According to Phil Spencer, Microsoft had started to take more interest in accessibility features for gaming following the Kinect motion sensing input device first introduced in 2010.

[4][5] The prototype device/input hub was designed and refined during several internal hackathon events where they built a controller that could use third-party accessories familiar to disabled gamers.

In 2017, Microsoft decided to turn the prototype into a product and began collaborating with accessory manufacturers and nonprofit groups in the gaming accessibility field such as SpecialEffect, Warfighter Engaged, and The AbleGamers Foundation.

[10] A second commercial entitled "We All Win" was broadcast during Super Bowl LIII, which featured testimonials from Owen and his family on the positive impact of the device.

[11][12][13][14] Microsoft's electronic voting system ElectionGuard includes an Xbox Adaptive Controller in its base alongside its touchscreen.

The jacks are designed to require more force than usual to insert or remove a plug, preventing inadvertent disconnection of the assistive input devices.

[17] According to Phil Spencer, the Adaptive Controller is not hardware-locked to Xbox, and was developed with the intention to be used with any gaming platform,[22] with Microsoft opening dialogue with Valve, Nintendo and Sony towards this effort.

[23] Further supporting that broad compatibility, Bluetooth LE (HID over GATT Profile) connectivity was added in a 2021 firmware update.

[29] Steven Spohn, the chair of AbleGamers, praised the affordability and wide availability of the controller comparing to existing assistive technology, saying that "a device specifically designed for the disability community costing $100 ... [is] a little like finding a unicorn hugging a leprechaun," all the while decrying the "disability tax" attached to devices that are considered "medically necessary.

"[30] Grant Stoner echoed criticism of the total cost of the controller and required accessories, writing in 2020 that while the price of the Adaptive Controller itself was "not too outrageous, especially considering its overall use and compatibility", the addition of required input switches and joysticks results in an "egregious price to assemble an appropriate setup [which] ultimately muddles the hopeful expectation of enabling everybody to play".

[31] In 2020, peripheral manufacturer Hori released the Flex Controller (NSW-280), which was designed by Technotool Co., Ltd. and provides similar functions for the Nintendo Switch.

The Mouse is a square-shaped core that provides two buttons and a scroll wheel and is designed to be clipped in to plastic accessories to enhance the physical interface.

[37] Sony announced it would release a similar accessible, customizable controller for the PlayStation 5 based on the Project Leonardo prototype shown at the Consumer Electronics Show in January 2023.