section 24102(4) of title 49).

(2) Qualified individual with a disability

The term "qualified individual with a disability" means an individual with a disability who, with or without reasonable modifications to rules, policies, or practices, the removal of architectural, communication, or transportation barriers, or the provision of auxiliary aids and services, meets the essential eligibility requirements for the receipt of services or the participation in programs or activities provided by a public entity.

Sec. 12132. Discrimination

Subject to the provisions of this subchapter, no qualified individual with a disability shall, by reason of such disability, be excluded from participation in or be denied the benefits of services, programs, or activities of a public entity, or be subjected to discrimination by any such entity.

Sec. 12133. Enforcement

The remedies, procedures, and rights set forth in section 794a of title 29 shall be the remedies, procedures, and rights this subchapter provides to any person alleging discrimination on the basis of disability in violation of section 12132 of this title.

Sec. 12134. Regulations

(a) In general

Not later than 1 year after July 26, 1990, the Attorney General shall promulgate regulations in an accessible format that implement this part. Such regulations shall not include any matter within the scope of the authority of the Secretary of Transportation under section 12143, 12149, or 12164 of this title.

(b) Relationship to other regulations

Except for "program accessibility, existing facilities", and "communications", regulations under subsection (a) of this section shall be consistent with this chapter and with the coordination regulations under part 41 of title 28, Code of Federal Regulations (as promulgated by the Department of Health, Education, and Welfare on January 13, 1978), applicable to recipients of Federal financial assistance under section 794 of title 29. With respect to "program accessibility, existing facilities", and "communications", such regulations shall be consistent with regulations and analysis as in part 39 of title 28 of the Code of Federal Regulations, applicable to federally conducted activities under section 794 of title 29.

(c) Standards

Regulations under subsection (a) of this section shall include standards applicable to facilities and vehicles covered by this part, other than facilities, stations, rail passenger cars, and vehicles covered by part B of this subchapter. Such standards shall be consistent with the minimum guidelines and requirements issued by the Architectural and Transportation Barriers Compliance Board in accordance with section 12204(a) of this title.

Part B - Actions Applicable to Public Transportation Provided by Public Entities Considered Discriminatory

Subpart I - Public Transportation Other than by Aircraft or Certain Rail Operations

Sec. 12141. Definitions

As used in this subpart:

(1) Demand responsive system

The term "demand responsive system" means any system of providing designated public transportation which is not a fixed route system.

(2) Designated public transportation

The term "designated public transportation" means transportation (other than public school transportation) by bus, rail, or any other conveyance (other than transportation by aircraft or intercity or commuter rail transportation (as defined in section 12161 of this title)) that provides the general public with general or special service (including charter service) on a regular and continuing basis.

(3) Fixed route system

The term "fixed route system" means a system of providing designated public transportation on which a vehicle is operated along a prescribed route according to a fixed schedule.

(4) Operates

The term "operates", as used with respect to a fixed route system or demand responsive system, includes operation of such system by a person under a contractual or other arrangement or relationship with a public entity.

(5) Public school transportation

The term "public school transportation" means transportation by school bus vehicles of schoolchildren, personnel, and equipment to and from a public elementary or secondary school and school-related activities.

(6) Secretary

The term "Secretary" means the Secretary of Transportation.

Sec. 12142. Public entities operating fixed route systems

(a) Purchase and lease of new vehicles

It shall be considered discrimination for purposes of section 12132 of this title and section 794 of title 29 for a public entity which operates a fixed route system to purchase or lease a new bus, a new rapid rail vehicle, a new light rail vehicle, or any other new vehicle to be used on such system, if the solicitation for such purchase or lease is made after the 30th day following July 26, 1990, and if such bus, rail vehicle, or other vehicle is not readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs.

(b) Purchase and lease of used vehicles

Subject to subsection (c)(1) of this section, it shall be considered discrimination for purposes of section 12132 of this title and section 794 of title 29 for a public entity which operates a fixed route system to purchase or lease, after the 30th day following July 26, 1990, a used vehicle for use on such system unless such entity makes demonstrated good faith efforts to purchase or lease a used vehicle for use on such system that is readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs.

(c) Remanufactured vehicles

(1) General rule

Except as provided in paragraph (2), it shall be considered discrimination for purposes of section 12132 of this title and section 794 of title 29 for a public entity which operates a fixed route system-

(A) to remanufacture a vehicle for use on such system so as to extend its usable life for 5 years or more, which remanufacture begins (or for which the solicitation is made) after the 30th day following July 26, 1990; or

(B) to purchase or lease for use on such system a remanufactured vehicle which has been remanufactured so as to extend its usable life for 5 years or more, which purchase or lease occurs after such 30th day and during the period in which the usable life is extended; unless, after remanufacture, the vehicle is, to the maximum extent feasible, readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs.

(2) Exception for historic vehicles

(A) General rule

If a public entity operates a fixed route system any segment of which is included on the National Register of Historic Places and if making a vehicle of historic character to be used solely on such segment readily accessible to and usable by individuals with disabilities would significantly alter the historic character of such vehicle, the public entity only has to make (or to purchase or lease a remanufactured vehicle with) those modifications which are necessary to meet the requirements of paragraph (1) and which do not significantly alter the historic character of such vehicle.

(B) Vehicles of historic character defined by regulations

For purposes of this paragraph and section 12148(a) of this title, a vehicle of historic character shall be defined by the regulations issued by the Secretary to carry out this subsection.

Sec. 12143. Paratransit as a complement to fixed route service

(a) General rule

It shall be considered discrimination for purposes of section 12132 of this title and section 794 of title 29 for a public entity which operates a fixed route system (other than a system which provides solely commuter bus service) to fail to provide with respect to the operations of its fixed route system, in accordance with this section, paratransit and other special transportation services to individuals with disabilities, including individuals who use wheelchairs that are sufficient to provide to such individuals a level of service

(1) which is comparable to the level of designated public transportation services provided to individuals without disabilities using such system; or

(2) in the case of response time, which is comparable, to the extent practicable, to the level of designated public transportation services provided to individuals without disabilities using such system.

(b) Issuance of regulations

Not later than 1 year after July 26, 1990, the Secretary shall issue final regulations to carry out this section.

(c) Required contents of regulations

(1) Eligible recipients of service

The regulations issued under this section shall require each public entity which operates a fixed route system to provide the paratransit and other special transportation services required under this section

(A)

(i) to any individual with a disability who is unable, as a result of a physical or mental impairment (including a vision impairment) and without the assistance of another individual (except an operator of a wheelchair lift or other boarding assistance device), to board, ride, or disembark from any vehicle on the system which is readily accessible to and usable by individuals with disabilities;

(ii) to any individual with a disability who needs the assistance of a wheelchair lift or other boarding assistance device (and is able with such assistance) to board, ride, and disembark from any vehicle which is readily accessible to and usable by individuals with disabilities if the individual wants to travel on a route on the system during the hours of operation of the system at a time (or within a reasonable period of such time) when such a vehicle is not being used to provide designated public transportation on the route; and

(iii) to any individual with a disability who has a specific impairment-related condition which prevents such individual from traveling to a boarding location or from a disembarking location on such system;

(B) to one other individual accompanying the individual with the disability; and

(C) to other individuals, in addition to the one individual described in subparagraph (B), accompanying the individual with a disability provided that space for these additional individuals are available on the paratransit vehicle carrying the individual with a disability and that the transportation of such additional individuals will not result in a denial of service to individuals with disabilities.

For purposes of clauses (i) and (ii) of subparagraph (A), boarding or disembarking from a vehicle does not include travel to the boarding location or from the disembarking location.

(2) Service area

The regulations issued under this section shall require the provision of paratransit and special transportation services required under this section in the service area of each public entity which operates a fixed route system, other than any portion of the service area in which the public entity solely provides commuter bus service.

(3) Service criteria

Subject to paragraphs (1) and (2), the regulations issued under this section shall establish minimum service criteria for determining the level of services to be required under this section.

(4) Undue financial burden limitation

The regulations issued under this section shall provide that, if the public entity is able to demonstrate to the satisfaction of the Secretary that the provision of paratransit and other special transportation services otherwise required under this section would impose an undue financial burden on the public entity, the public entity, notwithstanding any other provision of this section (other than paragraph (5)), shall only be required to provide such services to the extent that providing such services would not impose such a burden.

(5) Additional services

The regulations issued under this section shall establish circumstances under which the Secretary may require a public entity to provide, notwithstanding paragraph (4), paratransit and other special transportation services under this section beyond the level of paratransit and other special transportation services which would otherwise be required under paragraph (4).

(6) Public participation

The regulations issued under this section shall require that each public entity which operates a fixed route system hold a public hearing, provide an opportunity for public comment, and consult with individuals with disabilities in preparing its plan under paragraph (7).

(7) Plans

The regulations issued under this section shall require that each public entity which operates a fixed route system-

(A) within 18 months after July 26, 1990, submit to the Secretary, and commence implementation of, a plan for providing paratransit and other special transportation services which meets the requirements of this section; and

(B) on an annual basis thereafter, submit to the Secretary, and commence implementation of, a plan for providing such services.

(8) Provision of services by others

The regulations issued under this section shall

(A) require that a public entity submitting a plan to the Secretary under this section identify in the plan any person or other public entity which is providing a paratransit or other special transportation service for individuals with disabilities in the service area to which the plan applies; and

(B) provide that the public entity submitting the plan does not have to provide under the plan such service for individuals with disabilities.

(9) Other provisions

The regulations issued under this section shall include such other provisions and requirements as the Secretary determines are necessary to carry out the objectives of this section.

(d) Review of plan

(1) General rule

The Secretary shall review a plan submitted under this section for the purpose of determining whether or not such plan meets the requirements of this section, including the regulations issued under this section.

(2) Disapproval

If the Secretary determines that a plan reviewed under this subsection fails to meet the requirements of this section, the Secretary shall disapprove the plan and notify the public entity which submitted the plan of such disapproval and the reasons therefor.

(3) Modification of disapproved plan

Not later than 90 days after the date of disapproval of a plan under this subsection, the public entity which submitted the plan shall modify the plan to meet the requirements of this section and shall submit to the Secretary, and commence implementation of, such modified plan.

(e) "Discrimination" defined

As used in subsection (a) of this section, the term "discrimination" includes

(1) a failure of a public entity to which the regulations issued under this section apply to submit, or commence implementation of, a plan in accordance with subsections (c)(6) and (c)(7);

(2) a failure of such entity to submit, or commence implementation of, a modified plan in accordance with subsection (d)(3);

(3) submission to the Secretary of a modified plan under subsection (d)(3) of this section which does not meet the requirements of this section; or

(4) a failure of such entity to provide paratransit or other special transportation services in accordance with the plan or modified plan the public entity submitted to the Secretary under this section.

(f) Statutory construction

Nothing in this section shall be construed as preventing a public entity-

(1) from providing paratransit or other special transportation services at a level which is greater than the level of such services which are required by this section,

(2) from providing paratransit or other special transportation services in addition to those paratransit and special transportation services required by this section, or

(3) from providing such services to individuals in addition to those individuals to whom such services are required to be provided by this section.

