The Forgotten People: Designing for Cognitive Disability

Tuesday, July 25, 2006 22:29 | Filed in Accessibility, Articles

This article isn’t going to tell you information about types of cognitive disabilities, what causes cognitive disabilities or how to diagnose them.

It’s not even going to differentiate between them. All it is going to do is look at some of the problems people with cognitive difficulties frequently face, and provide advice on how to make their life easier.

It may be virtually impossible to design a website that is usable by a person with severe cognitive disabilities, but it is certainly possible to make sites more accessible to those with slight or moderate impairment, and doing so will also help improve the accessibility for other groups.

It is worth noting that there are commercial products available which can be installed on your website and may offer accessibility benefits, but I do not intend to cover those here — this article is designed to focus solely on changes that can be made without needing to buy anything.

Common areas where people with cognitive disabilities will have problems are with text comprehension, problem solving, memory retention and with retaining attention. People with cognitive disabilities may need to concentrate harder to complete tasks and so may tire much more easily.

There is no one-size-fits-all rule

Some amendments that make a site more suitable for one group may make it less suitable for another. What we have to do is look at the ways in which we can help and then decide which are appropriate in a given set of circumstances. For example, text-only versions of sites are often produced as an accessible version.

Aside from the fact that this is a bad idea, because it segregates the disabled user and ghettoises their experience, and the fact it means the developer has two separate sites to maintain — well, either that or actively discriminate against disabled people — it’s also a bad idea because a text-only site is generally going to be even more difficult than usual for a visitor with a cognitive disability to comprehend. Let’s just recap: text-only sites are bad. Okay?

Problem Solving Difficulties

As well as people with disabilities, making problems easier to solve will also increase the overall usability of your website and will be of particular benefit to the inexperienced or technophobic (which is not necessarily the same as "children" and the "elderly"!).

404 Error Pages

Make your pages user friendly. Tell your user they’ve encountered an error, and try to help them find the page they were looking for — link to a site map or a site search feature. Some people believe that you shouldn’t offer these features on a 404 page, but they are of direct benefit to users with cognitive disabilities.

Misleading Links

Generally, users expect a link to take them to a new web page, and it may be confusing if it appears that the current page has simply scrolled. Therefore keep the use of within-page links to a minimum and ensure that those used are clearly labelled. In common with standard accessibility practice, ensure that your link text is a good indicator of the content of the page at the other end of the link. Do not rely on the link title to provide additional information to users with cognitive disabilities.


Your in-page navigation should be clear and consistent across your site so that the users do not have to re-learn different navigation techniques for different parts of your site.

Comprehension Problems

Use Clear, Simple Language

Use Plain English — or whatever is your language of choice. Use the clearest, simplest language appropriate for your site’s content, and ensure that there are definitions provided for any jargon, obscure words or acronyms.

If you are aware the target audience for your site may include children or people with learning disabilities, pay particular attention to the language used and attempt to use the simplest words possible.

Problems without clear and simple language

AbilityNet and FramFab have produced a video showing an interview with a woman named Lorraine, who is an internet user with a mild to moderate learning disability. In the video, she is trying to access a video clip from the BBC’s Eastenders show and encounters a disclaimer on the site.

Disclaimer: The BBC has taken all reasonable care to ensure that these EastEnders screenmates contain no errors, viruses or defects, however, the BBC does not warrant that this is the case. You are advised to ensure that you take precautions to protect your computer from virus infection. The BBC will not be liable for any loss or damage which you may suffer as a result of or connected to the use of the software
sample BBC Eastenders disclaimer

The interviewer then asks Lorraine what she thinks of the text which has appeared, and whether she understands it.

No, not really. and for a start I don’t know what that word means, dis, disclammer? I don’t like a lot of jargon in it and I don’t like a lot of stuff on the page, loads of stuff on it. I like it simple, easy to read Lorraine

This sort of disclaimer is very common on internet sites which offer downloads, services etc. I can understand that the companies who are doing this want to make it clear that they are not responsible for any virus infections you may get as a result of looking at the content, but they are making these parts of their site very difficult to understand for children, and for people with learning disabilities. Surely the language used does not need to be as arcane as this! Would something like this not do?

