Mindful designs: practical tips for designing for cognitive & learning difficulties

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Presented at the UX Australia 2012 conference in Brisbane, Australia.

Did you know that about 16% of Australians have dyslexia? That’s about 3.6 million people…and that’s just dyslexia!

As UX designers, do we really know our audiences, and do we fully appreciate how some might experience things differently to others? What are we doing to design for the broad range of experiences and abilities of our users?

Designing for people with cognitive and learning disabilities is one of the most overlooked areas within the design and accessibility fields. Part of the reason is that there is a huge range of abilities and conditions, and they are often difficult to understand.

While there is some information out there, the furiously changing pace of technology and our hectic schedules as UX designers often do not give us the time to delve into the research, or we may not be aware of how general inclusive design principles can be applied in this context.

Many of the design principles will be well known and common sense, but reframing it in context of cognitive and learning disabilities will hopefully help you to realise that inclusive design is achievable, in many cases quite simple, and not too scary.

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  • Concept extremely broad, and not always well-defined. Anything that affects the brain’s ability to receive, process, store and respond to information.
  • Cognitive impairment can be associated with many disabilities and disorders that can be present at birth or acquired later in life, such as dementia and stroke.
  • That’s about 3.6 million people who are born with some sort of dyslexia.
  • Acquired brain injury (ABI) refers to any damage to the brain that occurred after birth. It results in deterioration in cognitive, physical, emotional or independent functioning. Common causes of ABI include accidents (e.g. blow to the head), stroke, Parkinson’s disease, dementia including Alzheimer’s disease, neurodegenerative conditions, alcohol-related brain injury, and falls (the last few are particularly relevant for those aged over 65).What’s interesting is that of those aged under 65 years of age with ABI, a traffic injury was the main cause for 55%. A number said that they acquired their brain injury when they were aged under 25 years.
  • Over 46% of adults in Australia had poor or very poor skills across one or more of the five skill domains* of literacy...Source: Adult Literacy and Lifeskills survey undertaken by the Australian Bureau of Statistics in 2006, summarised at http://www.thepunch.com.au/articles/almost-half-of-australians-have-problems-with-literacy/Photo credit: Microsoft ClipArt online
  • The proportion of people aged 65 years and over is increasing dramatically; increased from 11.1% to 13.6%. During the same period, the proportion of population aged 85 years and over has more than doubled from 0.9% of the population at 30 June 1990 to 1.8% of the total population at 30 June 2010.As people age, the limitations that often arise include:Declining vision – this include colour perception, colour contrast issues and decreasing ability to focus on near tasksHearing lossMotor skill diminishment – tremors, stiffness of limbs, slowness of movement, impaired balance and coordinationCognition effects – loss of memory, confusion and problems with speech and understandingSo to sum up: we’re talking about an audience who may have low levels of literacy, multinational, a large aging population, a known disability Source: http://www.abs.gov.au/Ausstats/abs@.nsf/mf/3201.0; http://www.w3.org/TR/wai-age-literaturePhoto credit: Microsoft ClipArt online
  • Many people hold certain stereotypes about “disability”, with the result that designing for cognitive disabilities tends to take a back step to other more visible disabilities such as vision impairment. One of the most important things to take away is that having cognitive disabilities is not a binary state – it can range greatly in severity from low to mild impairment, up to profound impairments. There are a significant amount of people who sit somewhere on this range, despite a number of people who would not normally classify their self as having a “disability”. For example, take dad who may be bad with numbers, or grandma who has a bad memory. Or even famous people like Richard Branson who has dyslexia. At the end of the day, accessibility is about a whole range of people, their abilities and preferences and their experiences.
  • I have family and friends who have a range of cognitive disabilities, including dyslexia, brain injuries, autism and Asperger Syndrome. I’ve always been curious about their experiences interacting with technology.It’s difficult to envision how to accommodate people without stopping to think about what they can do and what they do differently.The field of cognitive disabilities is rich, diverse and complex. In this 20 minute presso, we’ll be barely scratching the surface but we’ll do our best to cover a range of things to think about to help you improve the accessibility of your sites and products, while improving the usability for all. We’ll be focussing on general usability principles (i.e. The stuff you guys are already doing!), applied from the cognitive disabilities perspective.