Sec. 12144. Public entity operating a demand responsive system

If a public entity operates a demand responsive system, it shall be considered discrimination, for purposes of section 12132 of this title and section 794 of title 29, for such entity to purchase or lease a new vehicle for use on such system, for which a solicitation is made after the 30th day following July 26, 1990, that is not readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs, unless such system, when viewed in its entirety, provides a level of service to such individuals equivalent to the level of service such system provides to individuals without disabilities.

(a) Granting

With respect to the purchase of new buses, a public entity may apply for, and the Secretary may temporarily relieve such public entity from the obligation under section 12142(a) or 12144 of this title to purchase new buses that are readily accessible to and usable by individuals with disabilities if such public entity demonstrates to the satisfaction of the Secretary

(1) that the initial solicitation for new buses made by the public entity specified that all new buses were to be lift-equipped and were to be otherwise accessible to and usable by individuals with disabilities;

(2) the unavailability from any qualified manufacturer of hydraulic, electromechanical, or other lifts for such new buses;

(3) that the public entity seeking temporary relief has made good faith efforts to locate a qualified manufacturer to supply the lifts to the manufacturer of such buses in sufficient time to comply with such solicitation; and

(4) that any further delay in purchasing new buses necessary to obtain such lifts would significantly impair transportation services in the community served by the public entity.

(b) Duration and notice to Congress

Any relief granted under subsection (a) of this section shall be limited in duration by a specified date, and the appropriate committees of Congress shall be notified of any such relief granted.

(c) Fraudulent application

If, at any time, the Secretary has reasonable cause to believe that any relief granted under subsection (a) of this section was fraudulently applied for, the Secretary shall-

(1) cancel such relief if such relief is still in effect; and

(2) take such other action as the Secretary considers appropriate.

Sec. 12146. New facilities

For purposes of section 12132 of this title and section 794 of title 29, it shall be considered discrimination for a public entity to construct a new facility to be used in the provision of designated public transportation services unless such facility is readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs.

Sec. 12147. Alterations of existing facilities

(a) General rule

With respect to alterations of an existing facility or part thereof used in the provision of designated public transportation services that affect or could affect the usability of the facility or part thereof, it shall be considered discrimination, for purposes of section 12132 of this title and section 794 of title 29, for a public entity to fail to make such alterations (or to ensure that the alterations are made) in such a manner that, to the maximum extent feasible, the altered portions of the facility are readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs, upon the completion of such alterations. Where the public entity is undertaking an alteration that affects or could affect usability of or access to an area of the facility containing a primary function, the entity shall also make the alterations in such a manner that, to the maximum extent feasible, the path of travel to the altered area and the bathrooms, telephones, and drinking fountains serving the altered area, are readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs, upon completion of such alterations, where such alterations to the path of travel or the bathrooms, telephones, and drinking fountains serving the altered area are not disproportionate to the overall alterations in terms of cost and scope (as determined under criteria established by the Attorney General).

(b) Special rule for stations

(1) General rule

For purposes of section 12132 of this title and section 794 of title 29, it shall be considered discrimination for a public entity that provides designated public transportation to fail, in accordance with the provisions of this subsection, to make key stations (as determined under criteria established by the Secretary by regulation) in rapid rail and light rail systems readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs.

(2) Rapid rail and light rail key stations

(A) Accessibility

Except as otherwise provided in this paragraph, all key stations (as determined under criteria established by the Secretary by regulation) in rapid rail and light rail systems shall be made readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs, as soon as practicable but in no event later than the last day of the 3-year period beginning on July 26, 1990.

(B) Extension for extraordinarily expensive structural changes

The Secretary may extend the 3-year period under subparagraph (A) up to a 30-year period for key stations in a rapid rail or light rail system which stations need extraordinarily expensive structural changes to, or replacement of, existing facilities; except that by the last day of the 20th year following July 26, 1990, at least 2/3 of such key stations must be readily accessible to and usable by individuals with disabilities.

(3) Plans and milestones

The Secretary shall require the appropriate public entity to develop and submit to the Secretary a plan for compliance with this subsection

(A) that reflects consultation with individuals with disabilities affected by such plan and the results of a public hearing and public comments on such plan, and

(B) that establishes milestones for achievement of the requirements of this subsection.

Sec. 12148. Public transportation programs and activities in existing facilities and one car per train rule

(a) Public transportation programs and activities in existing facilities

(1) In general

With respect to existing facilities used in the provision of designated public transportation services, it shall be considered discrimination, for purposes of section 12132 of this title and section 794 of title 29, for a public entity to fail to operate a designated public transportation program or activity conducted in such facilities so that, when viewed in the entirety, the program or activity is readily accessible to and usable by individuals with disabilities.

(2) Exception

Paragraph (1) shall not require a public entity to make structural changes to existing facilities in order to make such facilities accessible to individuals who use wheelchairs, unless and to the extent required by section 12147(a) of this title (relating to alterations) or section 12147(b) of this title (relating to key stations).

(3) Utilization

Paragraph (1) shall not require a public entity to which paragraph (2) applies, to provide to individuals who use wheelchairs services made available to the general public at such facilities when such individuals could not utilize or benefit from such services provided at such facilities.

(b) One car per train rule

(1) General rule

Subject to paragraph (2), with respect to 2 or more vehicles operated as a train by a light or rapid rail system, for purposes of section 12132 of this title and section 794 of title 29, it shall be considered discrimination for a public entity to fail to have at least 1 vehicle per train that is accessible to individuals with disabilities, including individuals who use wheelchairs, as soon as practicable but in no event later than the last day of the 5-year period beginning on the effective date of this section.

(2) Historic trains

In order to comply with paragraph (1) with respect to the remanufacture of a vehicle of historic character which is to be used on a segment of a light or rapid rail system which is included on the National Register of Historic Places, if making such vehicle readily accessible to and usable by individuals with disabilities would significantly alter the historic character of such vehicle, the public entity which operates such system only has to make (or to purchase or lease a remanufactured vehicle with) those modifications which are necessary to meet the requirements of section 12142(c)(1) of this title and which do not significantly alter the historic character of such vehicle.

Sec. 12149. Regulations

(a) In general

Not later than 1 year after July 26, 1990, the Secretary of Transportation shall issue regulations, in an accessible format, necessary for carrying out this subpart (other than section 12143 of this title).

(b) Standards

The regulations issued under this section and section 12143 of this title shall include standards applicable to facilities and vehicles covered by this part. The standards shall be consistent with the minimum guidelines and requirements issued by the Architectural and Transportation Barriers Compliance Board in accordance with section 12204 of this title.

Sec. 12150. Interim accessibility requirements

If final regulations have not been issued pursuant to section 12149 of this title, for new construction or alterations for which a valid and appropriate State or local building permit is obtained prior to the issuance of final regulations under such section, and for which the construction or alteration authorized by such permit begins within one year of the receipt of such permit and is completed under the terms of such permit, compliance with the Uniform Federal Accessibility Standards in effect at the time the building permit is issued shall suffice to satisfy the requirement that facilities be readily accessible to and usable by persons with disabilities as required under sections 12146 and 12147 of this title, except that, if such final regulations have not been issued one year after the Architectural and Transportation Barriers Compliance Board has issued the supplemental minimum guidelines required under section 12204(a) of this title, compliance with such supplemental minimum guidelines shall be necessary to satisfy the requirement that facilities be readily accessible to and usable by persons with disabilities prior to issuance of the final regulations.

Subpart II - Public Transportation by Intercity and Commuter Rail

Sec. 12161. Definitions

As used in this subpart:

(1) Commuter authority

The term "commuter authority" has the meaning given such term in section 24102(4) of title 49.

(2) Commuter rail transportation

The term "commuter rail transportation" has the meaning given the term "commuter rail passenger transportation" in section 24102(5) of title 49.

(3) Intercity rail transportation

The term "intercity rail transportation" means transportation provided by the National Railroad Passenger Corporation.

(4) Rail passenger car

The term "rail passenger car" means, with respect to intercity rail transportation, single-level and bi-level coach cars, single-level and bi-level dining cars, single- level and bi-level sleeping cars, single-level and bi-level lounge cars, and food service cars.

(5) Responsible person

The term "responsible person" means

(A) in the case of a station more than 50 percent of which is owned by a public entity, such public entity;

(B) in the case of a station more than 50 percent of which is owned by a private party, the persons providing intercity or commuter rail transportation to such station, as allocated on an equitable basis by regulation by the Secretary of Transportation; and

(C) in a case where no party owns more than 50 percent of a station, the persons providing intercity or commuter rail transportation to such station and the owners of the station, other than private party owners, as allocated on an equitable basis by regulation by the Secretary of Transportation.

(6) Station

The term "station" means the portion of a property located appurtenant to a right-of-way on which intercity or commuter rail transportation is operated, where such portion is used by the general public and is related to the provision of such transportation, including passenger platforms, designated waiting areas, ticketing areas, restrooms, and, where a public entity providing rail transportation owns the property, concession areas, to the extent that such public entity exercises control over the selection, design, construction, or alteration of the property, but such term does not include flag stops.

Sec. 12162. Intercity and commuter rail actions considered discriminatory

(a) Intercity rail transportation

(1) One car per train rule

It shall be considered discrimination for purposes of section 12132 of this title and section 794 of title 29 for a person who provides intercity rail transportation to fail to have at least one passenger car per train that is readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs, in accordance with regulations issued under section 12164 of this title, as soon as practicable, but in no event later than 5 years after July 26, 1990.

(2) New intercity cars

(A) General rule

Except as otherwise provided in this subsection with respect to individuals who use wheelchairs, it shall be considered discrimination for purposes of section 12132 of this title and section 794 of title 29 for a person to purchase or lease any new rail passenger cars for use in intercity rail transportation, and for which a solicitation is made later than 30 days after July 26, 1990, unless all such rail cars are readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs, as prescribed by the Secretary of Transportation in regulations issued under section 12164 of this title.

(B) Special rule for single-level passenger coaches for individuals who use wheelchairs

Single-level passenger coaches shall be required to

(i) be able to be entered by an individual who uses a wheelchair;

(ii) have space to park and secure a wheelchair;

(iii) have a seat to which a passenger in a wheelchair can transfer, and a space to fold and store such passenger's wheelchair; and

(iv) have a restroom usable by an individual who uses a wheelchair, only to the extent provided in paragraph (3).

(C) Special rule for single-level dining cars for individuals who use wheelchairs

Single-level dining cars shall not be required to

(i) be able to be entered from the station platform by an individual who uses a wheelchair; or

(ii) have a restroom usable by an individual who uses a wheelchair if no restroom is provided in such car for any passenger.

(D) Special rule for bi-level dining cars for individuals who use wheelchairs

Bi-level dining cars shall not be required to

(i) be able to be entered by an individual who uses a wheelchair;

(ii) have space to park and secure a wheelchair;

(iii) have a seat to which a passenger in a wheelchair can transfer, or a space to fold and store such passenger's wheelchair; or

(iv) have a restroom usable by an individual who uses a wheelchair.

