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Understanding the effects of Cognitive Disorders (3 Parts)


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Part 1 - Naturally occurring


On the baseline, cognitive disorders are about the brain and problems understanding things. So there is no easy fix like slapping an alt attribute in code, increasing color contrast and we will not understand something whether written or read in a screen reader, using flexible widths where the content paragraphs are to long can even cause more trouble for us even though free flexing sizes are considered accessible.


So there is no easy fix for cognitive disorders, no good techniques have emerged yet. So I will try to explain our lives to you per real life examples. I am lucky that my issues are more minor, also one our members at Killersites has been effected and allowed me to tell her story. What I hope to share with you is both light and extreme cognitive disabilities as well as natural occurring and accidental disabilities so you see that you may have no users like this today, but may tomorrow and smack dab in your target group. Then finally that it is not always about disabilities either.


I am 44, a professional web developer/analyst programmer and web accessibility advocate instructing employees of the state of Alaska. I have a physical disability not related to the web, I have been diagnosed as depressive (cognitive disorder) and although not yet official, unofficially I am listed as having Asperger Syndrome (a cognitive disorder and a sub-section or High form of Autism). Yet meeting me in person you would not tag me as traditionally Autistic or depressive. Asperger did not exist when I was a kid so I was likely diagnosed late. It is also possible that I have a lesser known version of ADHD.

So how do these react with the web?


Patience: I tend to grow more impatient than I used to. I am immediately turned off by long stretches of content. It is like a switch being thrown, I see the long length of text and something just drops in me, I cringe and maybe buckle down to read, but mostly just go back and try to find a different source. I just cannot face long text on a computer screen... but enjoy a nice long book.


I also tend to feel I don't have enough time, even though I may, so again long text turn me off.


Medication: I am on anti-depressants, Cholesterol lowering meds and pain killers for my physical pains. This cocktail, of which 2 make you drowsy, can really effect my surfing habbits. Being tired makes it hard to read and concentrate on technical issues. The meds and drowsiness make it hard for me to focus on a web site, especially those with smaller fonts, and result in headaches or closing my eyes to rest them and falling a sleep. Web design does effect this to a small extent, a boring site design is just marginally worse than and interesting one... but more the colors and font sizes directly effect me. Poor choices cause eye strain and can result in headaches (and that really for anyone).


Attention: As touched on above, the meds cause attention issues, but so does Asberger and ADHD. So when trying to concentrate on complicated issues... any distracting Gif or Flash animations just compound that. If I am having trouble comprehending the content, I easily switch to something easier... I have to fight to stay focused. I think that is why I hate the modern design concept of multiple boxes and almost all content of the site smashed onto the index page. It overwhelms me and gives to to much straying of my attention. I despise such sites as M$N and the others with links upon links and all trying to offer subjects I care nothing for like news, stocks, weather.


Motivation: This is a direct reflection of both the depression and the Meds. I am not motivated, I tire of things easily. I don't care. In the Killersites forum I used to help allot, less these days because I am not motivated to do so. Just as described above I shy away from complicated subjects that I will have to think about. It is to straining to do so. To repeatedly answer the same questions, repeatedly argue with people who do not care about those with disabilities, those who want to be told how good they are and not listen to criticism. I patrol for spam more than anything. My own Blog suffers from this as well, I do not feel motivated to write and even have to fight to write this. Now that I am one of those with disabilities, I find myself drifting away from web accessibility advocacy. I do not even go on my computer much these days... I just do not feel like it. If Google gives me lots of hits I cringe, in no mood for reading through pages and pages of useless info to find the gem.


Problem Solving: This is the biggest issue for me I guess and is made up of all above. Asperger and depression both affect problem solving skills. I of course am now a programmer... wonderful. Programming is in fact problem solving. "This is what I need, who do I do it?", "This is what someone wrote, what were they thinking, what does it do, why is it broken and how to I fix it?", I earn my living doing exactly that which comes hardest to me these days. When I started in the Killersites Forums I helped people with problems, but now I cannot break down other peoples code to find the mistake... I give tips and hints at what to look for and hope the other regulars can figure it out. I feel headaches coming on as soon as I see a complicated issue before me.


I have just touched on a few items here, both to keep it short and because I have lost my train of thought... my concentration... what my point was to be. My conditions are minor... for those who are full fledged Autistic, these issues are multiplied!


So I would like to mention one of my favorite projects: Zac Browser (Zone for Autistic Children). It is the brain child of a Software Engineer who's grandson Zack is Autistic and was overwhelmed by to many buttons and actions in modern browsers. He created a browser for Autistic children with very few, large buttons using images that make their use clear and the browser has web sites embedded in it that are clean and built for children so Zack will be fairly focused and not torn between multiple decisions. I have played with it and find it excellent. Any one with children should have a go with it.


