Chapter 20
Psychology of Disability
Sport: Participation
and Performance
Anthony Papathomas and Brett Smith
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In its most prosaic form, disability is defined as
a physical or mental impairment that limits an
individual’s capacity to perform a task or engage
in an activity (Falvo, 2013). According to the most
rigorous estimates, more than a billion people—
approximately 15% of the world’s population—have
some form of disability (World Health Organization,
2011). Disability prevalence is highest in low- and
middle-income countries and among the elderly
population (Mitra & Sambamoorthi, 2014). In the
United States, statistically higher rates of disability
occur in minority ethnic groups compared with
non-Hispanic Whites, an effect that dissipates
when controlling for socioeconomic status (Goyat,
Vyas, & Sambamoorthi, 2016). Most disabilities
are acquired through disease or injury rather than
being congenital, and physical disabilities are more
common than intellectual disabilities (Goodley,
2016). Of course, large-scale prevalence studies are
limited by self-report measures and whether the
person defines his or her own disability broadly
(e.g., acute back pain) or narrowly (e.g., chronic/
congenital impairments). Nevertheless, disability is
a significant global issue associated with poverty.
Sport psychology researchers have acknowl-
edged the importance of disability as a topic of study
and a substantial body of knowledge has emerged
in recent years (e.g., Arnold, Wagstaff, Steadman,
& Pratt, 2017; Banack, Sabiston, & Bloom, 2011;
Haslett, Fitzpatrick, & Breslin, 2017; Martin, 2012;
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Copyright © 2019 by the American Psychological Association. All rights reserved.
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edited by M. H. Anshel, T. A. Petrie, and J. A. Steinfeldt
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Martin & Malone, 2013). Although this growing
literature base has advanced the understanding of
disability sport participation and competition, most
of the research exists within a disciplinary vacuum.
This insular focus means that sport psychology
researchers and practitioners have gone about their
work with little regard for the extensive insights within
the broader realm of disability studies (Martin, 2013).
Although such insularism is unsettlingly common
across all scientific disciplines, it is particularly
problematic when the focus is something as socially,
culturally, and politically contested as disability.
We argue that to study the psychology of disability
sport without regard for how disability resides
within a sociopolitical context is not to study
disability sport at all.
Following is a critical overview of the major
overarching approaches informing disability
studies. With the context established, we then
delve into two distinct areas of focus: participa-
tion and performance. First, we consider how
sport psychology has conceptualized participation
in disability sport, including the psychological
underpinnings to promoting engagement. Then,
we consider performance and the elite domain of
disability sport. Specifically, we explore the psycho-
logical factors associated with elite disability sport
success, such as motivation, coping, and mental
skills training. In reviewing this literature, we
maintain a critical psychological lens throughout
385
 Papathomas and Smith
by situating documented findings within the broader
context of disability studies.
BEYOND PATHOLOGY:
MODELS OF DISABILITY
There is an uneasy relationship between the general
disciplines of psychology and disability studies
(Goodley, 2016). At the heart of this uneasy relation-
ship lies psychology’s firm allegiance to a medical
model of research and practice, which prioritizes
individual pathology as etiologically central to
“disordered” thoughts and behaviors (see Deacon,
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2013, for a review). This medicalized perspective has
given rise to terms such as abnormal and irrational
and has supported the notion of “vulnerable indi-
viduals,” thus suggesting that individuals are respon-
sible for their illnesses (Papathomas & Lavallee,
2012). For some scholars, this process of individual-
izing psychological illness constitutes victim blaming
(Easter, 2012) and may even contribute to the
mental health stigma psychologists are keen to
dispel (Ben-Zeev, Young, & Corrigan, 2010).
The medical model used to understand psycho-
logical conditions is also the dominant framework
for conceptualizing disability. Specifically, an indi-
vidual is disabled by his or her physical or mental
impairment, not society’s response to that impair-
ment. Put simply, it is the paralysis of a person with
a spinal injury that limits the person’s gym access,
not the absence of a ramp or elevator. The medical-
izing of disability therefore results in those with
an impairment becoming stigmatized as abnormal
(Smith & Perrier, 2014) and variously incapable
due to their own personal defectiveness (Smith &
Bundon, 2018). Impairment becomes categorically
negative—something to be overcome, managed, or
simply accepted and tolerated. Given this backdrop,
it is not difficult to see why many disability scholars
take issue with the medical model and, by default,
with psychology. The sport psychology literature has
remained largely oblivious to these ongoing ethical,
moral, and philosophical critiques.
A landmark development in disability studies
that is seldom cited in the sport psychology litera-
ture is the emergence of the social model of disability.