We try to ensure that these downloads do not contain anything that could harm your computer, and that the info on them is right. However, we can’t always be sure of this, so you should not rely on the info given, and you should also make sure that your computer is properly protected from harmful programs. It is not our fault if you do not follow this advice. suggested disclaimer

Okay, I know that’s a long way from perfect, but there’s no need to insist on some of the legalistic words that seem to be always present in any disclaimer, such as "reasonable care", "not be liable for any loss or damage" and of course "disclaimer" itself.

Reading Problems

Resizable Text

Ensure that your text is resizable. This does not mean that you need to include a size changer in your site; it does mean that the font-size in your site should be measured in em or % units. This would enable people to adjust the size of your text to their preferences (for example, people with tunnel vision may reduce the size so that more words are available in a smaller area; elderly people, people with vision problems or those with dyslexia are likely to increase the size to make the words more readable).

Short reading lines

Keep reading line length short — a recommended upper limit seems to be around 65 to 70 characters per line as a maximum for someone with reading difficulties. Note however that if your text is resizable, the UK Cabinet Office point out that someone with reading difficulties will normally increase the size of your text, reducing the number of characters per line anyway.

Short and Sweet

Try to avoid long, dense paragraphs which are word-heavy and difficult to read. Remember that short sentences/paragraphs are NOT intellectually inferior to long ones. Instead:

  • keep paragraphs short,
  • use bullet points or lists,
  • use plenty of empty space to separate structures,
  • and use simple sentences.

Background Contrast

Ensure that there is sufficient contrast between the text and the background it is placed on. Use the Juicystudio Colour Contrast Analyser or Luminosity Contrast Analyser to check for this.

Font styles

Avoid the use of italics, all caps because in most cases these can be more difficult to read, particularly for users with Dyslexia.

There’s no need to justify yourself…

Right-justifying text can make your text more difficult to read, because the irregular and more frequent than usual white space gives the appearance of "rivers of white" running through the text, which can be very distracting, particularly for users with dyslexia.

Memory Problems

Be Consistent

Those with memory problems may find difficulties in remembering how they have arrived on a particular part of your site. Using consistent site navigation as previously described will be of benefit, as would the use of a breadcrumb trail.

Use Conventions

Using conventions such as making hyperlinks blue and underlined (and changing the colour for visited hyperlinks) will have particular benefit to users with memory problems because they won’t have to remember a method specific to your site to identify hyperlinks, and they will also be able to tell which pages they have already visited.

Use Pictures

The use of a picture or icon next to a particular piece of text, particularly if it is a standard picture for that sort of text will be very helpful (possibly also to those with comprehension problems) because it will provide another visual cue to the purpose or meaning of that text. Let’s just remind ourselves, text-only sites are bad.

Use Reminders

Where you’ve got a multi-stage process, tell the user how far they are through the process ("Stage 3 of 5");
when you’ve got a series of connected pages, don’t just link them with "previous page" or "next page",
try using "previous page (page title)" instead. It’s not hard to do, and not only does it make your site more accessible to users with cognitive disabilities, it makes it more user-friendly to everyone else, too.

Attention Problems

People with Attention Deficit Disorder (ADD), sometimes referred to as Attention Deficit Hyperactivity Disorder (ADHD) are more easily distracted, and so when designing pages to be used by people with ADD it is usually best to minimise any form of movement — avoid animated gifs, automatically scrolling text, blinking text and pop-ups.

On the other hand, I have received a personal communication from an ADD sufferer who informed me that he prefers sites with moving images, background pictures and the like because others are "too boring", so be warned it may be impossible to please everyone!

Some users with ADD will find it beneficial to use text-to-speech software and have the site read out to them through headphones, as this makes it easier for them to block out external distractions. To benefit this type of user, use a screen reader (if you can) or you can fall back on the free Opera browser with Voice (if you can’t) to get an idea of how your website would sound read out. This will help you spot any obvious errors so you can work out what needs to be improved, just by listening to what sounds wrong.


