Why Accommodations Are Not Justice

Bridgette Hamstead

The modern accommodation framework is often presented as evidence of progress. Laws exist. Policies exist. Forms exist. There are processes through which autistic and ADHD people can request adjustments to school, work, or healthcare environments that were not built with them in mind. This is frequently framed as fairness. But when we examine outcomes, accommodations have not reduced burnout, unemployment, health disparities, or premature mortality for neurodivergent adults. In many cases, they have merely formalized inequality.

Accommodations are not justice because they leave the system intact. They treat harm as an exception rather than as a design feature. They require neurodivergent people to adapt to environments that remain fundamentally hostile, while offering narrow, conditional relief to those who can successfully navigate bureaucratic gatekeeping. Justice, by contrast, demands redesign. It asks not how individuals can be modified to survive existing systems, but why those systems were designed in ways that predictably exclude neurodivergent people in the first place.

The evidence is clear that accommodation-based approaches have failed to produce equitable outcomes. Despite decades of disability rights legislation and workplace accommodation policies, autistic adults continue to experience unemployment and underemployment rates ranging from 50 to over 80 percent, even among those with postsecondary education (Hedley et al., 2018; Baldwin et al., 2014). ADHD adults similarly face higher rates of job instability, workplace discipline, and financial precarity compared to non-ADHD peers (Kessler et al., 2006; Barkley & Murphy, 2010). These disparities persist across countries with vastly different accommodation regimes, suggesting that the problem is not lack of awareness or legal protection, but structural design.

Accommodation frameworks are built on an individualizing logic. They assume that the system is fundamentally sound and that difficulty arises because certain people deviate from the norm. Under this logic, the solution is to carve out exceptions. A quiet room. Extra time. Flexible deadlines. Modified communication. These adjustments may provide short-term relief, and for some individuals they can be lifesaving. But structurally, they position neurodivergent people as problems to be managed rather than as stakeholders whose needs should shape the system itself.

This individualization has measurable consequences. Research consistently shows that neurodivergent distress correlates more strongly with environmental factors than with neurological traits. Autistic adults report that sensory overload, communication mismatch, social punishment, and lack of control over their environment are the primary drivers of exhaustion and decline (Milton & Sims, 2016). Burnout, anxiety, depression, and suicidality are most strongly associated with chronic masking and exposure to hostile environments, not diagnostic severity (Cassidy et al., 2018; Pellicano et al., 2018). Accommodation frameworks do little to address these drivers because they leave the hostile environment largely unchanged.

In practice, accommodations often function as pressure valves that allow institutions to avoid redesign. A workplace can maintain a sensory-hostile open office plan while offering noise-canceling headphones to a small subset of employees. A school can enforce rigid pacing and standardized testing while granting extended time to some students. A clinic can remain rushed, noisy, and inaccessible while offering longer appointments only to those who can secure documentation and advocate persistently. In each case, the default remains harmful, and responsibility for survival is shifted onto the individual.

This model also relies heavily on gatekeeping. Access to accommodations typically requires formal diagnosis, professional validation, and the capacity to navigate complex systems. Research shows that autistic women, gender-diverse autistic people, people of color, and low-income individuals are diagnosed later or not at all, and are more likely to be misdiagnosed with anxiety, depression, or personality disorders instead (Loomes et al., 2017). ADHD shows similar patterns of underrecognition and dismissal. As a result, those most harmed by institutional design are often least able to access accommodations. This is not a flaw in the system. It is a predictable outcome of a framework that ties access to legitimacy rather than need.

Even when accommodations are granted, they are frequently fragile. They are conditional, revocable, and dependent on goodwill. Studies of workplace accommodations show that employees who request adjustments are often perceived as less competent, less committed, or more burdensome, which can negatively affect evaluations and advancement (Santuzzi et al., 2014). Many autistic and ADHD adults report avoiding accommodations altogether because disclosure carries social and professional risk. When support is contingent on disclosure in hostile environments, it ceases to function as access and becomes another site of harm.

Accommodation frameworks also obscure cumulative harm. Systems tend to treat each accommodation request as an isolated event rather than as evidence of systemic failure. But public health research demonstrates that repeated exposure to marginalization produces cascading disadvantage across the life course. Chronic stress related to discrimination and exclusion is associated with dysregulation of stress response systems, increased inflammation, and elevated risk for cardiovascular and autoimmune conditions (Mason et al., 2018). Autistic adults experience significantly higher rates of premature mortality, often from preventable causes linked to healthcare avoidance and inadequate access (Hirvikoski et al., 2016). These outcomes cannot be addressed by piecemeal exceptions. They require structural change.

