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The Guidelines for Assessment and Intervention with Persons with Disabilities were adopted by the APA Council of Representatives in February 2022 and replace the original Guidelines for Assessment of and Intervention with Persons with Disabilities from 2011.

Key updates include heightened diversity, equity, and inclusion considerations across all facets of the Guidelines. There is a greater emphasis of the need for attention to the implications of the intersectional identities of people with disabilities in clinical practice. New or substantially new sections were added about men, transgender individuals, and developmental phases. Additional information was added about family/care assistants, abuse, and health promotion – all grounded in research. More emphasis was made on situational and disability related factors affecting assessment, and even more specifically multimodal assessment.

Updates also include: (1) the addition of current research and terminology throughout; (2) the addition of the call to the field of psychology to be advocates and allies inclusive of serving those with disabilities in their practices; (3) expansion of the practical information provided along with a resource guide; and (4) expansion of the content on assistive technology.

The Guidelines are primarily intended for psychologists and psychology trainees who work in various settings with clients with disabilities.

Introduction

Read the full guidelines (PDF, 900KB)

Over 41 million noninstitutionalized Americans are currently living with a disability (American Community Survey, U.S. Census Bureau, 2019). Individuals with disabilities and their advocates have worked for decades to eliminate attitudinal and physical barriers, to be fully included in all aspects of society, and to secure the freedom to choose their own futures (Jaeger & Bowman, 2005; Kerkhoff & Hanson, 2015; Krahn, et al., 2015; Priestley, 2001; Switzer, 2008). For a historical summary of events and legislative advancements and setbacks for people with disabilities, the reader is referred to two timelines (PAEC, 2018; National Consortium on Leadership and Disability for Youth, 2007). Advocacy efforts facilitated the passage of the Americans with Disabilities Act (ADA) of 1990 and more recently the ADA Amendments Act of 2008 (ADAAA) that broadened the definitions of “disability,” “substantially limits,” and “major life activities.” Nonetheless, many people with disabilities continue to encounter both blatant and subtle discrimination in employment, housing, education, recreation, child-rearing, and health care, including mental health services (Banks & Kaschak, 2003; Basnett, 2001; Kirschbaum & Olkin, 2002; Krahn, et al., 2015; National Council on Disability, 2012; Raphael, 2006; Schriner, 2001; Smart, 2001; Stapleton et al., 2004; Waldrop & Stern, 2003; Woodcock, Rohan, & Campbell, 2007).

Although many persons with disabilities experience discrimination, each individual responds differently to those experiences. Moreover, each person assigns a unique meaning to disability, depending on the nature of impairment, the quality of social support, and life demands (Olkin, 2012; Olkin & Taliaferro, 2005; Vash & Crewe, 2004). People with disabilities, like all people, have influences in their lives that contribute to their development and experiences, such as their culture, religion, family of origin, community, education, socio-cultural context, employment, friends, significant others, and co-workers. They are also affected by system-wide factors, such as governmental policies, available programs, and associated funding. Such common influences shape a person’s individual disability experience. Above and beyond their disability experiences, disabled individuals have their own life experiences and, like everyone else, their own personal characteristics, histories, intersecting identities, and life contexts that affect their psychological needs. To work effectively with people who have disabilities, psychologists should strive to become familiar with how disability and related factors influence their clients’ psychological well-being and functioning. For example, the disability experience may be influenced by functional capacities, energy levels, pain, age of onset, manner of onset (e.g., military trauma), and whether the disability is static, episodic, or progressive. It is also influenced by one’s experience of community. Disabled individuals who have limited contact with other people who have disabilities in their families, at school or work may experience feeling different from others or even ostracized. Individuals with invisible disabilities (e.g., learning disabilities, mental illness, brain injury, chronic pain) may have difficulty convincing others they even have a disability (Smart, 2001; Taylor & Epstein, 1999). Becoming familiar with the experience of living with a disability increases empathy and understanding, and thus enhances assessments and interventions. It is important for psychologists to become aware of how their own attitudes, reactions, conceptions of disability, and possible biases affect their professional relationships with clients who have disabilities. Psychologists can also benefit from learning the best “barrier-free” psychological practices in working with clients with disabilities, including providing reasonable accommodations and appropriately integrating disability-related issues into assessment and intervention. 

Unfortunately, while psychologists receive extensive training in how to approach mental health issues, they rarely receive adequate education or training in disability issues (Gibson, 2009; Olkin & Pledger, 2003; Strike, Skovholt, & Hummel, 2004). Few graduate psychology training programs offer disability coursework (Olkin & Pledger, 2003; Weiss, 2010). Limited training and experience may leave many psychologists unprepared to provide professionally and ethically sound services to clients with disabilities. Further, many psychologists seek to develop disability competence after they have completed formal training.

