Designing for People Who Struggle with Reading and Attention


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Imagine you’re almost done with your taxes—but you’re ravenous and the smell of Indian food is wafting through your window, your electricity is randomly turning off for 30-second blips, and the neighbor’s infant is incessantly scream-crying. How successful will you be finishing your taxes? This session will include simulations so you can get a sense of reading as a low-decoder, and of completing web-based tasks when you lack the ability to filter out distractions and/or struggle with short-term memory. We’ll observe usability test session video clips of some of the obstacles introduced by interface design choices. You can’t design effectively for low literacy and attention disorders if you don’t understand how these issues affect people as they try to work online. We will look at good and poor design implementations of forms, touch and ajax interactions, search interfaces, and layout choices. Come to this session and improve your design for as much as 15% your audiences.
(This presentation was given at UPA Boston's 2012 User Experience Conference)

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  • Thank you for coming! My name is Julie Strothman.\nUntil last September, I ran a user research lab at Landmark College, a school for students with learning disabilities. I’ve spent countless hours talking with and observing people who struggle with reading and attention as they try to do things online. I hope you leave this session with a greater understanding of what those struggles look like--and how you can make things easier.\n\nSo let’s get started. I’d like you to read a story--you’re all familiar with the story, I’m sure, but I’d like you to take two minutes to read it for details--I’ll ask you about it afterward.\n
  • Can anyone tell me what this was about? \nWhat was reading it like?\n\nIf you’ve got an underlying decoding issue, the degree of effort in trying to make out the words is similar to what you just experienced.\nIf you struggle with self-regulation—stopping yourself from noticing a distraction—that is, the ability to tune out distracting data, it is almost impossible to block out the distractions in a room. It’s not that you have limited attention. Rather you have limited ability to govern which things your attention is on, similar to the work of a conductor. Governing attention is one aspect of executive function. It’s a myth that people with attention disorders just need to concentrate harder. We can design to support attention.\n\nWe all know the design mantra “Don’t make me think.” This is about “Don’t make me work harder than I already have to work.”\nLet’s take another look at the effort involved in reading for people who are dyslexic or have decoding issues.\n\n(Soda wicket example) H.L. Chace, 1956, by Prentice-Hall, Inc. Englewood Cliffs, N. J.\n\nAttention-Deficit/Hyperactivity Disorder and Self-Regulation Russell A. Barkley. Handbook of self-regulation: research, theory, and applications\nGuilford Press, 2004 Roy F. Baumeister, Kathleen D. Vohs\n
  • We’re looking here at an eye track of a fluent reader. \nIn Landmark College’s Universal Design and Usability Lab we had an eye tracking system that monitors eye position while reading text, viewing websites, and working with digital resources\nEye trackers provides researchers, instructors, and students data about how the eye moves when information is accessed and used—they’re used to study cockpits, dashboards, and medical equipment as well as non-life-and-death problems, such as how people read. \nThe image on the screen is a paragraph from War of the Worlds. The red lines represent the eye’s movements. The track basically moves from left-to-right. Fluctuations and regressions are normal for fluent readers. The blue dots are fixations: pauses as the person reads. The fixations in this track are approximately 100-200 milliseconds long, and show up every other word or so.\n
  • This 2nd image is an eye track of a reader who is dyslexic. What do you see here?\nFar longer fixations—approximates 1 – 2 seconds compared to 100 milliseconds above. The pauses are far more frequent—each syllable. There are regressions in the track’s path, decoding each syllable than moving back to then put the the whole word or phrase together.\nThe effort of reading is extreme. \n\nDon’t make me work harder than I already have to work.\nSo why do we care? \n\n
  • Angela Colter gave an excellent talk at this year’s Information Architecture Summit about search strategies of users with low literacy skills. She stressed that low literacy “doesn’t mean someone can’t read--it means they don’t have adequate skills to easily read, understand, and use your content.” Colter indicates almost 50% of the U.S. adult population has low literacy skills.\nLow literacy can result from many things--inadequate education, the language at hand is not your primary language, cognitive disabilities--meaning having a very low IQ, or having a developmental (or learning) disability--where you might have a very high IQ but difficulty learning and processing language.\nThe CDC reports that 17% of children have a diagnosed learning disability.\n\n\n
