3.1.1.1 Auditory Discrimination§

(Main research - see Tallal et all (32)) This body of research has shown that many dyslexics have defects in the left auditory cortex. The auditory cortex is responsible for sound naming and identification and temporal processing (such as interval, duration, and motion discrimination).

Note that dyslexia does not affect hearing, but the identification and differentiation of sounds.

3.1.1.2 Visual Recognition Skills§

(Main school of research Livingstone (1993) and Martin and Lovegrove 1988) )(see 9, 15) Dyslexics have reduced synaptic activity in the V5 area (also known as visual area MT, middle temporal), is a region of extra-striate visual cortex that is thought to play a major role in the perception of motion.

V5 is part of the broader "magno-cellular -- large cell -- system" that processes fast-moving objects, and brightness contrasts. One interpretation is that a specific magno-cellular cell type develops abnormally in people with dyslexia (3).

For results of clinical tests see (1)

3.1.1.3 Phoneme Processing§

Main research from Shaymitz (1998) and Rumsy (1996), (see 5, 10,11, 14 –17) The language regions in the superior temporal gyrus (Wernike's area) and striate cortex are found to underachieve in the dyslexic. These areas respond to simple phoneme processing tasks. (Areas that respond to more complex language tasks, an anterior region, the IFG, displayed relative over activation in dyslexics.)

Games involving nonsense words, rhyme, and sound manipulation will be enhanced by special auditory effects: The consonants are recorded louder while the adjacent vowel is lengthened and its sounds softened. All games are carefully leveled by the complexity of the manipulations involved. (For results of clinical tests see Ojemann 1989, Bertoncini et al 1989 ).

3.1.1.4 Cross-modal Association§

Main research from Leon (1996) and Shaymitz (1998) (see 8, 22, 24, 28,30)

The angular gyrus, a brain region considered pivotal in carrying out cross-modal (e.g., vision and language) associations necessary for reading, is involved. The current findings of under activation in the angular gyrus of dyslexic readers coincide with earlier studies of those who lost the ability to read due to brain damage centered in that same area of the brain.

The ability to link visual stimuli to auditory interpretation can be stimulated by Multimedia implementation of the coming together of these separate disciplines. Activities are all carefully leveled to correlate the child's current ability level.

3.1.1.5 Visual Recognition Skills§

(Main school of research Livingstone (1993) and Martin and Lovegrove 1988) )(see 9, 15) Dyslexics have reduced synaptic activity in the V5 area.

V5 is part of the broader "magno-cellular -- large cell -- system" that processes fast-moving objects, and brightness contrasts. One interpretation is that a specific magno-cellular cell type develops abnormally in people with dyslexia (3).

For results of clinical tests see (1)

3.1.1.6 Working Memory§

(Main school of research Beneventi et al.2008)

Reduced activity in the pre-frontal and parietal cortex may result in working memory deficits. #40

3.1.3.1 Memory§

• Poor short term memory for facts, events, times, dates, symbols.
• Poor working memory; i.e. difficulty holding on to several pieces of information at the same time. This is especially challenging while undertaking a task e.g. taking notes as you listen, addressing compound questions.
• Mistakes with routine information e.g. giving your age, and phone number or the ages of children.
• Inability to hold on to information without referring to notes.

3.1.3.2 Automatizing Skills§

Dyslexics do not tend to automatize skills very well, and a high degree of mental effort is required in carrying out tasks that non-dyslexic individuals generally do not feel requires effort. This is particularly true when the skill is composed of several sub-skills (e.g. reading, writing, driving).

3.1.3.3 Information Processing.§

• Difficulties with taking in information efficiently (this could be written or auditory).
• Slow speed of information processing, such as a 'penny dropping' delay between hearing or reading something and understanding and responding to it.

3.1.3.4 Communication Skills§

• Lack of verbal fluency and lack of precision in speech. (relevant for voice systems)
• Word-finding problems
• Inability to work out what to say quickly enough
• Misunderstandings or misinterpretations during oral exchanges
• Sometimes mispronunciations or a speech impediment may be evident.

3.1.3.5 Literacy§

• Difficulty in acquiring reading and writing skills. Reading is likely to be slow.
• If they are undiagnosed or diagnosed late, may be illiterate, barely literate and it will be very laborious
• Where literacy has been mastered, problems continue such as poor spelling, difficulty extracting the meaning from written material, difficulty with unfamiliar words, and difficulty with scanning or skimming text.
• Particular difficulty with unfamiliar or new language such as jargon.

3.1.3.6 Organization, Sequencing§

• Difficulty organizing a sequence of events.
• Incorrect sequencing of strings of numbers and letters. (passwords, phone numbers)
• Chronic disorganization and misplacing/losing items.
• Difficulty with time management and passage of time

3.1.3.7 Navigation§

• Difficulty with finding the way to places or navigating - even in the context of a building. Often get lost.

3.1.3.8 Sensory Sensitivity§

• Sensitivity to noise and visual stimuli.
• Impaired ability to screen out background noise / movement.
• Sensations of mental overload
• Tendency to "switch off".

3.1.3.9 Lack of Awareness§

• Failure to notice body language.
• Failure to realize the consequences of their speech or actions.

3.1.3.10 Visual Stress§

• Some people with dyslexic difficulties may experience visual stress when reading but especially when dealing with large amounts of text. So breaks are often needed.

3.1.3.11 Coping Strategies§

It must be emphasized that individuals vary greatly in their learning difficulties. Key variables are the severity of the difficulties and the ability of the individual to identify and understand their difficulties and successfully develop and implement coping strategies.

By adulthood, many people with dyslexia are able to compensate through technology, reliance on others and an array of self-help mechanisms - the operation of which require sustained effort and energy. Unfortunately, these strategies are prone to break down under stressful conditions which impinge on areas of weakness.

3.1.3.12 Effects of Stress§

People are particularly susceptible to stress (compared with the ordinary population) with the result that their impairments increase.

3.1.4.1 Scenario: Online Research§

A is a high school student with dyslexia. Although he can read his level is slow and he finds it difficult. A has a school project and needs to do online research. A does not use a screen reader as they are afraid that that will stop him reading and improving his skills. A needs to be able to find the content he needs easily, both finding the right resource and the right information inside that resource with minimal reading, and will then read the sections that he needs. He will do a web search, and a quick review of different pages to find the pages he needs.

3.1.4.2 Scenario: Finding Out About a Change Event in an Email§

B is a mother with young children. She has dyslexia. B reads the words, and then stops to understand them. B is also a slow reader. B receives many emails and important emails often are below or behind the scroll bar. Reading the summaries of each email takes time. B has set her email app to tag emails from her child's school as important. However B still needs to differentiate between emails from her children’s school that are crucial and emails that are just informative. B needs to be able to find the important content (such as school finishing at a different time next Monday) in a long school newsletter.

B’s email application changes and she no longer knows how to tag senders as important. At the same time her child starts at a new school. She has difficulty finding the information on how to tag emails from the new school as important. Also the school starts sending many emails about projects they are doing and what is happening in class, so she does not have time to read each email from them as soon as it arrives. She postpones this task and important emails get lost.

3.1.4.3 Scenario: Using a Electronic Interface§

C is an adult living alone. He has dyslexia. C has impaired vision and auditory memory, and finds remembering sequences extremely challenging. C has a garden with an automatic watering system with a one line ICT (electronic) interface. The interface is not user friendly. C needs to select what sprinkler he is setting using an arrow key, then needs to set the first time it should go on, (using the arrow key in the number mode) press enter, and then set the duration the sprinkler should run. He then needs to repeat the steps for the second time (or leave it blank). He then needs to repeat the process for the next sprinkler in the correct order. C has been shown how to use the system many times, however each time the system needs to be adjusted he makes mistakes and gets confused. Ten years later C still needs to call the gardener to change the settings and is consonantly relearning the interface.

3.1.4.4 Scenario: Using a Phone Menu§

D is looking after his elderly father. D has dyslexia and impaired working memory and impaired auditory discrimination. D can do one mental process at a time. D is weak at remembering numbers. He can remember one number at a time. D typically makes mistakes when dialing numbers. Often he will dial a number 3 or 4 times before he gets it right. D needs to speak to a doctor about his father who is sick. The doctor's office has an answer phone system with multi-layers. It takes D two attempts to dial the office. When faced with the menu system, D needs to listen to several similar options, understand the words, process the words, make a choice and identify the correct number and enter the correct number into the keypad. Because he is trying to remember numbers whilst he is trying to listen to the next option he misunderstands the options. He makes an incorrect choice. When trying to recover from the error he enters an invalid number and gets thrown off the line. D needs to redial this number, but as he is now upset it takes him four attempts to dial it correctly. He is then faced with the same phone system. D makes more mistakes. After half an hour he asks a neighbor to help him. D is very upset which in turn upsets his sick father. D's self confidence at being able to look after his father is shattered.

3.1.8.1 Summary/Exerts of The British Dyslexia Association Guidelines and Dyslexia Style Guide§

This Guide is in three parts: 1. Dyslexia Friendly Text. 2. Accessible Formats. 3. Website design.

3.1.8.2 Accessible Formats§

Use an accessible format so that content can be read by screen reading software.

• We suggest offering both the source MS Word files and derived PDF files where possible.
• Publicise availability of accessible formats.

3.1.8.3 Other Guidelines§

Tips found across the web include http://www.dyslexia.com/library/webdesign.htm

• Keep paragraphs short, and use a small amount of text on each page.
• If a long article is posted, create a topic index at the beginning, so that the dyslexic reader can quickly narrow in on the parts that interest him or her.
• Use default font settings or provide a way for users to choose their own styles.

Read more: http://www.dyslexia.com/library/webdesign.htm#ixzz2yAl09G77

• Use small icons to help with navigation between frequently used web pages.
• Avoid using background images behind text. Make sure that there is a good contrast between the color of the background and the color of the text.
• Do not set up background music to play, unless the site gives the user a choice whether to turn it on.