The goal of these Guidelines for Assessment and Intervention with Persons with Disabilities is to help psychologists, psychology students, and psychology training programs conceptualize, design, and implement effective, fair, and ethical psychological assessments and interventions with persons with disabilities. The Guidelines provide suggestions on ways psychologists may make their practices more accessible and disability sensitive, and how they may enhance their working relationships with clients with disabilities. The Guidelines include information on how disability-related factors and sociocultural experiences of disability can impact assessment and intervention. Resources and suggestions are provided throughout the Guidelines to facilitate education, training, and experience with disability constructs important for effective psychology practice.

It is hoped that the Guidelines increase discussion, training, and awareness about disability across the profession and with other health professionals. It is also hoped that psychology training programs will use these guidelines to consider specific curricular revisions and program modifications that ensure disability issues are addressed and all training opportunities are accessible. 

Such interest may additionally contribute to needed research on disability-related issues in assessment (e.g., test construction, norms, use of accommodations) and interventions (e.g., empirically informed activities and programs) as well as enhanced, culturally appropriate communication and decision-making with clients and health care teams.

The Guidelines are based on core values in the Ethical Principles of Psychologists and Code of Conduct (American Psychological Association, 2017; Smart, 2001). The core values include respect for human dignity and recognition that individuals with disabilities have the right to self-determination, participation in society, and equitable access to the benefits of psychological services. Psychologists recognize their role in facilitating an individual’s health and well-being. Additionally, the core values include recognition that people with disabilities are diverse and have unique individual characteristics (like all people), and that disability is not solely a biological characteristic; it is also characterized by the individual’s interaction with the physical, psychological, socioeconomic, and political environment. For example, the intersectionality of poverty, disabilities, and multiple minoritized identities (e.g., gender, race, and ethnicity) is well documented (McAlpine & Alang, 2021) and is included in the discussion on intersectional identities in Guideline 7.

Disability is a broad concept that encompasses a wide range of functional limitations and barriers to participation in community life (World Health Organization, 2001). Psychologists are recognized for having a firm grasp on impairments that arise from issues of emotional disturbance and mental health disability. Accordingly, although the APA Guidelines apply to persons with all types of disabilities, including mental health issues, disability issues arising from impairments less known to many psychologists, such as mobility, sensory, communication, and neurological impairments, are emphasized. The Guidelines also emphasize environmental factors that may influence the experience of disability and that potentially limit assessment validity. Suggestions are included for accommodations that may mitigate these factors.

An extensive literature search was conducted of psychological, medical, rehabilitation, vocational, and educational databases, searching in the areas of disability models, professional relationship and communication issues, attitudes and biases, intersectionality, assessment and intervention across the developmental trajectory, and regulatory and legal resources. The literature reviews were broad in scope, covering both quantitative and qualitative traditions tied to various specialty areas in disability research (e.g., clinical rehabilitation, neuropsychology, rehabilitation psychology, disability studies, education, vocational rehabilitation, forensics). The identified literature represents theoretical, professional, and clinical literature focusing on specific disabilities as well as disability more broadly conceptualized. Along with the original Guidelines, this literature serves as a basis for the guidance offered in this document.

Guidelines are not standards. Standards are generally mandatory and may have an enforcement mechanism. Guidelines are intended to be aspirational and facilitate the profession’s continued systematic development and to ensure that psychologists maintain a high level of professional practice. Guidelines are not exhaustive and do not apply to every professional and clinical situation. They are not definitive and do not take precedence over a psychologist’s well-informed judgment. Applicable federal and state statutes also supersede these Guidelines.

The Guidelines are primarily intended for psychologists and psychology trainees who work in various settings with clients with disabilities. Setting examples include hospitals, rehabilitation, and community service settings; outpatient practice; educational, religious, and correctional facilities; employment settings; and business settings addressing legal, insurance, and/or compensation issues. The Guidelines are designed to facilitate a psychologist’s work with clients who have disabilities, not to restrict or exclude any psychologist from serving clients with disabilities or to require specialized certification for this work. The Guidelines also recognize that psychologists who specialize in working with clients with disabilities may seek more extensive disability training consistent with specialized practice. Many avenues exist for psychologists and their students to gain expertise and/or training to facilitate ethical, competent work with individuals who have disabilities. The Guidelines are not meant to be prescriptive, but instead offer recommendations on areas of knowledge and clinical skills considered applicable to this work.

Last updated: April 2022Date created: January 2011

Contact the Office on Disability Issues in Psychology