Access Isn’t Equity:

Why Higher Ed Keeps Getting It Wrong

Last week at the University of Rhode Island, I sat in a session on access and barriers at a neurodiversity conference. These are topics I talk about often — hell, I build my whole practice around them. But something happened in that room that stopped me in my tracks. You know those moments when you think you’ve got a handle on something, and then someone drops a perspective that makes you go, “oh shit, I hadn’t thought about it like that”? That was me.

The conversation wasn’t just about how we support neurodivergent students academically. It was about systems. Policies. Processes. The scaffolding or lack thereof, that decides who gets to succeed. And once again, it hit me: our systems are broken.

---

The Two Models We Can’t Escape

When we talk about neurodiversity, two frameworks always show up. And they don’t just live in academic papers, they shape how real people access support, or don’t.

The Medical Model vs. Social Model

• The Medical Model
  This is the framework built on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It says: here’s the “norm,” and here’s how you deviate from it. If you deviate, you are classified as having a disorder. The assumption is pathology: difference is deficit, something to be managed or corrected.
  The medical model is not optional. It’s what clinicians, insurance companies, schools, and universities use to decide whether someone “qualifies” for services. No DSM code? No therapy covered, no occupational therapy reimbursed, no extended test time approved. In practice, this makes the medical model a gatekeeper.

• The Social Model
  This comes from disability rights activism and the neurodiversity movement. It says: difference is normal. The “problem” isn’t the person, it’s the environment that was designed for one type of body and brain. Instead of asking how to fix the individual, it asks: what barriers can we remove so they can participate fully?
  Where the medical model assumes deficiency, the social model assumes diversity. It doesn’t mean every difference is easy; but it frames those differences as valid, human, and worthy of support without requiring people to prove their difference.

As an professor, advocate, and coach, I sit squarely in the social model. I see strengths first. I design classrooms and coaching spaces to reduce barriers, not demand conformity. But I’d be lying if I said I didn’t understand the role of the medical model. I’ve walked students, clients, and even my own children through the diagnostic process. I know that piece of paper matters. It opens doors. It pays for therapies. It validates what many have always known about themselves.

So yes, the medical model has a purpose. But when access to support depends entirely on your ability to clear its gates, it becomes less about equity and more about privilege.

---

The Price of a Diagnosis

In the U.S., a neuropsychological evaluation costs anywhere from $3,000 to $10,000 out of pocket . Insurance coverage is inconsistent, often nonexistent. That means if you want that “piece of paper”; the one that unlocks speech therapy, occupational therapy, academic accommodations, you either have the money or you don’t.

And let’s be honest: most students don’t. Especially not first-gen, low-income, or students of color who are already navigating systemic inequities. So what happens? The very people who would benefit most from scaffolding are the least likely to get it.

Diagnosis, then, isn’t just about access. It’s about privilege.

---

Unfortunately Higher Ed Isn’t Any Better

And this is where my frustration boils over.

I LOVE being a professor. I LOVE holding space for students in ways no one ever held space for me.

But this is where I need to call out my own industry. Colleges love to say they’re inclusive, but the truth is, they’re replicating the same broken gatekeeping.

Take accommodations. Want extra time on exams? A single dorm room because you struggle with sensory overload? A quiet testing environment? You need documentation. And documentation = diagnosis. Without it, Accessibility Services will often say, “Sorry, I can’t help you.” And that BREAKS MY HEART.

Here’s what it looks like in real life:

• A first-year student shows up without a prior diagnosis. Maybe they skated through high school with parental support, or maybe their school missed it entirely. Suddenly they’re struggling with executive function, sensory overload, or test anxiety.

• They walk into the Accessibility Office and ask for help.

• The first question? “Do you have documentation?”

• When the answer is no, the door shuts. The office can’t (or won’t) provide accommodations without a diagnosis.

So now that student has two options:

1. Pay thousands for a private evaluation they probably can’t afford.

2. Struggle silently, risk failing, or drop out.

I’ve watched it happen again and again; students walk into those offices hopeful, only to walk out devastated because they didn’t have the right paperwork. I’ve seen students cry in my office because the system told them in not so many words, “You don’t count.”

Now take academic coaching. This should be one of the most LOW-BARRIER supports we can offer; it exists of course; but again it’s a fee-for-service model. That means if a student needs help with executive function, time management, or just the scaffolding to keep their head above water, they can have it. Diagnosis or not. But they’ll have to pay out-of-pocket. So only those with the financial means can get the support they need. The rest are left to figure it out themselves.

That means the same problem repeats itself: the students with resources (the ones who can afford private evaluations) get the scaffolding. The students without? They struggle silently.

That’s not equity. That’s a velvet rope.

So when colleges boast about their “coaching” and “accommodation” programs, let’s be honest: what we really have is a paywall with a shiny sign over it designed for the very few.