Read more: http://www.dyslexia.com/library/webdesign.htm#ixzz2yAjpgQlL

3.1.12.1 References to Research§

1. Bakker ,(1990) Neurophysiological Treatment of Dyslexia, Oxford University Press,.

2. A Galaburda,(1993) Dyslexia and Development: Neurobiological Aspects of Extra-Ordinary Brains, ed., Harvard University Press, London.

3. Getting the Message Across, published by the Questions Publishing Company, Birmingham, England, 1996, on behalf of the British Dyslexia Association.

4. B Blachman and L. Erlbaum.(1997) Foundations of Reading Acquisition and Dyslexia: Implications for Early Intervention, ed. Associates Publishers, New Jersey,.

5. S Shaywitz et all (1998) Functional disruption in the organization of the brain for reading in dyslexia . Proc. Natl. Acad. Sci. USA Vol. 95, pp. 2636–2641

3. C. Njioktien ,(1998) Nuerological Arguments for a joint developmental Dysphasia-Dyslexia syndrome

7. M Snowling (1997) Dyslexia A Cognitive Developmental Perrspective, Blackwell Massachusetts USA

8. G Lyon and j. Rumsey,(1996) Neuroimaging a window to the neurological foundations of learnng and behavior in children, Pual Brooks 58-73

9. Eden, G. F., VanMeter, J. W., Rumsey, J. M., Maisog, J. M., Woods,R. P. & Zeffiro, T. A. (1996) Nature (London) 382, 66–69.

10. Paulesu, E., Frith, U., Snowling, M., Gallagher, A., Morton, J.,Frackowiak, R. S. J. & Frith, C. D. (1996) Brain 119, 143–157.

11. Rumsey, J. M., Nace, K., Donohue, B., Wise, D., Maisog, J. M.& Andreason, P. (1997) Arch. Neurol. 54, 562–573.

12. Van Orden, G. C., Pennington, B. F. & Stone, G. O. (1990)Psychol. Rev. 97, 488–522.

13. Lukatela, G. & Turvey, M. T. (1994) J. Exp. Psychol. Gen. 123,107–128.

14. Demonet, J. F., Price, C. Wise., R. & Frackowiak, R. S. J. (1994)Brain 117, 671–682.

15. Henderson, V. W. (1986) Brain Lang. 29, 119–133.

13. Petersen, S. E., Fox, P. T., Snyder, A. Z. & Raichle, M. E. (1990)Science 249, 1041–1044.

17. Pugh, K., Shaywitz, B., Constable, R. T., Shaywitz, S., Skudlarski, P., Fulbright, R., Bronen, R., Shankweiler, D., Katz, L., Fletcher,J. & Gore, J. (1996) Brain 119, 1221–1238.

18. Friston, K. J., Ashburner, J., Frith, C. D., Poline, J.-B., Heather,J. D. & Frackowiak, R. S. J. (1995) Human Brain Mapping 2, 165–189.

19. Talairach, J. & Tournoux, P. (1988) Coplanar Stereotaxic Atlas of the Human Brain. Three-Dimensional Proportional System: An Approach to Cerebral Imaging (Thieme, New York).

20. Bavelier, D., Corina, D., Jezzard, P., Padmanabhan, S., Clark, V. P., Karni, A., Prinster, A., Braun, A., Lalwani, A., Raus-checker, J. P. et al. (1997) J. Cognitive Neurosci. 9, 664–683.

21. Woodcock, R. W. (1987) Woodcock Reading Mastery Tests, Revised (American Guidance Service, Circle Pines, MI).

22. Black, S. E. & Behrmann, M. (1994) in Localization and Neuro-imaging in Neuropsychology, ed. Kertesz, A. (Academic, New York), pp. 331–373.

23. Geschwind, N. (1965) Brain 88, 237–294.

24. Benson, D. F. (1994) The Neurology of Thinking (Oxford Univ. Press, New York).

25. Galaburda, A. M., Sherman, G. F., Rosen, G. D., Aboitiz, F. & Geschwind, N. (1985) Ann. Neurol. 18, 222–233.

23. Geschwind, N. (1985) in Dyslexia: A Neuroscientific Approach to Clinical Evaluation, eds. Duffy, F. H. & Geschwind, N. (Little, Brown, Boston), pp. 195–211.

27. Shaywitz, B. A., Shaywitz, S. E., Pugh, K. R., Constable, R. T., Skudlarski, P., Fulbright, R. K., Bronen, R. T., Fletcher, J. M., Shankweiler, D. P., Katz, L. et al. (1995) Nature (London) 373, 607–609.

28. Dejerine, J. (1891) C. R. Societe du Biologie 43, 197–201.

29. Damasio, A. R. & Damasio, H. (1983) Neurology 33, 1573–1583.

30. Friedman, R. F., Ween, J. E. & Albert, M. L. (1993) in Clinical Neuropsychology, eds. Heilman, K. M. & Valenstein, E. (Oxford Univ. Press, New York), pp. 37–62.

31. Benson, D. F. (1977) Arch. Neurol. 34, 327–331.

32. Tallal et all (1993) Temporal information processing in the nervous system: special reference to dyslexia and dysphasia. New York : The New York academy of science

33 Tallal et all (1998) New York : The New York academy of science

34. Hulme (1981) Reading and retardation and multisensory teaching: London :ROUTLEDGE AND KEGAN PAUL

35. Bradley (1981),

36, Thomson and Gilchrich: Dyslexia a multidisiplinary approch London Chapan and Hall

37. Bradley and Bryant (1983), Categorising sounds asnd learning to read. Nature, 301, 419.

38. Dyslexia at college Miles Dorothy and Gilrpoy 1986 New York Methuen

^ 39 Brent Bowers (2007-12-06). "Tracing Business Acumen to Dyslexia". New York Times.Cites a study by Julie Logan, professor of entrepreneurship at Cass Business School in London, among other literature.

40 b Berninger, Virginia W.; Raskind, Wendy, Richards, Todd, Abbott, Robert, Stock, Pat (5 November 2008). "A Multidisciplinary Approach to Understanding Developmental Dyslexia Within Working-Memory Architecture: Genotypes, Phenotypes, Brain, and Instruction". Developmental Neuropsychology 33 (6): 707–744. doi:10.1080/87565640802418662. PMID 19005912.

<a name="41">41</a> a b Stein, John (1 January 2001). "The magnocellular theory of developmental dyslexia". Dyslexia 7 (1): 12–33. doi:10.1002/dys.183.

42http://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.2003.01684.x/abstract;jsessionid=0C68D8EFA292BDC2CD782A68E41AD2D4.f03t03

43 Cao, F., Bitan, T., Chou, T.-L., Burman, D. D. and Booth, J. R. (2006), Deficient orthographic and phonological representations in children with dyslexia revealed by brain activation patterns. Journal of Child Psychology and Psychiatry, 47: 1041–1050. doi: 10.1111/j.1469-7610.2003.01684.x

44 http://www.ncbi.nlm.nih.gov/pubmed/11305228

45 Developmental Psychopathology, Risk, Disorder, and Adaptation Donald J. Cohen John Wiley & Sons, Feb 27, 2006

3.2.3.1 Language Abilities Affected by Aphasia§

Aphasia can affect any aspect of language -- reading, writing, speaking or listening, or combinations of these abilities. However, difficulty in reading is probably the symptom that most impacts use of the web, because most websites do not make heavy demands on the other language-related skills. Minimal writing, such as form-filling, is common on websites, but extensive writing, such as a product review or blog comment, is usually optional. Speaking is rarely required for interacting with a conventional website. It may be used in websites that support real-time human-human communication, but then a human is present who can make an extra effort to understand someone who doesn't speak fluently. Speaking, however, is often required in telephone voice applications. Using the keypad as an alternative to voice may also be difficult for some people with aphasia. Listening is required for websites where audio or video material is presented. Closed-captioning is not necessarily an option because many people with aphasia are unable to read. Many people with aphasia have some degree of hemiplegia, associated with the brain injury that affected their language. This means that using a mouse or keyboard can be difficult, so typing is not necessarily available as an alternative. In addition to difficulty reading text, some people with aphasia find certain websites confusing, for example, if there's too much material.

3.2.3.2 Variability of Symptoms of Aphasia§

Another aspect of aphasia that impacts web accessibility is that the symptoms of aphasia vary considerably from person to person, and even in the same person from day to day. For example, some people with aphasia find that reading text for 15 or 20 minutes is ok, then the "brain shuts down". However, for some people reading is unaffected. Some people with aphasia can speak fairly well, but some don't talk at all. Specific aspects of reading might be differentially affected, for example, numbers, or people's names.

3.3.3.1 How Symptoms Result in Challenges for Young People who are Non-Vocal§

Young non-vocal communicators are very often encouraged to make vocal speech and all efforts are made to achieve that goal. There is a persistent idea that if AAC systems are introduced early in a child’s life it will delay or prevent the development of verbal speech. This conclusion is erroneous. Research (http://www.pecsusa.com/research.php) has shown that the introduction of AAC early in a child’s life will actually help the child develop verbal speech if that capability exists. The emphasis on making verbal speech still continues after AAC is introduced, but the fact that the child now has a means of communicating means that their right to communicate is already being supported. In situations where Speech and Language Pathologists (SLP) attempt to introduce AAC early the challenge to enlist the family/caregivers as supporters of AAC often fails. In situations where no SLP is available and/or the knowledge that there are relatively inexpensive interventions available and/or the parents/caregivers do not support the system, the child is not supported with an AAC system and expectations fall far short of the child's potential.