  • People with learning disabilities generally have a significant disparity between IQ and execution--regardless of the type of learning disability, there are common hurdles for which we can design.\nShort-term memory is an issue across all learning disabilities. We’ve long known it’s important to support recognition over recall--don’t make me think--help me remember what I need to know to complete a task.\nAnyone here aging? Just as curb cuts for wheelchairs ended up helping people on bikes, with strollers, and more--steps we take for people with learning disabilities help many more people. Supporting short-term memory will also help a distracted parent who leaves their screen to start laundry and arbitrate a sibling dispute.\nDiscriminating critical from non-critical. This comes up at my house frequently. I brought roasted beets for a Passover seder. Two nights later, I came home and my husband there was dinner ready but the beets needed some more time. I checked them and they were practically raw. I was distressed that I had brought way-undercooked beets to the seder. After I said a few times I couldn’t believe I’d brought these undercooked beets he mentioned that he had put them in recently. He never mentioned that they were NEW beets. Identifying the salient information is not his strength. (We support distinguishing critical info through headings, quote pullouts, essential info first, bulleted lists.)\nIdioms: ‘Raising the bar’\nFine motor coordination--we’re already familiar with ways to support this... Fitts’ law\n
  • Fitts’ Law tells us that he time to acquire a target is a function of the distance to and size of the target.\nOur QA practices should include ensuring that all form fields make use of ‘id’ and ‘for’ attributes to properly associate labels with inputs. Making clickable targets a reasonable size is extremely important on touch screens as well.\n
  • Login forms can provide more assistance than they often do to help people successfully log in. If a username is an email, the label should be ‘email address,’ not ‘username.’ If there are password rules, list them next to the password--have you ever had this happen with a service you don’t use often? You fail to log in enough that you end up requesting a password reset, only to find they require a capital letter, and if you’d known that, you would have known your password without the reset rigamarole?\nLabels and hints inside form fields can be problematic in that they disappear, and this can happen when your eye is off-screen.\nFor many people with low literacy, their eyes are on their keyboard when they are typing, not on the screen. The hints usually return when you empty the field, which is helpful, but more work than if the text were just outside the field to begin with. (There are accessibility issues as well--these hints/labels inside the text field are not semantically recognized as labels, and as such are unavailable to some screen reader functionality.\nJakob Nielsen first called for the unmasking of passwords in 2009. Masked passwords are a security measure throwback--we’re far more likely to have privacy with our screens. This is also helpful on touch devices where many more people’s eyes are on the keyboard and predictive touch targets don’t apply--more likely to enter an incorrect password.\n
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  • Wait, what did I need to do?\nErrors should list at the top of the page with links down to the form fields that need to be fixed--also helpful: inline support\n
  • These hints are much friendlier in a way (regardless of the copy)--it’s like having someone sitting next to you helping you fill out a form, rather than slapping your wrist afterward for the mistakes you’ve made.\n
  • You’ll often see definitions available where a pop-up window will appear or a glossary page will open. In an eyetracking study, we saw significant effort spent when returning to the content to find the place where the user had been reading, and often resulted in missing two or more sentences upon return to the content for which the people were trying to get support!\n
  • Following common web patterns is of huge value to these users and to conversion on your sites.\n
  • People with low literacy generally avoid typing online when possible.\nI’ve observed a common strategy I would not have expected: going straight to the FAQ:\n“I know there will be a phone number there. Sometimes I’d rather just talk with someone.”\n“I bet someone’s asked that on the FAQ.”--a compensation for the overwhelming nature of trying to navigate a site with a lot of content.\n
  • CAPTCHA stands for “Completely Automated Public Turing test to tell Computers and Humans Apart.” These are here to keep robots from filling out a form repeatedly and putting load on the server--an understandable problem for ticket sales, but for account creation? You’re already going to have to confirm via email that you really exist.\nThe first image is from Google’s account sign-up last year--it has changed since then, but what do we have here? I don’t know about you, but a wheelchair doesn’t make me think of audio (or reading difficulty for that matter.) \nHere’s one from’s account creation form. Now we have some reasonable alternatives--we can refresh the words in the hopes of something more legible, or we can listen to an audio version. However, the audio version requires you type in 6 words instead of 2, does not tell you how many words are coming, and distorts the sound by adding background sounds, as if you’re in a busy restaurant. People who are dyslexic and those who have attention disorders often have difficulty distinguishing sounds from background noise. They’ve also included ‘Wednesday’ which is difficult to spell. \nHow many times would someone have to hear this to get all the words, forget type them accurately?\nMy personal favorite here: “Stop spam. Read books.” What the heck? I really don’t get the connection--it’s almost funny, but it brings up an important point. It’s a common myth that people with ADD are impatient--I’ve observed many excruciatingly boring usability tests where people spend inordinate amounts of time perusing every piece of information on a page as they seek any hint to help them complete the task at hand. This is not the place for irrelevant information. This captcha is an induced barrier placed solely for the convenience of the site owner.\n[*Note: A participant explained to me that Re-Captcha comes from an OCR (optical character recognition) project, “digitizing books one word at a time.” Web users’ ReCaptcha entries assist the OCR project, hence the ‘Stop spam. Read books’ message. You can read more about the project at: . I would still suggest that the ambiguous meaning of this message makes it problematic.]\nCAPTCHA is costly for business owners: Animoto (video app) saw a 33% increase in conversion rate after they removed their captcha field and switched to a robot honey pot instead. Good opportunity for A/B testing--show your clients the difference in conversion rate (and lack of spam), and let them decide.\n\nAs a spam-reducing alternative to captcha, consider using CSS to hide a form field with an empty value. You can then use server-side form validation to check to see if a spam bot has unwittingly filled in this field (a ‘honey pot’). There are other alternatives suggested at these links.\n
