 Hi everybody, welcome to Embracing Minds of All Kinds, making digital content usable for people with cognitive disabilities. First, a little bit of housekeeping. If you are more comfortable viewing the slides on your device, you can find the slides at speakerdeck.com. So let's talk about what we're going to do today. We have three objectives to identify access barriers that people with cognitive disabilities experience online. To recognize 12 practical solutions recommended by the W3C that make content usable by people with cognitive disabilities. And to explore ways to get buy-in from your stakeholder so you can put some of those solutions in place. And here's our agenda for today. First, we're going to discuss some terminology and language around disabilities and accessibility. Then we're going to talk about some barriers that people with cognitive disabilities encounter on the web. And then we'll outline those 12 solutions. Then we'll talk about getting buy-in. And finally, I hope we'll have some time for questions. So let's take a moment to define some terms and talk about how we talk about accessibility and disabilities. So first of all, I'm going to use the terms disability and disabled. Those are not shameful or dirty words and they're preferred over other terms. The National Center on Journalism and Disability advises using the words disability and disabled and to avoid using terms like handy capable or diversability or special needs. Research as far back as 2016 has shown that people who are described as having special needs are viewed more negatively than those who are described as having a disability or being disabled, making special needs a particularly ineffective euphemism. So there's a link to that research and the resources guide, which are the last slides of the deck. And I will also tweet out links to each of the sources or resources that I refer to in the talk. So you may be wondering how we're going to define cognitive disabilities. Well, we're going to use the W3C's definition for the context of this talk. It is a very nebulous term. It's sort of an umbrella for neurodiversity as well as neurological disorders and mental and behavioral disorders that may or may not be neurological. So that includes a real wide variety of things. It includes ADHD, anxiety, aphasia, autism, dementia, depression, down syndrome, dyspraxia, epilepsy, traumatic brain injury, Tourette syndrome, and so many more. But we're not going to use those diagnostic labels today. I'm going to use functional terms over clinical terms today when we talk about barriers that people with cognitive disabilities face online. So that means instead of talking about specific clinical diagnoses which can be helpful for individuals in terms of getting support or treatment, we're going to talk about the underlying cognitive skills. So that means instead of talking about ADHD, dementia, traumatic brain injury, we'll talk about attention and focus, about memory impairments, about difficulties concentrating. I'm doing this because not everyone with a cognitive disability is aware that they have a disability, and not everyone with a cognitive disability has a diagnosis. For example, many people spend years unaware that their problems with reading comprehension are due to dyslexia, and many people don't have access to a diagnosis due to a variety of systemic barriers. Getting a diagnosis of ADHD as an adult can cost thousands of dollars out of pocket. And many Americans have more than one diagnosis. If someone who lives with depression and ADHD has trouble focusing, does it matter to us if it's due to the depression or to the ADHD? And what about other intersectional issues at play? And not everyone with a particular disability experiences it in the same way. So just because digital content is accessible to one autistic person, it doesn't mean it's accessible to every autistic person. When it comes to cognitive disabilities, there's very little that is binary or objective. It's all shades of gray. Using functional terms over clinical terms also helps us focus on the aspects of cognitive disabilities that have an impact on the way people use the web. So that's issues related to things like memory, problem solving and decision making, attention and focus, time management, processing speed, math reading and language comprehension and impulse control. It also includes executive function which the Harvard University Center for the Developing Child describes as mental processes that enable us to plan, focus attention, remember instructions and juggle multiple tasks successfully. So let's dive into the barriers that people with cognitive disabilities face online. And those barriers include sites with complex or overwhelming interfaces, sites with complex or unusual words, long passages of text or those visual walls of text, animation or media that autoplay, blinking, flashing, flickering, moving content, just sites that don't have help available. So let's take a look at a couple of sites that demonstrate what not to do. So here's an example of an overwhelming interface. It's a page on eBay to buy a shirt and there's a lot going on. So there isn't a single clear call to action. There are four buttons in the middle of the page with three different designs and there isn't much white space at all. There's a lot of information and it's all crowded in the middle of the page. So this isn't great for people with cognitive disabilities, people who struggle with focus, don't know where to look, people who struggle with decision-making are gonna agonize over those buttons. People with memory impairments are not gonna remember