Major Challenges:

3.3.3.2 How Symptoms Result in Challenges for People with Aphasia§

3.3.4.1 Young Non-Vocal Woman§

S is a 21 year old woman with a chromosomal deletion known as Cri-du-chat Syndrome, or Five P Minus (5p-). She is a mosaic; she has the transcription error in approximately 50 percent of her cells, so some of the classic Cri-du-chat symptoms are not present such as congenital heart problems and microcephaly. S has orthopedic impairments, is ataxic (loss of full control of bodily movements) and hypotonic (abnormally low body tone) and she is developmentally disabled. She is also nearly completely non-vocal, but she has a communication system. S uses the Picture Exchange Communication System (PECS) (http://www.pecsusa.com/pecs.php) as her base methodology and this is invoked in whatever communication book, picture schedule, choice boards, and other low-tech systems she uses. PECS methodology is also used in her high-tech voice output devices. Using PECS as the base methodology supports her with a consistent approach that has allowed her to develop into a very confident communicator. Since she cannot read or write she relies on icons and pictures to navigate and make her communication choices. She has been using a communication book since she was five years old (and still does) and she started using high-tech AAC systems when she was ten years old. All of her high-tech AAC devices have been purchased from a single vendor, and none of them have been interoperable, requiring her communication environment to be created manually at each change of device. None of her other non-vocal classmates/peers have communication systems.

3.3.4.2 Professional Man with Aphasia§

Mr C was a highly skilled accountant before he suffered a stroke, he read widely and enjoyed using technology for both his work and leisure activities. After a severe left sided brain haemorrhage he not only could not speak clearly and had difficulty understanding conversation, but he also found that he could not read or write in a recognizable way. He found it hard to concentrate and when trying to use the Internet he did not have the skills to search for things of interest let alone read the content of the web pages. He was extremely frustrated, found himself breaking down. It was extremely distressing for his family. Slowly words returned and reading skills improved but he found the clutter on the screen exasperating and often failed to select the correct link or menu item. As he progressed in his rehabilitation, he was able to read slowly and made limited use of text to speech and increased font sizing. However, he tired easily, complained of eye strain and would often give up if he could not find something he was searching for. He could not cope with CAPTCHA technology, found form filling difficult and would often buy the wrong items on Amazon by accident. However, with support and using simple technologies to de-clutter web sites, so that the text was clear without advertisements and excessive imagery Mr. C continued to take up the challenge of reading from the screen and his skills slowly improved. Eventually he was able to make use of social networks with friends who understood his difficulties and enjoyed asynchronous communication where he did not have to answer immediately and could take his time reading and composing messages.

3.4.2.1 Description of Alzheimer's§

Alzheimer’s disease (62% of those with dementia): A physical disease caused by changes in the structure of the brain and a shortage of important chemicals that help with the transmission of messages. In short, Alzheimer's is a brain disease that causes a slow decline in memory, thinking and reasoning skills.

Statistics are from 2013 UK Study. Need to map with WHO and others.

3.4.2.2 Description of Less Common (Non-Alzheimer's)§

Set of non-Alzheimer's Dementia diseases:

• Vascular Dementia (17%): Caused by problems in the supply of blood to the brain, commonly cause by a stroke or a series of small strokes.

• Mixed Dementia (10%): A type of dementia where a person has a diagnosis of both Alzheimer’s disease and vascular dementia.

• Dementia with Lewy bodies (4%): One of the less common forms of dementia, it is caused by irregularities in brain cells. Leading to symptoms similar to Alzheimer’s disease and Parkinson’s disease.

• Rarer causes of Dementia (3%): There are many rarer causes diseases and syndromes that can lead to dementia or dementia-like symptoms, including Corticobasal degeneration and Creutzfeldt-Jakob disease.

• Fronto-temporal Dementia (2%): Rare when all ages are taken into account but relatively common in people under 65, it is a physical disease that affects the brain.

Statistics are from 2013 UK Study. Need to map with WHO and others.

3.4.3.1 Research Sources§

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

1. Understanding the role of age and fluid intelligence in information search, ASSETS '12 Proceedings of the 14th international ACM SIGACCESS conference on Computers and accessibility, 119-126, S. Trewin, J.T. Richards, V.L. Hanson, D. Sloan, B.E. John, C. Swart, J.C. Thomas, 2012. (Contributed by Katherine Deibel)
2.  ??
3.  ??

3.4.3.2 Cognitive Function Decline Due to Dementia§

Overview: The parts of the brain and cognitive functions affected depend upon the type of dementia.

3.4.4.1 Research Sources§

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

1.  ??
2.  ??
3.  ??

3.4.4.2 Common Symptoms of Cognitive Decline Due to Both Aging and Dementia§

1. Difficulty remembering information, (tends to fluctuate as the day progresses, and decline over long periods of time)
2. Difficulty with organizing thoughts
3. Difficulty working within time limits
4. Visual processing difficulties, which can affect the ability to recognize places.

3.4.4.3 Symptoms of Cognitive Decline Due to Aging§

1. Memory: Sometimes forgets names or appointments, but then remembers them later.
2. Problem Solving: May make occasional errors when balancing a checkbook.
3. Completing Tasks: May need occasional help to use the settings on a microwave or to record a television show.
4. Confusion w/ Time or Place: May get confused about the day of the week but then figures it out later.
5. Visual/Spatial/Temporal Understanding: May have vision changes related to cataracts, low vision and/or color/contrast perception. May have some hearing or speech loss. May have diminished motor ability and acuity. May want/need to combine "Confusion w/ Time or Place" and "Visual/Spatial/Temporal Understanding".
6. Conversation: Sometimes has trouble finding the right word.
7. Misplacing Items: May misplace things from time to time and then need to retrace their steps to find them.
8. Judgment: Makes a bad decision once in a while.
9. Withdrawal: May on occasion feel weary of work, family and social obligations.
10. Mood/Personality: May develop very specific ways of doing things and therefore may become irritable when a routine is disrupted.

3.4.4.4 Symptoms of Cognitive Decline Due to Dementia§

3.4.4.5 Typical behaviours exhibited by people with Dementia§

1. Repetitive Behaviour - Asking the same question over and over again - As well as memory loss, this can be due to the person's feelings of insecurity or anxiety about their ability to cope. Repetitive phrases or movements - This can be due to noisy or stressful surroundings, or boredom. It can also be a sign of discomfort, e.g. too hot or cold.
   1. Repetitive actions - Actions such as repeatedly packing and unpacking a bag, or rearranging the chairs in a room, may relate to a former activity.
   2. Repeatedly asking to go home - This can be a sign of anxiety, insecurity, fear or depression. The concept of 'home' might evoke memories of a time or place where the person felt comfortable or safe – they may not recognise their present environment as their home even if it is the place where they live.
   3. Multiple phone calls - Some people with dementia phone their loved ones over and over again - particularly in the middle of the night, they may forget that they have already called, or may be insecure or anxious.
2. Restlessness
   1. Pacing up and down - Pacing may indicate that the person wants to use the toilet but is unable to tell you or they may be feeling frustrated and want some fresh air.
   2. Fidgeting - Someone with dementia may fidget constantly.
3. Shouting and Screaming
   1. The person may continually call out for someone, shout the same word, or scream or wail over and over again.
   2. They could be experiencing difficulties with visual perception or hallucinations.
   3. A person with dementia may feel lonely or distressed, if their short term memory is damaged they may not remember that you are in the next room and believe they are alone. They may feel anxious about their failing memory, bored, or stressed by too much noise and bustle.
4. Lack of inhibition
   1. Some people with dementia may undress in public, having forgotten when and where it is appropriate to remove their clothes.
   2. Apparently inappropriate sexual behaviour may be a result of the physical damage to the part of the brain that allows us to recognise acceptable social behaviours.
   3. Some actions, such as lifting a skirt or fiddling with flies may simply be a sign that the person wants to use the toilet.
   4. The person may behave rudely - for example, by insulting people or swearing or spitting.
5. Night-time Waking
   1. Many people with dementia are restless at night and find it difficult to sleep. Older people often need less sleep than younger people in any case. Dementia can affect people's body clocks so that they may get up in the night, get dressed or even go outside.
6. Trailing and Checking
   1. Living with dementia makes many people feel extremely insecure and anxious. This can result in the person constantly following their carers or loved ones around, or calling out to check where they are. A few moments may seem like hours to a person with dementia, and they may only feel safe if other people are nearby.
7. Hiding and Losing things
   1. People with dementia sometimes hide things and then forget where they are - or forget that they have hidden them at all. The wish to hide things may be due to feelings of insecurity and a desire to hold on to what little the person still has.
8. Suspicion
   1. Some people with dementia can become suspicious. If they have mislaid an object they may accuse someone of stealing it, or they may imagine that a friendly neighbour is plotting against them. These ideas may be due to failing memory or an inability to recognise people,
9. Sleeplessness and ‘sundowning’
   1. Many people with dementia, especially in the middle stages, experience periods of increased confusion at dusk, with their disorientation continuing throughout the night. These periods of what is known as 'sundowning' usually diminish as the dementia progresses. (1)

3.4.5.1 Research Sources§

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

1. Design recommendations for tv user interfaces for older adults: findings from the eCAALYX project, ASSETS '12 Proceedings of the 14th international ACM SIGACCESS conference on computers and accessibility, 41-48, F. Nunes, M. Kerwin, P Alexandra-Silva, 2012. (Contributed by Katherine Deibel)
2. How voice augmentation supports elderly web users, ASSETS '11 The proceedings of the 13th international ACM SIGACCESS conference on computers and accessibility, 155-162, D. Sato, M. Kobayashi, H. Takagi, C. Asakawa, J. Tanaka, 2011. (Contributed by Katherine Deibel)
3.  ??

3.4.5.2 Challenges§

• Remembering steps to complete a task, e.g. "How do I send an email?"
• Overwhelmed by too many functions, complex UIs.
• Copying information correctly.
• Difficulty figuring out new UI metaphors.
• Too many steps to complete a task.
• Advertising prompts added before getting to a web page are confusing.
• Menu systems are difficult to navigate and find the right path.
• 15% of people living with dementia – an estimated 112,500 people (in the UK) – have been victims of financial abuse such as cold calling, scam mail or mis-selling
• 62% of carers reported that the person they care for had been approached by cold callers or doorstep sales people
• 70% reported that telephone callers routinely targeted the person they care for. Not only have people lost money, but they and their families have also been suffering stress, exhaustion and frustration as a result.
• 76% of people reported having trouble managing their money, with a range of issues highlighted such as the challenges of bank’s security procedures, and a lack of dementia awareness in banks and other financial services organisations. UK ONLY (4)
• Mood/Personality: Controlling confusion and irritability when changes are made to their routine, environment or location. Difficulty in feeling safe.

