By Naomi Lorch, Ph.D., P.T.
Article to be reviewed: Nario-Redmond MR, Gospodinov D, & Cobb A.  Crip for a day: The unintended negative consequences of disability simulations. Rehabilitation Psychology 2017; 62: 324-333.

This article describes two studies that provide reasons to discontinue disability simulations.   Activities that give participants the opportunity to experience some of the limitations associated with having a disability have been used for many years.   They have been considered to promote better understanding of individuals with disabilities, to improve attitudes, and to be enjoyable.  The experience of moving around in a wheelchair is thought to show what it is like to have limited mobility, while wearing ear plugs is used to mimic a hearing impairment.  Simulations may lead to increased empathy for a person with a disability.  Since the portrayals are not authentic, however, they suggest that the deficit is in the person and ignore architectural barriers and discriminatory policies that increase the impact of a disability.  The simulations also do not  show how people have learned to cope with their disabilities.  Instead, stereotypes are promoted which emphasize incompetence and dependency.
The studies were conducted to evaluate the effects of simulating disabilities on mood, stereotypes,  motivation to interact with individuals with disabilities, and intentions to help improve accessibility of the college campus.  Two experiments were performed using college students.  In the first study, 60 undergraduate college students were recruited from psychology classes and offered partial credit for participating.  They were randomly assigned to one of three groups.   Hearing impairment was represented by having a student wear ear plugs and try to read the lips of another student who was reading aloud.  A second group was required to read a passage with all of the words typed backward, which was supposed to represent the experience of a person with dyslexia. This is reportedly a popular, though inaccurate  simulation.  The third group had to get their lunches while using a wheelchair to reflect the experiences of a person with  a mobility impairment.
The results included changes in mood, compared to pretest results. Students demonstrated increased confusion and anxiety, with those who simulated dyslexia also reporting greater hostility.  Participation in the study led to heightened frustration, embarrassment, helplessness, and feelings of vulnerability about acquiring a disability.  There was also an increase in empathetic concern (warmth) toward individuals with disabilities.
The second experiment was also done with undergraduate students.  Participation in the study was a course requirement for individuals enrolled in a general psychology class.  Each of the students performed three simulations.  They had to read a paragraph aloud while wearing  specialized goggles that caused 20/200 visual acuity to feign low vision.  To represent a hearing impairment, they were required to listen to the same paragraph while wearing ear plugs and headphones.  Students were then told that they were going to simulate a reading disability and were asked to read the same paragraph aloud at a normal pace.  (The relationship of this task to simulating a reading  disability is unclear from the study description, unless students were supposed to pretend to have a reading disability.)
Mood changes were found after the simulations, including increased confusion, hostility, helplessness, and vulnerability.  Students were also more embarrassed.  Those students who previously had fewer interactions with people with disabilities also felt more depression, guilt, frustration, and anxiety at the end of the study.  There was an increase in pity and discomfort about interacting with somebody with a disability in the future.  Study participants were not more willing to interview students with disabilities about a project to increase campus accessibility.
In the discussion it was suggested that future studies address aspects of society that are disabling and discriminatory.  Individuals could have the opportunity to learn about environmental barriers and public policies that can make life more difficult for people with disabilities. Participants could focus on how they would want to be treated if they had a disability and on increasing accessibility of the environment.  Equal status contact could help to counteract stereotypes.  This type of research would minimize the threats that caused the strong emotional reactions reported above.
The authors conclude that disability simulations result in distress and do not improve attitudes toward people with disabilities.  They suggest, instead, the promotion of increased participation and equality of individuals with disabilities.
Comments:  The results of the study are of particular significance for anyone who has been doing or contemplating simulations to introduce others to some of the difficulties encountered by people with disabilities. Promoting inclusive activities, where individuals with the whole range of disabilities participate with peers who do not have disabilities, can make a difference in contact with and acceptance of people with disabilities.  It is important that children and adults with disabilities join others in natural proportions to avoid the likelihood of separate groupings.  Supports will be needed for some of those with disabilities.  Helpers should be individuals who believe in inclusion and can step back when possible so as not to interfere with interactions among group members, or when appropriate can facilitate interactions.
Children with disabilities can participate with typically developing children, starting in parent-infant groups and classes for toddlers and preschool children.   Inclusive preschools have been around for many years, although currently most children with disabilities are placed in segregated special education settings.   At a young age children are ready to interact with peers with disabilities so long as the adults are accepting. (1)  Throughout life people with disabilities can participate in regular educational settings, recreation, religious activities, and family get-togethers.  The challenges are to find (and fund) the  support systems that facilitate participation and to seek activities that are preferred and feasible. (2)    Although it is more difficult to provide supports for inclusive activities when children and adults have complex medical needs, it can happen.  We as professionals can encourage patients and their families/caregivers to pursue a life in the real world,  beyond medical and rehabilitation services.  Assistance in finding meaningful activities would be beneficial, along with advocacy and education so that more activity leaders will accept all participants.  Help is needed (and possibly donations) so that transportation and supports  can be available to make inclusion successful.
When it is common to have peers with a variety of disabilities participating with others, there can be more acceptance of differences.  Interactions with people who communicate differently (e.g. nonverbal, augmentative communication, cognitive delays, autism spectrum disorders) will be enhanced if others model how to do so and offer guidance as needed.
(1) U.S. Department of Health and Human Services, U.S. Department of Education. Policy statement on inclusion of children with disabilities in early childhood programs. September 14, 2015. (online)
(2) Imms C, King G, Majnemer A,  Avery L, Chiarello L , Palisano R, Orlin M, Law M. Leisure participation-preference congruence of children with cerebral palsy: a Children’s Assessment of Participation and Enjoyment International Network descriptive study.  Developmental Medicine and Child Neurology 2017; 59: 380-387.