what button they pushed last time with about a $28 shirt on eBay. So this page does not have great cognitive accessibility. And our second example is the Wikipedia page on the planet Saturn. So this is an example of a page that uses complex words. The sidebar alone includes words like perihelion and other words like eccentricity seem common but become pretty opaque in this context. So readability is often determined through a method called the flesh reading ease score. So this system isn't perfect. There are definitely some valid criticisms of it but it can be a helpful gauge that can give you a general idea of how easy your text is to read. It looks at the number of words per sentence and the number of syllables per word and then it calculates a score that corresponds to a readability level. So our Wikipedia page on Saturn has a flesh reading ease score of 53 which means it's fairly difficult to read. A score of around 60 to 70 is what's considered standard or comfortable for most adults. And a person who struggles with concentration in language or reading comprehension probably needs an even higher reading ease score. So on our Saturn page they may get discouraged and leave before they're able to complete their task. And if they do find what they're looking for, if they do sort it out, they may pay a price, an exhaustion, lowered confidence and frustration. And really that's what it comes down to. What price are disabled users paying for inaccessible sites? How much energy are you asking users to consume to complete a task on your site? If it's accessible, it won't cost much at all but if it's not, it will cost something very valuable. It will cost spoons. So some of you are thinking to yourself what kind of nonsense is this? Does Christina collect spoons? Spoons weren't mentioned by Ken in the introduction as one of my special interests unless this is some sort of like deep cut Star Trek fan fiction thing or something. But some of you on the other hand may be very familiar with spoon theory. How many people out there not have to raise hands know what spoon theory is? Awesome, so there are a few of you, great. Okay, so spoon theory is a helpful model to keep in mind when thinking about cognitive accessibility. Christine Miserendino who has lupus developed spoon theory when explaining to a friend what it's like to live with a chronic illness. She and her friend were at a diner. Christine handed her friend 12 spoons. She asked her friend to describe the tasks in the day. Showering, getting dressed, making breakfast, going to work. Christine took away at least one spoon for each task. Each task takes energy. Each task takes at least a spoon. And then when there were no spoons left, there was little energy for anything else. And there are some days depending on how much pain she's in. When Christine starts the day, not with 12 spoons, but with 10 spoons, maybe even fewer. And on days with fewer spoons, less gets done. If you try to do 12 spoons of activities on a day when you only have 10 spoons, you pay a price in pain and exhaustion and will have to take more time to recover. Spoons can only be restored with rest and care. Otherwise, you start your day with fewer and fewer spoons. And low spoon days are bad days. So this metaphor works well for people with cognitive disabilities as well. Online activities, like paying bills, buying school supplies, researching recipes, catching up on the news, can take very few spoons on sites that have strong cognitive accessibility. But on sites that have weak cognitive accessibility, completing a task may take your spoon or two. You may think, I don't have the spoons to do that, to deal with that site today, to get that done. So the goal here today is to make your products take as few spoons as possible. Heck, there are even sites that I visit to help recover my spoons. So let's get into those solutions you can put in place to help folks with cognitive disabilities retain their spoons. So yes, just checking in with our agenda. Here's where we are now. We talked about language and terminology and barriers, and now we're gonna go into those 12 solutions. They're also known as design patterns that help make digital content usable by people with cognitive disabilities. First, a quick little bit of context. All of these solutions are from the W3C's April 2021 working group note on cognitive disabilities, which includes many, many more. This is just like Christina's top 12. I also wanna note that these are highly contextual and violations, for the most part, can't be identified by automated testing tools alone. That may change soon for a variety of reasons. That's probably a whole other talk. Cognitive accessibility involves a lot of critical thinking, experimentation, and listening. It's really hard to get this right without talking to users. But without further ado, here's number one. So number one is to make it easy for users to find the most important tasks on your site. By drawing attention to the most important tasks and features, a user can quickly determine whether or not the site will meet their needs. And this is important because users with impaired executive function and memory issues may have trouble determining what they can do on a site with a lot of noise and distractions. And they may give up when important information doesn't stand out. And it's totally obvious what the most important tasks on your site are, right? Well, perhaps not surprisingly, identifying the most important tasks can be tricky. It may involve user testing, focus groups, or analyzing usage data. And even that can be tricky because what a user considers, their most