---

Equality, Equity, and Access (And Why They’re Not the Same)

This is where the conversation about equity needs to happen and it can’t be reduced to buzzwords. We love to toss these terms around (in higher ed) like they’re interchangeable, but they aren’t.

• Equality says: everyone gets the same thing. Same test, same deadline, same lecture. That sounds fair — until you realize sameness can still exclude.

• Equity says: everyone gets what they need to succeed. It recognizes difference and adapts accordingly. This is where accommodations should live.

• Access is the most basic level. You can actually use what’s being offered.

Right now, our systems often confuse equity with equality. We pat ourselves on the back for offering the “same” resources to all students. Or we pretend to offer equity but then hide it behind the medical model’s gatekeeping.

In other words: we’ve built systems that look equitable on paper but fail in practice. We hand out “accommodations” — but only to the students who can prove they’re worthy via a $5,000 diagnosis. That’s not equity. That’s exclusion dressed up in policy language.

---

What the Science ACTUALLY Tells Us

This isn’t just philosophy — research backs it up. (For my legacy peers who thing customization negates rigor)

• Universal Design for Learning (UDL): Decades of research show that when courses are built with multiple pathways to engage, represent, and express knowledge, all students perform better, not just those with disabilities (CAST, 2018). UDL doesn’t lower standards — it removes arbitrary barriers that have nothing to do with learning outcomes.

• Flexibility in assessment: A large body of evidence shows that when faculty allow flexible deadlines, choice in assignment format (paper, presentation, portfolio, video), and adaptive pacing, students demonstrate deeper mastery and retention. Neurodivergent students benefit most, but so do multilingual learners, first-gen students, and frankly anyone navigating the chaos of life.

• Belonging and persistence: Sense of belonging is one of the strongest predictors of student success. When students feel excluded, misunderstood, or unsupported, attrition rises. When they feel seen and safe, persistence, GPA, and graduation rates go up.

So no, this isn’t about “catering to one or two students.” It’s about implementing practices that the evidence already tells us work better for everyone.

---

My Classroom, My Rule: Access for All

Here’s where I’ve landed: if access is behind a paywall, it isn’t access. It’s privilege.

That’s why in my classrooms:

• Extensions are always available. You don’t need to beg for an exception. If you need more time, you have it. Life happens.

• Alternative testing is always an option. If a student prefers to test in a quiet space, or needs time-and-a-half, I’ll arrange it. No paperwork required.

• Multiple modalities are always welcome. You can write me a paper, but you can also submit a podcast, a video essay, a design portfolio, a PowerPoint. If it demonstrates you’ve mastered the learning outcomes, it counts.

Students often look shocked the first time I tell them this. Some even tear up. Because for many of them, this is the first time they’ve been told they don’t have to prove their worthiness to deserve access.

And guess what? My classrooms aren’t less rigorous. Students still learn the content. If anything, they learn it more deeply because they’re not wasting energy fighting the system just to participate.

---

Where Do We Go From Here?

If we’re serious about equity, we have to stop pretending access = equity. That means:

• Reduce the gatekeeping around diagnosis. Institutions should accept self-reports, teacher evaluations, or alternative forms of evidence rather than forcing every student through a $5,000 medical hoop.

• Fund academic coaching as part of tuition, not an add-on. Coaching isn’t a luxury — it’s a critical support that helps students persist. Embedding it into the cost of attendance levels the playing field.

• Train faculty in UDL and inclusive pedagogy. One-off workshops and compliance checklists don’t cut it. Faculty need deep, ongoing training in how to design courses that reduce barriers for all learners.

• Redefine rigor. Rigor isn’t about how many students fail or how strictly you enforce deadlines. Rigor is about how deeply students engage with concepts and how well they can apply them.

These bullets aren’t wishful thinking they’re a roadmap (or rather points on a compass). And until we start following it, we’re lying to ourselves. We’re telling students, “You belong here” while making them prove it with their wallets and their paperwork.

---

I love being a professor. Aside from being a mom, it’s the role I treasure most. Every semester I get to watch students grow into themselves, discover strengths they didn’t know they had, and build futures they once doubted were possible. It’s sacred work.

But every time I sit in conference rooms like the one at URI, I’m reminded how much of that growth is happening in spite of the system, not because of it. Students succeed because they fight, hustle, self-advocate, or find the one professor willing to bend the rules — not because higher ed has built structures designed for them to thrive.

That reality should gut us. Because education is supposed to be the great equalizer. Instead, too often, it’s the great sorter.

Until access is universal, equitable, and free of gatekeeping, we are not supporting students. We are sorting them. And that is not education. That is elitism dressed up in ivy.

I refuse to accept that. Which is why, in my classrooms and in my coaching, access isn’t something you earn it’s something you get. Period.