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Inclusive Design:
cognitive disabilities,
neurodiversity, and chronic illness
Ted Drake, Intuit
UX Australia 2022
Agua Caliente
Band of Cahuilla
Nation
Agenda
● Explore neurodiversity leaders
● UX Principles
● Cognitive Load
● Short term memory
● Content Design
● Readability
● Sickle Cell Pain and Anxiety
Ted Drake (He, Him)
Intuit’s Accessibility and Inclusive
Design Leader
● 20+ Years in Accessibility
● International speaker and event
coordinator
● Yahoo! Accessibility Lab
● BFA: Fine Art (Painting,
Printmaking, and Photography)
● Web Developer
I do not have lived experiences
Ashlea McKay
@AshleaMcKay
Tori Clark,
Keli Sierra
Bradley
My Trigger, My Choice
Axe Con 2022
Laurel Beyers
laurelbeyers.com
Lona Moore
lonamoore.com
Gareth Ford
Williams
ab11y.com
René Brooks
blackGirlLostKeys.com
Jamie Knight
and Lion
JamieAndLion.com
No single
experience or
solution
UX Principles - Cognitive Accessibility
● Use standard elements
● Check your affordances
and signifiers
● Simplify interfaces
● Communicate clearly
● Build in redundant
interaction methods
● Use consistent patterns
● Design for recognition
rather than recall
● Vary stimuli to capture
attention
● Deliver effective feedback
and notification
● Give users control and
choice
Affordance and Signifier
The doors have the affordance of
opening in one direction.
Each side has different shaped
handles.
● Which signifier suggests a pull
direction?
● Which signifier suggests a push
direction?
What if they were switched?
Cognitive Load
Cognitive load is the amount of working memory or short-term memory
someone is using.
Minimizing the cognitive load it takes to use your product or service
makes it more accessible for people with cognitive disabilities.
When technology communicates and behaves well,
it enables you to do what you want to, on your terms.
It communicates in ways that allow you to focus, and
achieve the level of concentration you need to accomplish a
task.
- Respecting Focus: A behavior guide for Intelligent Systems
(Microsoft)
How can we reduce cognitive load?
● Simple instead of Complex
○ Which content actually serves a purpose. Leave out all the rest.
● Easy to understand content
○ Intuit’s readability target is 5th to 8th grade
● Use videos and illustrations to support content
● Clear affordances and signifiers
● Use headings and lists to make content scannable
● Consistent layout
● Label icons with visible text
“As a rule, people don’t like to puzzle over things.
They enjoy puzzles in their place– when they want to
be entertained or diverted or challenged– but not
when they’re trying to find out what time their dry
cleaner closes.”
–Steve Krug, Don’t Make Me Think
Design for Short Term Memory
● Focus on Recognition instead of Recall
● Provide tools that aid in decision making
● Have the system do some of the work for the user
● Response time must be fast
● Change the color of visited links
● Provide help in context instead
of external resource
Content
Design
Direct and simple language
● Avoid euphemisms
● Avoid language that is culturally dependent
● Use 5-6 Grade reading level
“Can it be substituted for something clearer or more
literal? (The answer is often yes.) Think about what the
term actually means and describe that.”
- Intuit Content Design, Abolish Racist Language
Multimodal
learning
experiences
Car rides are evil. Commence
midnight zoomies. Kitty kitty soft
kitty warm kitty little ball of furr
jump five feet high and
sideways when a shadow moves
touch water with paw then recoil
in horror or i love cats i am one
wake up scratch humans leg for
food then purr then i have a and
relax and hell is other people
and am in trouble, roll over, too
cute for human to get mad. Slap
the dog because cats rule.
Lasers are tiny mice
Sleeping in the box i could pee on this if i had the
energy yet jump launch to pounce upon little yarn
mouse, bare fangs at toy run hide in litter box until
treats are fed chirp at birds and get video posted to
internet for chasing red dot, and roll on the floor
purring your whiskers off.