(3) Accessibility of single-level coaches

(A) General rule

It shall be considered discrimination for purposes of section 12132 of this title and section 794 of title 29 for a person who provides intercity rail transportation to fail to have on each train which includes one or more single-level rail passenger coaches-

(i) a number of spaces-

(I) to park and secure wheelchairs (to accommodate individuals who wish to remain in their wheelchairs) equal to not less than one-half of the number of single-level rail passenger coaches in such train; and

(II) to fold and store wheelchairs (to accommodate individuals who wish to transfer to coach seats) equal to not less than one-half of the number of single-level rail passenger coaches in such train, as soon as practicable, but in no event later than 5 years after July 26, 1990; and

(B) Location

Spaces required by subparagraph (A) shall be located in single-level rail passenger coaches or food service cars.

(C) Limitation

Of the number of spaces required on a train by subparagraph (A), not more than two spaces to park and secure wheelchairs nor more than two spaces to fold and store wheelchairs shall be located in any one coach or food service car.

(D) Other accessibility features

Single-level rail passenger coaches and food service cars on which the spaces required by subparagraph (a) are located shall have a restroom usable by an individual who uses a wheelchair and shall be able to be entered from the station platform by an individual who uses a wheelchair.

(4) Food service

(A) Single-level dining cars

On any train in which a single-level dining car is used to provide food service

(i) if such single-level dining car was purchased after July 26, 1990, table service in such car shall be provided to a passenger who uses a wheelchair if

(I) the car adjacent to the end of the dining car through which a wheelchair may enter is itself accessible to a wheelchair;

(II) such passenger can exit to the platform from the car such passenger occupies, move down the platform, and enter the adjacent accessible car described in subclause (I) without the necessity of the train being moved within the station; and

(III) space to park and secure a wheelchair is available in the dining car at the time such passenger wishes to eat (if such passenger wishes to remain in a wheelchair), or space to store and fold a wheelchair is available in the dining car at the time such passenger wishes to eat (if such passenger wishes to transfer to a dining car seat); and

(ii) appropriate auxiliary aids and services, including a hard surface on which to eat, shall be provided to ensure that other equivalent food service is available to individuals with disabilities, including individuals who use wheelchairs, and to passengers traveling with such individuals.

Unless not practicable, a person providing intercity rail transportation shall place an accessible car adjacent to the end of a dining car described in clause (I) through which an individual who uses a wheelchair may enter.

(B) Bi-level dining cars

On any train in which a bi-level dining car is used to provide food service-

(i) if such train includes a bi-level lounge car purchased after July 26, 1990, table service in such lounge car shall be provided to individuals who use wheelchairs and to other passengers; and

(ii) appropriate auxiliary aids and services, including a hard surface on which to eat, shall be provided to ensure that other equivalent food service is available to individuals with disabilities, including individuals who use wheelchairs, and to passengers traveling with such individuals.

(b) Commuter rail transportation

(1) One car per train rule

It shall be considered discrimination for purposes of section 12132 of this title and section 794 of title 29 for a person who provides commuter rail transportation to fail to have at least one passenger car per train that is readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs, in accordance with regulations issued under section 12164 of this title, as soon as practicable, but in no event later than 5 years after July 26, 1990.

(2) New commuter rail cars

(A) General rule

It shall be considered discrimination for purposes of section 12132 of this title and section 794 of title 29 for a person to purchase or lease any new rail passenger cars for use in commuter rail transportation, and for which a solicitation is made later than 30 days after July 26, 1990, unless all such rail cars are readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs, as prescribed by the Secretary of Transportation in regulations issued under section 12164 of this title.

(B) Accessibility

For purposes of section 12132 of this title and section 794 of title 29, a requirement that a rail passenger car used in commuter rail transportation be accessible to or readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs, shall not be construed to require-

(i) a restroom usable by an individual who uses a wheelchair if no restroom is provided in such car for any passenger;

(ii) space to fold and store a wheelchair; or

(iii) a seat to which a passenger who uses a wheelchair can transfer.

(c) Used rail cars

It shall be considered discrimination for purposes of section 12132 of this title and section 794 of title 29 for a person to purchase or lease a used rail passenger car for use in intercity or commuter rail transportation, unless such person makes demonstrated good faith efforts to purchase or lease a used rail car that is readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs, as prescribed by the Secretary of Transportation in regulations issued under section 12164 of this title.

(d) Remanufactured rail cars

(1) Remanufacturing

It shall be considered discrimination for purposes of section 12132 of this title and section 794 of title 29 for a person to remanufacture a rail passenger car for use in intercity or commuter rail transportation so as to extend its usable life for 10 years or more, unless the rail car, to the maximum extent feasible, is made readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs, as prescribed by the Secretary of Transportation in regulations issued under section 12164 of this title.

(2) Purchase or lease

It shall be considered discrimination for purposes of section 12132 of this title and section 794 of title 29 for a person to purchase or lease a remanufactured rail passenger car for use in intercity or commuter rail transportation unless such car was remanufactured in accordance with paragraph (1).

(e) Stations

(1) New stations

It shall be considered discrimination for purposes of section 12132 of this title and section 794 of title 29 for a person to build a new station for use in intercity or commuter rail transportation that is not readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs, as prescribed by the Secretary of Transportation in regulations issued under section 12164 of this title.

(2) Existing stations

(A) Failure to make readily accessible

(i) General rule

It shall be considered discrimination for purposes of section 12132 of this title and section 794 of title 29 for a responsible person to fail to make existing stations in the intercity rail transportation system, and existing key stations in commuter rail transportation systems, readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs, as prescribed by the Secretary of Transportation in regulations issued under section 12164 of this title.

(ii) Period for compliance

(I) Intercity rail

All stations in the intercity rail transportation system shall be made readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs, as soon as practicable, but in no event later than 20 years after July 26, 1990.

(II) Commuter rail

Key stations in commuter rail transportation systems shall be made readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs, as soon as practicable but in no event later than 3 years after July 26, 1990, except that the time limit may be extended by the Secretary of Transportation up to 20 years after July 26, 1990, in a case where the raising of the entire passenger platform is the only means available of attaining accessibility or where other extraordinarily expensive structural changes are necessary to attain accessibility.

(iii) Designation of key stations

Each commuter authority shall designate the key stations in its commuter rail transportation system, in consultation with individuals with disabilities and organizations representing such individuals, taking into consideration such factors as high ridership and whether such station serves as a transfer or feeder station. Before the final designation of key stations under this clause, a commuter authority shall hold a public hearing.

(iv) Plans and milestones

The Secretary of Transportation shall require the appropriate person to develop a plan for carrying out this subparagraph that reflects consultation with individuals with disabilities affected by such plan and that establishes milestones for achievement of the requirements of this subparagraph.

(B) Requirement when making alterations

(i) General rule

It shall be considered discrimination, for purposes of section 12132 of this title and section 794 of title 29, with respect to alterations of an existing station or part thereof in the intercity or commuter rail transportation systems that affect or could affect the usability of the station or part thereof, for the responsible person, owner, or person in control of the station to fail to make the alterations in such a manner that, to the maximum extent feasible, the altered portions of the station are readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs, upon completion of such alterations.

(ii) Alterations to a primary function area

It shall be considered discrimination, for purposes of section 12132 of this title and section 794 of title 29, with respect to alterations that affect or could affect the usability of or access to an area of the station containing a primary function, for the responsible person, owner, or person in control of the station to fail to make the alterations in such a manner that, to the maximum extent feasible, the path of travel to the altered area, and the bathrooms, telephones, and drinking fountains serving the altered area, are readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs, upon completion of such alterations, where such alterations to the path of travel or the bathrooms, telephones, and drinking fountains serving the altered area are not disproportionate to the overall alterations in terms of cost and scope (as determined under criteria established by the Attorney General).

(C) Required cooperation

It shall be considered discrimination for purposes of section 12132 of this title and section 794 of title 29 for an owner, or person in control, of a station governed by subparagraph (a) or (b) to fail to provide reasonable cooperation to a responsible person with respect to such station in that responsible person's efforts to comply with such subparagraph. An owner, or person in control, of a station shall be liable to a responsible person for any failure to provide reasonable cooperation as required by this subparagraph. Failure to receive reasonable cooperation required by this subparagraph shall not be a defense to a claim of discrimination under this chapter.

Sec. 12163. Conformance of accessibility standards

Accessibility standards included in regulations issued under this subpart shall be consistent with the minimum guidelines issued by the Architectural and Transportation Barriers Compliance Board under section 12204 of this title.

Sec. 12164. Regulations

Not later than 1 year after July 26, 1990, the Secretary of Transportation shall issue regulations, in an accessible format, necessary for carrying out this subpart.

Sec. 12165. Interim accessibility requirements

(a) Stations

If final regulations have not been issued pursuant to section 12164 of this title, for new construction or alterations for which a valid and appropriate State or local building permit is obtained prior to the issuance of final regulations under such section, and for which the construction or alteration authorized by such permit begins within one year of the receipt of such permit and is completed under the terms of such permit, compliance with the Uniform Federal Accessibility Standards in effect at the time the building permit is issued shall suffice to satisfy the requirement that stations be readily accessible to and usable by persons with disabilities as required under section 12162(e) of this title, except that, if such final regulations have not been issued one year after the Architectural and Transportation Barriers Compliance Board has issued the supplemental minimum guidelines required under section 12204(a) of this title, compliance with such supplemental minimum guidelines shall be necessary to satisfy the requirement that stations be readily accessible to and usable by persons with disabilities prior to issuance of the final regulations.

(b) Rail passenger cars

If final regulations have not been issued pursuant to section 12164 of this title, a person shall be considered to have complied with the requirements of section 12162(a) through (d) of this title that a rail passenger car be readily accessible to and usable by individuals with disabilities, if the design for such car complies with the laws and regulations (including the Minimum Guidelines and Requirements for Accessible Design and such supplemental minimum guidelines as are issued under section 12204(a) of this title) governing accessibility of such cars, to the extent that such laws and regulations are not inconsistent with this subpart and are in effect at the time such design is substantially completed.

Subchapter III - Public Accommodations and Services by Private Entities [Title III]

Sec. 12181. Definitions

As used in this subchapter:

(1) Commerce

The term "commerce" means travel, trade, traffic, commerce, transportation, or communication-

(A) among the several States;

(B) between any foreign country or any territory or possession and any State; or

(C) between points in the same State but through another State or foreign country.

(2) Commercial facilities

The term "commercial facilities" means facilities-

(A) that are intended for nonresidential use; and

(B) whose operations will affect commerce.

Such term shall not include railroad locomotives, railroad freight cars, railroad cabooses, railroad cars described in section 12162 of this title or covered under this subchapter, railroad rights-of-way, or facilities that are covered or expressly exempted from coverage under the Fair Housing Act of 1968 (42 U.S.C. 3601 et seq.).

(3) Demand responsive system

The term "demand responsive system" means any system of providing transportation of individuals by a vehicle, other than a system which is a fixed route system.

(4) Fixed route system

The term "fixed route system" means a system of providing transportation of individuals (other than by aircraft) on which a vehicle is operated along a prescribed route according to a fixed schedule.

(5) Over-the-road bus

The term "over-the-road bus" means a bus characterized by an elevated passenger deck located over a baggage compartment.

(6) Private entity

The term "private entity" means any entity other than a public entity (as defined in section 12131(1) of this title).

