I tried an experiment recently using the Fifth Edition Character Sheet iOS app and a few dice: I made a random character. I rolled dice for race, for race variant (if applicable), background, stats (without reassigning them) and even class. Here is a brief of that character:
Rendo Andross, Hill Dwarf, Folk Hero, Fighter
Strength 4 (-3)
Dexterity 16 (+3)
Constitution 18 (+4)
Intelligence 8 (-1)
Wisdom 12 (+1)
Charisma 9 (-1)
While unusual, this turned out to be a fair character build. By the time I took class options like fighting style (archery), Andross became playable.
I decided to build a random character like Andross because I've become interested in how games might handle characters with disabilities. While Andross is playable, he would be a rather striking character study. As a dwarf and a fighter, strength would be rather prized. Instead, we see how -3 malus to all strength checks would be really challenging and likely character defining. I think that Andross has a physical disability. Nevertheless, Andross is more nimble and just as tough than most of his dwarven peers. Consider the uncanny physical prowess of Paralympians who train diligently, pushing their bodies beyond the limits of most able-bodied people; all the while they work with spinal cord injuries, amputations, and other life defining episodes or conditions. This is a kind of character Andross could be.
Imagine Rendo Andross growing up, being bullied by stronger dwarves or even abandoned by family members who assume he would measure up to nothing. Did he rise out of force of will? Did a family member stand with him? Did a mentor teach skills that were not highly valued in his community? And the background of a folk hero suggests that he was able to demonstrate his worth in the face of so many other challenges.
Now, let's take a moment to embrace that 4 (-3) value and how it might play out with the other attributes:
Dexterity 4 (-3): While a surface reading may suggest an extraordinary klutz, perhaps such a character suffers nerve damage or a degenerative health issue. Such a character may have to invest in additional mobility (such as a style of wheelchair), allowing unusual armor or cover options. Depending on other character options, the athletes of wheelchair rugby (see the documentary Murder Ball for more) come quickly to mind.
Constitution 4 (-3): Imagine a character that with each level increase (resulting from months and years of experience in the field), their health degrades. This is the life of someone with a progressive disease or other major health issues. The fact that such a condition is so extreme could mean a genetic health issue, something incurable. Also, with diligent training, such a character may train to a certain degree to manage this health issue, but only by setting aside many other kinds of advancement.
Intelligence 4 (-3): Characters with low intelligence can often be relegated to the archaism "simple," but if we look at the skills associated with Intelligence, we can get a more interesting picture. Such a character may lack clear vision needed for Investigation or was profoundly (even abusively) sheltered from accurate education. (I would consider this the case of Young Earth Creationists or anti-vaccination rhetoric in the real world.) Low intelligence doesn't necessitate a disability, though it could also be explained by blindness in a sight-focused culture or dyslexia in a world steeped in literature. Intelligence in Dungeons & Dragons (as well as Pathfinder and related RPGs) represents book learning, but many people are successful from the "school of hard knocks," better represented by Wisdom and Charisma.
Wisdom 4 (-3): With the association of Insight and Perception with wisdom, such a character may misunderstand or fail to read social cues much as many people on the Autism Spectrum do. Perception's association with Wisdom may suggest partial or complete deafness for a character, or peripheral blindness that inhibits scanning your surroundings but not central vision used in reading or face-to-face interactions.
Charisma 4 (-3): As it happens, one of my player's characters has this attribute score. We explained it as a massive facial scar that frightens or disturbs people, undermining Charisma attempts. (Caitie amps this up by frequently putting her character's foot squarely in her own mouth.) Alternatively, such a character may also fail to respond appropriately to social cues, overplay a hand, or be highly aware of others' gaze in social situations. While a low charisma character may sometimes act buffoonish, consider how social anxiety, Turrets Syndrome, or Parkinson's Disease (which would have other impacts) may be perceived in the world of a roleplaying game.
Let me be clear, these considerations are not intended to poke fun at people with disabilities and should not be used to create cruel, demeaning characterizations. Instead, see how player characters may better reflect the diversity of real world people, facilitate understanding of neuro-atypical people (a term I came upon and fell in love with when researching Autism Spectrum), and people with disabilities as lived experiences, with the goal of encouraging more people to see themselves in the games and stories they play.
It is common to see players create incredibly epic tales of daring deeds, but even Superman has weaknesses, and not just to kryptonite. I've often encouraged players to reroll very low or multiple low attribute scores (and I have preferred point-buy character creation). Low attribute rolls in Dungeons & Dragons represent something baked into the character, something much more akin to chronic health issues, disabilities, and traumatic injuries. Other game systems such as Cypher, The 7th Sea, and Apocalypse World discourage dramatic lows by using much less random attribute creation systems. Call of Cthulhu character attributes can be low, while skill advancement can climb fairly easily (a system I greatly enjoy for reasons I won't go into here).
To be honest, I am surprised to consider D&D a fairly functional system for representing characters with disabilities. I am also rather curious to see how players might adapt such characters in the game world. The god Hephaestus, who was thrown from Mt. Olympus for the deformity of his foot, returned to Olympus, becoming a patron of smiths and other craftspeople. How perfect, if simplified, a model for some metallurgical wizardry and unusual adventuring gear for characters with similar disabilities? (TVTropes.org's Disabled Deity page has a summary of this trope occurring in various media, including other legends and myths, often in unflattering ways.) RPG characters, especially in the fantasy mold, often become god-like, so consider how a heroic rise might look from a character beginning with a disability.
Real life disabilities cannot be simplified to a series of numbers or dice rolls. The lived experiences of people with disabilities are important to listen to compassionately, especially as access to care services are threatened. With this reflection and exercise, I want to see characters with disabilities in our media as a matter of representation as well as a matter of engaging, powerful stories. And who better to star in such stories as those who push themselves all the more toward excellence?