It’s hard to remember how strong the arguments were that women were lesser than men, that black people were lesser than white people, that gayness was a crime, a sin, and a disease in search of a cure. It can be hard to realize how many people still make these arguments, how many hated living under the authority of an African-American president and how many abhor the idea of a female president, how many would deny basic services to gay and trans people, how many regard the disabled with polite disdain.

Our society is rife with glass ceilings, and the disability ceiling has the fewest cracks in it. When I attended the 2018 annual convention of The Arc, the country’s largest and oldest organization for people with intellectual and developmental disabilities, I was struck by how seldom we see in common life what I saw there: the meeting of disabled and nondisabled people as equals.

Increasingly, decisions about what kind of child to have are made prenatally, either through preimplantation genetic diagnosis or through amniocentesis. An image of disability is set at the birth of a newborn child. But predictions about any individual life are always hypothetical and often wrong. In interviewing hundreds of parents of children with disabilities, I found a recurring theme of indignation from parents whose children had achieved much more — or much less — than doctors had anticipated. A baby, disabled or not, is a cipher, and only time will show how and what he or she will do.

Doctors who deliver prognostications are usually representing averages. On average, certain conditions bestow certain degrees of disability, but brains and bodies are highly adaptive, and the skills of an individual child can surprise everyone. It is a tough call for doctors. Creating an atmosphere of false hope can be catastrophic; it sets families up for renewed despair with every milestone their child misses. But presuming the worst often results in the worst results; low expectations can be a self-fulfilling prophecy. A tempered realism about the vagaries and uncertainties often obtains the best result, but parents crave assurances and doctors too often indulge that inclination.

The mother of a man with diastrophic dwarfism, a very disabling condition, described to me how for the first year of her son’s life, every doctor she saw rattled off a catalog of what was likely to go wrong and asked her if she was prepared to deal with it all. When her son was a year old, a doctor who specialized in skeletal dysplasias lifted the baby up, held him aloft in the light, and said, “Let me tell you. That’s going to be a handsome young man one day.” The rewarding life she was to have with her son began that very day, a fact she reflected on when we chatted at his joyous wedding years later.

The expectations with which a child is raised may have a strongly determining effect on what that child can do. Parents must hope for the best, but also believe that life will have meaning even with a child who achieves limited functioning. The process of forging meaning does wonders for both parents and child. A recent study looked at children with various complications at birth and found, simply, “The children of mothers who had tried harder to find meaning had a better developmental outcome.” How we frame disability determines how we live it, and if it is defined as calamitous from the start, the job of finding meaning is steeper than it need be. The fact that you wouldn’t have chosen something doesn’t mean that you can’t find joyful meaning in it.

Every condition manifests in a mix of inherent challenges, access challenges, and social challenges. Many people with achondroplasia (the most common form of dwarfism) have spinal compression and need surgery for it. We can fix social attitudes toward people with dwarfism all we want, and spinal decompression procedures will neither be obviated nor become pleasant. They are an inherent challenge of the condition. Challenges of access are amply addressed by the Americans With Disabilities Act and we recognize the need for accommodations to address them, but though things are much better than they were on this front, problems persist. So, someone with achondroplasia may be unable to reach the cereal at the local supermarket. The solution to this problem is not to make the LP (little person) taller, but to build grocery stores with lower shelving — or at least to give customers some tools or assistance that allow them to retrieve what they want to put in their cart. Because achondroplasia is a relatively infrequent disability, there are no standards for addressing high grocery shelves. That is a challenge of access.