  • Mid 30sHas the cutest (& active!) 2 year old childWorks in Government as a science communicatorTravels a lotOne day three years ago, Sharon was cooking dinner in her newly renovated kitchenShe had a strokeWas rushed to hospital
  • People with dyslexia or dyscalculia have difficulty visually processing text and numbers respectively. They benefit from clean, well-spaced text without any distracting elements that cause them to lose their place. People with dyslexia may experience a number of challenges including:Reading where letters or words can get switched around, for example bs and ds can get mixed uporganisational difficulties,difficulties in comprehension of complex written material,poor spellingand short term memory problems,slower writing speed.Some people with dyslexia can also perceive the meaning of a word of phrase as its exact opposite.
  • As much as I would love to give you a set of tips that works for all disabilities, there is no one size fits all set of rules. Everyone experiences your site differently. They have different needs, preferences and ways of interacting with your site. People also respond to different formats in different ways. Some may use assistive technologies, some way use low tech solutions and some may rely on your pictures to understand your content.Remember, cognitive disabilities are experienced by a very broad range of people. Accessibility features that make it easier for one user can often make things more difficult for another user. It is difficult to make definitive recommendations that will universally help ALL users with cognitive and learning disabilities.Sometimes, recommendations for one problem often seem in direct contradiction to the recommendations for others. But this does not mean that there *is* a direct conflict between the needs of people with different disabilities. It means that you need to be aware of the needs of your audience and design accordingly.
  • One way at looking at designing for cognitive disabilities is to take a human factors approach. These functional groupings are proposed by the WebAIM team (great organisation – go check them out!) and is really useful for helping people understand design techniques from the user point of view, rather than the relevant technical specification. These functional groupings help provide context around the issues experienced by people with cognitive disabilities.Memory: The power of retaining and recalling past experience. Problems may include: Trying to remember how they got to content, Lack of consistent navigation is confusing Problem solving: Difficulty recognising problems, Identifying, choosing or implementing solutions,Evaluation of the outcome E.g. 404 links, misleading linksAttention: Difficulty focussing attention to the task at hand, Distractions causes difficulty E.g. Overuse of animation, multiple popup windowsMath - Difficulty withComputation,Connecting abstract math with reality Reading etc: Difficulty interpreting series of letters or numbersVisual - Difficulty processing visual information, May not recognise objects for what they are E.g. Photograph of a person
  • Let’s look at a range of usability best practices that will give you an inclusive user experience. By using usability best practices,you’ll be making great strides in making your site or application accessible by people with cognitive disabilities as well as improving access for everyone.
  • Tip #1 is about addressing memory issues, where people have issues with retaining and recalling past experiences. Problems may include trying to remember how they got to content, and where they are within a process.The key point with this tip is to keep the user’s attention focused on specific tasks. For lengthy interactive processes, such as filling in a form, or purchasing an item, aim to keep the process as short as possible.Help users keep track of their progress so that they do not get lost in the process. Use simple reminders such as Step 1 of 4. This helps the user determine what they have done so far, and what’s left to do.Consider labelling each step in the process. Rather than using “previous step” or “next step”, consider labelling the step. For example, from Threadless.com: “next step, shipping method”.
  • Navigation placement, display, and functionality should not change from page to page. Users should not have to re-learn different navigation techniques for different parts of your site.Jumping from a web browser to a PDF can be a very jarring experience. Ensure that navigation is consistent throughout the siteSimilar interface elements and similar interactions should produce predictably similar results
  • Navigation placement, display, and functionality should not change from page to page. Users should not have to re-learn different navigation techniques for different parts of your site.Jumping from a web browser to a PDF can be a very jarring experience. Ensure that navigation is consistent throughout the siteSimilar interface elements and similar interactions should produce predictably similar results
  • This tip is about problem solving. People who have difficulties with problem solving have difficulty recognising problems, identifying, choosing or implementing solutions and evaluating outcomes. With this form, the user is told what is the problem, but it’s difficult to see where the actual problem is.Error messages should be as explanatory as possibleTell users what they did wrong and how to fix the problem
  • This is a slightly better example. Errors are clearly identified at the top of the page and at the field level. There are also additional visual indicators (highlighted yellow fields) which helps to clearly identify the problem fields.