The social model of disability turns away from
386
psychology’s long-standing, medically individualized
approach. Rather than conceptualize disability as
a medical problem with physical or mental impair-
ments at the root of limitations, the social model
emphasizes disabling cultural and environmental
barriers (Oliver, 2013). From this perspective, it is
not impairment that disables a person but rather the
physical and social world he or she inhabits.
People with physical and mental impairments
are not to be “saved,” “treated,” or “made better.”
Instead, society must find ways to adapt to the diverse
needs of all individuals who comprise it (Thomas,
2007). Although the social model can be credited
with numerous accomplishments (see Oliver &
Barnes, 2010, for a review), it is not immune to
critical inspection. For example, an exclusive concern
with sociocultural barriers can appear dogmatic,
simplistic, and practically impotent when set against
the reality that barriers, in some form, will always
exist for people with a physical impairment. Further,
decoupling the impaired body from the disability
trivializes the debilitating effect of some conditions
and ignores the corporal and interactional nature of
experience (Smith & Perrier, 2014). For example,
spinal cord injury pain or chronic fatigue exhaustion
can disable a person from participating in sport
independent of social oppression.
The social relational model (for a review, see
Thomas, 2004) seeks to address the limitations
of the social model by integrating an emphasis on
the biological realities of impairment with the way
these biological realities are experienced. It does
not ignore disabling social barriers but rather seeks
to also acknowledge the ways people are disabled
on a cultural, relational, and personal level.
To use a sport example, a disability such as chronic
fatigue can deter sports participation in and of itself
when a person does not have sufficient energy to
engage. In such a case, no structural social change
can adequately address the disabling impact of the
fatigue. Even more broadly, engaging in sport with
chronic fatigue is also difficult because of how this
disability is culturally conceived (e.g., lazy and illu-
sory), relationally constructed (e.g., judging looks
and sarcastic comments), and personally experienced
(e.g., shame and stigma). According to the social
relational model, disability is a social artifact, but

it is also a psychoemotional one. Psychoemotional
disablism occurs when the psychological well-being
of a disabled person is undermined through social
interactions that lead to exclusion, discrimination,
and prejudice (Reeve, 2002). Such disablism does not
always affect what disabled people can do, but it does
limit what they can become.
By introducing the concept of psychoemotional
disablism, the social relational model has delivered
something of a window of opportunity for psychology
in terms of the contribution it can make to disability
studies. The social relational model illustrates that
psychology can, when framed appropriately, align
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with the ethical and moral obligations of traditional
disability studies (Goodley, 2016). For example,
understanding the anger, frustration, and shame that
is experienced by a disabled child who is excluded
from a physical education class is very much a
focus for sport psychology inquiry. Critical psycho-
logical methodologies that are popular within sport
psychology, such as narrative inquiry and inter-
pretative phenomenological analysis, can inform
research that is conducted with and by disabled
people rather than merely about them.
In the review of literature that follows, we iden-
tify sport psychology research that has endeavored to
integrate with the disability studies agenda, as well as
research that remains rooted in traditional medicalized
psychology. We also discuss the consequences of these
differing ontological and epistemological leanings.
PARTICIPATION IN DISABILITY SPORT
Understanding the factors that affect participation in
disability sport holds implications for both population
health and elite performance. Increased participation
is likely to see more disabled people experience the
physical, mental, and social benefits associated with
sport and exercise. Sportwise, the greater the pool of
participants, the more chance of identifying the next
Paralympic medalist. To this end, there is a solid body
of work addressing the barriers and facilitators to
participating in disability sport.
Barriers and Facilitators
By focusing almost exclusively on barriers and
facilitators, research into participation in disability
Psychology of Disability Sport
sport mirrors research into disabled people’s engage-
ment in physical activity and exercise (see Williams,
Smith, & Papathomas, 2014, for a review). Often,
barrier–facilitator studies focus on leisure-time
physical activity, a broad term that encompasses
recreational sport, exercise, and fitness (e.g., Martin
Ginis et al., 2010). In an extensive narrative review
of the exercise barriers literature, Martin (2013)
identified a diverse range of individual (e.g., impair-
ment severity, lack of knowledge, fear of injury),
social (e.g., lack of social support, limited informa-
tion available, practitioner lack of disability exper-
tise, disablist attitudes), and environmental (e.g.,
inaccessible facilities, non­accessible equipment,
limited transportation options) factors that inhibit
engagement in leisure-time physical activity.
In terms of facilitators to participation in disability
sport, as well as the obvious environmental factors
such as accessible facilities (Arbour-Nicitopoulos
& Martin Ginis, 2011), a range of psychological
constructs have been identified. For example, a
sense of athletic identity (Shapiro & Martin, 2010),
high self-efficacy (Phang, Martin Ginis, Routhier, &
Lemay, 2012), and social support (Wilhite & Shank,
2009) have been identified as facilitating engage-
ment in disability sport. In a systematic review of
52 studies on factors affecting disability sport partici-
pation (Jaarsma, Dijkstra, Geertzen, & Dekker, 2014)
activity, enjoyment, and effective goal setting were
identified as additional major facilitators.