important tasks may not be what your team considers most important. The user tasks may not be the same, or user needs may not be the same as business needs. So let's say a library wants to feature upcoming events prominently on their home page. Getting users to register the event is what the team considers most important. But user testing and analytics can show that the most important tasks for users are identifying library hours and figuring out how to sign up for a library card. So it takes just a couple clicks to sign up for the event. But in order to figure out how to sign up for a library card, you've got to scroll a bunch and then click through some non-obvious links. So you may have to do some work to reconcile a user's most important tasks with business needs. But that's only possible once you've actually identified what those user needs are. Solution two is to provide a friendly search mechanism that includes features like autocomplete and spell check. And this is important because users with short-term memory impairments who get distracted easily or who struggle with executive function may rely on search to find what they need. So other ways that users find things include menus, categories, and browsing. But an advantage that search has is that you can usually find it on most sites in about the same place. Menus work differently on each site, and categories are used really inconsistently. And browsing multiple pages may take too long, causing a disabled user to forget what they were looking for in the first place. It's like that thing where you walk into the kitchen, but there's so much going on in the kitchen that you forget what you even came into the kitchen for. Like, that happens online. I keep bumping my mic, sorry. OK. Search is most useful when it cracks spelling errors and suggests auto-corrected versions of search terms. But an important note here is that search is less important on sites where every page is no more than two pages away from the home page. And search is more important on large and complex sites where it's a critical navigation tool. So consider the difference between a site for your local pizza joint and the site for a large museum. So this screenshot, which looks super teeny tiny, is from the Philadelphia Museum of Art website. And it shows a search interface that can be filtered in a number of ways and displayed in different formats. It doesn't automatically correct the spelling of search terms, but it does autocomplete. So if you start spelling the last name of the painter, Paul Cezanne, C-E-Z, it will help you with the rest. But if you start spelling Cezanne with an S, which you can sort of imagine it starting with an S, you're sort of out of luck. So the third solution is to use clear and understandable content. And content here isn't strictly defined as blog entries or post content. It includes everything on your site. It's especially important in instructions, error messages, navigational elements, and headings. And this is important because users with impaired language skills, users who struggle with reading comprehension, may not be able to understand complex language. And users with memory impairments may not be able to learn new words. And users who struggle with non-literal language may not understand jokes and metaphors. And using clear language is especially important when conveying information related to government services, utilities, housing, and anything related to health and safety. And there are many ways that you could help users with cognitive disabilities understand your content. So you can use easy-to-understand words. You can use common words and avoid acronyms and jargon. That helps a lot with readability. You can use short sentences and avoid nested clauses. You can use a simple tense in English. This is the present tense in the active voice. So speak directly to users and speak as naturally as you can. And use short blocks of text. The W3C actually advises 50 words or fewer. But again, context matters here. You may want to go even shorter than that in email newsletters and use the one sentence paragraph approach. You may need to go longer than 50 words per block and long form article content. On brochure sites, 50 words per block feels about right. And use unambiguous content, whose literal and concrete terms. Often examples are helpful, especially when explaining abstract concepts. People who struggle with non-literal content may be bottom-up thinkers who take in the details before processing the larger concept. And examples can really help bridge that gap. You can use generous white space. Use clear spacing between blocks of text to reduce clutter. What clear spacing means, again, may depend on the context. But users with cognitive disabilities can really be helped by that when it comes to understanding content. Our fourth solution or design pattern is to use clear formatting and punctuation. Use punctuation and formats for text numbers and symbols that reduce ambiguity and improve comprehension. So some users with communication difficulties use screen readers or text-to-speech software to help them understand content. And if content is phrased incorrectly or uses punctuation incorrectly, the user may not be able to understand it. So by contrast, a blind person who does not have a cognitive disability using text-to-speech software may still be able to understand content if words aren't pronounced correctly or if the formatting's off, but someone with a communication impairment may not be able to work out the correct meaning. So for example, in English, screen readers will pause when they encounter a comma, but they'll