Justice-oriented redesign looks fundamentally different. Instead of asking who needs accommodations, it asks what assumptions are embedded in the system. Why is constant availability treated as a marker of professionalism. Why are open offices considered efficient despite evidence that they reduce productivity and increase stress for most workers. Why is verbal participation privileged over written or asynchronous communication. Why are sensory needs treated as individual sensitivities rather than as design parameters. These are not neutral choices. They reflect values about control, visibility, and conformity that disadvantage neurodivergent people by design.

Research supports the effectiveness of redesign. Studies of flexible scheduling, predictable workflows, sensory-informed environments, and clear communication protocols show reductions in stress, improvements in retention, and better performance outcomes for neurodivergent workers (Robertson & Ne’eman, 2008; Hedley et al., 2017). Importantly, these changes benefit many non-neurodivergent people as well, including caregivers, people with chronic illness, and workers facing burnout. When environments are redesigned, access becomes durable rather than conditional.

Education offers a similar contrast. Extended time on tests does little to address classrooms structured around constant noise, rapid transitions, and behavioral compliance. Neurodivergent students continue to experience disproportionate discipline and exclusion, even when accommodations are in place. Autistic students are significantly more likely to be suspended or expelled than their non-autistic peers, controlling for behavior severity (U.S. Department of Education, 2020). Justice-oriented redesign would address pacing, sensory load, assessment methods, and relational safety at the system level, reducing the need for individual exceptions altogether.

Healthcare further illustrates the limits of accommodation. Longer appointments or written instructions do not compensate for environments that are sensory-hostile, rushed, and dismissive. Autistic and ADHD adults report high rates of medical trauma and avoidance, which directly contributes to worse health outcomes (Mason et al., 2018). Justice requires redesigning how care is delivered, including communication norms, appointment structure, sensory conditions, and clinician training. Without this, accommodations remain a bandage on a wound the system continues to inflict.

The distinction between accommodation and justice is therefore not semantic. It is structural. Accommodation accepts harm as inevitable and offers relief to a few. Justice challenges the conditions that produce harm in the first place. Accommodation asks neurodivergent people to identify themselves as exceptions. Justice treats neurodivergent people as part of the public for whom systems should be designed.

This distinction also clarifies why awareness and acceptance efforts often stall. Awareness can coexist with harmful defaults. Institutions can acknowledge neurodivergence while maintaining practices that predictably cause burnout, attrition, and trauma. Acceptance without redesign becomes a form of containment. It recognizes difference while refusing to redistribute power.

Neurodiversity justice insists on accountability. If a system consistently produces harm for neurodivergent people, that harm is not an unfortunate side effect. It is evidence of design failure. And design failures can be corrected. But only if institutions are willing to move beyond accommodations and confront the values embedded in their structures.

Justice does not mean eliminating all individual support. Some people will always need personalized assistance. The difference is that justice treats individualized support as supplemental rather than foundational. It builds systems that are accessible by default and reserves accommodations for genuine edge cases rather than for routine survival.

Why accommodations are not justice is ultimately a question of responsibility. Accommodation frameworks place responsibility on neurodivergent individuals to request, justify, and manage their access. Justice places responsibility on systems to prevent harm. One preserves the status quo. The other demands transformation.

Neurodivergent people have adapted for generations. The evidence shows the cost of that adaptation has been catastrophic. Justice asks something different. It asks systems to change.

Accommodation vs. Institutional Change

Workplace environment
Accommodation: Providing noise-canceling headphones or allowing an autistic employee to work from home as an exception to an open-plan office.
Institutional change: Redesigning the workplace to include quiet rooms, predictable sensory conditions, flexible work locations for all roles where possible, and eliminating open offices as the default. Justice removes the sensory hazard instead of asking individuals to armor themselves against it.

Work schedules and availability
Accommodation: Granting flexible hours only to employees who disclose a diagnosis and request it formally.
Institutional change: Designing roles around output rather than constant availability, normalizing flexible schedules, asynchronous work, and variable energy cycles. Justice treats time as an access issue, not a privilege.

Communication norms
Accommodation: Allowing an autistic or ADHD employee to follow up verbally delivered instructions with email summaries.
Institutional change: Making clear, written, asynchronous communication the standard for everyone. Meetings become optional, documented, and purpose-driven rather than the primary mode of decision-making.

Performance evaluation
Accommodation: Adjusting performance reviews for a neurodivergent employee who struggles with vague feedback or social self-promotion.
Institutional change: Redesigning evaluation systems to prioritize concrete outcomes, role clarity, and transparent criteria instead of charisma, visibility, or informal networking.

Disclosure and documentation
Accommodation: Requiring medical documentation to approve basic access needs like flexible deadlines or alternative communication methods.
Institutional change: Removing diagnosis as a gatekeeping requirement for common access features and treating accessibility as a design standard rather than a medical exception.