Perceived Benefits
Numerous benefits of disability sport, particularly
ones conceptualized as psychosocial, have been
recognized in the literature. Some examples include
enhanced self-esteem (Dinomais et al., 2010),
improved physical self-concept (Scarpa, 2011),
reduced stress (Lundberg, Bennett, & Smith, 2011),
and better social well-being (Caddick & Smith,
2014). When sport helps alleviate disability-related
conditions—such as reducing spasticity associated
with cerebral palsy—perceived quality of life also
may be improved (Groff, Lundberg, & Zabriskie,
2009). There is also evidence to suggest disabled
people’s psychological well-being—defined in terms
of perceived growth and development—increases
through participation in leisure-time physical activity
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 Papathomas and Smith
(Williams et al., 2014). The growth, human flour-
ishing, and actualization of potential that characterizes
psychological well-being (see Ryan & Deci, 2001)
align with efforts to deploy sport as a rehabilitation
tool for those who have acquired a disability.
The Paralympic Games was born out of Ludwig
Guttmann’s belief that competing in sports would
encourage psychological well-being in those recov-
ering from sudden paralysis (Brittain & Green,
2012). There is now a vast evidence base supporting
Guttmann’s general hypothesis and numerous psycho-
logical benefits are associated with sport participa-
tion in a variety of disability settings (e.g., Hawkins,
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Coffee, & Soundy, 2014; Lundberg, Bennett, & Smith,
2011; Richardson, Papathomas, Smith, & Goosey-
Tolfrey, 2017). For example, using a pretest–posttest
design, Lundberg et al. (2011) found that disabled
combat veterans experienced improved psychological
health and quality of life after engaging in three 1-week
adaptive sport programs. Sporting activities also have
been used within acute rehabilitation settings as an
effective means to improve psychological adjustment
to sudden paralysis (Lundberg et al., 2011). Further,
once discharged from a hospital rehabilitation setting,
continued investment in sport is considered a valu-
able tool to promote long-term adjustment to spinal
cord injury (Hawkins et al., 2014). All such benefits
also may act as facilitators of participation in sport,
either indirectly when a disabled person takes part
because of a testified benefit (e.g., “I heard sport
is great for confidence”) or directly by motivating
continued engagement through positive outcomes
(e.g., “Sport improves my mood so I keep doing it”).
Children-specific insights.  Understanding of
disability sport promotion would be incomplete
without a specific focus on disabled children.
Childhood is a time when play is considered essential
(Isenberg & Quisenberry, 2002) and is a crucial devel-
opmental stage for establishing a physically active
lifestyle (Telama, Yang, Hirvensalo, & Raitakari,
2006). Applying an exclusive focus on disabled
children, Shields, Synnot, and Barr (2012) conducted
a systematic review of 14 barrier–facilitator studies.
According to this review, many of the aforemen-
tioned barriers and facilitators identified in adult
disabled populations also existed for disabled
388
children. Nevertheless, Shields et al. documented a
select number of child-specific considerations.
In terms of barriers, children were hindered
by factors such as overprotective parenting, peer-
group teasing, and lack of familial support. Parents
dis­interested in or unaware of the benefits of sport
are unlikely to offer their disabled child an opportu-
nity to participate. Some parents actively discourage
involvement in sport because of fear it will expose
their child to prejudice or physical harm. The reverse
is also true, and the supportive actions of parents
and peers recurred as a key facilitator. Thus, when
parents believe in the benefits sport might bring a
child with a disability, encouragement and oppor-
tunities are forthcoming and sport participation
is more likely. The instrumental role parents and
peers play in a child’s behavioral choices is consis-
tent with broader developmental theories of early
adolescence (see Collins & Laursen, 2004, for
further discussion).
Toward disability-specific insights.  The descrip-
tive accounts given thus far provide a useful starting
point to understand disability sport participation.
The emphasis on lists of discrete factors, however,
fails to illuminate context and process. There is
often very little account of differences in barriers
and facilitators across varying types of disability.
This lack of nuance is problematic given that even
a seemingly universal barrier, such as inaccessible
facilities, will hold contrasting meanings to a person
with a visual impairment compared with a person
in a wheelchair. Lumping all those with an impair-
ment into the catch-all term of disabled people may
facilitate concise reporting of findings, but it is
insensitive to the spectrum of experiences that lie
within such a label. As such, we now delve into the
nuanced sports participation experiences associ-
ated with a particular disability, providing a critical
overview of studies into cerebral palsy and spinal
cord injury. Our goal in this overview is to describe
important advancements in knowledge while also
illuminating the limits of that knowledge within the
context of broader disability studies.