3.4.3.1 Research Sources§

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

1. Understanding the role of age and fluid intelligence in information search, ASSETS '12 Proceedings of the 14th international ACM SIGACCESS conference on Computers and accessibility, 119-126, S. Trewin, J.T. Richards, V.L. Hanson, D. Sloan, B.E. John, C. Swart, J.C. Thomas, 2012. (Contributed by Katherine Deibel)
2. Basic senior personas: a representative design tool covering the spectrum of European older adults, ASSETS '12 Proceedings of the 14th international ACM SIGACCESS conference on computers and accessibility, 25-32, B. Wockl, U. Yildizoglu, I. Buber, B. Aparicio-Diaz, E. Kruijff, M. Tscheligi, 2012. (Contributed by Katherine Deibel)
3. How voice augmentation supports elderly web users, ASSETS '11 The proceedings of the 13th international ACM SIGACCESS conference on computers and accessibility, 155-162, D. Sato, M. Kobayashi, H. Takagi, C. Asakawa, J. Tanaka, 2011. (Contributed by Katherine Deibel)

3.4.3.2 Scenarios§

• Struggling to remember recent events but easily recalling things from the past
• Finding it hard to follow conversations or programs (on TV, web, video, webcast)
• Forgetting the names of friends or everyday objects
• Repeating yourself or losing the thread of what you are saying
• Problems with thinking and reasoning
• Feeling anxious, depressed or angry about forgetfulness
• Other people starting to comment on your forgetfulness
• Confused even when in a familiar environment (in space and on TV, web, video, webcast)
• A decline in the ability to talk, read or write

3.4.3.3 User Stories§

3.4.3.4 Personas§

• “I have great difficulty remembering things, working things out and interpreting things. I use a Dictaphone which helps considerably. I can’t use a normal watch so I’ve gone digital, but that has its limitations. I can’t read very well so I use audio books. I can’t count money, but I haven’t found a way around that yet so any suggestions will be gratefully received! So, I’ve developed strategies to help. These can be very simple but effective if they work. Often it is the simplest things that get the better of us – things we have done all our lives without a problem. But now, because we can’t do them, it is very frustrating.” – Extract from a speech by Ann Johnson at the Uk Dementia Congress November 2010.

3.4.7.1 Research Sources§

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

1.  ??
2.  ??
3.  ??

3.4.7.2 {Section}§

To do: Add table.

3.4.8.1 Research Sources§

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

1.  ??
2.  ??
3.  ??

3.4.9.1 Summary of Existing Research and Guidelines - Research Sources§

Key features from Phiriyapkanon:

1. Reduction of complexity: Factions that are rarely used or not necessary should be removed
2. Clear structure of task: The starting point of tasks and every step should be easily recognized and understood
3. Consistency of information: Avoid contradictions and inconsistencies of information arraignment
4. Rapid and direct feedback: Applications should continuously provide easily recognizable feedback of success or failure with every action

They also quote minimize errors, provide onscreen help and high recover-ability Phiriyapkanon t. Is big button interface enough for elderly users, P34, Malardardalen University Press Sweden 2011

K Dobsz et. al. recommends:

1. Strong contrast of images with content
2. Simple and large graphics
3. Sound conformation of accepted and rejected operations
4. Automatic voicing reading tasks (instructions)

Computers helping people with special needed, 14 international conference ICCHP 2014 Eds. Miesenberger, Fels, Archambault, Et. Al. Springer (pages 401). Paper: Tablets in the rehabilitation of memory impairment, K Dobsz et al.

Key features from other guidelines:

1. To help with difficulties in completing complex tasks, one should weight until the elder completes one task before proceeding to the next step
2. Place tasks in step by step order -

but balance this because too many steps can give a feeling of getting lost.

1. One has to be consistent in naming steps such as naming all steps begin with a verb (such as "press the button")
2. Orientation impairments causes elderly to unlearn how to find their way in new surroundings. Therefor:
   1. Menus and useability interfaces need to be simplified to minimize the amount of information that needs to be memorized
   2. An application should work independent of other applications
   3. The screen should not have distracting elements (wallpaper, buttons etc)
3. Information should be broken down into discreet chunks that the elderly can absorb
4. Content and information give needs to be consistent
5. Avoid stress which will further imper cognitive function

Computers helping people with special needed, 14 international conference ICCHP 2014 Eds. Miesenberger, Fels, Archambault, Et. Al. Springer (pages 401). Paper: Never Too old to use a tablets, L. Muskens et al. pages 392 - 393

Key features for using tablets for the elderly from Dahn et.al:

1. The user interface should use widgets or large buttons rather then standard apps. Moving between screens should be possible using tabs or buttons and not just gestures.
2. Dedicated user interfaces often fall short of user requirements. Instead populate the tablet with standard apps with simple interfaces.
3. Offer a PC like mode with "file explorer" and familiar PC interface features
4. Supply have a printed manual
5. Privacy policies should be transparent to build trust
6. Supply a scaffolding approach to help and support but should allow flexible entry points.

Computers helping people with special needed, 14 international conference ICCHP 2014 Eds. Miesenberger, Fels, Archambault, Et. Al. Springer ( part 2 page 329). Paper: Supporting seniorr citizens in using tablet computors tablets,Dahn et.al

Lisa Seeman (talk)

1. Older Equipment and SoftwareSome people who are aging or have dementia will be using older browsers and devices that might not be as capable or fault tolerant as current technologies - or may be missing some of the customized and interactive content provided by newer technologies.

3.4.10.1 Research Sources§

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

1. How voice augmentation supports elderly web users, ASSETS '11 The proceedings of the 13th international ACM SIGACCESS conference on computers and accessibility, 155-162, D. Sato, M. Kobayashi, H. Takagi, C. Asakawa, J. Tanaka, 2011. (Contributed by Katherine Deibel)
2.  ??
3.  ??

3.4.11.1 Use of Language and Communication for Dementias§

[#LANG]

• Avoid use of voice recognition or spoken commands from the end-user.
• In either spoken or written information, use simple words, avoiding abstract, unfamiliar vocabulary.
• In either spoken or written information, use simple sentences with just one idea per sentence. Avoid long sentences with embedded ideas.
• Avoid pronouns or other forms of language which rely on the end-user having to recall information which they have just read or heard.
• Support writing with clear visual images to account for potential vision deficits impacting on reading ability.

3.4.13.1 Research Sources§

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

1.  ??
2.  ??
3.  ??

