By Brandon Gregory

Each month, A List Apart’s editors select an article An Event Apart attendees shouldn’t miss, and we share it here. Enjoy this month’s essential reading!—Ed.

Inclusive design is designing to be inclusive of as many users as possible, considering all aspects of diversity in users. With increased understanding, compassionate discussions around how to design for disabilities are becoming increasingly common in the web industry. But even with this growth, there are misconceptions: accessibility is still frequently thought of as “design for blind people” when it’s so much more than that. Users with limited motor functions and those who are hearing-impaired require separate considerations, for instance. But accessibility and inclusiveness also mean considering more than just physical symptoms. What about users with cognitive differences like inattention, anxiety, and depression?

Many affective and anxiety disorders qualify as disabilities, with inattention causing challenges on the web as well. Whatever the cause, inattention, anxiety, and depression can have a major impact on internet usage for users dealing with them. The unique issues presented by cognitive differences and the design considerations they require can be tricky to understand for people who have never dealt with them. Through this article, I’ll share some methods to accommodate these users’ unique needs.

Inattention

Inattention is often regarded as a joke in our industry (and just about everywhere else), but it can be a serious impediment for people who struggle with it. While Attention Deficit Hyperactivity Disorder (ADHD) is a common culprit, affecting 4.4% of adults, it’s not the only source of inattention. Bipolar disorder (estimated at 2.8% of adults), major depression (6.7% of adults), and anxiety disorders (19.1% of adults) can cause occasional inattention. More common conditions such as stress or sleep deprivation can cause inattention in people who don’t experience it as regularly.

I’m quite familiar with inattention because I have bipolar disorder, which frequently causes inattention in manic phases. The term inattention is a bit of a misnomer, because it implies that those suffering from it have trouble paying attention to anything. It’s more accurate to say that we have to pay attention to everything—we have trouble tuning things out, and the more things that are competing for our attention, the harder it is for us to focus on anything.

Designers who are able to focus normally rarely see the things that cause problems for users with inattention, but these things are everywhere, and they can make the web much harder for us to use. Some design considerations we can make to be more inclusive of users with inattention include adding an option to mute notifications at certain times, which is a more obvious solution while others are less so, such as giving users the ability to turn off design features that are distracting them.

Drowning in the ocean of motion

I was recently reading an article on search engine optimization, and the author saw fit to incorporate animated GIFs throughout the article. The GIFs, looped infinitely and placed prominently, didn’t add anything of substance. Worse, as I was already struggling through a manic episode, the GIFs actually prevented me from reading the article—I had to open Chrome DevTools and hide all of the GIFs to get through the content.

Motion is everywhere. This simple fact of the modern internet makes designers smile, while users with inattention issues cringe. Motion distracts people with inattention even when neurotypical people, or those not characterized by neurological patterns, are fine. Most users struggling with inattention won’t use Chrome DevTools to make your site usable for them, they’ll simply leave and probably end up on a competitor’s site. I cringe anytime I see an article with pointless animation, and often just click the back button. Even though I’m sure the designer or author saw the motion as beneficial, it can distract users who struggle with inattention from what they came to your site to do.

Motion isn’t always bad. Sometimes you need to use subtle motion to draw attention to something, such as when a user has to click a button before changes are applied. User-initiated motions, such as hover and click effects, usually don’t distract. Your website or app doesn’t need to be a static, motionless wasteland. But if you’re going to distract your users with motion that they don’t initiate, it had better accomplish something.

Unnecessary motion, like the animated GIFs I mentioned above, are nothing but a barrier for these users. If the motion is actually accomplishing something, you have to ask if what you’re drawing attention to is worth sacrificing other content on the page in return. Designers and content developers tend to use motion—autoplayed videos, animated GIFs, and CSS animations—simply to be cute or expressive. Inclusive design would use motion only to improve clarity so as not to exclude users struggling with inattention. If motion would significantly improve the experience for neurotypical users, but hurt it for users with inattention, you can give users the option to turn off motion, allowing them to choose which would be best for them.

Designing forms for inattention

Forms add layers of interactivity and are often at the center of what we want users to do on our websites or apps; and yet, forms are often hard to use for users who struggle with inattention. Poor design reduces clarity and increases errors; some interactions take so long that they become extremely difficult for those of us with inattention. Rather than slapping on a quick fix or letting ease of implementation define the user experience, we need to fix design issues to be more inclusive of these users.

In my twelve years in the industry, there’s a phrase I hear way too often: “Why can’t the users just follow the directions?” This doesn’t show a problem with the user, but with the site or app. The problem isn’t with the directions—it’s with the design.

If users are making mistakes on a form, our first instinct is to add instructions before it. There are two problems here:

• Most people will not read the instructions. Stats show that of the $13.8 billion of technical gadgets that were returned to the store by consumers in 20o7, only 5% were due to faulty products. The rest were because users did not understand how to use the products. Users hate reading instructions.
• Your form is so complicated that it requires instructions. A better solution would be to fix the design of the form itself so you’re not attempting to solve a design problem with content.

