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Confab Keynote: Amy Grace Wells

Presented at Confab 2022

Twenty percent of your users may be neurodivergent. Diagnosed with ADHD in adulthood, Amy Grace Wells has seen the mistakes in design and content that exclude users with different cognitive accessibility needs. Read more about this talk.

Video transcript

Amy Grace: [00:00:09] Thank you. All right. I'm first going to put down my emotional support fan. We're going to talk about emotional dysregulation here in a little bit. And you just heard that I am a post-baby body. So emotional support fan, just in case I need it. Okay. So hi, everybody. I'm Amy and I have ADHD. And if you're a little bit like me, that song may have resonated with you because we tend not to be morning people. Because, fun thing about being neurodivergent, is that it often comes with sleep disorders, whether that's delayed sleep or whatever else. It means that we really do have to tumble out of bed and stumble to the kitchen. But I am not here to talk about my poor sleep hygiene. I am here to talk about neurodivergence and what that means for accessibility and inclusive design. So if you really want to support inclusive design, you have to understand that we have to support differences in cognition. And what this means is that we're supporting variations in how brains work. Now, notice that I said brains. These are conditions, not of effort. These are conditions that are physical and have a physical meaning to them. And we're going to talk about that a lot. Again, if you are neurodivergent, it's not a matter of effort. It is a matter of how your brain connects things and uses neurotransmitters. So what do we have to do for people who are neurodivergent if we want to make our content more inclusive? Well, we have to remove the barriers for people whose disabilities affect how they process information and notice that I use the word disability there.

Amy Grace: [00:02:07] I have ADHD, and that may be something that you never thought about as a disability, but every one of these conditions … we have superpowers and we have things that really trip us up to the point of making it a disabling condition. I actually receive accommodations at work through the Americans with Disabilities Act for my ADHD. So this isn't one of those things where all we're all just a little bit ADHD or we're all just a little bit this. We are, but remember that people with these conditions experience something beyond that. So what is this big term of neurodivergence? This is just a term that's used to group together some conditions that describe natural variations in the human brain. Again, natural. These come down to how the brain works, how it is wired, and how it is built. Nothing made us this way. This is how our brains got put together. So what we're looking at is, we're looking at variations in the way we think, the way we learn, how we learn, things that affect our mood, how we handle those changes in mood, things that affect our attention, things that affect sociability, and other mental functions. So when you look at this list, how many of the things we do in our daily lives every single day are affected by things in this list? And it's not like people with neurodivergence get to pick and choose which of these things we get to have trouble with.

Amy Grace: [00:03:56] These all affect us every day. Oftentimes, being neurodivergent in a neurotypical world, which is the term we use for people whose brains are wired like the majority, is exhausting. It is exhausting and it's just hard because we're masking all the time. You might think, oh, this is another thing that oftentimes people who are really good at masking and have neurodivergent divergence hear a lot. So, oh, I wouldn't have even guessed that you were autistic or you were a person with autism. Let me rephrase that. Or that you were a person with ADHD, because we're really good at masking, and we have learned it our entire lives. So what is the neurodivergent spectrum? I've mentioned a few of these already. ADHD. We have autism, dyspraxia and dyslexia. I just realized my notes are not here. So hopefully, I remember all of the things that I want to tell you about each of these. And we're going to talk about working memory here in a little bit. So this is a really great ADHD challenge for me. Alright. So ADHD, attention deficit hyperactivity disorder. That is the worst name in the world for this condition. Everybody thinks that, if you aren't familiar with it, the kind of stereotypical thing is: Squirrel! And they're off.

Amy Grace: [00:05:32] But that's not what it is. We don't have a lack of attention. We have difficulty regulating our attention. We can't always choose what our brains want to focus on. And the big reason for this is we have a shortage of dopamine receptors, that really happy chemical that you get when you eat cake, that's what we're always chasing. We are always chasing dopamine. That's why we do a lot of new hobbies and new activities. And we're always trying to learn and find something new because we're always chasing the dopamine because once something becomes routine, that dopamine drops. So, autism is a processing disorder. People with autism have difficulties in a lot of different ways, with processing a lot of different things. They have difficulty processing language, they have difficulty processing emotions, and they have difficulty processing social interactions. That processing is just a lot of work. People with dyspraxia—I feel like this is the one that most people don't know about. So this is more of a motor control issue. People with dyspraxia often have trouble with, essentially, their brain doesn't know how to put things in order. So if you think about it from a motor standpoint, things like walking, things like … anything where your brain automatically goes, this is how we do this. People with dyspraxia are going to struggle with that. And then we have dyslexia and this is a disorder that deals with how they process language, how they use language, how they process it.

