Accessibility for Cognition

Cognitive disabilities cover a variety of conditions and experiences, but because they are not always obvious, they often get overlooked and are perhaps the least understood disabilities.

When it comes to addressing auditory, mobility or visual issues through your website, the approaches toward accessibility are more straightforward. For visual issues, a screen reader can help. For auditory issues, using closed captioning can replace audio output. Mobility issues allow for voice operation or other methods to enter information and interact. But due to the number of possible causes for cognitive disabilities, coming up with a set of solutions is challenging. And the goal for truly inclusive design is to engineer your site in such a way that assistive technologies aren’t always required.

Bearing both of these factors in mind, there are several approaches that a tester can look for to verify that sites are accessible by those with cognitive disabilities.

Types of Cognitive Issues

As with visual or auditory impairment, there are primary and secondary, or situational, cognitive disabilities. Primary disabilities include the following:

Down syndrome: A congenital disorder that comes from having all or part of an extra copy of chromosome 21 (trisomy 21) that involves both physical and cognitive abnormalities

Autism: A developmental disorder frequently manifested by challenges with communication, forming relationships and understanding concepts that are not literal

Asperger syndrome: An autism spectrum disorder that appears through difficulties with nonverbal communication and social interaction and frequently manifests a need for repetitive patterns of behavior

Dementia: A general term for a variety of symptoms, typically resulting in a decline I memory and a change to a previously normal personality and reasoning

Dyslexia: A disorder that makes learning to read and interpret words difficult, manifesting in mixing up letter or word order

Dyscalculia: A difficulty in understanding arithmetic, numbers, and mathematical concepts

There are also a variety of examples where cognition can be situationally impacted. These secondary disabilities could include the following:

  • Difficulty when having to interact with a foreign language, particularly one that uses a different alphabet
  • Being in a distracted, stressed or emotional state
  • Trouble understanding when wading through dense, minimally formatted and punctuated text

Considerations for Testers

Here are a few considerations for testers to verify that an application is accessible by those with cognitive disabilities. Note that many of these do not require assistive technology — which, again, is a primary goal of inclusive design.

Is content structured with clear headings, sections, paragraphs, and lists? Too much information badly formatted can be overwhelming for many people, and this is especially true for those dealing with cognitive issues. Create well-defined headers, employ bulleted or numbered lists, and use space to separate content.

Does the user interface avoid overly bright or contrasting colors? This is in conflict with advice that would be given for dealing with visual impairment. While it is a benefit to those with visual disabilities, such a stark contrast could be shocking or unsettling to someone with autism or another spectrum disorder. I also recommend limiting or removing elements that flash or otherwise draw attention in a jarring manner.

Are text alternatives provided? Having an audio or video file that goes with a text article can help users with dyslexia or dyscalculia better understand what is being presented. Many people with dyslexia use screen readers to help them digest and understand text passages, so the same techniques used to maximize the ability for screen reader use for those with visual impairments will also benefit those dealing with cognitive issues.

Are there prompts and visual support for actions? For many users with cognitive issues, it is not uncommon to lose track of what they are doing in the middle of a workflow. Being forced to remember a variety of steps to accomplish a task may be asking too much for many users. By providing prompts to highlight the previous and next steps, we can help them keep track of where they are and what they should be doing.

Opportunities for Automation

Because many of these accessibility ideas are implemented through programming, there are ample opportunities to automate accessibility testing. This saves you time and effort, and it decreases the likelihood of one of these approaches being left out.

Use breadcrumbs to identify where a user is in the page hierarchy: By implementing a breadcrumb option, you can validate that pages are appearing in the correct order, as well as determine that they can be navigated by following the breadcrumb trail as a series of links. This works in conjunction with testing the navigation elements on pages. Having a consistent design for both navigation elements and breadcrumbs can help users know where they are and what they are doing.

Provide options for text resizing: When users can rescale the text they are viewing, it can make for a more comfortable reading experience. Having buttons that cannot be resized will cause pixelation when they are enlarged, in some cases making them illegible or indeterminable. By looking for elements that use the CSS box model and inline styles, those elements can be resized, keeping their actions recognizable to the viewer.

Use the <ABBR> and <ACRONYM> HTML tags: It is common to see a variety of abbreviations or acronyms used across web pages, particularly in the software industry. These may not be understood by many readers, and not just those with cognitive disabilities. But if you use the <ABBR> and <ACRONYM> tags, users can hover over the letters and see what each abbreviation or acronym means in full text. You can make tests to search for all acronyms or abbreviations and determine whether accompanying tags and titles are provided.

Reformat justified text: If a paragraph uses full justification, words will appear equally spread out along the line, instead of centered or aligned left or right. This can have the unintended consequence of making the material difficult to read for many people. A simple test that looks for and highlights paragraphs that are formatted with “<p align=”justify”> can help pinpoint where there may be difficulties.

Making our sites usable by the largest possible group of people is an important goal. Unfortunately, it is impossible to make every site completely accessible to those with cognitive impairments due to the range and varying severity of issues, but that should still be the aim.

Conclusion

Principles that focus on clean, uncluttered design for pages and apps, that give suggestions as to what actions to take, and that use direct, focused language will go a long way toward helping users with cognitive impairments effectively interact with our applications. More to the point, these changes will benefit all of us by making products that are easier to use.

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About the Author

Michael Larsen has, for the better part of his 20+ year career, found himself in the role of being the “Army of One” or “The Lone Tester” more times than not. He has worked for with a broad array of technologies and industries including virtual machine software, capacitance touch devices, video game development and distributed database and web applications. Michael currently works with Socialtext in Palo Alto, CA.

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