  • People who are dyslexic will often avoid typing as long as possible--success after search is poor for users in general. When your spelling is not good, it’s even worse. ‘Type-ahead’ or ‘Auto-suggest’ or ‘Auto-Complete’ has long been available in ‘word prediction’ software--and is very helpful. \nThe travel site’s auto-suggest has the additional help of the visual, making it easier to differentiate among hotels and airports.\nLyricsFly gives the additional cue of artists’ name--though I’d be interested to see if the distance b/w the song title and the artists’ names is too large--perhaps actually slowing down the visitor.\n
  • Site search analysis and fine-tuning are extremely important because generally, the rate of success after on-site search is very poor.\nYour site search logs are a great source for popular & successful search terms, as well as common unsuccessful searches, including misspellings. Use this data to support better search success with best bets. This is an example from Peter Morville & Jeffrey Callender’s book, Search Patterns, in which Peter suggests: “best first is the most universal and important design pattern in search.”\n\n
  • Subject before verb\nSubject does action\nEliminate helping verb "to be" (am, is, are, was, were, being, or been)\n\n\n\n\n\n
  • Twitter users get good at this quickly.\n
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  • Designing for People Who Struggle with Reading and Attention

    1. 1. Designing for People WhoStruggle with Reading and Attention Julie Strothman User Experience & Project Manager Green River @strottrot
    2. 2. Soda wicket woof tucker shirt court, andwhinny retched a cordage offer groin‑murder,picked inner windrow, an sore debtor pore oilworming worse lion inner bet. Inner flesh,disk abdominal woof lipped honor bet,pauched honor pore oil worming, an barbled erupt. Den disrachet ammonol pot honor groin‑murders nut" cup andgnat‑gun, any crudled ope inner bet.Inner ladle wile, Ladle Rat Rotten Hut a raft attar cordage,an ranker dough ball. "Comb ink, sweat hard," setter wicket woof, disgracing is verse. Ladle Rat Rotten Hut entity bet rumj an stud buyer groin‑murders bet. “0 Grammar” crater ladle gull historically, “Water bag icer gut! A nervous sausage bad ice!”
    3. 3. Literacy Skills Sound recognition Spelling patterns Word meaning Inference Critical analysis
    4. 4. Common hurdles for people with learningdisabilities:Short-term memoryDiscriminating critical fromnon-critical informationHighly literal interpretationFine motor coordinationExecution of complex sequential operations
    5. 5. Make clickable targets larger This option (has no label) That option (has label) <input type=“radio” name=“this-option” id=“options-this” value=“”> <label for=“options-this”>This option</label> Fitts’ Law: The time to acquire a target is a function of the distance to and size of the target.
    6. 6. Support Attention Recovery
    7. 7. Support Recognition over Recall
    8. 8. Avoid Dismissible Error Messages
    9. 9. Provide hints inline: during data entry
    10. 10. Provide hints inline: vocabulary support
    11. 11. User Strategy: Guess When Possible “Do you know what this is for?” “I don’t know, but I really don’t like reading, so I am guessing... Like every time you open an account, they ask you two right- up questions that reminds you of your password... so I’m guessing that’s it. I hope so. ... If there’s anything I can guess without reading it, I’m going to go for it. Definitely.”
    12. 12. User Strategy: Go right to the FAQ • dAlene
    13. 13. Stop the CAPTCHA Madness ???
    14. 14. User Strategy: Avoid Typing
    15. 15. Design search results to improve success Your search terms Recommendations Spelling correction Specific page titles
    16. 16. Use Plain LanguageUse simple words and phrasesUse the active voiceReduce prepositional phrase useExplain idiomatic expressions, abbreviations, & acronyms the first time they are usedAnticipate likely questions
    17. 17. Use simple words and phrases Excess Words Plain Alternative accordingly so at a later date later at the present time now, currently in order to to eliminate cut, drop, end on a monthly basis monthly with regard to about
    18. 18. Use active voice Passive The bread was kneaded by the class. Active The class kneaded the bread. Passive The papers were corrected by the students. Active The students corrected the papers. • Subject before verb • Subject does action • Eliminate helping verb "to be" (am, is, are, was, were, being, or been)
    19. 19. Reduce prepositional phrases andthat/who/which clausesWith prepositional phrase SimplifiedThe name of the page The page nameThe person with the most The most-experienced personexperienceThe tool that is most The most efficient toolefficientThere are three things that Three things should be doneshould be done before before submitting:submitting.
    20. 20. Avoid all capitals when possible
    21. 21. Avoid all capitals when possible
    22. 22. Thank You!Slides, Links & References Julie Strothman User Experience & Project Manager Green River @strottrot