ignore hyphens. And question marks, exclamation points, and other pieces of punctuation will result in a change in intonation. So you want to be very intentional about the punctuation you use. It matters. In addition to using punctuation correctly, you can also format text to the meanings clear. So write out the month and dates so it's clear if 11-8 means November 8th or August 11th. And avoid using Roman numerals because they confuse a number of users and are unlikely to be read correctly by screen readers. Assistive technologies will read Roman numerals correctly if you use a special character, but even then they'll read something like chapter Roman numeral 4 instead of just chapter 4. And long numbers may be read as single digits or phrased as a single number. So use context and language appropriate separators. So in English, when you add a comma in the appropriate place, that will ensure that the number will be read as intended. For example, if the language of a site is set to English, 1 comma 234 will be read as 1,234. And if the site language is in German, that same number would be read as 1.234. And without any punctuation at all, a long number may be read as a series of digits, 1, 2, 3, 4. So it's important, again, to be intentional about how you format your numbers. Our fifth solution is to give clear step-by-step instructions so users can avoid making mistakes. Clear instructions help users prevent errors and increase their ability to complete a task independently, which is important. So clear and easy to understand instructions help a number of people. Instructions help users with anxiety, memory and concentration impairments, reading and math comprehension issues and general communication impairments. And without instructions, users can make multiple mistakes, use their spoons and abandon their task. So clear instructions are important at the start of a process. Don't wait until the user has made a mistake to give them help. Place the instructions before or next to the field of activity, and it's totally fine to hide them behind a familiar icon like the little I with the circle around at the info icon. And our sixth solution is to make short critical paths. It's a great way to help users focus. So critical paths in the user experience context, that means the most direct route that a user can take from the home page to the goal page. And the goal page can be like the receipt page, the confirmation screen, whatever screen indicates that a user has successfully completed a task. So another way to think about this is to simplify your user journeys. And this is important because unnecessarily long processes fatigue users and increase the chance that a user will get distracted and make a mistake. An overly long critical path will cost a user a spoon. So you can accomplish this by providing short navigation to key features and important tasks. Ideally, these are available without scrolling in the home page or in a global component like a header. Don't make user search for the start of a critical path. Critical paths should avoid any unnecessary steps. Don't require a user to go through anything optional. So for example, in an account creation process, avoid asking users to do unnecessary tasks like set an avatar, set their newsletter preferences, give you their birthday. Allow those things to happen after the account creation process is complete. So the New York Times, for example, offers many, many newsletters, but they don't require the user to set their preferences until after they have subscribed. So now that we're halfway through, let's recap solutions one through six. One was make it easy to find the most important tasks. Number two was to provide a friendly search. Number three was to use clear and understandable content. Number four was to use clear formatting and punctuation. Number five was to use clear step-by-step instructions or sort of a pattern here. And number six was make short critical paths. Okay, now on to number seven. Our seventh solution is to provide a login that doesn't rely on memory or really any type of cognitive skill. Make sure there's an easier option for logging in for folks who need it. And this is important because people with any sort of impairment that affects memory or language can find it difficult or impossible to overcome memory barriers when logging in. So when you're building a login process, make sure it doesn't require folks to use any spoons at all. Offer single sign-on, offer magic links, offer QR codes. It's really helpful. You need to be able to allow users to copy and paste their password, allow them to use a password manager. Password managers are enabled by default when you're using semantic HTML, so don't get in the way of that. So this example from Airbnb includes many options for logging in, including Facebook, Google, Apple, email. So solution eight also addresses memory issues and that's don't ask users to memorize or calculate data. And this is important because many users have impaired working memory, so they can't remember a lot of details at the same time. And other users with impaired executive function may not be able to really remember instructions. And so you can help those users by not resetting a form when a user makes a mistake and encounters an error, they make a mistake in one field in the form and then they get an error and everything gets cleared, it's horrible. You can also help those users by ensuring that each step in a process contains all the information the user needs to proceed and doesn't rely on memory from a previous step. So if a user needs to change their service plan, they shouldn't have