3.4.13.2 {Section}§

Add ideas for filling gaps

1. Memory:
   1. enhanced use of color
      1. 1.4.1 - Use of Color (A) requires that color is not used as the only visual means of conveying information, indicating an action, prompting a response, or distinguishing a visual element Perceivable
   2. Context and Orientation
      1. 2.4.3 - Focus Order (A) says "components receive focus in an order that preserves meaning and operability" Operable
      2. 2.4.7 - Focus Visible (AA) requires an ability for the "keyboard focus indicator (to be) visible" Operable
      3. 2.4.4 - Link Purpose (In Context) (A) requires that the purpose of a link can be determined from the link text alone, or from the link text together with its surrounding context Operable
      4. 2.4.9 - Link Purpose (Link Only) (AAA) says "a mechanism is available to allow the purpose of each link to be identified from link text alone" Operable
      5. 2.4.7 - Focus Visible (AA) requires a visible keyboard focus indicator that shows what component on the web page has focus Operable
      6. 2.4.8 - Location (AAA) says "information about the user's location within a set of Web pages is available" Operable
      7. 2.4.2 - Page Titled (A) says "web pages have titles that describe topic or purpose" (this is important for search results as the page title is usually displayed first in the listing) Operable
   3. prompts and cues
   4. index or table of contents
   5. support text with redundant visual and auditory elements
      1. 1.1.1 - Non-text Content (A) says "a text alternative that serves the equivalent purpose" is required Perceivable
      2. 1.3.1 - Info and Relationships (A) says "information, structure, and relationships" to be made available, for example to text-to-speech software Perceivable
      3. Software that visually highlights spoken text
   6. help index
   7. Context Sensitive (support and) Help
      1. 3.1.3 Unusual Words (Level AAA) Understandable
      2. 3.1.4 Abbreviations (Level AAA) Understandable
   8. grouping and symmetry (to leverage visual perception and attention)
   9. Intuitive Design - Ease of Interaction (to leverage spatial memory)
      1. 2.1.1 - Keyboard (A) says "the content is operable through a keyboard interface" Operable
      2. 2.1.2 - No Keyboard trap (A) makes sure that keyboard focus "can be moved away from that component using only a keyboard" Operable
      3. 2.1.3 - Keyboard (No Exception) (AAA) says "all functionality of the content is operable through a keyboard interface" Operable
      4. 2.4.1 - Bypass Blocks (A) says "a mechanism is available to bypass blocks of content that are repeated" Operable
      5. 2.4.3 - Focus Order (A) says "components receive focus in an order that preserves meaning and operability" Operable
      6. 2.4.7 - Focus Visible (AA) requires an ability for the "keyboard focus indicator (to be) visible" Operable
      7. 3.3.2 - Labels or Instructions (A) says that labels should be provided "when content requires user input" Understandable
   10. Consistent Navigation
       1. 2.4.5 - Multiple Ways (AA) says "more than one way is available to locate a Web page within a set of Web pages" Operable
   11. consistent identification
   12. simplified user controls
   13. error prevention and recovery
   14. Avoid Distractions and Seizures
       1. 1.4.2 - Audio Control (A) says "a mechanism is available to pause or stop the audio" Perceivable
       2. 2.2.2 - Pause, Stop, Hide (A) says "a mechanism for the user to pause, stop, or hide" moving or blinking content Operable
       3. 2.2.4 - Interruptions (AAA) says "interruptions can be postponed or suppressed" Operable
       4. 2.3.1 - Three Flashes or Below Threshold (A) Operable
       5. 2.3.2 Three Flashes (AAA) Operable
2. Problem Solving:
   1. Content Alternatives
      1. 1.1.1 - Non-text Content (A) Perceivable
      2. 1.2.1 - Audio-only and Video-only (Prerecorded) (A) Perceivable
      3. 1.2.2 - Captions (Prerecorded) (A) Perceivable
      4. 1.2.3 - Audio Description or Media Alternative (Prerecorded video) (A) Perceivable
      5. 1.2.4 - Captions (Live) (A) Perceivable
      6. 1.2.5 - Audio Description (Prerecorded video) (AA) Perceivable
      7. 1.2.7 - Extended Audio Description (Prerecorded video) (AAA) Perceivable
      8. 1.2.8 - Media Alternative (Prerecorded) (AAA) Perceivable
      9. 1.2.9 - Audio-only (Live) (AAA) Perceivable
      10. 1.4.7 - Low or No Background Audio (Prerecorded) (AAA) Perceivable
   2. prompts and cues
   3. logical workflow with redundant text, visual and auditory cues
   4. grouping and symmetry (to leverage visual perception and attention)
   5. Intuitive Design - Ease of Interaction (to leverage spatial memory)
   6. Consistent Navigation
      1. 2.4.5 - Multiple Ways (AA) says "more than one way is available to locate a Web page within a set of Web pages" Operable
   7. consistent identification
   8. easy user customization
   9. simplified user controls
3. Completing Tasks:
   1. prompts and cues
   2. grouping and symmetry (to leverage visual perception and attention)
   3. Intuitive Design - Ease of Interaction (to leverage spatial memory)
   4. easy user customizations
      1. 1.4.4 - Resize Text (AA) says "text can be resized without assistive technology up to 200 percent without loss of content or functionality". Perceivable
      2. 1.4.8 - Visual Presentation (AAA) includes requirements on text style, text justification, line spacing, line length, and horizontal scrolling. Perceivable
   5. simplified user controls
   6. error prevention and recovery
   7. Avoid Distractions and Seizures
      1. 1.4.2 - Audio Control (A) says "a mechanism is available to pause or stop the audio" Perceivable
      2. 2.2.2 - Pause, Stop, Hide (A) says "a mechanism for the user to pause, stop, or hide" moving or blinking content Operable
      3. 2.2.4 - Interruptions (AAA) says "interruptions can be postponed or suppressed" Operable
      4. 2.3.1 - Three Flashes or Below Threshold (A) Operable
      5. 2.3.2 Three Flashes (AAA) Operable
4. Confusion w/ Time or Place:
   1. Context and Orientation
      1. 2.4.3 - Focus Order (A) says "components receive focus in an order that preserves meaning and operability" Operable
      2. 2.4.7 - Focus Visible (AA) requires an ability for the "keyboard focus indicator (to be) visible" Operable
      3. 2.4.4 - Link Purpose (In Context) (A) requires that the purpose of a link can be determined from the link text alone, or from the link text together with its surrounding context Operable
      4. 2.4.9 - Link Purpose (Link Only) (AAA) says "a mechanism is available to allow the purpose of each link to be identified from link text alone" Operable
      5. 2.4.7 - Focus Visible (AA) requires a visible keyboard focus indicator that shows what component on the web page has focus Operable
      6. 2.4.8 - Location (AAA) says "information about the user's location within a set of Web pages is available" Operable
      7. 2.4.2 - Page Titled (A) says "web pages have titles that describe topic or purpose" (this is important for search results as the page title is usually displayed first in the listing) Operable
   2. identify current state
   3. Consistent Navigation
      1. 2.4.5 - Multiple Ways (AA) says "more than one way is available to locate a Web page within a set of Web pages" Operable
   4. consistent identification
   5. simplified user controls
   6. error prevention and recovery
   7. Avoid Distractions and Seizures
      1. 1.4.2 - Audio Control (A) says "a mechanism is available to pause or stop the audio" Perceivable
      2. 2.2.2 - Pause, Stop, Hide (A) says "a mechanism for the user to pause, stop, or hide" moving or blinking content Operable
      3. 2.2.4 - Interruptions (AAA) says "interruptions can be postponed or suppressed" Operable
      4. 2.3.1 - Three Flashes or Below Threshold (A) Operable
      5. 2.3.2 Three Flashes (AAA) Operable
5. Visual/Spatial/Temporal Understanding: May want/need to combine "Confusion w/ Time or Place" and "Visual/Spatial/Temporal Understanding".
   1. Content Alternatives
      1. 1.1.1 - Non-text Content (A) Perceivable
      2. 1.2.1 - Audio-only and Video-only (Prerecorded) (A) Perceivable
      3. 1.2.2 - Captions (Prerecorded) (A) Perceivable
      4. 1.2.3 - Audio Description or Media Alternative (Prerecorded video) (A) Perceivable
      5. 1.2.4 - Captions (Live) (A) Perceivable
      6. 1.2.5 - Audio Description (Prerecorded video) (AA) Perceivable
      7. 1.2.7 - Extended Audio Description (Prerecorded video) (AAA) Perceivable
      8. 1.2.8 - Media Alternative (Prerecorded) (AAA) Perceivable
      9. 1.2.9 - Audio-only (Live) (AAA) Perceivable
      10. 1.4.7 - Low or No Background Audio (Prerecorded) (AAA) Perceivable
   2. large selection targets
   3. zoom controls, large fonts
      1. 1.4.4 - Resize Text (AA) says "text can be resized without assistive technology up to 200 percent without loss of content or functionality". Perceivable
   4. close proximity
   5. Context and Orientation
      1. 2.4.3 - Focus Order (A) says "components receive focus in an order that preserves meaning and operability" Operable
      2. 2.4.7 - Focus Visible (AA) requires an ability for the "keyboard focus indicator (to be) visible" Operable
      3. 2.4.4 - Link Purpose (In Context) (A) requires that the purpose of a link can be determined from the link text alone, or from the link text together with its surrounding context Operable
      4. 2.4.9 - Link Purpose (Link Only) (AAA) says "a mechanism is available to allow the purpose of each link to be identified from link text alone" Operable
      5. 2.4.7 - Focus Visible (AA) requires a visible keyboard focus indicator that shows what component on the web page has focus Operable
      6. 2.4.8 - Location (AAA) says "information about the user's location within a set of Web pages is available" Operable
      7. 2.4.2 - Page Titled (A) says "web pages have titles that describe topic or purpose" (this is important for search results as the page title is usually displayed first in the listing) Operable
   6. prompts and cues
   7. support text with redundant visual and auditory elements
   8. help index
   9. context sensitive help
   10. plain language
   11. grouping and symmetry (to leverage visual perception and attention)
   12. Intuitive Design - Ease of Interaction (to leverage spatial memory)
   13. Consistent Navigation
       1. 2.4.5 - Multiple Ways (AA) says "more than one way is available to locate a Web page within a set of Web pages" Operable
   14. consistent identification
   15. enhanced use of color and contrast
       1. 1.4.1 - Use of Color (A) requires that color is not used as the only visual means of conveying information, indicating an action, prompting a response, or distinguishing a visual element Perceivable
       2. 1.4.3 - Contrast (Minimum) (AA) requires a contrast ratio of at least 4.5:1 for the visual presentation of text and images Perceivable
       3. 1.4.6 - Contrast (Enhanced) (AAA) requires a higher contrast ratio of at least 7:1 for the visual presentation of text and images Perceivable
   16. easy user customizations
       1. 1.4.4 - Resize Text (AA) says "text can be resized without assistive technology up to 200 percent without loss of content or functionality". Perceivable
       2. 1.4.8 - Visual Presentation (AAA) includes requirements on text style, text justification, line spacing, line length, and horizontal scrolling. Perceivable
   17. simplified user controls
   18. error prevention and recovery
   19. Avoid Distractions and Seizures
       1. 1.4.2 - Audio Control (A) says "a mechanism is available to pause or stop the audio" Perceivable
       2. 2.2.2 - Pause, Stop, Hide (A) says "a mechanism for the user to pause, stop, or hide" moving or blinking content Operable
       3. 2.2.4 - Interruptions (AAA) says "interruptions can be postponed or suppressed" Operable
       4. 2.3.1 - Three Flashes or Below Threshold (A) Operable
       5. 2.3.2 Three Flashes (AAA) Operable
6. Conversation:
   1. text
   2. support text with redundant visual and auditory elements
   3. simplified user controls
7. Misplacing Items:
   1. site map
   2. index or table of contents
   3. help index
   4. context sensitive help
   5. Consistent Navigation
      1. 2.4.5 - Multiple Ways (AA) says "more than one way is available to locate a Web page within a set of Web pages" Operable
   6. consistent identification
8. Judgment:
   1. prompts and cues
   2. support text with redundant visual and auditory elements
   3. grouping and symmetry (to leverage visual perception and attention)
9. Withdrawal:
   1. easy user customizations
      1. 1.4.4 - Resize Text (AA) says "text can be resized without assistive technology up to 200 percent without loss of content or functionality". Perceivable
      2. 1.4.8 - Visual Presentation (AAA) includes requirements on text style, text justification, line spacing, line length, and horizontal scrolling. Perceivable
   2. simplified user controls
   3. error prevention and recovery
   4. emotional expression (EmotionML)
10. Mood/Personality:
    1. encouragement
    2. immediate positive feedback
    3. safety controls
    4. grouping and symmetry (to leverage visual perception and attention)
    5. Consistent Navigation
       1. 2.4.5 - Multiple Ways (AA) says "more than one way is available to locate a Web page within a set of Web pages" Operable
    6. consistent identification
    7. easy user customizations
       1. 1.4.4 - Resize Text (AA) says "text can be resized without assistive technology up to 200 percent without loss of content or functionality". Perceivable
       2. 1.4.8 - Visual Presentation (AAA) includes requirements on text style, text justification, line spacing, line length, and horizontal scrolling. Perceivable
    8. simplified user controls
    9. error prevention and recovery
    10. emotional expression (EmotionML)

3.4.14.1 Research Sources§

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

1.  ??
2.  ??
3.  ??