  • Avoid distracting background images, noises or moving elementsThis tip is about attention. People with attention problems often have difficulty focussing their attention to the task at hand and can be very easily distracted by things such as popup windows and moving elements. Avoid multiple pop-up windows and blinking or moving elements, as this can pull attention away from the content.
  • Avoid distracting background images, noises or moving elementsClean layouts help minimise distractions.
  • Clean layout, fairly clear call to actions.Use of white space and borders to help provide visual distinction between areas.
  • It’s annoying and distracting, particularly if the person is using a screen reader.It’s easy to get distracted from reading information when sound is playing on the page.And while we’re on the subject of video content, it can be difficult to follow video content when it is fast paced and the scenes change quickly.
  • Maths computations or formulas can be difficult for many people to understand. This could be due to a person’s deficit math comprehension abilities or a number of cultural factors leading to dislike of maths (evident in many parts of the US).Where calculations are required, such as e-commerce sites that add the prices of items bought, GST, shipping and handling and any other, do this automatically.
  • People with more profound cognitive disabilities need short, simple and unambiguous phrases. In this example, the content may have contained the phrase “raining cats and dogs”. A person with linguistic difficulties may interpret this literally as raining cats and dogs. In some cases, some people will need to reply on images and other non-text aids to help them understand the content. If you’re designing content aimed at people with more severe cognitive disabilities, you may need to create a site with primary uses of images, and minimal text.
  • Don’t right justify text. This leads to variable spacing between words, which can create visual patterns of white space called “rivers of white”. These “rivers of white” can make it difficult to read as they are difficult to ignore and can be distracting.
  • Many people with dyslexia benefit from good contrast as this can help make the structure of words and sentences easier to understand. But there are also many dyslexic users are sensitive to the brightness of pure black text on a pure white background due to its high contrast. One of these conditions is called  Scoptic Sensitivity Syndrome. This syndrome can make high contrast text difficult to read because the words seem to constantly move on the page.One option is to use slightly lower contrast colours, but be aware that you still have to meet colour contrast requirements as set out by the WCAG 2.0 guidelines. Don’t rely on people using browser tools – not everyone may know them or even REMEMBER how to use them
  • The more ways to convey your content, the easier it becomes to communicate to others. People with difficulty in reading, linguistic, verbal or visual comprehension have difficulty interpreting series of letters or numbers and processing visual information.Provide information in multiple formats, with a particular focus on visual formats. No one method is sufficient by itself. The more ways to convey your content, the easier it becomes to communicate to others. Video or audio alternatives provide an additional method of perceiving content. Provide text alternatives (captions and/or a transcript) for video and audio content. Closed captioning, which gives users the option to turn off the captions, is optimal.
  • Pair icons or graphics with text to provide contextual cues and help with content comprehension
  • Transcripts and captioning can help make information processing easier.Audio description: Where this helps someone on the autistic spectrum is it identifies the emotion which may be difficult for them to pin down and it also provides another input track to reinforce the information. Captions: For somebody who is on the autistic spectrum it gives a greater depth of understanding and context by providing a second input stream. People on the autistic spectrum may struggle with audio processing, that is filtering out different sounds and distinguishing between what’s relevant and what is not relevant. If there is an audio overload with lots of different sounds because of the audio processing issues some people on the autistic spectrum have, all or most of the audio could be rendered totally meaningless and captions provide a backup for when this occurs.