Typography
● Use left alignment
● Respect user preferences for color
and size
● “Dyslexic Fonts” are not a solution
● Use headings and lists
Avoid
● Large blocks of centered text
● Justified alignment
● Black/white contrast
Inclusive Design for Pain and Anxiety
Pain is a suffering.
Suffering is a torture.
Pain memory sticks with you long
after the crisis. It causes Post-
Traumatic Stress and anxiety.
- Hertz Nazaire
Improve this form
Remove Extraneous
Inputs
Treat the crisis first. Get
additional information later
● Patient information after
treatment
● “Guarantor” - Use simple
language
● Emergency Contact - looking for
another payee, embarrassing
● Remove Sex, Race, Marital Status
● Add primary doctor
Updated form
Focus on the Core
Purpose
Facilitate immediate treatment
for the crisis.
● Critical information
● Who is the primary doctor?
● What is the pain level?
● What treatment is effective?
● What medication do you take?
● What complications do you
have?
Patient Expertise
Warriors knows their
body.
● They want to be
respected for their
self-advocacy
● believed for their pain
levels
● and the seriousness of
the crisis.
Quick Fill + Details
Too much pain to fill out this
form!
● Checkboxes and simple inputs
for fast, important information
● Critical information first
● Notes for details
● Readability: 5-6 grade level
In Summary
● Focus on your customer’s purpose
○ Optimize their experience, not yours
● Trust your customer’s expertise
● Your customer may not be the person interacting with your
design
● Use simple language
● Don’t ask for non-essential information
● Follow design standards for vision, cognitive, and mobility
When you meet one
person with
autism…
Include neurodivergent
people in customer
research.
Additional Resources
● Cognitive and Learning Disabilities Accessibility Task Force (Coga
TF)
● UX Principles that include Cognitive Accessibility (Ab11y)
● COGA: Cognitive Accessibility User Research
● Making Content Usable for People with Cognitive and Learning
Disabilities
Questions

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Inclusive Design for cognitive disabilities, neurodiversity, and chronic illness

  • 1. Inclusive Design: cognitive disabilities, neurodiversity, and chronic illness Ted Drake, Intuit UX Australia 2022
  • 2. Agua Caliente Band of Cahuilla Nation
  • 3. Agenda ● Explore neurodiversity leaders ● UX Principles ● Cognitive Load ● Short term memory ● Content Design ● Readability ● Sickle Cell Pain and Anxiety
  • 4. Ted Drake (He, Him) Intuit’s Accessibility and Inclusive Design Leader ● 20+ Years in Accessibility ● International speaker and event coordinator ● Yahoo! Accessibility Lab ● BFA: Fine Art (Painting, Printmaking, and Photography) ● Web Developer
  • 5. I do not have lived experiences
  • 7. Tori Clark, Keli Sierra Bradley My Trigger, My Choice Axe Con 2022
  • 14. UX Principles - Cognitive Accessibility ● Use standard elements ● Check your affordances and signifiers ● Simplify interfaces ● Communicate clearly ● Build in redundant interaction methods ● Use consistent patterns ● Design for recognition rather than recall ● Vary stimuli to capture attention ● Deliver effective feedback and notification ● Give users control and choice
  • 15. Affordance and Signifier The doors have the affordance of opening in one direction. Each side has different shaped handles. ● Which signifier suggests a pull direction? ● Which signifier suggests a push direction? What if they were switched?
  • 16. Cognitive Load Cognitive load is the amount of working memory or short-term memory someone is using. Minimizing the cognitive load it takes to use your product or service makes it more accessible for people with cognitive disabilities.