If I have raised your awareness to the issues and you are interested in more, I offer you these reference points:

  • Job Accommodation Network (JAN) - Disabilities A-Z. Explanations on how to accommodate employees with given disabilities.
  • JAN - Asperger Syndrome
    "People with Asperger Syndrome can excessively elaborate on their own topics of interest, however, be unable or unwilling to participate in other parts of conversation or to end a conversation, partially because of the inability to gauge social context or interpret social cues (Klin et al., 2000)."
    - My regular readers should recognize this :D.
  • JAN - Depression
  • JAN - Attention Deficit Disorder (Learning Disabilities)
  • JAN also discusses other cognitive disorders that can affect use of the web. Consider Anxiety Disorders, Cognitive Impairments, Bipolar Disorders, Epilepsy, Migraine Headaches... as well as some web related physical disabilities.
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Part 2 - Illness & Accident


Another form is shall we say Accidental. Another is per injury or Illness... but not occurring as part of your normal development. This can be more devastating. I have worked for years under my problems without knowing I had any. As they developed so did I, developing ways to deal with them. But the accidental form just hits you one day and tips your world upside down. You think your target group is healthy and has no disabilities? Wrong, accidents and illnesses happen across age groups, gender, culture, ethnic barriers, and religions.


I have asked and been given permission to speak about Shelley. Shelley is a young woman, mother, wife, and quite a successful freelance web designer. That is until recently. She got ill and now has complications resulting in cognitive difficulties. I will use as much of her own words here as I can. I have edited some parts out as being just technical info on the disease or not pertaining to Web use per say which this article focuses on. It is not about "The disease", it is about the way "A disease" has changed her use of the web and her need for accessible web sites.


"I have Lyme Disease. I tested positive twice with Canadian testing (which is rare), and I am waiting on co-infection results. Some will know what this means... Some will not. Those who know about it might or might not know what it means when I say I am in Stage 3 and I likely have Neuroborreliosis which is when the disease passes the blood brain barrier. There are a number of things that indicate this including memory issues, cognitive issues, central nervous system issues, mobility issues, motor skill problems and the one I am loving the most this week (a newer development) Bell's Palsy (minor but I'm admittedly a bit vain so I am praying this one fixes up more and I am thanking the stars I am only around a II on the HB scale).


Even a year ago I could still partake in my love of website design, and coding for hours on end but even that became too much. This isn't to say I can not work on sites, and maintain sites. I just can no longer put a site out in 24 hours (as someone here once joked with me - ok... yes... I know it was true). Now I am like most and take at least a week, more complicated sites obviously take longer... Some will get this, and what this means about me and some won't. Basically it takes me 1-8 times as long to do something which is hard to accept."


Her symptoms as she spelled them out for me:


My symptoms include (but are not limited to):

  • Fatigue - Sometimes the fatigue is relatively mild, allowing me to continue working, perhaps in a diminished capacity. Sometimes, however, the symptoms may be quite severe, such that I have been bedridden due to intractable fatigue for 1-4 days at a time.
    [Note: This can effect how well she can concentrate or even "enjoy" surfing, complicated dry technical articles of length will likely be avoided.]
  • Memory problems - Memory problems, too, can be mild or quite severe. I have days where I am "ON" and days where I have a serious case of CRS (Can't Remember S***!).
    [Note: Possible examples here and she mentions this further down, is not remembering what was just read, why you went to the site or page, what info you want or even where you are in the site and what pages you already visited.]
  • Photophobia - idiosyncratic responses to particular kinds of light and often am in a very dark home as I pull all the shades. Which of course has my hubby wondering if I am part vampire?
    [Note: here the possibility is that movement from GIFS or Flash or extreme changes between dark and light could be problematic.]
  • Panic-attacks - that seemed to be triggered by sound or light stimulation-especially bright lights that flicker, such as fluorescent lights, headlights of cars moving in the opposite line of traffic - I am ok overall but I must take my glasses off at night when I am driving (which is fine because I see exponentially better at night but I can't see anything at twilight so I wait that one out).
    [Note: Again potentially over use of flickering Flash could cause a panic attack making further use of your site impossible for the time being if not permanently avoided.]
  • Sound sensitivity - hypersensitivity to and/or idiosyncratic responses to sound stimulation - ordinary conversation can be deafening, any sudden sound, like the phone ringing, and certain household sounds, like the running of tap water makes me shake, get flustered and lose all thought lines.
    [Note: Potential issues with use of Music on a web site that may be to loud or hectic to what she may be using. The sudden flash of unexpected sound on loading the page could cause reactions that end her visit to our site or her surfing for the day and most likely she would not return to the site.]
  • Increased irritability (extreme) - Sudden, intense irritability is most often triggered by sensory stimulation brought on by my sensitivities to sound, touch or light but may also occur unprovoked and seemingly inexplicably.
    [Note: Any of the above mentioned notes could cause this and ruin her day as well as that of her family.]
  • Emotional lability - unprovoked laughter, crying, smiling... and not always situationally appropriate.
    [Note: I considered dropping this one than decided against it. My daughter has emotional issues and she often cries not just at the sad parts of shows, but happy ones to. A web site with sad images, like those often used by animal rights groups are extreme examples of web sites that can cause an issue. However this is not really an issue you can do anything about on your web site.]
  • Word Reversals When Speaking and/or Letter Reversals When Writing - I have a history of dyscalculia and dyslexic complications - but I should note that these did not really crop up until I was 9-10-ish and I remember clearly not having problems reading and writing certain simple things as a child. I remember practicing handwriting my name at one house and I haven't lived there since I was 5-6 years old but by the time I was 11 my printing was atrocious, and I was having a lot of issues.
    - Patients with no prior history of dyslexia have found themselves writing letters backwards, reversing numbers or routinely reversing the first and second letters of a word.
    [Note: This is more an issue with her job. However to closely packed text can cause her to place words in wrong orders or letters from close words into the wrong word making the content hard to understand. Be aware of it, but not something you can do much about except consider letter spacing more than you might now.]
  • Spatial Disorientation - lost in ones own neighborhood, on the way to someplace you know? Or... someone repeatedly bumping into things on the left side of their body, dropping things from their left hand despite having no weakness in that hand and occasionally placing objects, such as a milk carton, several inches short of a table edge with the result that they would fall to the floor. - This happens to me all the time!
    [Note: Again border line... but it could be an issue for the user when trying to click on small hot spots for buttons or text; they may repeatedly miss it and get frustrated. Or choose to use Keyboard navigation rather than a mouse. Be sure to have plenty of room in hotspots for the user to click on.]
  • One I have not pegged but is partly a number of these things - I get "lost" part way through a page. I have to read, re-read, and go back to a previous page/post to figure out what I was reading if anyone goes on a tangent or even if they don't.
    [Note: Mentioned above.]