  • Transcripts and captioning can help make information processing easier.Audio description: Where this helps someone on the autistic spectrum is it identifies the emotion which may be difficult for them to pin down and it also provides another input track to reinforce the information. Captions: For somebody who is on the autistic spectrum it gives a greater depth of understanding and context by providing a second input stream. People on the autistic spectrum may struggle with audio processing, that is filtering out different sounds and distinguishing between what’s relevant and what is not relevant. If there is an audio overload with lots of different sounds because of the audio processing issues some people on the autistic spectrum have, all or most of the audio could be rendered totally meaningless and captions provide a backup for when this occurs.
  • Include Kim’s awesome card here!
  • Mindful designs: practical tips for designing for cognitive & learning difficulties

    1. Mindfuldesigns:Practical tips for designing forcognitive & learning difficultiesBy @RuthEllisonfrom @StamfordUX
    2. Things not to do at UX Australia
    3. Lose your voice
    4. I’ll be doing the rest of this talk in interpretive dance
    5. Hi, I’m Ruth Stamford Interactive Passionate about UX & inclusive design Love robots Make things with frikin’ lasers! @RuthEllison from @StamfordUX
    6. What are cognitive disabilities? ...any sort of cognitive disorder that impairs understanding and functioning @RuthEllison from @StamfordUXAustralian Human Rights Commission http://www.hreoc.gov.au/social_justice/publications/preventing_crime/part1.html#fn1
    7. @RuthEllison from @StamfordUX
    8. 16% of Australians have dyslexia* @RuthEllison from @StamfordUX* This is an estimated figure, from http://www.dyslexiaaustralia.com.au/faqs-mainmenu-84
    9. 1 45 in Australians have an acquired brain injury (ABI) @RuthEllison from @StamfordUXORance L 2007. Disability in Australia: acquired brain injury. Cat. no. AUS 96. Canberra: AIHW.
    10. Over 46% of adults in Australia have poor or very poor literacy skills in one or more areas... @RuthEllison from @StamfordUX* Prose literacy, document literacy, numeracy, problem-solving and health literacy Source: ABS, 4228.0 - Adult Literacy and Life Skills Survey, SummaryResults, Australia, 2006 (Reissue) http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/4228.0Main%20Features22006%20(Reissue)?opendocument&tabname=Summary&prodno=4228.0&issue=2006%20(Reissue)&num=&view=
    11. Disabilities I don’t I have a have a disability disability @RuthEllison from @StamfordUX
    12. Disabilities I don’t I have a have a disability disability @RuthEllison from @StamfordUX
    13. Getting old sucks! @RuthEllison from @StamfordUXImage source: http://www.gettingthroughthis.com/wp-content/uploads/2012/08/False-teeth.jpg
    14. Percentage of people aged 65+ is increasing dramatically @RuthEllison from @StamfordUXSource: ABS, 3201.0 - Population by Age and Sex, Australian States and Territories, Jun 2010, http://www.abs.gov.au/Ausstats/abs@.nsf/mf/3201.0
    15. Spectrum of disabilities Dad: bad with numbers Richard Branson: dyslexiano profound Grandma: bad memoryimpairment impairment @RuthEllison from @StamfordUX
    16. My family and friends @RuthEllison from @StamfordUXSource: http://www.flickr.com/photos/tekf/3520262986/
    17. Meet Sharon @RuthEllison from @StamfordUXSource: http://1.babyology.com.au/wp-content/uploads/2012/05/minifig-babies21.jpg
    18. What’s the experience @RuthEllison from @StamfordUX
    19. Dyslexia simulation @RuthEllison from @StamfordUX
    20. Cognitive disability simulation @RuthEllison from @StamfordUX
    21. How do we design for all of this? ??? @RuthEllison from @StamfordUX
    22. There is noone-size-fits-allrule @RuthEllison from @StamfordUX
    23. Functional groupings Memory Problem solving Attention Maths Reading, linguistic and Visual comprehension verbal comprehension comprehension @RuthEllison from @StamfordUXFrom Bohman & Anderson’s functional cognitive disabilities model, 2005 and http://webaim.org/articles/cognitive/