If most users are making mistakes on a form, users with inattention will struggle even more. When this happens, figure out exactly where the errors are occurring, and fix the design of the form to target that error. For instance, if you’re receiving the wrong data for a field, it’s a sign that form labels are unclear; if you have inline-only labels, adding regular labels outside of the fields will do more than adding an explanatory note. Taking steps like this will make the process less confusing, reducing the need to have long instructions. If an explanation is needed, add it adjacent to the form field where users are having trouble, not at the top of the form where users will likely ignore it. The best option is to simplify the form so that explanations are not needed.

Inattention also makes sustained concentration considerably more difficult, and the longer your form or process is, the harder it will be for users with inattention to complete in one sitting. If it is more than two steps or pages, add the functionality to save progress and come back later to finish it. Please, please, please don’t have your multi-page form time out quickly—if they come back from a break and find that your form has lost their progress, they probably won’t be starting over.

Anxiety

Anxiety is a fairly common problem for adults. Among adults, 19.1% have an anxiety disorder, but anxiety can also result from other things, like taking certain medications, withdrawal from drugs or alcohol, prolonged stress, or chronic pain. As common as anxiety is, you’d think we’d be better at designing for it than we are.

Anxiety has been described as knowing that you turned off the stove, but having to turn your car around to check anyway. Users with anxiety fear that they will do something wrong when interacting with your site or app. To counteract this, provide reassurance that what they’re doing is the right thing, and make the experience forgiving if they do the wrong thing. Reassuring them reduces stress and helps to retain anxious users who are more likely to leave in the middle of a difficult process.

Let users think like users

Nobody goes to your site not knowing why they’re there. If users go to your site to solve a problem, they need to know where to find the solution. The problem may be common to all users, but users with anxiety will struggle more when they can’t find the answers they need or when the way forward is unclear.

One of the biggest culprits of unclear user flow is basing the user experience on your company’s understanding of the problem. Companies have their own internal terminology and organizational structures to address these problems internally. Users likely won’t understand any of this and shouldn’t require a glossary of industry terms or internal structures in order to use your website or app.

Define clear paths for users to solve common problems, and design them to address the user’s concerns; don’t give a list of the types of data you accept or organize things according to how your company receives them. If you have multiple types of users using your site (for instance, parents applying for school as well as school administrators), define clear user paths for each.

Remember that many of your users will not always start on the homepage of your site. If the user paths are only clear on the homepage, then they’re not clear.

Provide clear wayfinding. Even once anxious users are on the path to their solution, they need to know they’re heading in the right direction. On each step of a process, state not only what step they’re on, but what the end of that path is. Remember, anxious users may have a need to keep checking to make sure they’re in the right spot—don’t make them click the back button to do that.

There’s no anxiety like form anxiety

With a good chunk of anxiety being caused by the fear that you’re doing something wrong, forms are a huge stressor for anxious users. A lack of clarity on forms really harms usability and accessibility for users with anxiety, sometimes causing them to stop the process altogether. Improving clarity and providing reassurance can go a long way in reducing anxiety in these users.

Every form and action should be clearly labeled with a headline that plainly states what the form does. I occasionally struggle with anxiety, and there are times when I have to glance up at the headline to double-check that I’m filling out the right form.

Similarly, submit buttons should clearly state what happens when users click them. Submit buttons should have copy like “send message,” “complete purchase,” “continue to the next step,” or “sign up for our newsletter.” One of the worst things you can do with a submit button is have it just say “submit.”

There’s a trend for designers to get overly clever with form labels: inline-only labels, labels that only appear when their field has focus, or even labels that start inside their field and then animate elsewhere. I’ve never encountered a situation where I was glad these overly clever solutions were in place. A label exists not only to tell users what information to put in the field, but also to confirm to users who have already filled out the form that their information is in the right place. Inline-only form labels make this impossible and cause undue stress to anxious users. Labels that cover up auto-filled text (common with labels that start inside form fields and then move somewhere else) cause similar problems. Form labels are not a medium for creative expression; they’re a tool for users to know how to use a form. This basic functionality should not be hindered.

If you’re asking the user for any personal information, privacy is a huge concern, especially for users suffering from social anxiety who dread getting unexpected phone calls. Include a prominent link to your privacy policy on the form itself so it’s easy to find. Also, if it’s not immediately obvious why a piece of information is needed in your form, like a phone number, add a bit of help text to explain it. (For example, clicking a “Why do we need this?” link displays a “We need your phone number to call you in case of a mix-up with your order” tooltip.) If you don’t have a good reason for asking for a piece of personal information or can’t clearly explain why you need it, get rid of the field.

And your job is not done once the user has submitted the form. Confirmation messages can be either a huge relief or a huge source of stress for anxious users. I can’t tell you how many times I’ve submitted a form online and the confirmation message just says, “Your data was submitted.” For users with anxiety, this can start the stress cycle all over again. What data? Submitted where? What if I messed something up?