(7) Public accommodation

The following private entities are considered public accommodations for purposes of this subchapter, if the operations of such entities affect commerce

(A) an inn, hotel, motel, or other place of lodging, except for an establishment located within a building that contains not more than five rooms for rent or hire and that is actually occupied by the proprietor of such establishment as the residence of such proprietor;

(B) a restaurant, bar, or other establishment serving food or drink;

(C) a motion picture house, theater, concert hall, stadium, or other place of exhibition entertainment;

(D) an auditorium, convention center, lecture hall, or other place of public gathering;

(E) a bakery, grocery store, clothing store, hardware store, shopping center, or other sales or rental establishment;

(F) a laundromat, dry-cleaner, bank, barber shop, beauty shop, travel service, shoe repair service, funeral parlor, gas station, office of an accountant or lawyer, pharmacy, insurance office, professional office of a health care provider, hospital, or other service establishment;

(G) a terminal, depot, or other station used for specified public transportation;

(H) a museum, library, gallery, or other place of public display or collection;

(I) a park, zoo, amusement park, or other place of recreation;

(J) a nursery, elementary, secondary, undergraduate, or postgraduate private school, or other place of education;

(K) a day care center, senior citizen center, homeless shelter, food bank, adoption agency, or other social service center establishment; and

(L) a gymnasium, health spa, bowling alley, golf course, or other place of exercise or recreation.

(8) Rail and railroad

The terms "rail" and "railroad" have the meaning given the term "railroad" in section 20102[1] of title 49.

(9) Readily achievable

The term "readily achievable" means easily accomplishable and able to be carried out without much difficulty or expense. In determining whether an action is readily achievable, factors to be considered include

(A) the nature and cost of the action needed under this chapter;

(B) the overall financial resources of the facility or facilities involved in the action; the number of persons employed at such facility; the effect on expenses and resources, or the impact otherwise of such action upon the operation of the facility;

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

(D) the type of operation or operations of the covered entity, including the composition, structure, and functions of the workforce of such entity; the geographic separateness, administrative or fiscal relationship of the facility or facilities in question to the covered entity.

(10) Specified public transportation

The term "specified public transportation" means transportation by bus, rail, or any other conveyance (other than by aircraft) that provides the general public with general or special service (including charter service) on a regular and continuing basis.

(11) Vehicle

The term "vehicle" does not include a rail passenger car, railroad locomotive, railroad freight car, railroad caboose, or a railroad car described in section 12162 of this title or covered under this subchapter.

Sec. 12182. Prohibition of discrimination by public accommodations

(a) General rule

No individual shall be discriminated against on the basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of any place of public accommodation by any person who owns, leases (or leases to), or operates a place of public accommodation.

(b) Construction

(1) General prohibition

(A) Activities

(i) Denial of participation

It shall be discriminatory to subject an individual or class of individuals on the basis of a disability or disabilities of such individual or class, directly, or through contractual, licensing, or other arrangements, to a denial of the opportunity of the individual or class to participate in or benefit from the goods, services, facilities, privileges, advantages, or accommodations of an entity.

(ii) Participation in unequal benefit

It shall be discriminatory to afford an individual or class of individuals, on the basis of a disability or disabilities of such individual or class, directly, or through contractual, licensing, or other arrangements with the opportunity to participate in or benefit from a good, service, facility, privilege, advantage, or accommodation that is not equal to that afforded to other individuals.

(iii) Separate benefit

It shall be discriminatory to provide an individual or class of individuals, on the basis of a disability or disabilities of such individual or class, directly, or through contractual, licensing, or other arrangements with a good, service, facility, privilege, advantage, or accommodation that is different or separate from that provided to other individuals, unless such action is necessary to provide the individual or class of individuals with a good, service, facility, privilege, advantage, or accommodation, or other opportunity that is as effective as that provided to others.

(iv) Individual or class of individuals

For purposes of clauses (i) through (iii) of this subparagraph, the term "individual or class of individuals" refers to the clients or customers of the covered public accommodation that enters into the contractual, licensing or other arrangement.

(B) Integrated settings

Goods, services, facilities, privileges, advantages, and accommodations shall be afforded to an individual with a disability in the most integrated setting appropriate to the needs of the individual.

(C) Opportunity to participate

Notwithstanding the existence of separate or different programs or activities provided in accordance with this section, an individual with a disability shall not be denied the opportunity to participate in such programs or activities that are not separate or different.

(D) Administrative methods

An individual or entity shall not, directly or through contractual or other arrangements, utilize standards or criteria or methods of administration

(i) that have the effect of discriminating on the basis of disability; or

(ii) that perpetuate the discrimination of others who are subject to common administrative control.

(E) Association

It shall be discriminatory to exclude or otherwise deny equal goods, services, facilities, privileges, advantages, accommodations, or other opportunities to an individual or entity because of the known disability of an individual with whom the individual or entity is known to have a relationship or association.

(2) Specific prohibitions

(A) Discrimination

For purposes of subsection (a) of this section, discrimination includes

(i) the imposition or application of eligibility criteria that screen out or tend to screen out an individual with a disability or any class of individuals with disabilities from fully and equally enjoying any goods, services, facilities, privileges, advantages, or accommodations, unless such criteria can be shown to be necessary for the provision of the goods, services, facilities, privileges, advantages, or accommodations being offered;

(ii) a failure to make reasonable modifications in policies, practices, or procedures, when such modifications are necessary to afford such goods, services, facilities, privileges, advantages, or accommodations to individuals with disabilities, unless the entity can demonstrate that making such modifications would fundamentally alter the nature of such goods, services, facilities, privileges, advantages, or accommodations;

(iii) a failure to take such steps as may be necessary to ensure that no individual with a disability is excluded, denied services, segregated or otherwise treated differently than other individuals because of the absence of auxiliary aids and services, unless the entity can demonstrate that taking such steps would fundamentally alter the nature of the good, service, facility, privilege, advantage, or accommodation being offered or would result in an undue burden;

(iv) a failure to remove architectural barriers, and communication barriers that are structural in nature, in existing facilities, and transportation barriers in existing vehicles and rail passenger cars used by an establishment for transporting individuals (not including barriers that can only be removed through the retrofitting of vehicles or rail passenger cars by the installation of a hydraulic or other lift), where such removal is readily achievable; and

(v) where an entity can demonstrate that the removal of a barrier under clause (iv) is not readily achievable, a failure to make such goods, services, facilities, privileges, advantages, or accommodations available through alternative methods if such methods are readily achievable.

(B) Fixed route system

(i) Accessibility

It shall be considered discrimination for a private entity which operates a fixed route system and which is not subject to section 12184 of this title to purchase or lease a vehicle with a seating capacity in excess of 16 passengers (including the driver) for use on such system, for which a solicitation is made after the 30th day following the effective date of this subparagraph, that is not readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs.

(ii) Equivalent service

If a private entity which operates a fixed route system and which is not subject to section 12184 of this title purchases or leases a vehicle with a seating capacity of 16 passengers or less (including the driver) for use on such system after the effective date of this subparagraph that is not readily accessible to or usable by individuals with disabilities, it shall be considered discrimination for such entity to fail to operate such system so that, when viewed in its entirety, such system ensures a level of service to individuals with disabilities, including individuals who use wheelchairs, equivalent to the level of service provided to individuals without disabilities.

(C) Demand responsive system

For purposes of subsection (a) of this section, discrimination includes

(i) a failure of a private entity which operates a demand responsive system and which is not subject to section 12184 of this title to operate such system so that, when viewed in its entirety, such system ensures a level of service to individuals with disabilities, including individuals who use wheelchairs, equivalent to the level of service provided to individuals without disabilities; and

(ii) the purchase or lease by such entity for use on such system of a vehicle with a seating capacity in excess of 16 passengers (including the driver), for which solicitations are made after the 30th day following the effective date of this subparagraph, that is not readily accessible to and usable by individuals with disabilities (including individuals who use wheelchairs) unless such entity can demonstrate that such system, when viewed in its entirety, provides a level of service to individuals with disabilities equivalent to that provided to individuals without disabilities.

(D) Over-the-road buses

(i) Limitation on applicability

Subparagraphs (B) and (C) do not apply to over-the-road buses.

(ii) Accessibility requirements

For purposes of subsection (a) of this section, discrimination includes

(I) the purchase or lease of an over-the-road bus which does not comply with the regulations issued under section 12186(a)(2) of this title by a private entity which provides transportation of individuals and which is not primarily engaged in the business of transporting people, and

(II) any other failure of such entity to comply with such regulations.

(3) Specific construction

Nothing in this subchapter shall require an entity to permit an individual to participate in or benefit from the goods, services, facilities, privileges, advantages and accommodations of such entity where such individual poses a direct threat to the health or safety of others. The term "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.

Sec. 12183. New construction and alterations in public accommodations and commercial facilities

(a) Application of term

Except as provided in subsection (b) of this section, as applied to public accommodations and commercial facilities, discrimination for purposes of section 12182(a) of this title includes

(1) a failure to design and construct facilities for first occupancy later than 30 months after July 26, 1990, that are readily accessible to and usable by individuals with disabilities, except where an entity can demonstrate that it is structurally impracticable to meet the requirements of such subsection in accordance with standards set forth or incorporated by reference in regulations issued under this subchapter; and

(2) with respect to a facility or part thereof that is altered by, on behalf of, or for the use of an establishment in a manner that affects or could affect the usability of the facility or part thereof, a failure to make alterations in such a manner that, to the maximum extent feasible, the altered portions of the facility are readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs. Where the entity is undertaking an alteration that affects or could affect usability of or access to an area of the facility containing a primary function, the entity shall also make the alterations in such a manner that, to the maximum extent feasible, the path of travel to the altered area and the bathrooms, telephones, and drinking fountains serving the altered area, are readily accessible to and usable by individuals with disabilities where such alterations to the path of travel or the bathrooms, telephones, and drinking fountains serving the altered area are not disproportionate to the overall alterations in terms of cost and scope (as determined under criteria established by the Attorney General).

(b) Elevator

Subsection (a) shall not be construed to require the installation of an elevator for facilities that are less than three stories or have less than 3,000 square feet per story unless the building is a shopping center, a shopping mall, or the professional office of a health care provider or unless the Attorney General determines that a particular category of such facilities requires the installation of elevators based on the usage of such facilities.

Sec. 12184. Prohibition of discrimination in specified public transportation services provided by private entities

(a) General rule

No individual shall be discriminated against on the basis of disability in the full and equal enjoyment of specified public transportation services provided by a private entity that is primarily engaged in the business of transporting people and whose operations affect commerce.