A range of personal and environmental barriers
and facilitators were identified in a study of the
sport and physical activity experiences of children

and adolescents with cerebral palsy (Verschuren,
Wiart, Hermans, & Ketelaar, 2012). In this study,
Verschuren et al. conceptualized a category of
child-related psychological factors under the umbrella
of personal barrier or facilitator. Although this
category delivers a number of useful insights on the
factors affecting participation in sport for children
with cerebral palsy, a close inspection of the data
suggests a troubling allegiance to a medical model
of disability. Children with cerebral palsy reported
that they felt like “an outsider” during physical
activity opportunities and that they experienced
shame and embarrassment. These feelings were
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considered to be child-related psychological barriers
and therefore the relational origins of these feelings
was ignored. The unintended subtext is that it is
the child’s sensitivity to psychoemotional disablism
that is the barrier to engaging in sport and physical
activity, not the psychoemotional disablism itself.
Verschuren et al.’s (2012) converse child-related
psychological facilitators are also open to critique.
In particular, the authors identified “accepting the
disability” and “having perseverance” as psycho­
logical strengths supporting physical activity in
those with cerebral palsy. These strengths are illus-
trated using the example of a child who is able to
accept, ignore, and rise above the teasing and staring
that typically accompanies playing disability sport.
First, the authors appeared to conflate accepting
the disability with accepting others’ reactions to the
disability—taunting behaviors from peers should
not be construed as part and parcel of disability or
disability sport. Those disabled children who are
unable or unwilling to rise above or persevere in
the face of stigmatizing peer reactions should not be
considered to have failed to accept their disability.
Second, identifying perseverance as a psychological
facilitator for sport and physical activity implies
that disabled children who disengage somehow lack
perseverance, which again implies failure on the
part of the children. Our critique is not meant to
suggest that Verschuren et al. (2012) consciously
adopted such a stance, nor to disparage the fact that
their environmental category identified numerous
relevant social and relational barriers and facilitators.
Nevertheless, in choosing to segregate findings into
a false psychological–social dichotomy, Verschuren
Psychology of Disability Sport
et al. produced an unduly simplified analysis that
wrongly reinforces a child’s accountability for
managing psychoemotional disablism.
In a study exploring spinal cord injury and
involvement in organized sport, the principal barriers
were grouped into the following five themes: organi-
zation, medical, emotional, lack of available informa-
tion, and views held by others (Stephens, Neil, &
Smith, 2012). Although this study claimed to adopt a
social model approach, the results were more consis-
tent with a social relational perspective. Specifically,
the authors identified impairment-based barriers to
sport (e.g., spinal injury–related infections) and rela-
tional barriers (e.g., the stigmatized views of others).
The findings, therefore, pertained to both the biolog-
ical and the sociocultural facets of disability.
Regarding the benefits of sport that were identified
by Stephens et al. (2012), which included improved
socialization, increased self-worth, physical chal-
lenge, and better emotionality, the analysis fell into
the trappings of an overly medicalized understanding
of disability sport. In arguing, for example, that
self-worth is increased through processes such as
“proving physical strength to others,” “redefining the
self,” and “demonstrating competence,” the authors
risk confirming various disability stereotypes and
reinforcing disability stigma. From this perspec-
tive, disability sport becomes a way for individuals
to normalize themselves toward an able-bodied
standard—a means to demonstrate that they can be
as good as nondisabled people if they really try. This
is not to doubt the authenticity of these themes;
the qualitative data presented by Stephens et al.
support themes emphasizing sport as a means for
disabled participants to prove their worth. Never-
theless, participants in this study may have had a
particular conception of disability from having lived
most of their lives as able-bodied. By not framing
participants’ responses within dominant cultural
understandings of disability (i.e., as symbolizing
inferiority), the analysis lacks nuance. Again, by not
accounting for the interaction between the psycho-
logical and the social, the sophistication of the
analysis is limited.
To summarize, participation in recreational
disability sport is associated with numerous phys-
ical, social, and psychological benefits. From a
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 Papathomas and Smith
psychological perspective, participation in disability
sport can increase confidence and self-esteem and
can provide a sense of personal growth. Participation
in disability sport may even support adjustment to
an acquired disability, both during rehabilitation and
following medical discharge. Despite these benefits, a
complex web of personal, social, and environmental
barriers to participation prevent many disabled
individuals from taking full advantage of sport.
Understanding the perceived impact of barriers—
as well as relevant facilitators—to participation
is necessary for understanding what motivates
disabled people to engage in sport. More disability-
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specific insights and fewer “catch-all” accounts can
support this endeavor. Further, by engaging with
the major models of disability, researchers will be
better placed to acknowledge how the psychology
of disability sport participation is socially and
culturally situated.