  • 17. When technology communicates and behaves well, it enables you to do what you want to, on your terms. It communicates in ways that allow you to focus, and achieve the level of concentration you need to accomplish a task. - Respecting Focus: A behavior guide for Intelligent Systems (Microsoft)
  • 18. How can we reduce cognitive load? ● Simple instead of Complex ○ Which content actually serves a purpose. Leave out all the rest. ● Easy to understand content ○ Intuit’s readability target is 5th to 8th grade ● Use videos and illustrations to support content ● Clear affordances and signifiers ● Use headings and lists to make content scannable ● Consistent layout ● Label icons with visible text
  • 19. “As a rule, people don’t like to puzzle over things. They enjoy puzzles in their place– when they want to be entertained or diverted or challenged– but not when they’re trying to find out what time their dry cleaner closes.” –Steve Krug, Don’t Make Me Think
  • 20.
  • 21. Design for Short Term Memory ● Focus on Recognition instead of Recall ● Provide tools that aid in decision making ● Have the system do some of the work for the user ● Response time must be fast ● Change the color of visited links ● Provide help in context instead of external resource
  • 23. Direct and simple language ● Avoid euphemisms ● Avoid language that is culturally dependent ● Use 5-6 Grade reading level “Can it be substituted for something clearer or more literal? (The answer is often yes.) Think about what the term actually means and describe that.” - Intuit Content Design, Abolish Racist Language
  • 24.
  • 25. Multimodal learning experiences Car rides are evil. Commence midnight zoomies. Kitty kitty soft kitty warm kitty little ball of furr jump five feet high and sideways when a shadow moves touch water with paw then recoil in horror or i love cats i am one wake up scratch humans leg for food then purr then i have a and relax and hell is other people and am in trouble, roll over, too cute for human to get mad. Slap the dog because cats rule. Lasers are tiny mice Sleeping in the box i could pee on this if i had the energy yet jump launch to pounce upon little yarn mouse, bare fangs at toy run hide in litter box until treats are fed chirp at birds and get video posted to internet for chasing red dot, and roll on the floor purring your whiskers off.
  • 26. Typography ● Use left alignment ● Respect user preferences for color and size ● “Dyslexic Fonts” are not a solution ● Use headings and lists Avoid ● Large blocks of centered text ● Justified alignment ● Black/white contrast
  • 27. Inclusive Design for Pain and Anxiety
  • 28.
  • 29. Pain is a suffering. Suffering is a torture. Pain memory sticks with you long after the crisis. It causes Post- Traumatic Stress and anxiety. - Hertz Nazaire
  • 31.
  • 32. Remove Extraneous Inputs Treat the crisis first. Get additional information later ● Patient information after treatment ● “Guarantor” - Use simple language ● Emergency Contact - looking for another payee, embarrassing ● Remove Sex, Race, Marital Status ● Add primary doctor
  • 34. Focus on the Core Purpose Facilitate immediate treatment for the crisis. ● Critical information ● Who is the primary doctor? ● What is the pain level? ● What treatment is effective? ● What medication do you take? ● What complications do you have?
  • 35. Patient Expertise Warriors knows their body. ● They want to be respected for their self-advocacy ● believed for their pain levels ● and the seriousness of the crisis.
  • 36. Quick Fill + Details Too much pain to fill out this form! ● Checkboxes and simple inputs for fast, important information ● Critical information first ● Notes for details ● Readability: 5-6 grade level
  • 37. In Summary ● Focus on your customer’s purpose ○ Optimize their experience, not yours ● Trust your customer’s expertise ● Your customer may not be the person interacting with your design ● Use simple language ● Don’t ask for non-essential information ● Follow design standards for vision, cognitive, and mobility
  • 38. When you meet one person with autism…
  • 39. Include neurodivergent people in customer research.
  • 40. Additional Resources ● Cognitive and Learning Disabilities Accessibility Task Force (Coga TF) ● UX Principles that include Cognitive Accessibility (Ab11y) ● COGA: Cognitive Accessibility User Research ● Making Content Usable for People with Cognitive and Learning Disabilities

Editor's Notes

  1. Learn how to design for people with short term memory loss, problems focusing on a task, struggling with anxiety, and dealing with chronic pain. This presentation will introduce you to the people you need to include in your designs. You will also have clear action items for inclusive design.