(b) Construction

For purposes of subsection (a) of this section, discrimination includes

(1) the imposition or application by an entity described in subsection (a) of eligibility criteria that screen out or tend to screen out an individual with a disability or any class of individuals with disabilities from fully enjoying the specified public transportation services provided by the entity, unless such criteria can be shown to be necessary for the provision of the services being offered;

(2) the failure of such entity to

(A) make reasonable modifications consistent with those required under section 12182(b)(2)(A)(ii) of this title;

(B) provide auxiliary aids and services consistent with the requirements of section 12182(b)(2)(A)(iii) of this title; and

(C) remove barriers consistent with the requirements of section 12182(b)(2)(A) of this title and with the requirements of section 12183(a)(2) of this title;

(3) the purchase or lease by such entity of a new vehicle (other than an automobile, a van with a seating capacity of less than 8 passengers, including the driver, or an over- the-road bus) which is to be used to provide specified public transportation and for which a solicitation is made after the 30th day following the effective date of this section, that is not readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs; except that the new vehicle need not be readily accessible to and usable by such individuals if the new vehicle is to be used solely in a demand responsive system and if the entity can demonstrate that such system, when viewed in its entirety, provides a level of service to such individuals equivalent to the level of service provided to the general public;

(4)

(A) the purchase or lease by such entity of an over-the-road bus which does not comply with the regulations issued under section 12186(a)(2) of this title; and

(B) any other failure of such entity to comply with such regulations; and

(5) the purchase or lease by such entity of a new van with a seating capacity of less than 8 passengers, including the driver, which is to be used to provide specified public transportation and for which a solicitation is made after the 30th day following the effective date of this section that is not readily accessible to or usable by individuals with disabilities, including individuals who use wheelchairs; except that the new van need not be readily accessible to and usable by such individuals if the entity can demonstrate that the system for which the van is being purchased or leased, when viewed in its entirety, provides a level of service to such individuals equivalent to the level of service provided to the general public;

(6) the purchase or lease by such entity of a new rail passenger car that is to be used to provide specified public transportation, and for which a solicitation is made later than 30 days after the effective date of this paragraph, that is not readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs; and

(7) the remanufacture by such entity of a rail passenger car that is to be used to provide specified public transportation so as to extend its usable life for 10 years or more, or the purchase or lease by such entity of such a rail car, unless the rail car, to the maximum extent feasible, is made readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs.

(c) Historical or antiquated cars

(1) Exception

To the extent that compliance with subsection (a)(2)(C) or (b)(7) of this section would significantly alter the historic or antiquated character of a historical or antiquated rail passenger car, or a rail station served exclusively by such cars, or would result in violation of any rule, regulation, standard, or order issued by the Secretary of Transportation under the Federal Railroad Safety Act of 1970, such compliance shall not be required.

(2) Definition

As used in this subsection, the term "historical or antiquated rail passenger car" means a rail passenger car-

(A) which is not less than 30 years old at the time of its use for transporting individuals;

(B) the manufacturer of which is no longer in the business of manufacturing rail passenger cars; and

(C) which-

(i) has a consequential association with events or persons significant to the past; or

(ii) embodies, or is being restored to embody, the distinctive characteristics of a type of rail passenger car used in the past, or to represent a time period which has passed.

Sec. 12185. Study

(a) Purposes

The Office of Technology Assessment shall undertake a study to determine

(1) the access needs of individuals with disabilities to over-the-road buses and over-the- road bus service; and

(2) the most cost-effective methods for providing access to over-the-road buses and over-the-road bus service to individuals with disabilities, particularly individuals who use wheelchairs, through all forms of boarding options.

(b) Contents

The study shall include, at a minimum, an analysis of the following:

(1) The anticipated demand by individuals with disabilities for accessible over-the-road buses and over-the-road bus service.

(2) The degree to which such buses and service, including any service required under sections 12184(a)(4) and 12186(a)(2) of this title, are readily accessible to and usable by individuals with disabilities.

(3) The effectiveness of various methods of providing accessibility to such buses and service to individuals with disabilities.

(4) The cost of providing accessible over-the-road buses and bus service to individuals with disabilities, including consideration of recent technological and cost saving developments in equipment and devices.

(5) Possible design changes in over-the-road buses that could enhance accessibility, including the installation of accessible restrooms which do not result in a loss of seating capacity.

(6) The impact of accessibility requirements on the continuation of over-the-road bus service, with particular consideration of the impact of such requirements on such service to rural communities.

(c) Advisory committee

In conducting the study required by subsection (a) of this section, the Office of Technology Assessment shall establish an advisory committee, which shall consist of

(1) members selected from among private operators and manufacturers of over-the-road buses;

(2) members selected from among individuals with disabilities, particularly individuals who use wheelchairs, who are potential riders of such buses; and

(3) members selected for their technical expertise on issues included in the study, including manufacturers of boarding assistance equipment and devices.

The number of members selected under each of paragraphs (1) and (2) shall be equal, and the total number of members selected under paragraphs (1) and (2) shall exceed the number of members selected under paragraph (3).

(d) Deadline

The study required by subsection (a) of this section, along with recommendations by the Office of Technology Assessment, including any policy options for legislative action, shall be submitted to the President and Congress within 36 months after July 26, 1990. If the President determines that compliance with the regulations issued pursuant to section 12186(a)(2)(B) of this title on or before the applicable deadlines specified in section 12186(a)(2)(B) of this title will result in a significant reduction in intercity over-the-road bus service, the President shall extend each such deadline by 1 year.

(e) Review

In developing the study required by subsection (a) of this section, the Office of Technology Assessment shall provide a preliminary draft of such study to the Architectural and Transportation Barriers Compliance Board established under section 792 of title 29. The Board shall have an opportunity to comment on such draft study, and any such comments by the Board made in writing within 120 days after the Board's receipt of the draft study shall be incorporated as part of the final study required to be submitted under subsection (d).

Sec. 12186. Regulations

(a) Transportation provisions

(1) General rule

Not later than 1 year after July 26, 1990, the Secretary of Transportation shall issue regulations in an accessible format to carry out section 12182(b)(2)(B) and (C) of this title and to carry out section 12184 of this title (other than subsection (a)(4)).

(2) Special rules for providing access to over-the-road buses

(A) Interim requirements

(i) Issuance

Not later than 1 year after July 26, 1990, the Secretary of Transportation shall issue regulations in an accessible format to carry out sections 12184(b)(4) and 12182(b)(2)(D)(ii) of this title that require each private entity which uses an over-the-road bus to provide transportation of individuals to provide accessibility to such bus; except that such regulations shall not require any structural changes in over-the-road buses in order to provide access to individuals who use wheelchairs during the effective period of such regulations and shall not require the purchase of boarding assistance devices to provide access to such individuals.

(ii) Effective period

The regulations issued pursuant to this subparagraph shall be effective until the effective date of the regulations issued under subparagraph (a).

(B) Final requirement

(i) Review of study and interim requirements

The Secretary shall review the study submitted under section 12185 of this title and the regulations issued pursuant to subparagraph (A).

(ii) Issuance

Not later than 1 year after the date of the submission of the study under section 12185 of this title, the Secretary shall issue in an accessible format new regulations to carry out sections 12184(b)(4) and 12182(b)(2)(D)(ii) of this title that require, taking into account the purposes of the study under section 12185 of this title and any recommendations resulting from such study, each private entity which uses an over-the-road bus to provide transportation to individuals to provide accessibility to such bus to individuals with disabilities, including individuals who use wheelchairs.

(iii) Effective period

Subject to section 12185(d) of this title, the regulations issued pursuant to this subparagraph shall take effect

(I) with respect to small providers of transportation (as defined by the Secretary), 3 years after the date of issuance of final regulations under clause (ii); and

(II) with respect to other providers of transportation, 2 years after the date of issuance of such final regulations.

(C) Limitation on requiring installation of accessible restrooms

The regulations issued pursuant to this paragraph shall not require the installation of accessible restrooms in over-the-road buses if such installation would result in a loss of seating capacity.

(3) Standards

The regulations issued pursuant to this subsection shall include standards applicable to facilities and vehicles covered by sections 12182(b) (2) and 12184 of this title.

(b) Other provisions

Not later than 1 year after July 26, 1990, the Attorney General shall issue regulations in an accessible format to carry out the provisions of this subchapter not referred to in subsection (a) of this section that include standards applicable to facilities and vehicles covered under section 12182 of this title.

(c) Consistency with ATBCB guidelines

Standards included in regulations issued under subsections (a) and (b) of this section shall be consistent with the minimum guidelines and requirements issued by the Architectural and Transportation Barriers Compliance Board in accordance with section 12204 of this title.

(d) Interim accessibility standards

(1) Facilities

If final regulations have not been issued pursuant to this section, for new construction or alterations for which a valid and appropriate State or local building permit is obtained prior to the issuance of final regulations under this section, and for which the construction or alteration authorized by such permit begins within one year of the receipt of such permit and is completed under the terms of such permit, compliance with the Uniform Federal Accessibility Standards in effect at the time the building permit is issued shall suffice to satisfy the requirement that facilities be readily accessible to and usable by persons with disabilities as required under section 12183 of this title, except that, if such final regulations have not been issued one year after the Architectural and Transportation Barriers Compliance Board has issued the supplemental minimum guidelines required under section 12204(a) of this title, compliance with such supplemental minimum guidelines shall be necessary to satisfy the requirement that facilities be readily accessible to and usable by persons with disabilities prior to issuance of the final regulations.

(2) Vehicles and rail passenger cars

If final regulations have not been issued pursuant to this section, a private entity shall be considered to have complied with the requirements of this subchapter, if any, that a vehicle or rail passenger car be readily accessible to and usable by individuals with disabilities, if the design for such vehicle or car complies with the laws and regulations (including the Minimum Guidelines and Requirements for Accessible Design and such supplemental minimum guidelines as are issued under section 12204(a) of this title) governing accessibility of such vehicles or cars, to the extent that such laws and regulations are not inconsistent with this subchapter and are in effect at the time such design is substantially completed.

Sec. 12187. Exemptions for private clubs and religious organizations

The provisions of this subchapter shall not apply to private clubs or establishments exempted from coverage under title II of the Civil Rights Act of 1964 (42 U.S.C. 2000-a(e)) or to religious organizations or entities controlled by religious organizations, including places of worship.

Sec. 12188. Enforcement

(a) In general

(1) Availability of remedies and procedures

The remedies and procedures set forth in section 2000a-3(a) of this title are the remedies and procedures this subchapter provides to any person who is being subjected to discrimination on the basis of disability in violation of this subchapter or who has reasonable grounds for believing that such person is about to be subjected to discrimination in violation of section 12183 of this title. Nothing in this section shall require a person with a disability to engage in a futile gesture if such person has actual notice that a person or organization covered by this subchapter does not intend to comply with its provisions.

(2) Injunctive relief

In the case of violations of sections 12182(b)(2)(A)(iv) and Section 12183(a) of this title, injunctive relief shall include an order to alter facilities to make such facilities readily accessible to and usable by individuals with disabilities to the extent required by this subchapter. Where appropriate, injunctive relief shall also include requiring the provision of an auxiliary aid or service, modification of a policy, or provision of alternative methods, to the extent required by this subchapter.

(b) Enforcement by Attorney General

(1) Denial of rights

(A) Duty to investigate

(i) In general

The Attorney General shall investigate alleged violations of this subchapter, and shall undertake periodic reviews of compliance of covered entities under this subchapter.

(ii) Attorney General certification

On the application of a State or local government, the Attorney General may, in consultation with the Architectural and Transportation Barriers Compliance Board, and after prior notice and a public hearing at which persons, including individuals with disabilities, are provided an opportunity to testify against such certification, certify that a State law or local building code or similar ordinance that establishes accessibility requirements meets or exceeds the minimum requirements of this chapter for the accessibility and usability of covered facilities under this subchapter. At any enforcement proceeding under this section, such certification by the Attorney General shall be rebuttable evidence that such State law or local ordinance does meet or exceed the minimum requirements of this chapter.