to remember the name of their current plan and that information should be displayed along with relevant details, like how much the user paid, when the plan expires and what benefits they receive. Our ninth solution is to provide alternative content for complex tasks and information. Help users complete tasks on their own by presenting information in different formats. And this is important because complex information and data formats can present a significant barrier to people with cognitive disabilities, but they may be able to overcome that adversity with the help of supplementary content. Some people have impairment that affects numbers, but not language and other people have a language impairment that may not understand numbers. So provide content in various formats to help users save those spoons. And you can do this by using charts and graphs to support text, adding video clips to support instructions, including a flow chart to visualize a process, and even linking keywords to a glossary. Our 10th solution is to provide human help. Many people rely on human help. And this is important because when a user gets stuck or confused for any reason, getting help from a real person is often the most effective solution. And in reality, many sites provide this option only to users who can navigate complex systems, who can figure out how to find the help through social or something like that, or can navigate complex navigation systems. So you can provide a way for users to access a real person who can support users by offering a telephone number to talk or to text, an email address, or an option for live chat or video. So this Contact Us section from the e-commerce brand Me Undies gives users four different options for human help. 24-7 live chat, email, text, and social. So something that they're doing here that you probably can't read because the text is really small, is that they're doing something helpful for users with anxiety, and that is to let users know how quickly to expect a response. So if a user chooses email, they may have to wait two days, but they can expect a text response within an hour. And then there's 24-7 live chat because you never know when you're gonna need 24-7 live chat for your Meet Undies order. Our 11th solution is to let users know when content moves or changes. That is ensure that changes of content, functionality, or orientation are initiated only by the user or request, or make sure the user has an easily available mechanism to turn off those changes. I'm gonna raise my hand like this is a personal one for me because I get really, use a spoon when content changes too much, okay. So this is important because any content that changes unexpectedly without user initiation can result in loss of focus, anxiety, or confusion for a variety of disabled users. Changes can be especially disruptive and distracting for users with attention impairments or sensory sensitivities. So this includes auto-loading and playing new content without the user initiating it, but changes can also include automatically launching of new windows or pop-ups, submitting forms through a mechanism other than a submit button and opening new content. So you give users controls that allow them to personalize when content changes. So in this screenshot from YouTube, there's a toggle that allows users to choose whether the next video will play automatically. So it's great that this toggle is available, but I wish it were more clearly labeled and that it were turned off by default. But at least this is one way to allow users control over their experiences. So our final design pattern is to enable APIs and extensions. Support the use of tools that users have chosen for themselves to complete tasks. There are browser add-ons that add white space between lines and chunks of text, that create maps out of heading structures, read acronyms, simplify content, manage passwords, check spelling, et cetera. But what I wanna be clear about is that I mean that users should be able to choose the tools that they need so that they can use their products. I do not recommend or advise the use of overlays or widgets that claim to provide a quick, low cost, set it and forget it solution to accessibility without changing your source code. These overlays do not provide legal coverage as over 200 lawsuits were filed in 2020 alone against companies that were using these overlays. These overlays do not actually make your site fully compliant with the web content accessibility guidelines as they don't address many accessibility issues like alt text on images, non semantic headings and a variety of issues related to forms, keyboard, accessibility, et cetera. And these overlays and widgets even interfere with the assistive technologies that disabled people use, making it even harder for them to complete tasks. In fact, there are now browser extensions that disabled people add so that they can get around the overlays. And there's actually a lot more to say on this topic, but again, it's outside the scope of this talk. And if you're interested in more information about these overlays, visit overlayfactsheet.com. So anyway, back to APIs and extensions. And when add-ons and extensions are blocked or not supported, disabled users may not be able to use a site at all when password managers are blocked. Users with memory impairments may not be able to use a site at all. When distraction removing extensions are blocked, a user with attention or focus issues may become overwhelmed and not be able to use a site at all. And when simplification add-ons are blocked, a lot of users may not be able to parse content at all. So when it