  2. “I want to respectfully acknowledge the Cahuilla Nation, who have stewarded this land in Palm Springs throughout the generations. We ask you to join us in acknowledging the Cahuilla Nation community, their ancestors and elders both past and present, as well as their future generations. We also acknowledge that our presence on this land is the result of the occupation of Indigenous land. This acknowledgement is part of our commitment to work towards honoring the ongoing legacies of the Cahuilla Nation and indigenous peoples around the world.”
  3. Twitter @ted_drake Website: last-child Flickr: Ted Drake | Flickr LinkedIn: Ted Drake - Steering Committee Member - Web4all Conference | LinkedIn Slideshare: Ted Drake, Accessibility leader for intuit at Intuit | SlideShare Github: 7mary4 (Ted Drake) · GitHub
  4. As a person that identifies as neurotypical, I can provide information on how to design for neurodiversity, but I cannot give you the insights of someone with lived experience. The following people are design and technology leaders that are also neurodivergent.
  5. Ashlea McKay is an autistic UX researcher, designer, writer, keynote speaker and Diversity & Inclusion leader with a background in industrial design. She has more than 6 years of experience spanning both the public and private sectors and is an accomplished UX thought leader and international conference speaker. Ashlea McKay - UX Australia Ashlea McKay - Chief People Officer - Parbery | LinkedIn
  6. Following up on the previous presentation by Fiona Armstrong about designing for sensitive areas. This presentation by Toric Clark and Keli Sierra Bradley has excellent guidance for providing warnings for triggering content and designs. My Trigger, My Choice: UX for Trigger and Content Warnings - axe-con YouTube video: My Trigger, My Choice: UX for Trigger and Content Warnings - axe-con 2022 Tori Clark has been working in the accessibility field for nearly a decade as a way to bring her lifelong passion for disability rights to the worldwide web. Raised by two public school teachers, she believes that accessibility education and awareness can be seeded at every stage of the product development lifecycle and loves to see learning blossom. She specializes in UX for low vision and motor disabilities, lending her lived experience as a native user of Windows high contrast settings and Dragon NaturallySpeaking. Keli Bradley has worked as an event planner and nonprofit development coordinator for nearly a decade, pursuing accessibility at the intersection of digital and physical spaces. With the rise of virtual events during the pandemic, and navigating a recent diagnosis of multiple sclerosis, she began to experience the many barriers that people with disabilities faced and chose to pursue digital accessibility more formally. In particular, her graduate work in therapy and counseling shines a light on the many ways the web can cause mental and emotional harm. Keli believes that accessibility is essential to all facets of life, and she is excited to bring her unique and well-rounded perspective to the accessibility world.
  7. Laurel Beyers Designing for Dyslexia (Laurel Beyers @ Designers + Geeks) Laurel's leadership style revolves around her values of individual growth, vulnerability, and light-hearted humor. She is passionate about sharing these values when speaking on topics such as personal growth, UX/UI, leadership, and the realities of working in design. She most recently spoke at Designers+Geeks about Designing for Dyslexia, VioletHacks about the design process, and at Citrix about pedigree bias. Laurel is actively involved in the design community, by blogging, public speaking, and mentoring young designers!
  8. https://lonamoore.com/media As ExxonMobil's Principal Design Program Manager, I enable thousands of people to practice design and build meaningful connections worldwide. I'm disabled and on the spectrum, and I'm incredibly passionate about designing inclusive experiences and scaling design across the enterprise. I started my design journey when I was twelve years old by creating a website about space and cats: two topics that delight me to this day.