Education pacing
Accommodation: Giving autistic or ADHD students extended time on tests.
Institutional change: Redesigning curricula to allow multiple pacing tracks, varied assessment methods, and mastery-based evaluation instead of speed-based compliance.

Classroom behavior expectations
Accommodation: Allowing a student to stim, use fidgets, or step out of class with special permission.
Institutional change: Eliminating punitive behavioral compliance models and designing classrooms that expect movement, sensory regulation, and varied engagement styles as normal.

Sensory environments in schools
Accommodation: Letting a student wear headphones or sunglasses in a loud, bright classroom.
Institutional change: Reducing noise, visual clutter, and sensory overload at the classroom and building level so regulation tools are optional rather than necessary for survival.

Healthcare appointments
Accommodation: Offering longer appointments or written instructions only to patients who request them.
Institutional change: Redesigning healthcare delivery to include sensory-aware waiting areas, predictable appointment flow, alternative communication formats, and clinician training that assumes neurodivergent communication as part of the patient population.

Medical communication
Accommodation: Asking clinicians to “be patient” with neurodivergent patients.
Institutional change: Structuring care around consent-based communication, clear explanations, reduced power imbalance, and explicit permission to pause, ask questions, or process information asynchronously.

Meetings and participation
Accommodation: Allowing a neurodivergent employee to skip certain meetings.
Institutional change: Questioning why meetings exist at all, reducing them by default, and ensuring decisions are documented and accessible regardless of real-time participation.

Professionalism standards
Accommodation: Overlooking “odd” communication, eye contact differences, or flat affect for certain employees.
Institutional change: Redefining professionalism away from neurotypical social performance and toward reliability, clarity, and ethical collaboration.

Burnout response
Accommodation: Granting medical leave after an employee burns out.
Institutional change: Redesigning workloads, expectations, and recovery norms to prevent burnout rather than treating collapse as inevitable.

Discipline systems
Accommodation: Making exceptions to attendance or punctuality rules for diagnosed students or employees.
Institutional change: Rethinking attendance, pacing, and productivity metrics altogether so they no longer function as sorting mechanisms that punish neurodivergent bodies and minds.

Support services
Accommodation: Offering coaching or therapy to help neurodivergent people cope with hostile environments.
Institutional change: Treating high turnover, disengagement, and distress as signals of system failure and redesigning conditions rather than outsourcing harm to mental health services.

The distinction between accommodation and justice ultimately comes down to who is expected to carry the burden of change. Accommodation frameworks assume that harm is inevitable and that survival is an individual responsibility. They ask neurodivergent people to identify themselves as exceptions, to disclose, to document, to negotiate, and to endure the social and professional consequences of needing access. Justice rejects this premise. It recognizes that when a system routinely requires exceptions to function, the problem is not the people asking for relief. It is the system itself.

The data make this unavoidable. Decades of accommodation-based policy have not closed employment gaps, reduced burnout, or improved health outcomes for autistic and ADHD adults. Unemployment remains staggeringly high. Rates of burnout, depression, and suicidality remain elevated. Preventable health conditions continue to go untreated because systems remain inaccessible. These are not implementation failures. They are predictable outcomes of frameworks that preserve harmful defaults while offering narrow, conditional relief. Public health research is clear that durable improvements in population-level outcomes come from changing conditions, not from asking individuals to cope better within them.

Justice reframes accessibility as an obligation rather than a favor. It treats clear communication, flexible pacing, sensory safety, and predictable structure as baseline design requirements, not as special permissions granted to a few. This shift matters because it redistributes power. When access is built into systems, neurodivergent people are no longer dependent on goodwill or vulnerability for survival. They can participate without self-erasure. They can conserve energy for living rather than for constant negotiation.

This is not an argument against individualized support. Some people will always need tailored assistance, and justice requires that those supports be available without stigma or gatekeeping. The difference is that justice does not rely on individual accommodation as the primary mechanism of access. It builds systems that work for the many and reserves exceptions for true edge cases, rather than treating neurodivergent existence itself as an exception.

Moving from accommodation to justice also clarifies accountability. If a workplace, school, or healthcare system consistently produces harm for neurodivergent people, that harm is not accidental. It reflects design choices, priorities, and values. Justice demands that institutions name those choices and change them. It asks leaders, policymakers, and professionals to stop congratulating themselves for granting exceptions and start interrogating why those exceptions are necessary at all.

Neurodivergent people have adapted for generations. The evidence shows the cost of that adaptation has been profound, cumulative, and often devastating. Accommodations did not fail because neurodivergent people asked for too much. They failed because they asked too little of systems that were never willing to change. Justice asks something different. It asks systems to become accountable to the people they shape. It asks for redesign instead of endurance. And it insists that access, safety, and dignity are not privileges to be granted, but conditions that must be built.