(B) Potential violation

If the Attorney General has reasonable cause to believe that

(i) any person or group of persons is engaged in a pattern or practice of discrimination under this subchapter; or

(ii) any person or group of persons has been discriminated against under this subchapter and such discrimination raises an issue of general public importance, the Attorney General may commence a civil action in any appropriate United States district court.

(2) Authority of court

In a civil action under paragraph (1) (B), the court-

(A) may grant any equitable relief that such court considers to be appropriate, including, to the extent required by this subchapter-

(i) granting temporary, preliminary, or permanent relief;

(ii) providing an auxiliary aid or service, modification of policy, practice, or procedure, or alternative method; and

(iii) making facilities readily accessible to and usable by individuals with disabilities;

(B) may award such other relief as the court considers to be appropriate, including monetary damages to persons aggrieved when requested by the Attorney General; and

(C) may, to vindicate the public interest, assess a civil penalty against the entity in an amount [*]

(i) not exceeding $50,000 for a first violation; and

(ii) not exceeding $100,000 for any subsequent violation.

[*Agency Note: Please see the Department's title III regulation at 28 CFR 36.504(a)(3) for the most recent civil monetary penalty amounts, which are periodically adjusted in accordance with the Federal Civil Penalties Inflation Adjustment Act of 1990, Public Law 101-410, 28 USC 2461 note, as amended.]

(3) Single violation

For purposes of paragraph (2) (C), in determining whether a first or subsequent violation has occurred, a determination in a single action, by judgment or settlement, that the covered entity has engaged in more than one discriminatory act shall be counted as a single violation.

(4) Punitive damages

For purposes of subsection (b) (2) (B) of this section, the term "monetary damages" and "such other relief" does not include punitive damages.

(5) Judicial consideration

In a civil action under paragraph (1)(B), the court, when considering what amount of civil penalty, if any, is appropriate, shall give consideration to any good faith effort or attempt to comply with this chapter by the entity. In evaluating good faith, the court shall consider, among other factors it deems relevant, whether the entity could have reasonably anticipated the need for an appropriate type of auxiliary aid needed to accommodate the unique needs of a particular individual with a disability.

Sec. 12189. Examinations and courses

Any person that offers examinations or courses related to applications, licensing, certification, or credentialing for secondary or postsecondary education, professional, or trade purposes shall offer such examinations or courses in a place and manner accessible to persons with disabilities or offer alternative accessible arrangements for such individuals.

Subchapter IV - Miscellaneous Provisions [Title V]

Sec. 12201. Construction

(a) In general

Except as otherwise provided in this chapter, nothing in this chapter shall be construed to apply a lesser standard than the standards applied under title V of the Rehabilitation Act of 1973 (29 U.S.C. 790 et seq.) or the regulations issued by Federal agencies pursuant to such title.

(b) Relationship to other laws

Nothing in this chapter shall be construed to invalidate or limit the remedies, rights, and procedures of any Federal law or law of any State or political subdivision of any State or jurisdiction that provides greater or equal protection for the rights of individuals with disabilities than are afforded by this chapter. Nothing in this chapter shall be construed to preclude the prohibition of, or the imposition of restrictions on, smoking in places of employment covered by subchapter I of this chapter, in transportation covered by subchapter II or III of this chapter, or in places of public accommodation covered by subchapter III.

(c) Insurance

Subchapters I through III of this chapter and title IV of this Act shall not be construed to prohibit or restrict-

(1) an insurer, hospital or medical service company, health maintenance organization, or any agent, or entity that administers benefit plans, or similar organizations from underwriting risks, classifying risks, or administering such risks that are based on or not inconsistent with State law; or

(2) a person or organization covered by this chapter from establishing, sponsoring, observing or administering the terms of a bona fide benefit plan that are based on underwriting risks, classifying risks, or administering such risks that are based on or not inconsistent with State law; or

(3) a person or organization covered by this chapter from establishing, sponsoring, observing or administering the terms of a bona fide benefit plan that is not subject to State laws that regulate insurance.

Paragraphs (1), (2), and (3) shall not be used as a subterfuge to evade the purposes of subchapter I and III.

(d) Accommodations and services

Nothing in this chapter shall be construed to require an individual with a disability to accept an accommodation, aid, service, opportunity, or benefit which such individual chooses not to accept.

(e) Benefits under State worker's compensation laws

Nothing in this chapter alters the standards for determining eligibility for benefits under State worker's compensation laws or under State and Federal disability benefit programs.

(f) Fundamental alteration

Nothing in this chapter alters the provision of section 12182(b)(2)(A)(ii), specifying that reasonable modifications in policies, practices, or procedures shall be required, unless an entity can demonstrate that making such modifications in policies, practices, or procedures, including academic requirements in postsecondary education, would fundamentally alter the nature of the goods, services, facilities, privileges, advantages, or accommodations involved.

(g) Claims of no disability

Nothing in this chapter shall provide the basis for a claim by an individual without a disability that the individual was subject to discrimination because of the individual's lack of disability.

(h) Reasonable accommodations and modifications

A covered entity under subchapter I, a public entity under subchapter II, and any person who owns, leases (or leases to), or operates a place of public accommodation under subchapter III, need not provide a reasonable accommodation or a reasonable modification to policies, practices, or procedures to an individual who meets the definition of disability in section 12102(1) solely under subparagraph (C) of such section.

Sec. 12202. State immunity

A State shall not be immune under the eleventh amendment to the Constitution of the United States from an action in Federal or State court of competent jurisdiction for a violation of this chapter. In any action against a State for a violation of the requirements of this chapter, remedies (including remedies both at law and in equity) are available for such a violation to the same extent as such remedies are available for such a violation in an action against any public or private entity other than a State.

Sec. 12203. Prohibition against retaliation and coercion

(a) Retaliation

No person shall discriminate against any individual because such individual has opposed any act or practice made unlawful by this chapter or because such individual made a charge, testified, assisted, or participated in any manner in an investigation, proceeding, or hearing under this chapter.

(b) Interference, coercion, or intimidation

It shall be unlawful to coerce, intimidate, threaten, or interfere with any individual in the exercise or enjoyment of, or on account of his or her having exercised or enjoyed, or on account of his or her having aided or encouraged any other individual in the exercise or enjoyment of, any right granted or protected by this chapter.

(c) Remedies and procedures

The remedies and procedures available under sections 12117, 12133, and 12188 of this title shall be available to aggrieved persons for violations of subsections (a) and (b), with respect to subchapter I, subchapter II and subchapter III of this chapter, respectively.

Sec. 12204. Regulations by Architectural and Transportation Barriers Compliance Board

(a) Issuance of guidelines

Not later than 9 months after July 26, 1990, the Architectural and Transportation Barriers Compliance Board shall issue minimum guidelines that shall supplement the existing Minimum Guidelines and Requirements for Accessible Design for purposes of subchapters II and III of this chapter.

(b) Contents of guidelines

The supplemental guidelines issued under subsection (a) of this section shall establish additional requirements, consistent with this chapter, to ensure that buildings, facilities, rail passenger cars, and vehicles are accessible, in terms of architecture and design, transportation, and communication, to individuals with disabilities.

(c) Qualified historic properties

(1) In general

The supplemental guidelines issued under subsection (a) of this section shall include procedures and requirements for alterations that will threaten or destroy the historic significance of qualified historic buildings and facilities as defined in 4.1.7(1)(a) of the Uniform Federal Accessibility Standards.

(2) Sites eligible for listing in National Register

With respect to alterations of buildings or facilities that are eligible for listing in the National Register of Historic Places under the National Historic Preservation Act (16 U.S.C. 470 et seq.), the guidelines described in paragraph (1) shall, at a minimum, maintain the procedures and requirements established in 4.1.7(1) and (2) of the Uniform Federal Accessibility Standards.

(3) Other sites

With respect to alterations of buildings or facilities designated as historic under State or local law, the guidelines described in paragraph (1) shall establish procedures equivalent to those established by 4.1.7(1)(b) and (c) of the Uniform Federal Accessibility Standards, and shall require, at a minimum, compliance with the requirements established in 4.1.7(2) of such standards.

Sec. 12205. Attorney's fees

In any action or administrative proceeding commenced pursuant to this chapter, the court or agency, in its discretion, may allow the prevailing party, other than the United States, a reasonable attorney's fee, including litigation expenses, and costs, and the United States shall be liable for the foregoing the same as a private individual.

Sec. 12205a. Rule of Construction Regarding Regulatory Authority

The authority to issue regulations granted to the Equal Employment Opportunity Commission, the Attorney General, and the Secretary of Transportation under this chapter includes the authority to issue regulations implementing the definitions of disability in section 12102 of this title (including rules of construction) and the definitions in section 12103 of this title, consistent with the ADA Amendments Act of 2008.

Sec. 12206. Technical assistance

(a) Plan for assistance

(1) In general

Not later than 180 days after July 26, 1990, the Attorney General, in consultation with the Chair of the Equal Employment Opportunity Commission, the Secretary of Transportation, the Chair of the Architectural and Transportation Barriers Compliance Board, and the Chairman of the Federal Communications Commission, shall develop a plan to assist entities covered under this chapter, and other Federal agencies, in understanding the responsibility of such entities and agencies under this chapter.

(2) Publication of plan

The Attorney General shall publish the plan referred to in paragraph (1) for public comment in accordance with subchapter II of chapter 5 of title 5 (commonly known as the Administrative Procedure Act).

(b) Agency and public assistance

The Attorney General may obtain the assistance of other Federal agencies in carrying out subsection (a), including the National Council on Disability, the President's Committee on Employment of People with Disabilities, the Small Business Administration, and the Department of Commerce.

(c) Implementation

(1) Rendering assistance

Each Federal agency that has responsibility under paragraph (2) for implementing this chapter may render technical assistance to individuals and institutions that have rights or duties under the respective subchapter or subchapters of this chapter for which such agency has responsibility.

(2) Implementation of subchapters

(A) Subchapter I

The Equal Employment Opportunity Commission and the Attorney General shall implement the plan for assistance developed under subsection (a) of this section, for subchapter I.

(B) Subchapter II

(i) Part A

The Attorney General shall implement such plan for assistance for part A of subchapter II.

(ii) Part B

The Secretary of Transportation shall implement such plan for assistance for part B of subchapter II.

(C) Subchapter III

The Attorney General, in coordination with the Secretary of Transportation and the Chair of the Architectural Transportation Barriers Compliance Board, shall implement such plan for assistance for subchapter III of this chapter, except for section 12184 of this title, the plan for assistance for which shall be implemented by the Secretary of Transportation.

(D) Title IV

The Chairman of the Federal Communications Commission, in coordination with the Attorney General, shall implement such plan for assistance for title IV.

(3) Technical assistance manuals

Each Federal agency that has responsibility under paragraph (2) for implementing this chapter shall, as part of its implementation responsibilities, ensure the availability and provision of appropriate technical assistance manuals to individuals or entities with rights or duties under this chapter no later than six months after applicable final regulations are published under subchapters I, II, and III and title IV.

