The Americans With Disabilities Act of 1990 (ADA) (Public Law 101–336) is a civil rights law intended to bring men, women, and children with disabilities into the mainstream of American life. This paper discusses the relation of the law to pediatric occupational therapy practice. The spirit of the ADA is highly compatible with occupational therapy’s philosophical perspective. Occupational therapy personnel value functional independence, which requires an interactive relation between the environment and the child. Current pediatric practice models focus on deficit reduction and give limited attention to the environment, even though physical, social, and temporal environments contribute to disability, as do performance component deficits. An environment-centered model is suggested as a pediatric service provision approach compatible with the philosophical background of the ADA. This model emphasizes education and consultation to businesses and individuals for the purpose of altering environments to be accessible and accommodating to children and adolescents with disabilities. Three examples of environment-centered services are presented: (a) an evaluation of environments and reasonable accommodation recommendations for a teenager with a physical disability, (b) the mother of a child with cerebral palsy, and (c) the parents and program director of a community recreation program.