ELITE DISABILITY SPORT
The popularity of elite disability sport has grown
exponentially in recent years and it is now recognized
as a major commercial enterprise (Legg & Steadward,
2011). The Paralympic Games in particular, once
considered a poorer cousin to the Olympic Games,
now attracts huge television viewing figures and
capacity stadia (see Webborn, 2013). Thus, modern
Paralympic success is associated with greater financial
rewards and a corresponding increase in competition.
Whereas in the past, budding Paralympians may have
experienced success with some talent and limited
training, the current landscape demands total dedica-
tion, sport science support, and government funding
or private sponsorship (see Goosey-Tolfrey, 2010;
Keogh, 2011; Houlihan, 2013).
Paralympic athletes have become professionals
and the pressures associated with competitive perfor-
mance have increased (Brittain, 2012). These changes
make elite disability sport a fertile area for sport
psychology researchers interested in the psycho-
logical factors supporting elite sports performance.
In the following subsections, we discuss what moti-
vates elite disabled athletes, the sources of pressures
for these athletes, and the role of mental skills in
managing such pressures. We also discuss the poten-
390
tial “dark side” of disability sport, and we consider
why so few studies have addressed the risks associated
with being a disabled athlete.
Motivation in Elite Disability Sport
In a survey-design study, 76 Dutch Paralympians
reported that fun, health, and competition were
central motivations for their initial engagement in
disability sport (Jaarsma, Geertzen, de Jong, Dijkstra,
& Dekker, 2014). Once involvement in sport inten-
sifies toward elite competition, however, the sources
of motivation among disabled athletes change.
For example, former Paralympians described their
commitment to a disability sport career as fueled by
a desire to prove themselves capable and a prefer-
ence for an athletic identity ahead of a disabled
identity (Wheeler et al., 1999). Yet, the idea that
elite disability sport is an attractive career because
it provides an escape from a disabled sense of self
is not without problems.
The motivation to compete in disability sport
to “prove worth” implicitly suggests an under-
lying perceived “lack of worth.” To this end, elite
disability sport may not be the haven of disability
rights and equality that it is often portrayed to be.
It is difficult to conceive of an equality that is reliant
on outstanding sporting feats measured against an
able-bodied standard. In this sense, elite disability
sport may actually reduce equality by highlighting
the limitations of disabled people who are not moti-
vated or perhaps not able to reach for Paralympic
gold. Even for successful elite disabled athletes, the
sense of equality that comes through their sporting
prowess may be short lived. As illustrated by a
participant in the Wheeler et al. (1999) study, upon
retirement from elite disability sport Paralympians
may no longer be protected from the prejudices
experienced by disabled nonathletes:
There are issues surrounding having
a disability that being an athlete with
a disability overcomes. . . . It’s a tough
thing to give up because you are getting
recognition, the respect, the equality;
the equity that other people are getting
that we may no longer have access to
without that sexy sports image. (p. 227)

For some athletes, therefore, retirement from
elite disability sport may be especially trouble-
some because retirement represents a return to
being disabled. From this perspective, the disability
in disability sport is not so much celebrated as
concealed. That is, disability is not celebrated in
its own right or for its uniqueness but rather for
its capacity to be overcome. Disability is celebrated
when it does not prevent outstanding athletic
feats (i.e., when it doesn’t disable). Upon ending
their athletic career, Paralympian athletes may feel
“exposed” as ordinary disabled persons who are
stripped of their athletic defenses and vulnerable to
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the same disablist stigma as other disabled people.
Given these insights, understanding the deep, under-
lying motivations of elite disabled athletes for their
involvement in sport is an important step toward
supporting their long-term psychological health.
Sport psychology researchers have also consid-
ered elite disabled athletes sporting motivations with
reference to self-determination theory (Deci & Ryan,
2012; see Chapter 15, this volume). According to
this theory, the more self-determined an individual’s
motivation level, the more likely he or she will be
to persist with a given behavior or pursuit. Further,
motivation is more likely to be self-determined if
a behavior fulfills three basic psychological needs:
autonomy, competence, and relatedness. An abun-
dance of research (e.g., Adie, Duda, & Ntoumanis,
2012; Hodge, Lonsdale, & Jackson, 2009; Quested
& Duda, 2011) suggests that elite sport coaches
should support the basic needs of these disabled
athletes so as to promote a better quality of motiva-
tion and facilitate sustained athletic engagement.