(d) Grants and contracts

(1) In general

Each Federal agency that has responsibility under subsection (c) (2) of this section for implementing this chapter may make grants or award contracts to effectuate the purposes of this section, subject to the availability of appropriations. Such grants and contracts may be awarded to individuals, institutions not organized for profit and no part of the net earnings of which inures to the benefit of any private shareholder or individual (including educational institutions), and associations representing individuals who have rights or duties under this chapter. Contracts may be awarded to entities organized for profit, but such entities may not be the recipients or grants described in this paragraph.

(2) Dissemination of information

Such grants and contracts, among other uses, may be designed to ensure wide dissemination of information about the rights and duties established by this chapter and to provide information and technical assistance about techniques for effective compliance with this chapter.

(e) Failure to receive assistance

An employer, public accommodation, or other entity covered under this chapter shall not be excused from compliance with the requirements of this chapter because of any failure to receive technical assistance under this section, including any failure in the development or dissemination of any technical assistance manual authorized by this section.

Sec. 12207. Federal wilderness areas

(a) Study

The National Council on Disability shall conduct a study and report on the effect that wilderness designations and wilderness land management practices have on the ability of individuals with disabilities to use and enjoy the National Wilderness Preservation System as established under the Wilderness Act (16 U.S.C. 1131 et seq.).

(b) Submission of report

Not later than 1 year after July 26, 1990, the National Council on Disability shall submit the report required under subsection (a) of this section to Congress.

(c) Specific wilderness access

(1) In general

Congress reaffirms that nothing in the Wilderness Act (16 U.S.C. 1131 et seq.) is to be construed as prohibiting the use of a wheelchair in a wilderness area by an individual whose disability requires use of a wheelchair, and consistent with the Wilderness Act no agency is required to provide any form of special treatment or accommodation, or to construct any facilities or modify any conditions of lands within a wilderness area in order to facilitate such use.

(2) "Wheelchair" defined

For purposes of paragraph (1), the term "wheelchair" means a device designed solely for use by a mobility-impaired person for locomotion, that is suitable for use in an indoor pedestrian area.

Sec. 12208. Transvestites

For the purposes of this chapter, the term "disabled" or "disability" shall not apply to an individual solely because that individual is a transvestite.

Sec. 12209. Instrumentalities of Congress

The Government Accountability Office, the Government Publishing Office, and the Library of Congress shall be covered as follows:

(1) In general

The rights and protections under this chapter shall, subject to paragraph (2), apply with respect to the conduct of each instrumentality of the Congress.

(2) Establishment of remedies and procedures by instrumentalities

The chief official of each instrumentality of the Congress shall establish remedies and procedures to be utilized with respect to the rights and protections provided pursuant to paragraph (1).

(3) Report to Congress

The chief official of each instrumentality of the Congress shall, after establishing remedies and procedures for purposes of paragraph (2), submit to the Congress a report describing the remedies and procedures.

(4) Definition of instrumentalities

For purposes of this section, the term "instrumentality of the Congress" means the following: the General Accounting Office, the Government Printing Office, and the Library of Congress.

(5) Enforcement of employment rights

The remedies and procedures set forth in section 2000e -16 of this title shall be available to any employee of an instrumentality of the Congress who alleges a violation of the rights and protections under sections 12112 through 12114 of this title that are made applicable by this section, except that the authorities of the Equal Employment Opportunity Commission shall be exercised by the chief official of the instrumentality of the Congress.

(6) Enforcement of rights to public services and accommodations

The remedies and procedures set forth in section 2000e -16 of this title shall be available to any qualified person with a disability who is a visitor, guest, or patron of an instrumentality of Congress and who alleges a violation of the rights and protections under sections 12131 through 12150 of this title or section 12182 or 12183 of this title that are made applicable by this section, except that the authorities of the Equal Employment Opportunity Commission shall be exercised by the chief official of the instrumentality of the Congress.

(7) Construction

Nothing in this section shall alter the enforcement procedures for individuals with disabilities provided in the General Accounting Office Personnel Act of 1980 and regulations promulgated pursuant to that Act.

Sec. 12210. Illegal use of drugs

(a) In general

For purposes of this chapter, the term "individual with a disability" does not include an individual who is currently engaging in the illegal use of drugs, when the covered entity acts on the basis of such use.

(b) Rules of construction

Nothing in subsection (a) of this section shall be construed to exclude as an individual with a disability an individual who

(1) has successfully completed a supervised drug rehabilitation program and is no longer engaging in the illegal use of drugs, or has otherwise been rehabilitated successfully and is no longer engaging in such use;

(2) is participating in a supervised rehabilitation program and is no longer engaging in such use; or

(3) is erroneously regarded as engaging in such use, but is not engaging in such use;

except that it shall not be a violation of this chapter for a covered entity to adopt or administer reasonable policies or procedures, including but not limited to drug testing, designed to ensure that an individual described in paragraph (1) or (2) is no longer engaging in the illegal use of drugs; however, nothing in this section shall be construed to encourage, prohibit, restrict, or authorize the conducting of testing for the illegal use of drugs.

(c) Health and other services

Notwithstanding subsection (a) of this section and section 12211(b)(3) of this subchapter, an individual shall not be denied health services, or services provided in connection with drug rehabilitation, on the basis of the current illegal use of drugs if the individual is otherwise entitled to such services.

(d) "Illegal use of drugs" defined

(1) In general

The term "illegal use of drugs" means the use of drugs, the possession or distribution of which is unlawful under the Controlled Substances Act (21 U.S.C. 801 et seq.). Such term does not include the use of a drug taken under supervision by a licensed health care professional, or other uses authorized by the Controlled Substances Act or other provisions of Federal law.

(2) Drugs

The term "drug" means a controlled substance, as defined in schedules I through V of section 202 of the Controlled Substances Act (21 U.S.C. 812).

Sec. 12211. Definitions

(a) Homosexuality and bisexuality

For purposes of the definition of "disability" in section 12102(2) of this title, homosexuality and bisexuality are not impairments and as such are not disabilities under this chapter.

(b) Certain conditions

Under this chapter, the term "disability" shall not include

(1) transvestism, transsexualism, pedophilia, exhibitionism, voyeurism, gender identity disorders not resulting from physical impairments, or other sexual behavior disorders;

(2) compulsive gambling, kleptomania, or pyromania; or

(3) psychoactive substance use disorders resulting from current illegal use of drugs.

Sec. 12212. Alternative means of dispute resolution

Where appropriate and to the extent authorized by law, the use of alternative means of dispute resolution, including settlement negotiations, conciliation, facilitation, mediation, fact-finding, minitrials, and arbitration, is encouraged to resolve disputes arising under this chapter.

Sec. 12213. Severability

Should any provision in this chapter be found to be unconstitutional by a court of law, such provision shall be severed from the remainder of the chapter, and such action shall not affect the enforceability of the remaining provisions of the chapter.

Title 47 - Telegraphs, Telephones, and Radiotelegraphs [Title IV]

Chapter 5 - Wire or Radio Communication

Subchapter II - Common Carriers

Part I - Common Carrier Regulation

Sec. 225. Telecommunications services for hearing-impaired and speech-impaired individuals

(a) Definitions

As used in this section-

(1) Common carrier or carrier

The term "common carrier" or "carrier" includes any common carrier engaged in interstate communication by wire or radio as defined in section 153 of this title and any common carrier engaged in intrastate communication by wire or radio, notwithstanding sections 152(b) and 221(b) of this title.

(2) TDD

The term "TDD" means a Telecommunications Device for the Deaf which is a machine that employs graphic communication in the transmission of coded signals through a wire or radio communication system.

(3) Telecommunications relay services

The term "telecommunications relay services" means telephone transmission services that provide the ability for an individual who is deaf, hard of hearing, deaf-blind, or who has a speech disability to engage in communication by wire or radio with one or more individuals in a manner that is functionally equivalent to the ability of a hearing individual who does not have a speech disability to communicate using voice communication services by wire or radio.

(b) Availability of telecommunications relay service

(1) In general

In order to carry out the purposes established under section 151 of this title, to make available to all individuals in the United States a rapid, efficient nationwide communication service, and to increase the utility of the telephone system of the Nation, the Commission shall ensure that interstate and intrastate telecommunications relay services are available, to the extent possible and in the most efficient manner, to hearing-impaired and speech-impaired individuals in the United States.

(2) Use of general authority and remedies

For the purposes of administering and enforcing the provisions of this section and the regulations prescribed thereunder, the Commission shall have the same authority, power, and functions with respect to common carriers engaged in intrastate communication as the Commission has in administering and enforcing the provisions of this subchapter with respect to any common carrier engaged in interstate communication. Any violation of this section by any common carrier engaged in intrastate communication shall be subject to the same remedies, penalties, and procedures as are applicable to a violation of this chapter by a common carrier engaged in interstate communication.

(c) Provision of services

Each common carrier providing telephone voice transmission services shall, not later than 3 years after July 26, 1990, provide in compliance with the regulations prescribed under this section, throughout the area in which it offers service, telecommunications relay services, individually, through designees, through a competitively selected vendor, or in concert with other carriers. A common carrier shall be considered to be in compliance with such regulations-

(1) with respect to intrastate telecommunications relay services in any State that does not have a certified program under subsection (f) of this section and with respect to interstate telecommunications relay services, if such common carrier (or other entity through which the carrier is providing such relay services) is in compliance with the Commission's regulations under subsection (d) of this section; or

(2) with respect to intrastate telecommunications relay services in any State that has a certified program under subsection (f) of this section for such State, if such common carrier (or other entity through which the carrier is providing such relay services) is in compliance with the program certified under subsection (f) of this section for such State.

(d) Regulations

(1) In general

The Commission shall, not later than 1 year after July 26, 1990, prescribe regulations to implement this section, including regulations that-

(A) establish functional requirements, guidelines, and operations procedures for telecommunications relay services;

(B) establish minimum standards that shall be met in carrying out subsection (c) of this section;

(C) require that telecommunications relay services operate every day for 24 hours per day;

(D) require that users of telecommunications relay services pay rates no greater than the rates paid for functionally equivalent voice communication services with respect to such factors as the duration of the call, the time of day, and the distance from point of origination to point of termination;

(E) prohibit relay operators from failing to fulfill the obligations of common carriers by refusing calls or limiting the length of calls that use telecommunications relay services;

(F) prohibit relay operators from disclosing the content of any relayed conversation and from keeping records of the content of any such conversation beyond the duration of the call; and

(G) prohibit relay operators from intentionally altering a relayed conversation.

(2) Technology

The Commission shall ensure that regulations prescribed to implement this section encourage, consistent with section 157(a) of this title, the use of existing technology and do not discourage or impair the development of improved technology.

(3) Jurisdictional separation of costs

(A) In general

Consistent with the provisions of section 410 of this title, the Commission shall prescribe regulations governing the jurisdictional separation of costs for the services provided pursuant to this section.

(B) Recovering costs

Such regulations shall generally provide that costs caused by interstate telecommunications relay services shall be recovered from all subscribers for every interstate service and costs caused by intrastate telecommunications relay services shall be recovered from the intrastate jurisdiction. In a State that has a certified program under subsection (f), a State commission shall permit a common carrier to recover the costs incurred in providing intrastate telecommunications relay services by a method consistent with the requirements of this section.