    24. for an inclusiveuser experience
    25. Indicate progress Memory Provide simple Consider labelling each reminders such as a step progress bar @RuthEllison from @StamfordUXSource: https://www.threadless.com/cart/step/shipping-info
    26. Be predictable Memory @RuthEllison from @StamfordUXSource of tip: http://wave.webaim.org/cognitive
    27. Be predictable Memory @RuthEllison from @StamfordUX
    28. Help recover from errors Problem solving @RuthEllison from @StamfordUX
    29. Help recover from errors Problem solving Attention @RuthEllison from @StamfordUX
    30. Avoid distractions Attention @RuthEllison from @StamfordUXSource: http://www.dyslexia-parent.com/mag35.html
    31. White space anyone? Attention @RuthEllison from @StamfordUX
    32. White space anyone? Attention @RuthEllison from @StamfordUX
    33. Don’t autoplay video/sounds Attention @RuthEllison from @StamfordUX
    34. Calculate it automatically Maths comprehension @RuthEllison from @StamfordUX
    35. Being literal... Reading, linguistic and verbal comprehension @RuthEllison from @StamfordUX
    36. Left align What is industrial What is industrial Reading, linguistic and biotechnology? biotechnology? verbal comprehension Industrial biotechnology is a Industrial biotechnology is a set of practices that use living set of practices that use living cells (such as bacteria, yeast, cells (such as algae) or component cells like bacteria, yeast, algae) or enzymes, to generate component cells like industrial products and enzymes, to generate processes. industrial products and Products include biomass- processes. based materials such as fuels Products include biomass- and chemicals, while based materials such as fuels processes include the and chemicals, while treatment of waste water and processes include the energy efficiency measures. treatment of waste water and The most established energy efficiency measures. application of industrial The most established biotechnology is in the application of industrial food and beverage sector. For biotechnology is in the example, microbes (yeast) or food and beverage sector. For enzymes are used to produce example, microbes (yeast) or beer and wine as well as dairy enzymes are used to produce goods such as cheese. beer and wine as well as dairy However, biotechnology is goods such as cheese. being increasingly applied to However, biotechnology is improve manufacturing being increasingly applied to processes and to solve... improve manufacturingSource: (text) processes and to solve... @RuthEllison from @StamfordUXhttp://www.innovation.gov.au/Industry/Biotechnology/IndustrialBiotechnology/Pages/default.aspx, , http://www.pws-ltd.com/sections/articles/2009/justified_text.html
    37. Careful use of colour Reading, linguistic and verbal comprehension @RuthEllison from @StamfordUXMore info: http://www.bdadyslexia.org.uk/about-dyslexia/further-information/eyes-and-dyslexia.html
    38. Careful use of colour Reading, linguistic and verbal comprehensionGet from http://www.visionaustralia.org.au/info.aspx?page=628 @RuthEllison from @StamfordUX
    39. Mix content types Reading, linguistic and verbal comprehension Visual comprehension @RuthEllison from @StamfordUXSource: http://wave.webaim.org/cognitive
    40. Mix content types Reading, linguistic and verbal comprehension Visual comprehension @RuthEllison from @StamfordUXImage source: Antonia Hyde, http://hiantonia.com/
    41. Use transcripts, captions & audio descriptions Reading, linguistic and verbal comprehensionhttp://mindfulresearch.co.uk/2011/08/29/autistic- @RuthEllison from @StamfordUXspectrum-captions-and-audio-description/
    42. Use transcripts, captions & audio descriptions Reading, linguistic and verbal comprehension “Outside the international airport terminal, Sal and Darryl walk with Trace and Con while Dale pushes a trolley of luggage along” Watch it at http://www.youtube.com/watch?v=ixUwZy5M-Uo&feature=share&list=UUKZrlbrdEAQR07caKSmk95Ahttp://mindfulresearch.co.uk/2011/08/29/autistic- @RuthEllison from @StamfordUXspectrum-captions-and-audio-description/
    43. Let’s bring it all together...A challenge @RuthEllison from @StamfordUX