3.4.14.2 Prevalence of Dementia§

• UK (2013 Study)
  • Alzheimer’s Society estimates that there are 428,000 people in the UK who are living with dementia that haven’t been formally diagnosed.
  • Two thirds of people with dementia are women
  • One in three people over 65 will develop dementia
  • 40-64 years: 1 in 1,400
  • 65-69 years: 1 in 100
  • 70-79 years: 1 in 25
  • 80+ years: 1 in 6
  • Future Projections: The number of people in the UK with dementia will double in the next 40 years.
    • 800,000 people with dementia in 2012
    • 1,000,000 people with dementia in 2021
    • 1,700,000 people with dementia in 2051

3.4.14.3 Prevalence of Aging§

• World Health Organization: 2012 Study
  • The world population is rapidly aging
    • Between 2000 and 2050, the proportion of the world's population over 60 years old will double from about 11% to 22%. The number of people aged 60 years and over is expected to increase from 605 million to 2 billion over the same period.
  • The number of people aged 80 and older will quadruple in the period 2000 to 2050
    • By 2050 the world will have almost 400 million people aged 80 years or older.
  • By 2050, 80% of older people will live in low- and middle-income countries
  • The main health burdens for older people are from non-communicable diseases while the greatest causes of disability are visual impairment, dementia, hearing loss and osteoarthritis.
  • Older people in low- and middle-income countries carry a greater disease burden than those in the rich world
  • The need for long-term care is rising
    • The number of older people who are no longer able to look after themselves in developing countries is forecast to quadruple by 2050.
  • Effective, community-level primary health care for older people is crucial
  • Supportive, “age-friendly” environments allow older people to live fuller lives and maximize the contribution they make
    • Creating “age-friendly” physical and social environments can have a big impact on improving the active participation and independence of older people
  • Healthy aging starts with healthy behaviors in earlier stages of life
  • We need to reinvent our assumptions of old age
    • Society needs to break stereotypes and develop new models of aging for the 21st century. Everyone benefits from communities, workplaces and societies that encourage active and visible participation of older people.

3.4.15.1 References on Aging§

• World Health Organization: On Aging: http://www.who.int/topics/ageing/en/

• W3C Developing Websites for Older People: How WCAG 2.0 Applies: http://www.w3.org/WAI/older-users/developing

3.4.15.2 References on Dementia§

• UK: Alzheimer's Society: http://www.alzheimers.org.uk/site/index.php
  • 2013 Study: (Text Only Version) http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=2164
• UK: Dementia Voices: http://dementiavoices.org.uk/
  • Designing Websites for People with Dementia: http://dementiavoices.org.uk/wp-content/uploads/2013/11/DEEP-Guide-Creating-websites.pdf

3.4.15.3 References from literature reviews on Dementia and ICT from Peter Cudd§

INDIVUI

How Individual Should Digital AT User Interfaces Be for People with Dementia. Peter Cudd, Philippa Greasley, Zoe Gallant, Emily Bolton and Gail Mountain. AAATE proceedings 3012

Abstract. A literature review of papers that have explored digital technology user interface design for people with dementia is reported. Only papers that have employed target user input directly or from other works have been included. Twenty four were analysed. Improvements in reporting of studies are recommended. A case is made for considering the population of people with dementia as so heterogeneous that one design does not suit all, this is illustrated through some case study reports from people with dementia. Furthermore it is proposed that by grouping people into functionally similar sub-groups interfaces may be designed for these groups that will collectively establish a sequence of ‘stepping stone ‘ interfaces that better address appropriate functioning and maintain self-efficacy. Fundamentally people living with dementia are unique individuals with unique specific needs. A priori, in life experiences, interests, willingness to learn, environmental factors and co-morbidities they are as varied as any of their age peers. One thing they do not share with those peers is the degenerative consequences of the specific dementia they have. The progression of their disease also follows a unique timeline – even if the general symptoms (and thus perhaps functional ability) change in a fairly predictable order. In the face of these statements it might be inferred that it is most likely that people with dementia require individual but adaptive (to progression of the disease) bespoke solutions for sustained independent living.

Given the breadth of individuality in people, the effects of dementias and indeed their progression it is impossible to view them as a single homogeneous population in terms of specifying a single user interface. In consequence rather than simply designing for all people living with dementia it is suggested that design for populations at stages of functional ability be investigated. Methods that set out to identify shared and bespoke requirements are needed to systematically establish any generalizability. Currently studies on design of digital AT and indeed other ICT for people living with dementia need to report much more detail on: describing their participants; details of user interface features that worked well; how much and what form carers help took. More attention also needs to compare strategies and features that work to identify those that are best or at least best for specific functional ability or tasks.

3.5.1.1 Overview§

Improvements in medical interventions for people with Down's syndrome have led to a substantial increase in their longevity. Diagnosis and treatment of neurological complications are important in maintaining optimal cognitive functioning.

The cognitive phenotype in Down's syndrome is characterized by impairments in morphosyntax, verbal short-term memory, and explicit long-term memory. However, visuospatial short-term memory, associative learning, and implicit long-term memory functions are preserved. Seizures are associated with cognitive decline and seem to cause additional decline in cognitive functioning, particularly in people with Down's syndrome and comorbid disorders such as autism. Vision and hearing disorders as well as hypothyroidism can negatively impact cognitive functioning in people with Down's syndrome.

Dementia that resembles Alzheimer's disease is common in adults with Down's syndrome. Early-onset dementia in adults with Down's syndrome does not seem to be associated with atherosclerotic complications.

Source: The Lancet

3.5.1.2 Auditory Discrimination§

People with Down syndrome often struggle with short-term auditory memory. Most people use memory to process, hold, understand and assimilate spoken language. Auditory memory relates directly to the speed with which we can articulate words, and influences the speed at which people learn new words and learn to read.

Theories about memory suggest that words we hear are received and stored in our working memory in order to make sense of them. They are then transferred to a more long-term store. However, words are only retained in the working memory for two seconds unless consciously kept there by silently repeating them to oneself, called rehearsing. The amount of information we can retain within the two-second span is called the auditory digit span.

Is there a relationship between Down’s syndrome and working memory?

Yes, many people with Down’s syndrome have difficulties in this area. Generally, long-term memory is not impaired; neither is the visual memory, which is often far stronger.

Source: Sandy Alton

3.5.1.3 Visual Recognition Skills§

The cognitive profile observed in Down syndrome is typically uneven with stronger visual than verbal skills, receptive vocabulary stronger than expressive language and grammatical skills, and often strengths in reading abilities. There is considerable variation across the population of people with Down syndrome.

Many studies have included typically developing children matched for chronological age, for non-verbal mental age or on a measure of language or reading ability. Individuals with Down syndrome have also been compared to individuals with learning difficulties of an unknown origin and to individuals who have learning difficulties of a different aetiology (e.g., specific language impairment).

The particular measures of language, reading or non-verbal ability used for matching can affect the conclusion drawn. There are also behavioral aspects of the Down syndrome phenotype other than non-verbal ability and language ability (such as motivational style) that may affect their performance on tasks, including attainment tests, and need to be taken into account.

In terms of education, there is strong evidence to suggest that the relatively recent policy of educating children with Down syndrome in mainstream schools has had a positive effect on language skills and academic attainments. This means that the findings of studies conducted a number of years ago need to be interpreted with caution.

Source: Margaret Snowling, Hannah Nash and Lisa Henderson

3.5.3.1 Memory§

• Poor short term memory for facts, events, times, dates, symbols.
• Poor working memory; i.e. difficulty holding on to several pieces of information at the same time. This is especially challenging while undertaking a task e.g. taking notes as you listen, addressing compound questions.
• Mistakes with routine information e.g. giving your age, and phone number or the ages of children.
• Inability to hold on to information without referring to notes.

3.5.3.2 Automatising skills§

Down syndrome do not tend to automatise skills very well, and a high degree of mental effort is required to carrying out tasks that other individuals generally do not feel requires effort. This is particularly true when the skill is composed of several subskills (e.g. reading and writing).

3.5.3.3 Information Processing§

• Difficulties with taking in information efficiently (this could be written or auditory).
• Slow speed of information processing, such as a 'penny dropping' delay between hearing or reading something and understanding and responding to it.

3.5.3.4 Communication Skills§

• Lack of verbal fluency and lack of precision in speech. (relevant for voice systems)
• Word-finding problems.
• Inability to work out what to say quickly enough.
• Misunderstandings or misinterpretations during oral exchanges.
• Sometimes mispronunciations or a speech impediment may be evident.

3.5.3.5 Literacy§

• Difficulty in acquiring reading and writing skills. Reading is likely to be slow.
• If they are undiagnosed or diagnosed late, may be illiterate, barely literate and it will be very laborious
• Where literacy has been mastered, problems continue such as pore spelling, difficulty extracting the meaning from written material, difficulty with unfamiliar words, and difficulty with scanning or skimming text.
• Particular difficulty with unfamiliar or new language such as jargon.

3.5.3.6 Organization, Sequencing§

• Difficulty organizing a sequence of events.
• Incorrect sequencing of strings of number and letter. (passwords, phone numbers)
• Chronic disorganisation and misplacing/losing items.
• Difficulty with time management and passage of time

3.5.3.7 Navigation§

• Difficulty with finding the way to places or navigating - even in the context of building. Often get lost.

3.5.3.8 Sensory Sensitivity§

• Sensitivity to noise and visual stimuli.
• Impaired ability to screen out background noise / movement.
• Sensations of mental overload
• Tendency to "switch off".