(e) Enforcement

(1) In general

Subject to subsections (f) and (g), the Commission shall enforce this section.

(2) Complaint

The Commission shall resolve, by final order, a complaint alleging a violation of this section within 180 days after the date such complaint is filed.

(f) Certification

(1) State documentation

Any State desiring to establish a State program under this section shall submit documentation to the Commission that describes the program of such State for implementing intrastate telecommunications relay services and the procedures and remedies available for enforcing any requirements imposed by the State program.

(2) Requirements for certification

After review of such documentation, the Commission shall certify the State program if the Commission determines that-

(A) the program makes available to hearing-impaired and speech-impaired individuals, either directly, through designees, through a competitively selected vendor, or through regulation of intrastate common carriers, intrastate telecommunications relay services in such State in a manner that meets or exceeds the requirements of regulations prescribed by the Commission under subsection (d); and

(B) the program makes available adequate procedures and remedies for enforcing the requirements of the State program.

(3) Method of funding

Except as provided in subsection (d), the Commission shall not refuse to certify a State program based solely on the method such State will implement for funding intrastate telecommunication relay services.

(4) Suspension or revocation of certification

The Commission may suspend or revoke such certification if, after notice and opportunity for hearing, the Commission determines that such certification is no longer warranted. In a State whose program has been suspended or revoked, the Commission shall take such steps as may be necessary, consistent with this section, to ensure continuity of telecommunications relay services.

(g) Complaint

(1) Referral of complaint

If a complaint to the Commission alleges a violation of this section with respect to intrastate telecommunications relay services within a State and certification of the program of such State under subsection (f) is in effect, the Commission shall refer such complaint to such State.

(2) Jurisdiction of Commission

After referring a complaint to a State under paragraph (1), the Commission shall exercise jurisdiction over such complaint only if

(A) final action under such State program has not been taken on such complaint by such State-

(i) within 180 days after the complaint is filed with such State; or

(ii) within a shorter period as prescribed by the regulations of such State; or

(B) the Commission determines that such State program is no longer qualified for certification under subsection (f).

Subchapter VI - Miscellaneous Provisions

Any television public service announcement that is produced or funded in whole or in part by any agency or instrumentality of Federal Government shall include closed captioning of the verbal content of such announcement. A television broadcast station licensee-

(1) shall not be required to supply closed captioning for any such announcement that fails to include it; and

(2) shall not be liable for broadcasting any such announcement without transmitting a closed caption unless the licensee intentionally fails to transmit the closed caption that was included with the announcement.

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Americans with Disabilities Act of 1990, As Amended

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The text of the Americans with Disabilities Act of 1990 (ADA), including changes made by the ADA Amendments Act of 2008.

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Kids Meet A Deaf Person | Kids Meet | HiHo Kids

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A spinal cord injury is any damage to the spinal cord that is caused by trauma, rather than a birth defect or medical condition. Learn more from Boston Children's.

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Kids Describe Color to a Blind Person | Kids Describe | Cut

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Centers for Disease Control and Prevention

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From birth to 5 years of age, a child should reach movement goals―also known as milestones ―such as rolling over, sitting up, standing, and walking. A delay in reaching these movement milestones could be a sign of CP. It is important to note that some children without CP also might have some of these signs. The following are some other signs of possible CP.
In a baby 3 to 6 months of age:

Head falls back when picked up while lying on back

Feels stiff

Feels floppy

Seems to overextend back and neck when cradled in someone's arms

Legs get stiff and cross or scissor when picked up

In a baby older than 6 months of age:

Doesn't roll over in either direction

Cannot bring hands together

Has difficulty bringing hands to mouth

Reaches out with only one hand while keeping the other fisted

In a baby older than 10 months of age:

Crawls in a lopsided manner, pushing off with one hand and leg while dragging the opposite hand and leg

Scoots around on buttocks or hops on knees, but does not crawl on all fours

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11 Things to Know about Cerebral Palsy | CDC

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From birth to 5 years of age, a child should reach movement goals―also known as milestones ―such as rolling over, sitting up, standing, and walking. A delay in reaching these movement milestones could be a sign of CP. It is important to note that some children without CP also might have some of these signs.

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This website has a lot of different resources on it.

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Accessible Playgrounds | The Home for Accessible and Inclusive Playgrounds

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Developed by a group of playground and child development experts and edited by Let Kids Play, the Playworld Inclusive Play Design Guide gives you the tools to so that you can incorporate the principles of inclusive play into a new or existing playgrounds.. From information on planning, layout, and access, to play richness, equipment selection, and more, this guide offers unbiased best practices for creating a play environment everyone can enjoy.
Get your free copy today!

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Playground Resources | Accessible Playgrounds

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Developed by a group of playground and child development experts and edited by Let Kids Play, the Playworld Inclusive Play Design Guide gives you the tools to so that you can incorporate the principles of inclusive play into a new or existing playgrounds..

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National Institute of Neurological Disorders and Stroke

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Complex tics aredistinct, coordinated patterns of movement involving several muscle groups in different parts of the body.

The National Institute of Neurological Disorders and Stroke ( ) and other components of the National Institutes of Health ( )-such as the National Institute of Mental Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute on Drug Abuse, and the National Institute on Deafness and Other Communication Disorders-support research relevant to TS, either at NIH laboratories or through grants to major research institutions across the country.

You may find more information about research on TS by using a searchable database of current and past research projects supported by NIH and other federal agencies. RePORTER also includes links to publications and resources from these projects.

Learn About Clinical Trials

Consider participating in a clinical trial so clinicians and scientists can learn more about TS. Clinical research uses human volunteers to help researchers learn more about a disorder and perhaps find better ways to safely detect, treat, or prevent disease.

For information about participating in clinical research visit NIH Clinical Research Trials and You . Learn about clinical trials currently looking for people with TS at Clinicaltrials.gov , a searchable database of current and past federal and private clinical trials.

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Tourette syndrome (TS) is a neurological disorder that may cause you to have sudden unwanted and uncontrolled rapid and repeated movements or vocal sounds called tics. TS is one of a group of disorders of the developing nervous system called tic disorders.

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A comprehensive suite of e-learning resources designed for all ages and abilities with articles, videos, educator tools, eBooks, research guides and more.

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Quadriplegia is when both of a person's arms and both legs stop working.

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What Is Autism Spectrum Disorder?

Autism spectrum disorder is a difference in the way a person's brain develops. People with ASD are born with it and their problems usually begin in the first couple of years of life. They may have trouble with communicating and relating to others.

What's it Like to Have Autism Spectrum Disorder?

ASD affects different people in different ways. Some people can't speak or learn. Their behavior may seem strange; they may avoid other people; they may pace and move their bodies in unusual ways, like flapping their hands. They may repeat lines from TV shows or movies.

People with less severe ASD are able to talk and learn. But they may have trouble:

expressing feelings. They may seem cold and distant.

understanding the feelings of others. They may ignore or misunderstand how other people might feel or behave in a situation.

reading social cues. They might not understand body language or facial expression; they stand too close; they ignore signs of boredom or frustration.

handling sensory information. Loud noises, bright lights, or crowds may bother them.

handling a new routine. It might be hard for them to sit in a different seat or having a substitute teacher.

Some might get get super-focused on a single topic or hobby, some of which may be unusual (apple varieties, World War I).

What Causes Autism Spectrum Disorder?

No one knows exactly what causes ASD. It probably has something to do with DNA - the genes passed down from your parents - and other things, like infections or toxins that change the way the brain develops. Problems during pregnancy and around the time of birth raise the chance of getting autism.

Vaccines do not cause autism.

How Is Autism Diagnosed?

Doctors check babies and little kids for signs of autism at each checkup visit. A parent may think that something is wrong and tell the doctor. Maybe the child is old enough to speak but doesn't. Or a kid doesn't seem interested in people or plays in unusual ways.

If the doctor suspects autism, a team of experts (which may include doctors, a psychologist, speech therapist, occupational therapist, and a special education teacher) will evaluate a child.

How Is Autism Spectrum Disorder Treated?

There is no cure for autism, but treatment can make a big difference. The sooner treatment starts, the better. With therapy, people with autism learn language, improve in school, and build social skills. Many kids with ASD are in special education classes or get special education services.

A treatment program might include:

speech therapy to help with talking and language skills

occupational therapy to help with everyday tasks, like dressing and playing

behavioral therapy to help improve behavior

social skills training to help with relating to others

special education to help learning

medicine to help with things like sleep, paying attention, and hyperactivity

How Can I Help a Friend With Autism?

People with ASD have a very wide array of signs and symptoms. Some people with ASD do not feel that they have a disorder and don't want to change. They're proud of who they are and they want to be accepted, even though they may have different strengths and weaknesses than most other people.

All people deserve respect. But people with ASD may be teased, bullied, or left out because they're different. Bullying and teasing are never the right way to treat other people, but it may be hard to be a friend with someone who has ASD.

People with ASD often don't understand playful jokes or sarcasm. You may need to be very clear and factual when you communicate with someone who has ASD.

Try to be patient and kind. Remember how hard it might be for the person with ASD to understand how to be a friend. Stand up for classmates who are bullied. Tell adults, so they can help protect kids who are bullied.

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Autism spectrum disorder is a difference in the way a person's brain develops. People with ASD are born with it and their problems usually begin in the first couple of years of life. They may have trouble with communicating and relating to others. ASD affects different people in different ways.

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Kids Meet a Guide Dog for the Blind | Kids Meet | HiHo

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National Institute of Neurological Disorders and Stroke

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The National Institute of Neurological Disorders and Stroke, ( ), a part of the National Institutes of Health ( ), is the nation's leading funder of research on brain and nervous system disorders. Another NIH agency, the ), also conducts and supports research on cerebral palsy. Eunice Kennedy Shriver National Institute of Child Health and Human Development (

(CPRN) is a multi-institution collaboration that was created during an NIH workshop that examined the goals of research and current gaps in cerebral palsy studies. Participating clinicians use its data-rich patient registry to build powerful multicenter studies that can more rapidly find practice variations and develop quality improvement initiatives. CPRN enables groundbreaking clinical research on CP and the study of long-term outcomes from the many interventions that children go through after their initial diagnosis of CP.

For research articles and summaries on cerebral palsy, search , which contains citations from medical journals and other sites.

Learn About Clinical Trials

Clinical trials are studies that allow us to learn more about disorders and improve care. They can help connect patients with new and upcoming treatment options.

Consider participating in a clinical trial so clinicians and scientists can learn more about carpal tunnel syndrome. Clinical research uses human volunteers to help researchers learn more about a disorder and perhaps find better ways to safely detect, treat, or prevent disease.

For information about participating in clinical research visit NIH Clinical Research Trials and You . Learn about clinical trials currently looking for people with cerebral palsy at Clinicaltrials.gov .

Where can I find more information about cerebral palsy?

The following resources may help individuals, families, friends, and caregivers of people living with cerebral palsy:

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Cerebral palsy (CP) refers to a group of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination. CP is caused by damage to or abnormalities inside the developing brain that disrupt the brain's ability to control movement and maintain posture and balance.