This theoretical position was explored in rela-
tion to disability sport in a sample of more than
100 Canadian Paralympians (Banack et al., 2011).
The disabled athletes completed measures relating
to perceived coach autonomy support, intrinsic
motivation (i.e., complete self-determination), and
basic psychological needs satisfaction. The results
demonstrated a significant relationship between
Paralympians’ perceptions of coach autonomy support
and perceptions of autonomy and relatedness. In
turn, perceptions of autonomy, albeit not related-
ness, predicted intrinsic motivation. From these
results, it can be deduced that the creation of an
Psychology of Disability Sport
autonomy-supportive environment may promote
basic needs satisfaction and promote intrinsic
motivation in a Paralympic setting.
Cheon, Reeve, Lee, and Lee (2015) provided
experimental evidence to support the benefits of an
autonomy-supportive environment. The authors
examined the effectiveness of an intervention
designed to promote autonomy-supportive coaching
in coaches preparing their athletes for the London
Paralympics. They found that Paralympic athletes
who received a coach autonomy-supportive inter­
vention better maintained motivation compared with
a control group who received their usual coaching.
This result reinforces the motivational benefits of
supporting athlete autonomy, even in “high-stakes”
situations where coaches often adopt controlling
behaviors and practices. The study also showed
that competence was linked to intrinsic motivation
despite being unaffected by autonomy support. This
finding suggests that strategies to promote a sense of
competence also should be considered.
Psychosocial Stress and Coping
In their narrative review of the psychological
environment of elite disability sport, Dieffenbach
and Statler (2012) contended that Olympic and
Paralympic sport domains are more similar than
different. They suggested that practitioners working
with disabled athletes should base their practice on
a nondisabled elite athlete paradigm. Supporting
this view, Campbell and Jones (2002) identified a
range of fairly commonplace performance-related
psychological stressors in wheelchair basketball
players. Examples included preevent nerves, post-
match performance concerns, and team cohesion
issues. In a related study, organizational stressors
reported by elite disabled athletes were mapped
onto a preexisting taxonomy of stressors devised
from an able-bodied athlete population (Arnold
et al., 2017). Reinforcing the “more similar than
different” perspective, Arnold et al. (2017) suggested
that for both disabled and nondisabled elite athletes,
organizational stressors can be grouped into the
core themes of leadership and personnel issues,
cultural and team issues, logistical and environ-
mental issues, and performance and personal issues.
These themes are sufficiently broad to allow for
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 Papathomas and Smith
nuance between disabled athletes’ experiences and
those of nondisabled athletes, and a small number of
disability-specific organizational stressors are high-
lighted. One such stressor that was identified and
distinct to disabled athletes was frustration caused
by a lack of disability-specific coaching and training.
Although coach education appears an obvious solu-
tion to this stressor, the situation is complicated by the
requirement for coach education to be morally attuned
to the needs of disabled athletes (see Townsend, Smith,
& Cushion, 2015, for a review). Disability awareness
alone is insufficient if coaches merely consider it as
something to surmount in the pursuit of athletic
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success. Coach awareness must go beyond the biolog-
ical realities of disability (i.e., the medical model) and
incorporate cultural and experiential features (i.e., the
social relational model). According to Townsend et al.
(2015), without this broader appreciation coaching
practice will continue to be perceived by disabled
athletes as a major stressor.
In addition to describing performance-related
stressors, a select number of studies have sought
to identify the coping strategies used by disabled
athletes. For example, in a comparison of athletes at
the Winter Olympic and Paralympic Games, no differ-
ences were found regarding the coping strategies used
to manage stress and anxiety (Pensgaard, Roberts, &
Ursin, 1999). Both disabled and nondisabled groups
of performers adopted a range of predominantly adap-
tive problem-focused and emotion-focused strategies.
The types of coping strategies adopted also may be
a function of the type of motivation an individual
possesses. Exploring this hypothesis in a sample of
wheelchair basketball players, Perreault and Vallerand
(2007) identified a relationship between more self-
determined forms of motivation and healthier
coping strategies. In turn, amotivation was nega-
tively correlated with coping skills. The authors
suggested that these findings offer support for the
idea that self-determined motivation promotes
enhanced psychological functioning.
Further, the relationship between achievement
goal orientation and athletic coping skills was investi-
gated in a sample of elite wheelchair basketball players
( Jooste, Kubayi, & Paul, 2015). Results indicated
that a task orientation (i.e., success judged in terms
of learning and self-improvement) was related
392
to effective coping strategies, such as goal setting,
mental preparation, and increased concentration. In
contrast, an ego orientation (i.e., success judged in
terms of normative comparisons) was not associated
with these strategies. These findings align well with
studies of elite nondisabled athletes (e.g., Harwood,
Cumming, & Fletcher, 2004; Kristiansen, Roberts, &
Abrahamsen, 2008), suggesting that, on the surface at
least, the psychology of Olympic and Paralympic sport
is more similar than different.