Confirmation messages should state:

• what action was taken (“Thank you for signing up for our newsletter!”);
• what data was posted (“Your email address, brandon.gregory@myemail.com, has been added to our distribution list.”);
• and what the user should do if they made a mistake (“If you want to stop receiving our newsletter at any time, you can unsubscribe on your user profile.”).

Adding this little bit of reassurance can really help users struggling with anxiety to avoid undue stress.

Depression

Depression is not something we think about often in design, but it impacts how a lot of people use the web. About 6.7% of adults have major depression, and 2.8% of adults have bipolar disorder, which involves severe depression at times. Additionally, temporary or even long-term depression can be caused by traumatic events, drug use, or certain medications.

The book Design for Real Life, by Sara Wachter-Boettcher and Eric Meyer (excerpt here), reminds us that we can’t just design for happy users. Some of our users will be in crisis: having their order mishandled, desperately needing information that’s not readily available, or just having an exceptionally bad day. For users with depression, any ordinary day has the potential to be an exceptionally bad day or crisis, and minor annoyances in user experience can become overwhelming.

Keep it easy

Depression is thought of as a psychological condition, but it also has physical side effects. For instance, depression actually impairs contrast perception—the world really does look gray for users dealing with depression. Fatigue and physical pain are common and can be hard to deal with. Everything is harder with depression. If your site or app is hard to use, many depressed users will simply not use it. A lot of the shortcuts we take in the web industry add up to insurmountable challenges for these users.

A great example of this is unnecessary user registrations. Registering for a user account is a lengthy (and, for depressed users, exhausting) process. If it’s not absolutely required for a user task, you’re punishing depressed users (and probably everyone else too). If your site has a checkout process, make sure users can check out as a guest. Forcing a user to register for an account just to look at the content (I’m looking at you, Pinterest) is a great way to make sure depressed users will never look at your content.

Long sign-up processes, unforgiving forms, and loss of data can quickly make depressed users give up altogether. Minor annoyances such as these can slide through the design-and-build process for our sites and apps, and impact depressed users much more than neurotypical ones.

If content requires significant effort to locate, it will also be ignored by depressed users. Large blocks of endless content, like wall-to-wall tiles, force users to sift through it to find what they’re looking for. Long videos without accompanying text (that is searchable) can similarly be a deterrent. Assuming that users are so in love with your content that they will read or view every bit of it is naïve and creates a significant barrier for depressed users (and can also hinder users with inattention).

Chat can be a lifesaver

I get severely depressed three to six months out of the year, and talking to people is one of the hardest things I have to do. The effort required to carry on an actual conversation is immense, and it prevents me from doing a lot of things that I would ordinarily be doing. Add to that stress the stress of a botched order or customer service fiasco, and I sometimes get so stressed out, I can’t make phone calls that I need to. In these situations, any place that lets me contact them via chat instead of a phone call gains my eternal gratitude.

A great example of this is the National Suicide Prevention Hotline (because if anyone knows how to design for depressed users, it’s this group), who opened their online chat in 2013. By 2015, the chat lines were open 24 hours a day. Chat lines are unfortunately frequently clogged, partly due to the influx of users and partly due to a lack of funding, but the number of chat operators is growing each year. Chat lines attract a different demographic: while the phone line is roughly a 50-50 split between male and female, the chat line is 78–80% female (70% of the total were women under 25).

The article linked to in the paragraph above revealed some other interesting stats. The National Suicide Prevention Hotline is not the only crisis center that has caught onto this. The National Domestic Violence Hotline launched chat in 2013 and now receives 1,000–1,500 chats a month. The Rape, Abuse & Incest National Network (RAINN) has implemented a chat on their site, and they’ve found that chat users typically go into more depth about their traumatic issues than callers. And, like the National Suicide Prevention Hotline, both of these organizations are looking to scale up their chat services due to how popular they are.

Businesses that regularly work with users in crisis have realized that chat is a vital tool for their users and are rapidly expanding their chat services to accommodate. Your business may not exclusively deal with crisis users, but with depression affecting a significant portion of the population, any day can be a crisis day for these users. If you have a phone line but not a chat, consider adding one. If you have a chat line and it’s constantly clogged, consider expanding the service.

Disability takes many forms, as should inclusive solutions

Far from being just about impaired vision and wheelchairs, disability takes many forms, and accessibility and inclusive design need to take just as many. In our industry, compassionate discussion around physical disabilities has been a huge benefit, and cognitive differences need to be part of the conversation too. Removing unnecessary distractions, reassuring users that they’re doing the right thing, and keeping things easy for users who are struggling are things we can do to accommodate these users and make them feel like you actually want them to use our sites and apps. As one of these users myself, I can say we would really appreciate your efforts. This can be just as important as including alt text for your images.

About the author

Brandon Gregory is a designer and developer in the Kansas City area, currently working at Sprint as a senior application developer. He’s into cats, music, psychology, writing, and cats. He writes about mental health and other things on Medium and reviews classic films. Also, he’s in a band. One time, he rocked so hard it killed a man.

Illustration by Dougal MacPherson.

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