    44. Make an origami cup 1. Find a blank piece of paper. 2. If it isnt already perfectly square, cut off one edge of the paper until it is perfectly square. 3. Fold the paper in half diagonally. 4. Lay the paper down in front of you so that the longest edge is facing you. 5. Take the bottom left corner and fold it over the main area of the piece of paper so that the corner touches the opposite edge, and so that the top of the newly folded edge is parallel with the bottom of the piece of paper. 6. Do the same thing to the right corner, folding it across the main area of the piece of paper until it touches the opposite edge. The top edge of this fold should be exactly on top of the top edge of the previous fold. 7. Take the outer layer of the very top corner and fold it down until the corner touches the spot where the bottom of the other two folds meet. You should see a pattern in the shape of an "X." 8. Do the same thing to the other layer, but in the opposite direction. 9. Spread apart the two layers on the top and gently push the sides in. 10. You made an origami cup! (Or did you?) @RuthEllison from @StamfordUXSource: http://wave.webaim.org/cognitive
    45. The fix...Picture of the end goal @RuthEllison from @StamfordUX
    46. The fix...Visual & text step-by-step instructions @RuthEllison from @StamfordUX
    47. The fix...Video instructions @RuthEllison from @StamfordUX
    48. There is no one-size-fits-all rule @RuthEllison from @StamfordUX
    49. Inclusive personasInclude people with access needs in your research SALLY 23 yr old Single Sporty, healthy University student @RuthEllison from @StamfordUX
    50. Test with real people We’re all on the spectrum UX My friend Sharon ROCKS!no impairment profound impairment @RuthEllison from @StamfordUX
    51. ResourcesClear Helper: Web Accessibility for People with Intellectual / Cognitive Disabilities http://clearhelper.wordpress.com/Cognitive Disabilities Part 1: We Still Know Too Little, and We Do Even Less, Bohman, Paul. 2004. from http://webaim.org/articles/cognitive/cognitive_too_little/Cognitive Disabilities and the Web: Where Accessibility and Usability Meet? By Mariger, Heather. from http://ncdae.org/tools/cognitive/What Problems Do People with Disabilities Have? and Why?, from http://trace.wisc.edu/docs/software_guidelines/software.pcs/disabil.htmHow People with Disabilities Use the Web by W3C, from http://www.w3.org/WAI/intro/people-use-web/Overview.htmlThe Forgotten People: Designing for Cognitive Disability, from http://www.thepickards.co.uk/index.php/200607/the-forgotten-people-designing-for- cognitive-disability/An Accessibility Frontier: Cognitive disabilities and learning difficulties, Hudson, Roger., Weakley, R. And Firminger, P. from http://www.usability.com.au/resources/cognitive.cfmEvaluating Cognitive Web Accessibility, from http://webaim.org/articles/evaluatingcognitive/Designing for Dyslexics: http://accessites.org/site/2006/10/designing-for-dyslexics-part-1-of-3/, http://accessites.org/site/2006/11/designing-for- dyslexics-part-2-of-3/, http://accessites.org/site/2006/11/designing-for-dyslexics-part-3-of-3/Standards.Next rocking cognition and accessibilityMy Mind is a Web Browser: How People with Autism Think, by Temple Grandin, 2000 - http://www.grandin.com/inc/mind.web.browser.htmlLayout Guidelines for Web Text and a Web Service To Improve Accessibility for Dyslexics http://www.slideshare.net/luzrello/rellokanvindebaezaw4a2012Ruth Ellison’s cognitive disabilities bookmarks: http://www.delicious.com/RuthEllison/accessibility+cognitive @RuthEllison from @StamfordUX
    52. CreditsSlide 1- My Brain by My Name is Rom ™ from http://www.flickr.com/photos/romsimplicio/2615636782/ Available under a Creative Commons Attribution-Noncommercial-No Derivative Works 2.0 Generic licenseSlide 7 - http://www.brickset.com/minifigs/gallery/?theme=Spider%20ManScott Lacey for many of the illustrationsOpen-Dyslexic for the fonts http://dyslexicfonts.com/ @RuthEllison from @StamfordUX
    53. Thank you!Ruth Ellison@RuthEllison @stamfordux

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