3.5.3.9 Lack of Wwareness§

• Failure to notice body language.
• Failure to realize the consequences of their speech or actions.

3.5.3.10 Visual Stress§

• Some people with Down syndrome difficulties may experience visual stress when reading. Especially when dealing with large amounts of text. So brakes are often needed

3.5.3.11 Coping Strategies§

It must be emphasized that individuals vary greatly in their Specific Learning Difficulties profile. Key variables are the severity of the difficulties and the ability of the individual to identify and understand their difficulties and successfully develop and implement coping strategies.

By adulthood, many people with Specific Learning Difficulties are able to compensate through technology, reliance on others and an array of self-help mechanisms - the operation of which require sustained effort and energy. Unfortunately, these strategies are prone to break down under stressful conditions which impinge on areas of weakness.

3.5.3.12 Effects of Stress§

People are particularly susceptible to stress (compared with the ordinary population) with the result that increase their impairments.

Scenario A is a high school student with Down syndrome.

Although she can read at a 3rd grade level it is slow and she finds it difficult. Books geared towards a younger audience with a lot of pictures help. Plus she can comprehend and remember stories read by others. Test taking is very stressful and it helps when the teacher can help her take the test orally. She is strong on the computer especially when interested in the topics. She can surf the internet and do research but needs to be reminded to stay on task and not get distracted by other sites and advertisements. She does not use assistive technology but has in the past to improve her reading skills. The teacher aide has to remind her to stay on task during exercise. She can do simple research projects but only if supported with reminders and visual ques.

3.5.9.1 Headings and Emphasis§

• Avoid underlining and italics: these tend to make the text appear to run together. Use bold instead.
• AVOID TEXT IN BLOCK CAPITALS: this is much harder to read.
• For Headings, use larger font size in bold, lower case.
• Boxes and borders can be used for effective emphasis.

3.5.9.2 Layout§

• Use left-justified with ragged right edge.
• Avoid narrow columns (as used in newspapers).
• Lines should not be too long: 60 to70 characters.
• Avoid cramping material and using long, dense paragraphs: space it out.
• Line spacing of 1.5 is preferable.
• Avoid starting a sentence at the end of a line.
• Use bullet points and numbering rather than continuous prose.

3.5.9.3 Writing Style§

• Use short, simple sentences in a direct style.
• Give instructions clearly. Avoid long sentences of explanation.
• Use active rather than passive voice.
• Avoid double negatives.
• Be concise.

3.5.9.4 Increasing Accessibility§

• Flow charts are ideal for explaining procedures.
• Pictograms and graphics help to locate information.
• Lists of 'do's and 'don'ts' are more useful than continuous text to highlight aspects of good practice.
• Avoid abbreviations if possible or provide a glossary of abbreviations and jargon.
• For long documents include a contents page at the beginning and an index at end.

Note: Checking Readability. To set your spell checker in Word 2003 to automatically check readability, go to Tools, Options, Spelling, and Grammar, then tick the Readability request. Word will then show your readability score every time you spell check. In Word 2007 Click the Microsoft Office Button, and then click Word Options. Click Proofing. Make sure Check grammar with spelling is selected. Under When correcting grammar in Word, select the Show readability statistics check box. Check long documents in sections, so that you know which parts are too hard.

References:

• RNIB Web Access Centre: http://www.rnib.org.uk/professionals/webaccessibility/Pages/web_accessibility.aspx.
• BBC: My web, my way. Making the web easier to use: http://www.bbc.co.uk/accessibility/guides/allguides_index.shtml

3.7.3.1 How Symptoms Result in Challenges for This Group§

• may not pay attention to primary content because distracted by secondary content
• may be confused by:
  • instructions that are not well-defined
  • transitions among content-delivery types (e.g., text to video)
  • presentations of content using different formats or designs

• may not participate in web-based interactions with other people
• may not recall instructions when subsequently presented with an action to perform
• may react negatively to auto-playing video or audio

3.7.3.2 Observations from Interview with Anonymous User X§

• Positive: web facilitates social communication between those who struggle with face to face communication.
• Negative: communication via the web allows people with ASD to become even more isolated.
• Often the web is avoided except for work or communication purposes as it is not very user friendly.
• Some websites specifically are avoided due to the predominant color (red is particularly bad).
• In many cases there are some very-useful accessibility features that users of websites and applications have the option to adjust. However, it is often difficult to find out how and where to do this. (See 10.)

3.7.3.3 Suggestions from Interview with Anonymous User X§

• It is easier to view websites that are more visual and use only plain, simple language that doesn’t contain any jargon.
• Numerous search results can be difficult to sort through to find the right link. Therefore, easy-to-access links are more helpful without many options.
• Font: very much a personal preference, however in general:
  • Big, plain fonts at least point 12.
  • Bold fonts not skinny.
  • Sites that allow users to customize the font to their own preferences.

• Color coordination for different parts of the site relating to each other.
• Key for different colors for different sections.
• In some cases poor concept of time means can be looking at one site/page/document for many hours without realizing - timer on screen to alert user to how long they have been on that page. (See 10.)

3.7.4.1 Scenario A: Use a Web Browser to Open a Web Page§

"Trevor is a bright 18-year-old who plays games and watches music videos on his laptop. He lives at home with his parents and younger sister. He attends a special school where the teachers and staff can help with his social and communication challenges from his Autism Spectrum Disorder, while he works to pass his high school exams.

He has problems with visual information and recognizing things on the page, and his reading skills are not helped by his trouble concentrating on the page or screen long enough to read. His teachers showed him how to make the text bigger on the page, and told him how to use a printable view to hide all the ads with moving images that distract him, because he reads every word on the page very carefully and literally. He can be easily confused by colloquialisms and metaphors. He can also be overwhelmed by sites that offer too many choices.

He likes using the school’s forum to talk to his friends. It’s easier to just read what they want to say than to listen and try to figure out their facial expressions.

He shares a laptop with the family, but has first dibs on it because his parents want him to get his schoolwork done. He uses it for homework, but he really likes games with repetitive actions. He doesn’t like new sites much, in the same way that he doesn’t like any changes in his routine: they are tolerated, but not encouraged." (See 8, 9.)

3.7.4.2 Scenario B: Send an Email Message§

Middle-aged female with PDD-NOS (Pervasive Development Disorder-Not Otherwise Specified). She experiences significant social deficits and meets all the diagnostic criteria for autistic disorder, but her stereotypical and repetitive behaviors are noticeably mild. She finds it easier to send an email message than communicate via speech with people as it eliminates any social anxiety she may experience when interacting with people in person.

3.7.4.3 Scenario C: Buy a Train Ticket Online§

Older male with Asperger’s who does not have any cognitive impairment. However, he exhibits repetitive behavior and has significant trouble with social situations, specifically communicating with others. He prefers to buy his train tickets online as it eliminates any social interaction which he is not keen on. He struggles to communicate with others successfully. He has extreme anxiety. He has been either unable to purchase a ticket in person, or ended up with the wrong ticket through his lack of ability to express what he needs specifically to the ticket-office attendant. When buying train tickets, there is noticeable task avoidance amongst many people on the spectrum.

3.7.4.4 Scenario D: Shop an Online Supermarket§

Young adult male with ‘classic’ Autism. He has a severe cognitive delay and is non-verbal, a side effect of which is extreme social inhibition. He is able to communicate via pictures when necessary with his family and carers. A local supermarket is a good example of a place where he can easily become overwhelmed, which severely affects his ability to communicate effectively. However, in the comfort of his own home he is much better able to function, and therefore is less dependent upon others for help. The task of online shopping is made much easier if a very- specific item is required and there is little choice.

3.7.3.1 Consistency§

• "Ensure that navigation is consistent throughout a site.
• Similar interface elements and similar interactions should produce predictably similar results." (See 7.)

3.7.3.2 Transformability§

• "Support increased text sizes
• Ensure images are readable and comprehensible when enlarged
• Ensure color alone is not used to convey content
• Support the disabling of images and/or styles" (See 7.)

3.7.3.3 Multi-modality§

• "Provide content in multiple mediums
• Use contextually-relevant images to enhance content
• Pair icons or graphics with text to provide contextual cues and help with content comprehension" (See 7.)

3.7.3.4 Focus and Structure§

• "Use white space and visual design elements to focus user attention
• Avoid distractions
• Use stylistic differences to highlight important content, but do so conservatively
• Organize content into well-defined groups or chunks, using headings, lists, and other visual mechanisms
• Use white space for separation
• Avoid background sounds" (See 7.)

3.7.3.5 Readability and Language§

• "Use language that is as simple as is appropriate for the content
• Avoid tangential, extraneous, or non-relevant information
• Use correct grammar and spelling
• Use a spell-checker. Write clearly and simply.
• Maintain a reading level that is adequate for the audience
• Be careful with colloquialisms, non-literal text, and jargon
• Expand abbreviations and acronyms
• Provide summaries, introductions, or a table of contents for complex or lengthy content
• Be succinct
• Ensure text readability
  • Line height: The amount of space between lines should generally be no less than half the character height.
  • Line length: Very long lines of text (more than around 80 characters per line) are more difficult to read.
  • Letter spacing, word spacing, and justification: Provide appropriate (but not too much) letter and word spacing. Avoid full justified text as it results in variable spacing between words and can result in distracting "rivers of white" - patterns of white spaces that flow downward through body text.
  • Sans-serif fonts: These fonts are generally regarded to be more appealing for body text.
  • Adequate text size (Very small text): Text should generally be at least 10 pixels in size.
  • Content appropriate fonts: Visually appealing and content-appropriate fonts affect satisfaction, readability, and comprehension.
  • Paragraph length: Keep paragraph length short.
  • Adequate color contrast: Ensure text is easily discerned against the background and that links can be easily differentiated from surrounding text.
  • No horizontal scrolling: Avoid horizontal scrolling when the text size is increased 200-300%" (See 7.)