Mental Skills in Elite Disability Sport
A related line of inquiry concerns how mental skills
training might protect elite disabled athletes from
the typical stresses of competitive sport environ-
ments. Martin (2012) argued that techniques such
as positive self-talk, imagery, and emotional control
may help Paralympians deal with stress, but they
accepted that the evidence base in disability sport
was sparse. Martin also warned against the simple
application of mental skills research conducted
with able-bodied athletes into work with disabled
athletes. It is a view shared by Hanrahan (2015),
who outlined a range of important practical modifi-
cations when using some psychological skills with
disabled athletes. For example, progressive muscular
relaxation routines may be difficult for individuals
with cerebral palsy who experience high levels of
spasticity, and so they may benefit from skipping the
tension phase of the routine. Further, athletes who
have acquired a disability may struggle with imagery
scripts because they fall into a habit of visualizing
themselves as able-bodied. This can minimize the
effectiveness of the imagery process and may be
particularly relevant if the disability is relatively new.
Like Martin’s (2012), Hanrahan’s (2015) reflec-
tions were not based on an existing evidence base
but rather a combination of insights drawn from the
able-bodied literature and personal practitioner expe-
rience. An important goal for the sport psychology
research community is to begin establishing an
empirical foundation related to mental skill use
in disability sport. In a rare move toward this
goal, Martin and Malone (2013) explored mental
skill use in Paralympians, four of whom were gold
medal winners. Acknowledging the scarcity of
research in this area, the researchers stated that

their primary objective was to provide a descriptive
account of mental skills use. To this end, the elite
disabled athletes reported above average use on the
popular mental skills surveyed (e.g., imagery,
self-talk, coping skills). The second aim of this study
was to ascertain whether increased use of these
mental skills was associated with better engage-
ment in sport. Again, the findings were encouraging;
multiple regression analyses showed that mental
skill use accounted for 50% of the variance in athlete
engagement. As welcome as this primary research is,
more research is needed to build on these preliminary,
correlational findings.
Copyright American Psychological Association. Not for further distribution.
The Dark Side of Elite Disability Sport
Much of the evidence to date, despite being nascent
and descriptive, suggests elite disabled athletes
adopt a range of coping strategies and mental skills
to effectively manage performance pressures in
much the same way as do their nondisabled peers.
In contrast, consequences of maladaptive coping
have rarely been studied, analyzed, or discussed in
the extant literature.
What happens when elite disabled athletes
struggle to manage the burden of competitive
sport? What negative consequences are associated
with a highly competitive disability sport environ-
ment? There are few answers to these questions
because the sport psychology community has not
engaged with the dark side of disability sport.
Within sport psychology, the dark side refers to
negative psychological consequences or socially
undesirable behaviors associated with involvement
in competitive sport (e.g., Cruickshank & Collins,
2015; Douglas & Carless, 2014; MacNamara &
Collins, 2015). In contrast, sport psychology research
has extensively addressed the dark side of non­
disabled sport. For example, able-bodied athletes
can experience great psychological trauma in terms
of perfectionism (Flett & Hewitt, 2014), burnout
(Olusoga & Kenttä, 2017), chronic stress (Nixdorf,
Frank, & Beckmann, 2015), depression (Larkin,
Levy, Marchant, & Martin, 2017), eating disorders
(Papathomas & Petrie, 2014), emotional abuse
(Stirling & Kerr, 2013), and sexual abuse (Owton &
Sparkes, 2017). All of these issues are conspicuous
by their absence from how elite disability sport
Psychology of Disability Sport
currently is theorized and addressed by researchers.
More research is clearly needed in these areas.
Findings from selected studies suggest there is
sufficient material for examining evidence of the dark
side of elite disability sport. For example, in a survey
of 99 Paralympians’ attitudes toward boosting—that
is, intentionally inducing autonomic dysreflexia for
performance gains—more than two thirds acknowl-
edged its usefulness for performance across various
sports (Bhambhani et al., 2010). Further, more
than 95% stated the practice was “somewhat to
very dangerous,” yet 16.7% disclosed having
previously used the method. The psychological
factors that underpin a disabled athlete risking health
for sporting success would represent a significant
development in terms of understanding elite disability
sport and its potential negative consequences to the
athlete’s physical and mental well-being.
Within the broader social sciences, there have
been personal accounts of how life as a Paralympian
is not necessarily an uplifting experience. Peers
(2012), an elite disabled athlete who has muscular
dystrophy, described instances of discrimination,
stigma, and ignorance within the competitive sport
environment. In her stories of life competing as a
disabled athlete, she reflected on feelings of frustra-
tion, sadness, and anger. She also openly renounced
the “inspirational” tag bequeathed on Paralympians
and argued that it is patronizing and disingenuous.