Amy Grace: [00:07:23] It goes beyond kind of that stereotypical, oh, their letters get flipped around or things like that. It affects reading comprehension. It affects how they use language. It can affect whether or not they are able to recognize common idioms like: piece of cake. Does that mean easy to them? It might not. Now, the other interesting thing is, oftentimes, if you have one of these conditions, it's not uncommon for you to have more than one of these conditions. It's like a fun little bingo card for neurodivergent people. And a lot of these conditions have things that cross over them. So when you're looking at all of this, 20% of your users may be neurodiverse. 20%. And the neurodivergent spectrum is expanding as we learn more about conditions and expand it. So neurodiversity is not an edge case. If there was something on your website that affected 20% of users, would you call that an edge case? No. I know that we're all advocates for designing for edge cases in this room, but again, this is not an edge case. And so, if you want to advocate for making your content more inclusive and more accessible, you don't start with that argument. This is not an edge case. This is something that affects your business goals and affects all of your users. So let's say: I want to create a neurodiverse-friendly experience. How do I start to address that? How do I do things that make it easier for people with neurodivergence? First of all, first and foremost, before I get into kind of my six tenants, you have to understand that our brains may not be able to physically match your requirements.

Amy Grace: [00:09:29] Again, these are not conditions of effort. These are physical conditions. We may not be able to match it, just as somebody who may be missing a limb, may have a vision impairment. You would not expect those people to be able to have the same physical requirements for everything. Neurodivergence and cognitive accessibility is the same way. These are physical conditions and you have to understand that. So people with neurodiverse brains often experience superpowers or deficits in several key areas. And again, this is where that conversation about disability comes in. I have some superpowers. I can process large amounts of information very quickly, but I have a deficit in task initiation, meaning it's really hard for me to then take that information and start on the deliverable that is going to communicate it, to the point where it can be disabling on days. And I have a whole list of coping mechanisms to deal with that. So one disclaimer here: every person with neurodivergence is going to experience it differently. They're going to have superpowers in some areas. They're going to have disabilities in others. And so there isn't one solution. And it's getting to know the people and it's getting to understand to provide people a space in whatever way they need it.

Amy Grace: [00:11:04] So, number one. Lower cognitive load and memory. This is the foundation of inclusive, neurodiverse-friendly experiences. So many design patterns don't really take this into consideration. The number of decisions I have to make to take a shower, a lot of people with neurodivergence can deal with difficulties with daily things like this to me. So some of you, you get up, you take a shower, that's all your brain thinks. For me, I have to get up. I have to turn on the shower. I have to get undressed. I have to get in the shower. I have to check the water temperature, then get in the shower. Then I have to shampoo and have to rinse out the shampoo. Then I have to wash my body. Then if I'm going to condition, if I'm not super tired, I'm going to condition my hair. Then I have to rinse that out. I have to go through every single step. I have to get out of the shower, I have to dry myself off. So before 9 a.m., I have already done all of my cognitive load for the day. I have nothing left. So you have to think about this like it's not just the cognitive load of your experience—it is the cognitive load of their experiences for the entire day. It is the cognitive load of every distraction, every sensory issue, and everything they ate. Everything is a decision.

Amy Grace: [00:12:38] So why is this important? From a website experience or from just a digital experience standpoint, limited working memory is just one of the reasons. So limited working memory. If you go to the store without a list, how many things can you remember? Somebody with neurodivergence, that's just not going to stick. Working memory is not our long-term memory. It's not necessarily our short-term memory either. It's how we hold information in our heads to be able to do something with it. So how can you write? How can you create experiences that help with that? We can write at a lower grade level, making sure we don't have to remember anything from a previous step or from another channel. So if you put something in your email that somebody is going to have to enter into a form, that's increasing cognitive load. Anything you can do to lower that, fight the good fight, and take out all that superfluous content. How much content do you need? No. Cut it out. Cut out all the extra stuff. We need to reduce complexity. So as technology advances, it doesn't always advance to simplicity. Sometimes we get simple, sometimes we don't. One of the things that drives me absolutely insane is one of my clients. We have to use a two-factor authentication app to get into their CMS and their backend. For some reason, the push notifications will not work for our team, so I have to unlock my phone and go find an app.