3.7.3.6 Orientation and Error Prevention/Recovery§

• Give users control over time sensitive content changes: Avoid automatic refreshes or redirects. Allow users to control content updates or changes. Avoid unnecessary time-outs or expirations. Allow users to request more time.
• Provide adequate instructions and cues for forms: Ensure required elements and formatting requirements are identified. Provide associated and descriptive form labels and fieldsets/legends.
• Give users clear and accessible form error messages and provide mechanisms for resolving form errors and resubmitting the form
• Give feedback on a user's actions: Confirm correct choices and alert users to errors or possible errors.
• Provide instructions for unfamiliar or complex interfaces
• Use breadcrumbs, indicators, or cues to indicate location or progress: Allow users to quickly determine where they are at in the structure of a web site (e.g., a currently active "tab" or Home > Products > Widget, for example) or within a sequence (Step 2 of 4). Next/Previous options should be provided for sequential tasks.
• Allow critical functions to be confirmed and/or canceled/reversed
• Provide adequately-sized clickable targets and ensure functional elements appear clickable: Use labels for form elements, particularly small checkboxes and radio buttons, and ensure all clickable elements appear clickable and do not require exactness.
• Use underline for links only
• Provide multiple methods for finding content: A logical navigation, search functionality, index, site map, table of contents, links within body text, supplementary or related links section, etc. all provide multiple ways for users to find content." (See 7.)

3.7.7.1 Guidelines§

• Cognitive Web Accessibility Checklist (Last Updated September 2, 2009). WebAIM, Center for Persons with Disabilities, Utah State University.
• Friedman M, Bryen D (2007). Web accessibility design recommendations for people with cognitive disabilities. Technology and Disability; 19(4): 205-212.
• Designing websites suitable for people with autism spectrum disorders (Last Updated March 16, 2008). The National Autistic Society.
• Poulson D, Nicolle C (2004). Making the Internet accessible for people with cognitive and communication Impairments. Universal Access in the Information Society; 3(1): 48-53.
• Telecommunications Problems and Design Strategies for People with Cognitive Disabilities (Last Updated August 16, 1999). World Institute on Disability.

3.8.4.1 Booking a Train Ticket Online§

Scenario A “Jenny” is dyscalculic. She is a mother with 2 young children. She is trying to book train tickets online for herself and her two children. The train journey involves 1 change where she must walk to a different platform and also must ensure that her first train arrives at the change destination with enough time for her to find the correct platform before the train sets off for the second part of her journey. She needs to be able to book the tickets for the correct time and with the appropriate rail card, in order to be able to qualify for discounts. She also needs to be able to remember her password for her bank’s security system in order that she can purchase the tickets; this password is made up of a combination of letters and numbers to fulfil the bank’s ‘secure password’ criteria.

3.8.4.2 Using Online Banking to Pay Someone New§

Scenario B “Emily” is a high school student who struggles to understand many of the topics covered in her maths, science and music lessons. She needs to use her online banking account to transfer some money into a friend’s bank account. She hasn’t transferred money online to this particular friend before so she must set up a new user which requires using a card reader and typing in a code which appears on the card reader only for 30 seconds before it changes to increase security.

3.8.4.3 Changing the Payment Details for an Online Supermarket Shop§

Scenario C “George” is an elderly gentleman who doesn't like to leave his house and does his supermarket shop online once a week and gets it delivered to his door. His bank details are stored on the shopping website so he doesn’t have to keep typing them in, however he has just been sent a new bank card as his old one has expired so he must re-enter all the details necessary to complete his shop.

3.8.4.4 Online Shopping§

Whilst dyscalculics may find it relatively simple to set up an online shopping account, it is far harder to complete the actual task of shopping. This stems from the inability to grasp the concept of money and the amount a product costs in relation to the amount of money they might have in their bank account. As a result of this dyscalculics frequently find themselves overdrawn as the task of calculating the numbers to produce a final figure which has some meaning to them as opposed to being a collection of random numbers is a concept they cannot master. This often leads to active avoidance of the task or strong reliability on others- neither of which is a sustainable solution. Quantities are also an abstract concept with dyscalculics often buying far too much or not nearly enough as it is difficult for them to work out exactly how much they need. Anything that involves weights and measures e.g. 1 kg of potatoes is also almost impossible to understand.

3.8.8.1 Etiology§

Adult neuropsychological and neuroimaging research points to the intraparietal sulcus as a key region for the representation and processing of numerical magnitude (4). This raises the possibility of a parietal dysfunction as a root cause of dyscalculia (4). The following two studies support this research.

Virtual Dyscalculia Induced by Parietal-Lobe TMS Impairs Automatic Magnitude Processing

UCL scientists state that dyscalculia is a result of a malformation in the right parietal lobe in the brain – however the underlying dysfunction is relatively unknown (c.07). The study involved using neuronavigated transcranial magnetic stimulation (TMS) to stimulate the brain and cause dyscalculia, only for a few hundred milliseconds, in non-dyscalculic individuals. The subjects then completed maths tasks whilst under stimulation and produced dyscalculic like behaviour. However when the left parietal lobe was stimulated under TMS this behaviour was not observed and therefore it can be reasonably assumed that there is a causal relationship between defects in the right parietal lobe and dyscalculia. (3)

The above research is supported by the following research study: Impaired parietal magnitude processing in developmental dyscalculia - The study was conducted by Gavin R. Price, Ian Holloway, Pekka Räsänen, Manu Vesterinen and Daniel Ansari. The study shows that in children with developmental dyscalculia the right intraparietal sulcus is not modulated in response to numerical processing demands to the same degree as in typically developing children. This suggests a causal relationship between impairment of parietal magnitude systems and developmental dyscalculia. (4)

Research by Shalev, et al. suggests that some families have a genetic predisposition to dyscalculia resulting in prevalence 10x higher than in the general population. (5) Although Dyscalculia cannot be cured, it is hoped that early detection and remedial teaching can go a long way to reducing the effects of dyscalculia on the individual.

3.8.8.2 Comorbidity§

High comorbidity with ADHA (estimates range between 15-26%) and Dyslexia (estimates range between 17-64%)(6). There is strong evidence to suggest Turners Syndrome and Gerstmann’s Syndrome are associated with Dyscalculia(7).

3.8.8.3 Guidelines§

Although there are no specific guidelines produced by a governing body, there are several ways to help an individual with dyscalculia in order to improve their mathematical abilities.

• Study sheets/summary sheets/outlines of most important facts
• Supplementry aids (vocabulary, multiplication cards, etc.)
• Visual demonstrations
• Instructions/directions given in different channels (written, spoken, demonstration)
• Visual or multisensory materials
• Mnemonic aids/devices

Some more useful guidelines regarding Dyscalculia, specifically for school children are available from Leeds City Council (PDF): Guidelines for Specific Learning Difficulties in Maths/Dyscalculia

Dyscalculia is still a relatively unknown disability with many of those affected by it not being diagnosed until later in life. Often, children in schools especially, those affected are thought to be stupid or lazy as many people are unaware of dyscalculia’s existence. This is analogous to the treatment of people with dyslexia.

7.1.1 Definitions§

from: LDonline - What is Executive Function?

1. Inhibition - The ability to stop one's own behavior at the appropriate time, including stopping actions and thoughts. The flip side of inhibition is impulsivity; if you have weak ability to stop yourself from acting on your impulses, then you are "impulsive."
2. Shift - The ability to move freely from one situation to another and to think flexibly in order to respond appropriately to the situation (
3. Emotional Control - The ability to modulate emotional responses by bringing rational thought to bear on feelings. (tolerate frustration)
4. Initiation - The ability to begin a task or activity and to independently generate ideas, responses, or problem-solving strategies (also, ability to finish)
5. Working memory - The capacity to hold information in mind for the purpose of completing(/performing) a task
6. Planning/Organization - The ability to manage current and future- oriented task demands.
7. Organization of Materials - The ability to impose order on work, play, and storage spaces.
8. Self-Monitoring - The ability to monitor one's own performance and to measure it against some standard of what is needed or expected.

7.1.2 Functional implications of executive function disorder§

from http://learningdisabilities.about.com/od/eh/a/executive_funct.htm

Trouble with the following:

• Estimating and visualizing outcomes;
• Analyzing sights, sounds, and physical sensory information;
• Perceiving and estimating time, distance, and force;
• Anticipating consequences;
• Mentally evaluating possible outcomes of different problem-solving strategies;
• Ability to choose actions based on the likelihood of positive outcomes;
• Choosing the most appropriate action based on social expectations and norms; and
• Performing tasks necessary to carry out decisions.

Manifested as:

• difficulty planning and completing projects;
• problems understanding how long a project will take to complete; (jim-author task - estimated time to complete form, application, etc.)
• struggling with telling a story in the right sequence with important details and minimal irrelevant details;
• trouble communicating details in an organized, sequential manner;
• problems initiating activities or tasks, or generating ideas independently; and
• difficulty retaining information while doing something with it such as remembering a phone number while dialing.

Strategies to over-come or manage deficits:

• Give clear step-by-step instructions with visual organizational aids. (jim-author task)
  • Be as explicit as possible with instructions. (jim-author task)
  • Use visual models and hands-on activities when possible. (jim -perhaps videos or audio)

7.1.3 Other References§

• Executive Function Dysfunction: The Newest “Learning Disability”
• What Is Executive Function?
• Wikipedia - Executive Functions
• Executive Function Fact Sheet
• Wikipedia - Executive Dysfunction
• What Is Executive Functioning?
• http://trace.wisc.edu/docs/comp_screen_interfaces_96/comp_screen_interfaces.htm Computer & screen-based interfaces: Universal design filter (Ellen Francik - 1996)
• Telecommunications Problems and Design Strategies for People with Cognitive Disabilities (PDF) - (Francik, et al 1999)
• Designing for Cognitive Disabilities
• Developing sites for users with Cognitive disabilities and learning difficulties