  9. Gareth Ford Williams
  10. Who is René Brooks? René Brooks is a late-life ADHD success story. After being diagnosed 3 times as a child (age 7, 11, and 25), she was finally able to get the treatment she deserved. René decided that her passion for helping others should be put toward people with this disorder who are struggling in silence or shame. She started Black Girl, Lost Keys to empower black women with ADHD and show them how to live well with the condition. She has contributed to Kaleidoscope Society, ADHD Women’s Palooza, Mindfully ADD, and ADHD Essentials while also writing for Healthline and being a Patient Contributor for TEVA Pharmaceutical’s Life Effects.
  11. Spaced Out & Smiling Jamie + Lion 1800 Seconds on Autism on Apple Podcasts
  12. From an article by Gareth Ford Williams UX Principles that include Cognitive Accessibility
  13. Designing for cognitive disabilities | by Tolu Adegbite | Shopify UX
  14. Respecting Focus: https://www.microsoft.com/design/assets/inclusive/InclusiveDesign_RespectingFocus.pdf
  15. Intuit Content Design - readability Aim for 5th to 8th grade readability | Accessibility & inclusion | Intuit Content Design System Designing for Cognitive Disabilities (Shopify) Designing for cognitive disabilities | by Tolu Adegbite | Shopify UX Affordances and Signifiers Affordances and signifiers. Creating designs, components and… | by H Locke | Medium
  16. Don't Make Me Think: A Common Sense Approach to Web Usability, 2nd Edition: Krug, Steve: 8601404639708
  17. Short-Term Memory Limitations Impact User Interface Design
  18. Short-Term Memory Limitations Impact User Interface Design (Video) Short-Term Memory and Web Usability
  19. Intuit’s Content Design guidelines Accessibility and inclusion | Intuit Content Design System
  20. In the southern part of the United States, “Bless your heart” doesn’t mean what you think What "Bless Your Heart" Really Means
  21. People learn in different ways. Provide images, illustrations, and videos when content may be difficult to understand This screen has a snippet of Cat Ipsum and an image of jewelry featuring cats being rude. The image can make the text easier to understand. Cat Ipsum: Cat Ipsum. If you like that, you’ll love placekitten: https://placekitten.com/
  22. A Guide to Understanding What Makes a Typeface Accessible | by Gareth Ford Williams | The Readability Group | Medium Gareth Ford Williams on LinkedIn: Don’t Believe The Type! - axe-con 2021 | 25 comments Best: SF Pro 69% Segoe UI 65% BBC Reith Sans 64% Verdana 64% Red Hat Text 62% Atkinson Hyperlegible 62% Worst: Lexie Readable 39% Sylexiad Sans 34% Comic Sans 22% Dyslexie 22% Open Dyslexic 12%
  23. Video introduction for The Waiting Chair Project
  24. Hertz Nazaire - interview
  25. Hertz discussing how he’s not able to read the forms due to the pain and discomfort during a crisis Transcript Most of the time, or regular vision, a regular warrior would would 2020 vision is not gonna be able to read your form because they're grant grunting they're squinting there, there are crying. They've had a rough eight hours. Normally we wait eight or so hours just to know that this is actually a crisis that's not going to go away, because sometimes you have a crisis comes on, you take two Tylenol extra weight, four hours, it goes away you It goes away you start feeling better and you don't have to go in, waited hours. It doesn't go away. Now you have to face the music now you have to go and so are normal sickle cell warrior, Dan probably waited eight or more hours before they got their paint taken care of. So they've already been through hell and back. So form is the last thing they can probably focus on. So there's gonna be a lot of difficulties for firms in the first place was. So normally, there's an advocate their parent or somebody else who is going to help you fill out those forms, or if you're alone, that form is not going to get filled, it's going to get get get filled by the nurse, who's asking the questions, and they're filling out the form for you and they ask you to sign it. You know, that's usually how it works.
