Gaming has been a huge part of Erin Hawley's life since she started playing Atari as a little girl.

When the Keyport, New Jersey-based, 35-year-old digital content producer for the Easterseals charity gets off work, she gets right on her computer or Xbox and often keeps going until it's time for bed.

Hawley is a fan of shooter titles such as "Overwatch" and "Half-Life," but she’ll play adventure games, puzzles, almost anything. She’s also a regular on the Amazon-owned Twitch live streaming platform.

Gaming is how Hawley typically relaxes, interacts with friends and takes her mind off things.

And it provides a social outlet for other purposes: Hawley has Muscular Dystrophy, anxiety, and scoliosis, and she is an advocate for the disabled.

She created a blog called The Geeky Gimp. Through her work with Easterseals, Hawley has helped foster communities of young women with disabilities called Thrive, where she facilities discussions around gaming, technology and living life with a disability.

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“Putting myself out there like that is an act of self-love, Hawley explains. She met her partner of nearly four years after the person recognized her in a Twitter chat about tabletop gaming.

“Video gaming as a way to make connections can be useful, especially when people have no other way to connect,” says Pittsburgh psychologist Dr. Nancy Mramor.

That potentially includes at least 46 million gamers in the U.S. alone, according to researchers at the AbleGamers charity, a non-profit that attempts "to wield the power of gaming to break down the barriers of economic and social isolation for children, adults and veterans with disabilities.”

If anything, that’s a low-ball estimate, since the number doesn’t factor in folks with dexterity, strength or tremor related disabilities, neuro-diverse challenges, or even people whose motor or other skills are in decline as they age.

As a rule, disabled people are no less fanatical about playing video games than people without physical or cognitive challenges. Of course, there are many types and degrees of disabilities, whether from birth, a progressive illness or injury. And, unsurprisingly just like those who aren't disabled, their skill levels also vary.

Making video games more accessible

The challenges faced by disabled gamers often mean that certain accessibility accommodations be made.

Hawley is among those who rely on the $99.99 Xbox Adaptive Controller from Microsoft, which lets gamers customize the controller to exactly what they need in order to play in a way that is most comfortable to them. For example, the controller can be placed on the floor to allow gamers to use buttons with their feet. It can also be mounted onto wheelchairs or tables.

Microsoft partnered with AbleGamers, The Cerebral Palsy Foundation, SpecialEffect, Warfighter Engaged and Craig Hospital in developing the controller. Just last month, Microsoft and the U.S. Department of Veterans Affairs announced a collaboration to provide the controller and other gaming technology (hardware, services, games) to 22 VA rehab centers across the country.

Bryce Johnson, who spearheaded the creation of the controller at Microsoft said, “While we do want to make sure that we’re empowering people with disabilities to play video games, we also need to recognize that we’re not providing an unworthy competitive advantage to someone who might not have a disability.”

Game developers also must confront this balancing act. For example, the designers of the Celeste video game for the Xbox One, PlayStation 4, Nintendo Switch and Steam (PC and Mac) from developer Matt Makes Games – the goal is to have a character survive inner demons and hardcore challenges to scale Celeste Mountain – added an Assist Mode accessibility option that lets someone play at their own pace and difficulty level.

After receiving feedback, CEO Chandana Ekanayake of Outerloop Games changed the shapes and intensity of colors inside his company's Falcon Age first-person action adventure game for PlayStation4 and PlayStation VR to make it simpler for people who are colorblind. He also made sure the PlayStation controller could be remapped to support certain features of the game to accommodate people with special needs. Large text in the game makes it easier for people who may be hard of hearing or deaf.

"There's a spectrum of our fans, and we want to support them," Ekanayake says. At our size, "it's easy for us to take feedback and adjust. Our timetables for making changes to our games is a lot quicker than a triple-A game that has to come out at a certain time."

In general, though, more needs to be done, advocates say.

The companies that are slowly but surely paying more attention to accessibility are driven by a confluence of factors. Yes, some want to be more inclusive and do the right thing. But there are also market imperatives.

“I never told a game company a sad story,” says Mark Barlet, the disabled vet who founded AbleGamers back in 2004. Instead, he says he told them “that people with disabilities have a trillion dollars in expendable income,” and that “there is money being left on the table” if you ignore them.

The message is getting across. “The industry in the last three years is 180 degrees from where it was before," Barlet says. "I am talking to every triple-A studio out there right now. I will say that accessibility isn’t a dirty word anymore and it was at one point.”

For example, EA has created an accessibility portal with the goal of making it easier for players to find accessibility features and resources across games.

Karen Stevens, a software engineer who leads the accessibility efforts at EA Sports says she thinks of "accessibility as the correction of a mismatch between a person and their environment. It’s up to developers to create games that everyone can enjoy, inclusive of individuals with disabilities."

This past October, AbleGamers launched a “user-driven” model for developing accessible games called the Accessible Player Experience or APX, described this way: “Though we may learn, socialize or otherwise improve ourselves through games, most players play because they want to have a wide variety of experiences. Players with disabilities are no different. To get players really playing your game, it is not enough to simply give players access to the controls of your games so that they can steer a car or shoot an arrow, but instead to give them the experience of being Formula 1 driver or an adventurer in a fantasy world.”

Don't water down the game

Keeping that in mind, what APX is not meant to provide is a version of a game that waters down that experience.

Disabled gamers or those with accessibility needs typically want to play the same games everybody else plays.

The developers of "Shadow’s Edge" have taken a different approach. Their free self-help mobile game for iOS and Android, a recent Edison Awards winner, is aimed at teens and young adults with serious illnesses.

Sheri Brisson, who survived brain cancer when she was younger, and the co-author of "Digging Deep: A Journal for Young People Facing Health Challenges," on which "Shadow’s Edge" is based, says "the goal is to take kids through an emotional healing process when they have a medical condition, something that makes them different than the other kids at school or in their peer groups.” Kids express their emotions through journaling and graffiti.

But Hawley and others like her are, for the most part, engaged by mainstream games.

Disclosing a disability

“People are relating to you in the context of the game; you are no longer disabled in that environment," says Dr. Pamela Rutledge, director of the media psychology research center in Newport Beach, California. "You have the ability to improve your self-confidence because you are skilled at something that others value,”

AbleGamers chief operating officer Steve Spohn concurs: “Virtually, we can play these games together, and we can all have this shared experience of conquering that beast or winning the game or being the clutch person at the last second and getting that comradery of 'yeah, we did it.’ That kind of social input is just as important as sunlight is to your body.”

Hawley plays against friends who like her have disabilities, one of whom, for example, uses an eye-tracking device to participate. But not all her opponents are disabled.

When playing against strangers, Hawley openly shares the fact that she is disabled. “I think it’s important to not pretend that I’m not disabled because the more people see it the more people can normalize disabilities.”

Most disabled people want to avoid stigma and be treated just like everyone else.

Still, some choose to keep it private.

“Disclosure is a funny thing. There’s lots of people we work with whose disability is a factor of their identity, and that’s wonderful and we celebrate that,” Microsoft’s Johnson says. “But there are other people who are just like, 'I play these games as an escape from my day-to-day. I want to be different in here.’”

Barlet of AbleGamers describes video games as "the great equalizer. You don’t know if I’m disabled. You just know that I’m an ogre or whatever character or manifestation I am in the game. To me, games are about community, about connecting with a shared experience.”

Email: ebaig@usatoday.com; Follow @edbaig on Twitter