comes to enabling APIs and extensions, the request here is simply to ensure that browser add-ons and extensions work as expected. You can do some testing. You don't have to go and download a bunch of accessibility extensions from a browser store. You probably have a password manager on your computer. Give that a try with your product, make sure it works, and just really avoid code and designs that stop these things from working. And let people decide what's best for them. Don't stand in their way of engaging with your product in a way that's comfortable for them. And I hope that's really the message of all 12 of these solutions. So let's recap solutions seven through 12. So they are to provide a login that doesn't rely on memory. Don't ask users to memorize or calculate data. Provide alternative content for complex tasks and information. Provide human help. Let users control when content changes and enable APIs and extensions. So you may be saying, all right, Christina, this is super great. But how do I get buy-in from my team? How do I make a case for incorporating any of these, especially if there's that tension between accessibility needs and business goals? So you can make a business case that poor accessibility means fewer users or that when you make a site more accessible to disabled people, it makes it more accessible to everyone and that a lot of the patterns I mentioned here are very close to just general user experience, usability, best practices. You can also make the case that cognitive accessibility and accessibility in general is the right thing to do. You can make that ethical case. But I wanna recognize that sometimes these broad arguments aren't sufficiently persuasive. So I wanna leave you with just a few tips for resolving that tension between accessibility goals and business goals. So the first is to test, conduct AB testing or any other kinds of user testing and let the results speak for themselves in terms of conversions, revenue, or whatever KPIs matter to you. I find that testing with real users often provides relatively clear guidance about a path forward. If you do test with real disabled users, make sure you ask them what accommodations they need so that they can have a supportive testing experience and don't forget to compensate them as you would other testers. And the second is to prioritize. Identify the accessibility changes that will have the greatest impact on users and may have a positive impact on business goals. Find those win-wins. Identifying users' most important tasks and placing them into more prominent positions may have a positive impact on business goals. Shortening a critical path by removing an unnecessary step is another accessibility change that could increase conversions and revenue. And ensuring that your content is clear and understandable, using shorter sentences and proper punctuation can really help disabled people and may give you a little SEO bump and may just even have a neutral effect on business goals. All this really depends on the context of your particular product. And the third is to research and track. Adding a huge overlay that takes over the entire screen to force newsletter signups may be successful in the short term. It may do nothing for long-term conversions or upgrades and may also result in less time on the site. So you might be able to make a stronger case for cognitive accessibility if you have research and data to support that accessibility is better for your product over the long run. So there's currently no way to measure the number of spoons saved or spoons consumed, but if somebody builds a spoon index app that measures the cognitive accessibility of a site, please let me know a free idea. So I think that's all I have for you today. I appreciate everybody joining here. I also shout out to everybody watching online to learn about cognitive accessibility and I hope that when you return to work after the conference, you'll be able to use something you learned here to help someone out there save their spoons. And if you found this interesting and want to do amazing work, we at Ali are hiring, find me later or reach out to me on Twitter to find more. And now I think we have time for questions. Questions, do we have time for questions? We have two minutes. Thank you for doing this. Seriously. You're welcome. And I only have one question. Okay. Where were you when I was in grade school? I think part of the, I do talks that I want to hear and I hope that everybody else here, like if you have a talk that you want to hear and you don't see anybody here doing that talk, like give that talk, because I needed to hear some of these things five years ago, 10 years ago, like heaven helped me and third grade. So I hear you. Yes. Hey, thanks for doing this. I'm just wondering, is there a good resource for emulating a screen reader experience if you just want to go try it out? The best way to understand how screen readers work is to, if you have a Mac, you have a screen reader called voiceover that is already built into your machine. And there are some pretty, when you turn it on, there are actually some, it will go through a tutorial. There are also some instructions and cheat sheets online on how to navigate your, how to navigate your machine with a screen reader. And what's helpful for testing with a screen reader too with voiceover is that it actually gives you a visual display of what's being read in addition to hearing it. So I think that rather than emulating the screen reader experience, the better option is to actually just give it a try. Are you good? Are you good? Thumbs up? Okay, thank you everybody. Thank you.