The needs of people with cognitive disabilities

People with cognitive, language and learning disabilities comprise the largest group of those with disabilities accessing the web—approximately 15 to 20% of the population. It is important to remember that people with cognitive disabilities often have a problem in only one area of cognition and can be of average or higher-than-average intelligence. People with cognitive disabilities are just as likely as those without disabilities to be in technical careers and/or careers requiring high intelligence. People with cognitive disabilities may even work in industries which would appear to be impossible for them due to their disability. For instance, Tom Cruise has dyslexia, and as a dyslexic he has great difficulty reading; however, his career as an actor requires him to read and interpret scripts on a daily basis.

Unfortunately, the W3C Web Content Accessibility Guidelines, Version 2.0 and 2.1 do not include many requirements aimed at assisting this sub-group, as evidenced by the formal objection tabled by Lisa Seeman and co-signed by more than 50 people involved in the accessibility industry. In fact, when WCAG2 was released, it included the following statement:

“Note that even content that conforms at the highest level (AAA) will not be accessible to individuals with all types, degrees, or combinations of disability, particularly in the cognitive language and learning areas. Authors are encouraged to consider the full range of techniques, including the advisory techniques, as well as to seek relevant advice about current best practice to ensure that Web content is accessible, as far as possible, to this community.”

But WCAG2.2 has aimed to correct this. These are the new features in WCAG2.2:

And I would argue that every single one of them assists people with cognitive disabilities. However, the addition of these nine success criteria (three of which are at Level AAA), does not mean that WCAG fully meets the needs to people with cognitive disabilities. So what else can we do? Before delving into that, let’s get some definitions right first.

What are the type of cognitive disabilities

There are many different types of cognitive disabilities; however, they all incorporate varying degrees of problems associated with:

  • Memory: Memory impairments include difficulty obtaining, recognising or retrieving information from short-term, long-term or remote memory.
  • Perception: Perception impairments include difficulty digesting, attending to and discriminating between sensory information.
  • Problem-solving: Problem-solving impairments include difficulty recognising problems, identifying, choosing or implementing solutions and evaluation of the outcome.
  • Conceptualising: Conceptualising impairments include difficulties with sequencing, generalising previously learned information, categorising, cause and effect, abstract concepts, skill development and comprehension.

Making sites accessible to people with cognitive disabilities

There are some simple things you can do to ensure that your site is accessible to people with cognitive disabilities:

  • Ensure that your site is simple-to-use: People with cognitive disabilities often have difficulty locating information or can be easily distracted. Providing a simple and clean design can assist this group.
  • Provide equivalents: One of the most important ways you can make a site accessible to as many users as possible is to provide equivalent information in different formats. The more formats your content is in the more people can use it. Video, graphical or audio versions of content should be used wherever possible. It can also be helpful to pair an icon or graphic with commonly used text—such as navigation—to allow users to read via icon instead of text. You should also provide standard equivalents for media, such as transcripts, captioning and audio descriptions.
  • Ensure the site can be used by assistive technologies: Often people with a reading disability will use an assistive technology, such as a screen reader, to enhance their comprehension. Thus, it is important to ensure that a web site fulfils standard accessibility requirements, such as appropriate alternative text, table headers, headings, field labels and keyboard operability. As people with cognitive disabilities may use a screen reader in addition to viewing the content, there are some additional requirements that should also be included. For example, any links should make sense out-of-context, and field labels should always be visible (especially the Search field label). Another important step is to ensure that the reading order matches the source order—if not, then the content will be read in a different order to how a person sees it on the page, making it extremely difficult, if not impossible, to use.
  • Ensure the site is consistent: Consistent navigation throughout the site is very important; however, consistency in a site doesn’t end there. It is also important that the links are consistent—if two links have the same link text, then they should have the same target. A consistent style of presentation across the site is necessary, including standard use of fonts and font sizes. Please note that consistent presentation does not mean the same presentation. It is also important that a site is consistent with other sites, for example, by underlining text links, having the Search bar in the top right corner and providing global navigation separate to content navigation.
  • Provide orientation mechanisms: Orientation mechanisms, such as breadcrumbs, are an important way of assisting users to orient themselves within a site and find appropriate content. Further, it is valuable to always clearly identify the current section of the site. It is also imperative not to break the Back button by opening links in a new window.
  • Reduce distractions: Content that is a mere distraction to the general public can make a site completely inaccessible to people with cognitive disabilities. Movement is one of the biggest hurdles that people with cognitive disabilities face, and it is important that movement is minimal or that it can be easily stopped by the user. It is also helpful to avoid background audio, as this will be both distracting and interfere with screen reader output. Background images can make text difficult to read.
  • Enhance readability: Recent research has found that using sans serif font is not as useful as previously thought for people with reading disabilities. There are many other ways to enhance readability on the web which provide for much better comprehension by people with cognitive disabilities. For example, text size should be 11px or higher, and the site should allow for users to increase text up to 400%. People with cognitive disabilities will often zoom in on images, so allowing for magnification of images is also recommended. Readability can be enhanced further by increasing the line height on the text and breaking the content into columns no wider than 75 characters. Abbreviations should be expanded on their first use. Formatting effects, such as bold, should be used sparingly, and only to highlight content. Italics, ALLCAPS and justified text should be avoided as they are difficult to read.
  • Provide feedback on user interaction: Feedback on user interaction can be very helpful to people with cognitive disabilities, whether this is a hover effect or audio feedback. Include a hover effect on links, so that it is obvious when a link has mouse or keyboard focus. This facility is also useful for table cells and fields. Audio feedback can be provided on activation of a link or the submission of a form.
  • Allow users to transform the site: Just as users prefer content in different formats, they also prefer to be able to modify the look or design of a web site to suit their needs. One of the most important requirements for people with cognitive disabilities is a low colour contrast, which is in direct opposition to conventional accessibility wisdom, which deems that high colour contrast is the most accessible. Thus, providing a mechanism to change the colour contrast of text and background is important. Furthermore, increasing the text size and allowing users to turn off images and style sheets is also valuable. In addition to enabling modifications to a site, the site owner can enable a type of assistive technology that transforms the site for the user. One example is ReachDeck Toolbar, which allows users to change the colour contrast and to have text read aloud on hover. ReachDeck Toolbar also includes dictionary software to assist in the comprehension of complex words.
  • Use plain language: Plain language is very important for people with cognitive disabilities. For this reason, it is important to reduce the amount of text wherever possible, and limit one idea per sentence. Some people with cognitive disabilities have difficulty with abstract or figurative concepts, so ensure that the content is literal. Summaries of the content and text boxes with key information also facilitate comprehension, especially when they are provided at the top of the page. As in all communications, spelling and grammatical mistakes must be avoided.
  • Allow for error prevention and recovery: People with cognitive disabilities benefit from instructions for forms and unusual interfaces. Informative error messages and further suggestions can also be helpful. Users should be allowed to modify any time-sensitive content and recover from errors, especially for critical functionality such as internet banking.
  • Focus on information and assist in readability: People with cognitive disabilities often have difficulty noticing and focusing on information. Alternatively, they could have trouble reading information if it is formatted in a particular way.
  • Ensure forms are easy to use: People with cognitive disabilities often have difficulty completing forms. Providing information about the use of a form, such as timeout information, mandatory fields and help text, can assist this group.