The changes you will need to make to your site will vary depending on the content of your site, but in general if you keep it simple and keep it user-friendly, you won’t be going too far wrong.

You can leave a response, or trackback from your own site.

31 Comments to The Forgotten People: Designing for Cognitive Disability

  1. Sally says:

    July 30th, 2006 at 4:28 pm

    Oh bliss, oh joy, someone who understands and provides for cognitive dysfunction. Sometimes I feel very cogdysfunck’d and don’t blog, or comment on blogs, sometimes I feel only partially dysfunck’d and do, and often I do not feel or appear cogdysfunck’d at all because (a) I am careful and walk slowly through the blogosphere and (b) because that day or time I am not. I am fortunate to have mild cognitive dysfunction from Systemic Lupus (non CNS Lupus), and only slightly more cogdysfunck’d from neuro toxic weekly drug. Most of the time I achieve enough to get by, thankfully.
    Thank you for your site.

  2. Liam McGee says:

    November 8th, 2006 at 2:45 pm

    Hello, Web Chemist! Nice article.

    Cognitive dysfunction is such a wide spectrum that it’s hard to know where to begin when considering how to provide for the needs of users who have it. So, well-begun :-)

    It all piqued my interest and I thought I’d check out WCAG2.0 in the light of it, to see which of the recommendations you lay out are already included within the guidelines, and which are not. And some other random comments. I do help out with one of the W3C working Groups (Education and Outreach) in my spare time, and cognitive dysfunction has been discussed quite a bit.

    Problem Solving

    404 error pages: doesn’t seem to have been raised. 404′s are s ymptom of brokenness, never mind accessibility, so perhaps. Guideline 2.4 covers general ‘oops’ messages.

    Misleading links: partially covered, but not sure how you could test for ‘minimal’ use of in-page links. I find in-page links highly useful (I rarely use a mouse), and would be sorry to see them go.

    Consistent navigation: yup, covered in 3.2


    Clear, simple language: yup, covered in 3.1, but hard to test for. Would be good to see a more definite testing procedure (although there is discussion of readability testing in the notes).

    Reading problems

    Resizeable text: yup, covered (although needs a bit of copy writing specifically for ‘how to allow resizing of text’)

    Short reading lines: tricky. I have read quite deeply into the subject (for, er, a two week period of the experimental psychology section of my degree) and most of the experiments that led to the 65-ish characters optimal limit were based on users without cognitive dysfunction, and rarely with on-screen text. Margin-width appears to have a substantial effect on comprehension and reading speed, together with line-spacing, typeface and character kerning. I think that this subject needs fuller discussion and some more recent experiments. Will dig up some references on all this and write seomthing up on it. Eventually.

    Short and sweet: more-or-less covered in ‘clear, simple language’.

    Background contrast: already covered in WCAG1.0

    Font styles: hmmm… again, tricky. Well marked-up text can be restyled by the user, so it becomes a question of where the onus should be — on the designer or the user.

    Justification: reckon I’d hold a similar line to that on font-styles. The user can override this by turning off stylesheets or adding his/her own.

    Be consistent: yes, consistency is covered at length.

    Conventions: Hmmm. This is normally considered a general usability issue rather than an accessibility issue. I’d be inclined to hold my line as for font-styles but for the fact this is such an important factor in site usability. I guess it might fit under 3.2.4, ‘consistent functionality’, but that seems to be worded to apply to consistency within a site, rather within the web as a whole. Definitely one to raise with the working group.

    Pictures: covered, interestingly, again in 3.2.4, ‘consistent functionality’.

    Reminders: The step in the process example is excellent, and could easily be added into the ‘navigation mechanisms – location’ examples. Another one to raise, I think.

    Attention problems: covered in that the user should be able to switch off movement or timed interaction.

    What next
    The next thing is to pass any suggestions in to the W3C when WCAG2 is once again opened up for comments, which I would imagine will be after the WCAG working group has dealt with the last bunch of comments for the Last Call working draft. The W3C process ‘opportunities to contribute’ document notes that there can be several ‘Last Calls’, so here’s looking forward to the next one.

    Right. This has ended up a much longer comment than I intended. Hope this adds something to your excellent article.



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