Finally, Peers addressed the pain that can occur
when elite level training is combined with a physical
impairment. Although there are numerous theo-
retical layers to Peers’s story, the crux is that elite
disability sport is not the fairy tale it is oft-portrayed
to be and Paralympic athletes remain exposed to
psychoemotional disablism, much of which emanates
from the sporting environment that supposedly
serves as a conduit to equality and better psycho-
logical health. The psychology of disability sport can
no longer afford to be disengaged from these issues
and controversies. Understanding the full spectrum
of experiences of elite disabled athletes is essential if
they are to receive appropriate psychological support
for all the challenges elite competition can bring.
In summary, elite disability sport has grown in
stature in recent times. The modern Paralympic
Games is a high-stakes competitive environment
393
 Papathomas and Smith
to which athletes dedicate years of training and
preparation. The motivation to pursue a Paralympic
career can come from athletes’ desire to prove capabil-
ities against able-bodied norms. Sustained commit-
ment also is supported by autonomy-supportive
coaching environments. The limited research to date
suggests that disabled athletes have similar stress
and coping experiences to nondisabled athletes.
Despite this proposed similarity of experience, the
dark side of the elite disability sport experience is
less documented compared to able-bodied sport.
The overt research emphasis on the psychological
benefits of disability sport has served to deempha-
Copyright American Psychological Association. Not for further distribution.
size potential negative outcomes, resulting in an
incomplete picture of the disability sport experience.
LIMITATIONS OF CURRENT RESEARCH
AND FUTURE DIRECTIONS
In this chapter, we have delivered a critical overview
of research into the psychology of disability sport.
We have acknowledged that research to date has
provided important psychological insights and that
the body of work continues to expand. The principal
limitation underpinning many studies is a lack of
regard for the broader field of disability studies as
well as sporadic appreciation for specific disability
models. Too much existing sport psychology research
is characterized by undertones of the medical model
and this can result in simplistic conclusions that
are ill-attuned to the social and cultural facets of
disability. Future research must seek to embrace
learnings from across disciplinary borders and
leverage the significant history of disability studies.
Adopting the perspective of the social relational
model is an obvious starting point, given the model
attends to the psychoemotional processes at the heart
of disability. Constructing the disability experience
as a function of impairment, culture, and relational
interactions will add complexity and authenticity
to sport psychology research findings. Traditional
topics of interest, such as performance, excellence,
and behavior, can still be studied but in a way that
better accommodates social relational considerations
(Smith & Perrier, 2014). As an example, instead
of attributing athlete dropout to individual impair-
ment (e.g., pain, fatigue) or lack of motivation,
394
researchers might also consider social–relational
factors that reinforce barriers to sport participation.
These factors might concern low levels of disability
awareness in coaches, which lead to practices
that precipitate pain or fatigue or that minimize
opportunities for recuperation. Further, cultural
conceptions of mental toughness that are reinforced
during peer and coach interactions could work to
shame disabled athletes who struggle with pain or
fatigue. Such an analysis might show that although
impairment-related pain and fatigue could cause
dropout in their own right, social and relational
factors also may contribute. Ultimately, constructing
the disability experience as a function of impairment,
culture, and relational interactions will add complexity
to sport psychology research findings and lend
authenticity to what is still an evidence base in
its infancy.
CONCLUSION
There is little doubt that sport psychology has begun
to engage with disability sport in terms of research
and practice across participation and performance
domains. The field has made great strides toward
understanding how disabled people become motivated
to play sport, as well as toward detailing the various
psychological factors associated with elite competi-
tion. Often unwittingly, much of the research to
date is informed by a naive medical model. The result
is that disability is presumptively and uncritically
conceptualized as a disorder or defect.
Prominent alternative approaches within the
broader arena of disability studies, such as those
adopting a social model or social relational model,
typically are ignored by sport psychology. Indeed,
these models of disability have not informed sport
psychologists’ thinking (Smith & Perrier, 2014).
At best, not drawing from the wider lens of disability
studies leads to simplified understandings of disability
sport that are situated within a social vacuum and
ignorant to the broader sociocultural influences
on disability. At worst, these naive medicalized
understandings promote a body of knowledge
that conceptualizes disability as something to be
hidden, overcome, or accepted through engagement
with sport. Sport becomes a simple antidote to the

wealth of disability-related biopsychosocial afflic-
tions, from improved confidence to reduced pain to
increased esteem. This kind of dogmatic approach to
researching the psychology of disability sport risks
producing findings that merely confirm existing
narrow, unsophisticated ideas.
Sport psychology has much to offer the field of
disability studies, but before it can begin to contribute
researchers must consider alternative understandings
of disability, sport, and the relationship between the
two. Integration of the psychological and the socio-
cultural is imperative if the field of sport psychology
is to produce knowledge that positively influences the
Copyright American Psychological Association. Not for further distribution.
broader disability studies community.
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