Checklist to ensure your site is accessible to people with disabilities

  • Create a clean design with minimal distractions
  • Provide instructions for unfamiliar interfaces
  • Provide informative error messages, including detailed 404 errors
  • Do not have more than seven navigation options
  • Avoid background audio or images
  • Provide transcripts, captions and audio descriptions for all video content
  • Include breadcrumbs
  • Ensure the site can be printed legibly
  • Use a font of 11px or higher
  • Do not make columns of text larger than 70 characters
  • Use a sufficient, but low, contrast between text and background (e.g., a pastel background and black text)
  • Limit different fonts within the site
  • Ensure all the links work
  • Ensure links are always underlined
  • Provide large, clickable areas for links
  • Provide features so the user can easily change text and background colour and text font and size
  • Provide summary information about the site on the homepage, including the purpose of the site and what can be achieved in the site
  • Highlight key information at the beginning of the page or in text boxes
  • Reduce text where possible
  • Limit complex ideas
  • Include only one idea per sentence
  • Ensure content is literal; avoid abstract or figurative concepts
  • Avoid tangential information
  • Use correct grammar and spelling
  • Do not use abbreviations
  • Identify the target of each link
  • Include a FAQs page
  • Include a Contact Us page
  • Include a glossary
  • Ensure headings are used
  • Do not use italics
  • Do not use ALLCAPS
  • Increase the line height on paragraphs
  • Include a hover effect on links so that the link highlights when the user hovers over it
  • Include a hover effect on table cells so that a particular cell is highlighted when a user hovers over it
  • Hide content until the user requests it
  • Include audio feedback for any activation (e.g., a “ping” sound when a link is clicked)
  • Provide multi-sensory error feedback (e.g., a dialog box and an audio error message)
  • Supplement text navigation with graphic icons
  • Reduce the complexity of forms
  • Limit the number of procedural steps
  • Autofill form input where possible
  • Provide information at the beginning of forms to reduce the likelihood of errors
  • Include cues and prompts
  • Limit the options or choices within forms
  • Provide a list of links to choose from instead of requiring the user to type in options
  • Allow users to enter a short code to represent a longer sequence (e.g., VIC instead of Victoria)
  • Provide field labels for all fields
  • Ensure field labels are positioned physically close to the relevant field
  • Ensure dual controls (e.g., Submit and Reset) are not close together
  • Do not use time limits
  • Ask users to confirm choices before submitting them

I hope this is useful to you!

While WCAG has made great strides, there’s still room for improvement when it comes to addressing cognitive disabilities. I’m really looking forward to discussing how we can better support mental health disabilities too!

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