"Fluctuations in Symptoms -This can be one of the most frustrating and perplexing aspects of the illness. A patient with late-stage Lyme disease might feel totally drained one day, the next day be able to function almost normally and the day after experience such mental confusion as to be unable to focus on even the simplest of tasks."

[Note: Like following web site navigation.]


"Once a person reaches a certain level of pain they start to have impaired judgment, thinking, reasoning, and potential minor personality changes."


So basically if you put it all together it all makes computer usage more frustrating. God forbid someplace has a flashing animation that moves quickly or is too bright. Outside of the taste and smell sensitivities I get lambasted by the world around me and being on the Internet is no different. Even the forums can be daunting because I have to re-read something over and over and over."


So you see accessibility goes beyond "Target groups" because accidents and illnesses happen. Anyone any age can be bitten by a tick and develop Lyme Disease. To make my point, even JAN ( the Job Accommodation Network) lists Lyme disease in its own category for workplace accommodation.


[The original post can be found at http://www.killersites.com/mvnforum/mvnforum/viewthread?thread=13267]

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Part 3 - Language Barriers


The last as promised is not really a disability in the usual sense at all. It is just who you are. I have no person in mind in this case, just general examples.


Here in Alaska we have, for me, a surprisingly large number of Filipinos. Many of these speak with tainted to extreme accents and have any where from Good to poor English skills. This has to be considered on state web sites.


States Like Texas, Florida and California have large populations of Spanish speakers; these populations do not stop there but lesson the farther north one goes. Parts of Canada, like Toronto for instance have large populations of Vietnamese as I understand it. Then there is my favorite, Berlin Germany.


Berlin has the largest Turkish population outside of Turkey's capitol Istanbul, often jokingly called Turkey's second largest city. These Turks are some newer immigrants, but most are second and third generation of those Turks who came to rebuild Berlin after WWII when most of Germany's men were imprisoned or dead. They stayed and built up lives in Berlin, but never really adopted German Culture. It is not uncommon to have third generation Turks, German by Birth who by High school still does not speak German worth mentioning. Parents living in the city for 50 years and still do not speak German. This means that all government buildings and web sites as well as Hospitals etc. have Turkish and German languages signs and sites.


Here I speak only of those people who do not speak the language of their current country well.


What of those outside, I speak German... but not Turkish or Hebrew for instance. Clearly I need an English version. others may understand some of the language. Danish is close to German so I can "get the jist of a page"... if it is in simple and basic Danish.


So not only should you consider disabilities in your content... keep in mind non-native speakers, both in country as well as foreign visitors, remember the internet is International. Just because I live in Alaska does not mean I won't have a customer in Utah or Luxemburg.


Lastly to keep in mind is techno speak. You beginners know what I mean... we toss around things like user agent, validation, CSS, includes... and we understand it second nature... but you do not. So keep in mind that people not in your immediate culture may not understand what you mean either, a gardener can speak of things I don't understand and won't understand me. Just look at the Military! Danny Deveto in "Renaissance man" getting directions from an MP, to hang a left at the PX, to the motor pool with the APC's and then stop at the something or other and look for the room marked CEO and ask the Spec 4 for the LT., that is not quite how it went but you get the point. Remember to keep those not in or new to your "circle" in mind so you can write text that either is clear to them or take the time to explain terms you use.


These people are not disabled, but they benefit from accessible sites the same way and for the same reason cognitive disorder sufferers do... We, all of us, have trouble understanding things you may not have issues with. There are no real great tricks to making sites accessible to us. So keep the distractions down and keep the content fairly simple... writing a certain way may make you think you sound professional, but does no good if people do not know what you're saying.


Plain English Campaign & Free Guides

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