Amy Grace: [00:14:13] I have to add 10 to 15 minutes to that task because inevitably, I end up on TikTok. Every time, every time. I cannot unlock my phone, and then I have to search for the app because I don't remember where I put it on my phone. And, it's gone. As soon as I unlock that phone, my brain is someplace else. So think about every single place and where you can reduce complexity. Why do we do this? Because we have difficulty with task initiation. As soon as I unlock that phone, that task initiation is out the door. So think about things like if you are going to require documents. I bought a house this summer. My mortgage company was amazing. They had a portal that told me every single document I was going to need. And as I uploaded them, it checked it off for me. That was the best experience ever. Bonus: downloads. I feel like we're kind of starting to get out of that. Same thing as the print print-friendly view. Those actually are really helpful to us. If I can have it in my hand and something I can look at, it really helps me with some of these other areas. Try not to rely on accurate spelling if you will have a table that can be filtered by a keyword or search. Make sure you're trying to build that so that it can be like adjacent spellings, because that's really going to help people with dyslexia especially, but not only everybody else.

Amy Grace: [00:16:01] Eliminate time challenges. Now, if you were into the third principle here and you're probably noticing that like these are pretty common things, but these are critical things for people with neurodivergence. So these all sound intuitive, but they're just that much more important. And why? Time blindness. You all have probably experienced this, but if you have neurodivergence, number one, I can lose 3 hours. If that dopamine is flowing. Well, I can't tell you how much time I spend on TikTok because it is like a dopamine drip right to my brain. I open it and then all of a sudden it's like 3 hours later and it's dark outside and I'm like, what happened? But time blindness is also hard because if I think something's going to take a long time, I'm less likely to do it. I need more dopamine to be able to initiate that task because I think it's going to take a long time. So try to provide time estimates or how many steps, how many pages are in a task. This is where you can really add content and make things accessible because you help set expectations. You know, it's like going someplace and you need to know about the parking situation. You need to know how long people are going to be there. Do people show up 5 minutes late? Do they show up 10 minutes late? Do they show up on time? I don't know.

Amy Grace: [00:17:24] That's what we need to know. And so anything you can do to tell us that in context is really great. Focus attention and remove distractions. So we're usually pulled in multiple directions and we all know that when we're using an app or a website experience, we're not in a bubble of just that. There are distractions everywhere around us. But again, take that experience that you have and amp it up to the point where it would be disabling. And then you start to have an idea of what we're going through every moment of the day. So why does this matter? Attention regulation. Again, I don't always have the ability to choose how long my attention stays in one area or how I can get myself to focus on something else. I have a whole bunch of tools and tricks, so if you're like me, come talk to me. Because I've done them all. But make sure that your related content, that you're interrupters, that your pop-ups, oh, anything that takes me out of my flow could keep me and prevent me from buying the thing. It could prevent me from filling out the form. Whatever your business goal is, if you interrupt my flow, I'm gone. I'm gone. My attention will be someplace else. Don't use bold or like another formatting when it's not needed.

Amy Grace: [00:19:00] I still run into people who want to bold keywords because it makes it easier to scan. No, it makes it harder to read. And if it's hard to read, we learned this from David Dylan Thomas yesterday, if it's hard to read, it's hard to do. And if you're neurodivergent, that means it's impossible. Aid in your task completion. So executive functions like this. If I can start it, if I get interrupted, I'm gone, I'm gone. I'm never coming back to it. Not completely true, but it's going to be really difficult. So all of these things are in the frontal cortex. And so just one area that we have problems with this is analysis paralysis. You should see me trying to book travel. It takes me hours and multiple sessions because I get overwhelmed so quickly. So provide context, provide helper text. This is where you can use all the tooltips you want. I love tooltips where I can just hover and understand that. Yes. And I keep going. It's perfectly great. Make calls to action clear and unmistakable. Explain what will happen after an action. I feel like this is something we don't do enough. Go ahead and tell me what's going to happen. After an interaction, before I do it. Remember emotion. There's probably a lot of content that you work on that you don't think is emotional. My husband is on the neurodivergent spectrum as well. Let me tell you, everything is emotional for him and for me as well.