  26. This form should never be seen by the patient when they first arrive. This is a barrier to treatment, not a facilitator. Get me relief now, fill out the information later. Emergency contact for what? For life/death decisions or someone to be responsible if there’s a lack of payment. Guarantor This is a term Hertz was not familiar with and would create anxiety. It means the hospital is going to get paid and that is their primary interest. This could be written differently if presented to the patient. He thought this might be something the hospital agent was filling in.
  27. The ideal patient form is completed after the person receives care. It should be specific to the condition, i.e. a form that is customized for Sickle Cell patients. This shows respect, belief, and preparedness for the disease.
  28. People want to be treated better. They want to be respected for their self-advocacy, believed for their pain levels, and the seriousness of the crisis. Not every person with SCD has the same symptoms, medical history, and experience with medication. The form needs to include this information, but in a way that is easy to complete by a family member or care taker. What is beneficial for pain? The most common SCD medications should be listed and identified as an allergy or effective treatment. There should be a section for other medications to be listed and their history, i.e. insulin for diabetes. Symptoms should also be listed in a checklist format with an open text area. This will help the patient and medical team quickly identify the current crisis. A pain scale is necessary (1-10) with an area for comments. Mental attitude (anxiety) scale. Identify the type and regional variant of SCD: SS, SC, SB, SD, and SO. Also recognize not everyone with SCD is African-American. Is their variant associated with Africa, South Asia, South America, Bahrain...
  29. Hertz said he would never fill in a form. A person experiencing a crisis is not in a state where they could read and fill out the form. They are in terrible pain, their eyes are watering, squinting, they may be curled up trying to remain motionless, doing whatever it takes to avoid additional pain. The form would be completed by an advocate or hospital staff. The patient may have the best knowledge of their medication, medical history, and symptoms. So the form should use simple language for those who don’t know the terminology. Use checkboxes or selections instead of open text. During a crisis, the simplest movements can generate enormous pain. The form will be completed by a caregiver, family member, nurse, or someone else. While the patient knows their body and health, the form needs to be designed for someone else. Checkboxes allow the patient to answer simple questions and the notes allow the person to dictate additional information.
  30. Sickle Cell Disease has historically been underfunded. Especially when compared to Cystic Fibrosis, which predominantly affects the white population. SCD affects more people, approximately 3:1 From 2008 through 2018, federal funding was greater per person with CF compared with SCD: $2807 vs $812. Foundation expenditures were greater for CF than for SCD : $7690 vs $102 . Significantly more research articles : 1594 vs 926 US Food and Drug Administration drug approvals (4 vs 1) were found for CF compared with SCD, but the total number of clinical trials was similar 27.3 vs 23.8 Resource: Comparison of US Federal and Foundation Funding of Research for Sickle Cell Disease and Cystic Fibrosis and Factors Associated With Research Productivity | Adolescent Medicine | JAMA Network Open
  31. If you met one person with autism, you’ve met one person with autism. Everyone that is neurodivergent is unique. Dr Stephen Shore once said, “When you meet one person with Autism, you’ve met one person with Autism”. This is a popular quote that highlights how Autism is very diverse. When you meet one person with Autism, you’ve met one person with Autism Dr. Stephen Shore: This quote emphasizes that there is great diversity within the autism spectrum. While the commonalities of people on the autism spectrum include differences in communication, social interaction, sensory receptivity, and highly focused interests, it’s important to understand that the constellation of these characteristics blends together differently for each individual. This is why some on the spectrum are good at mathematics while other may be good in their arts, sports, or writing – just like the rest of humanity. Autism is an extension of the diversity found in the human gene pool. Interview with Dr. Stephen Shore: Autism Advocate & on the Spectrum
  32. UX Principles that include Cognitive Accessibility Cognitive Accessibility User Research Distraction Issue papers: https://w3c.github.io/coga/issue-papers/distractions.html Making Content Usable for People with Cognitive and Learning Disabilities Making Content Usable for People with Cognitive and Learning Disabilities