Amy Grace: [00:20:34] We have difficulty with emotional regulation, and a lot of design patterns contribute to emotional overload. When that cognitive overload starts to go up, that emotional overload starts to go up. And then you have to remember everything we're dealing with around us. So always try and provide success or feedback. Messages for tasks help users avoid and fix mistakes, so anything you can provide them ahead of time. Again, context and know that we are always managing a state of overwhelm. I was in Tracy's workshop yesterday and we talked about overwhelm all day and I was like, this is perfect because this is me all the time. We are always on the edge of overwhelm. We are always on the edge of basically shutting down because we live in a neurotypical world. So the ultimate theme here is executive dysfunction. Again, I have honed in so hard that these are physical things, and most of them reside in our frontal cortex. And so it's how our frontal cortex is wired. If you know anything about the brain, there's a lot of things that are focused in that frontal cortex, including everything we've talked about, decision making, emotion, all of that is really tied into that area. And so anything you can do to lower that cognitive load, to help with that executive dysfunction, that's where you're making things easier, not just for the neurodivergent, but for the neurotypicals as well.

Amy Grace: [00:22:09] We love you too. You may not understand us, and that's okay. You might find us awkward. And that's alright. We want to make things easier for you to. So, again, looking through these six areas, if you can ask yourself questions in all of these areas, that is going to help you build things that lower that cognitive load, that make things more neurodiverse friendly. That just is a breath of fresh air, man. When something is easy for me, because almost nothing is, I will be loyal to you forever. And I will. Of course, ADHD. We like to overshare. I will tell everybody about it as well. So in these last couple of minutes, now let's talk about our teams. Let's talk about like how do you get to know more? How do you get to meet some neurodivergent folks? Well, first of all, there is a neurodiversity channel in Slack. Come join us. Let's talk. But also make sure you're including neurodivergent users in your research and your testing. So take the time specifically to recruit neurodiverse participants. You don't have to ask them which condition. Give them a space to self-identify as neurodivergent. Now not everybody on the spectrum may understand that term. So just a nice little tooltip that says, you know, typically neurodivergent includes the conditions of blah, blah, blah blah. Define the term, but don't ask for specifics. It doesn't really matter if I have ADHD or if I have autism.

Amy Grace: [00:23:56] It doesn't really matter. You don't need to know that. You just need to know that my brain might work differently than you think somebody's brain works. Ask questions. You don't want to say, oh, hey, you're neurodivergent was this difficult for you? So some questions that you can ask are: were there areas or steps that tested your focus or attention? Was anything distracting? Did anything require you to use memory to complete? So these are general questions that can address those specific concerns and the specific needs of neurodiverse users without calling them out and being like, you're my neurodivergent person. I'm going to put you over here and tell me all about it. Then the other big part of this is hiring people to your teams with neurodivergence. Yes. And I know a lot of people. So I run a private Slack group at my company for my neurodivergent colleagues and it is private. It's separate from H.R., it's separate from leadership. Like it's a safe space. And a lot of them don't feel comfortable telling people that they're neurodivergent. So keep that in mind. You can't just ask on a form. Do you have neurodivergence? Make sure that you're communicating clearly. If you can send interview questions ahead of time, make the process accessible. When you do have somebody on your team, provide safe spaces for support, and adjust your expectations or requirements. We all have that matrix that tells us how we get promoted and things like that.

Amy Grace: [00:25:48] Talk with them, understand which areas they're going to have strengths in and which ones they're going to have weaknesses in, and then work with them to reset those expectations and make sure you're setting goals that match the individual. Alright. And remember that some people don't want to disclose this. So if you have a thought that they might be, this is still just a human process. It's a human process. You don't have to ask them. You don't have to call them out. Just be like, hey, let's talk about your goals and what matches your working style, what matches how your brain works? Remember that the problem is not the person. I've said it so many times. These are not conditions of effort. If you have one of these conditions, it is not because you don't try hard. It's not because you don't work hard. It is because of physical structures in your brain. Alright. So the problem is not the person. I'll just leave you with this quote: The world would benefit significantly from the talents such as empathy, emotional intensity, certitude, sensitivity, ability to detect details, depth of thoughts, a will to embrace, and many other things that we need in a time where alienation, coldness, superficiality, and emotional hardness are predominating. Neurodivergent people bring a lot to the table, so come find us, talk to us and just think about us. That's all we ask. Thank you.

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