Designing for People with ADHD

Attention Deficit Hyperactivity Disorder, or ADHD, seems to be growing much more popular in recent years - especially with the COVID pandemic and rise of TikTok. In actual fact, diagnosis rates have been on the rise for a number of years. This can be attributed to a number of elements, including wider (online) health access, increased recognition of inattentive (rather than exclusively hyperactive or impulsive) symptoms, growing awareness of symptoms in women and marginalised populations, and a developing understanding of the impacts of childhood trauma on our cognitive and emotional development.

TikTok and Instagram have undoubtedly played a role in the more recent uptick in adult diagnoses, but it is less to do with trendiness and much more a result of increased awareness, shared experiences, decreased stigma, and the power of online communities. As one comic creator explained in a 2022 interview with The Guardian:

“I see the relief and the belonging that has started to occur from people who have felt like they didn’t fit anywhere,” says [Dani] Donovan, the ADHD comics artist. “They found this space to be, like, ‘Oh OK, these are my people’. These are my people.”

“TikTok trends or the pandemic? What’s behind the rise in ADHD diagnoses” from The Guardian

What does this all mean?

Attention Deficit Hyperactivity Disorder is a specific diagnosis of a cluster of symptoms which fall within the spectrum of neurological differences, specifically as a Neurodivergent condition. Neurodivergence can also include Dyslexia, Dyspraxia, Autism, Tourette’s, and other less common diagnoses. In short, neurodiversity “refers to the different ways a person’s brain processes information", while Neurodivergence applies to a specific collection of conditions and diagnoses.

Each Neurodivergent condition comes with its own common (though not necessarily universal) set of strengths and challenges - many of which can be shared across numerous conditions. For ADHD, this often includes:

• Difficulties with time perception and management
• Impulsivity and recklessness
• Disorganisation and forgetfulness
• Inconsistent or lacking focus
• Hyperfocus on specific tasks
• Fidgeting or difficulty relaxing
• Low threshold for overstimulation
• Fatigue and low energy
• Periods of excitability and high energy

While some of these symptoms may present as minor for some people, the frequent difficulties with education, employment, and basic life tasks mean that the total experience of ADHD "is considered a disability from both legal and medical perspectives".

Attention deficit hyperactivity disorder (ADHD) is a common mental health condition that affects the way people think, behave, and navigate everyday life.

According to federal law, it can also be considered a disability if it negatively impacts your ability to succeed at work or school.

“Is ADHD a Disability?” from PsychCentral

How is this impacted by design?

For someone with ADHD, the disregulation of attention and diminished control over focus can make navigating digital products difficult, distracting, and disagreeable at times. Consider the following patterns or experiences we commonly see on the web or throughout native applications:

• Autoplaying video or audio, especially when the pause/stop controls are not easily found or available at all
• Drawn out walkthroughs, introductions, or “what’s new” slides that must be manually skipped through before reaching the intended content
• Lengthy loading or processing times, advertisements that can’t be skipped, or other material that forces users to wait longer than expected
• Multi-step forms with no clear “step x of y” or other indicators of progress - especially when they can not be saved and completed at another time
• Navigation, labelling, or instructions that are inconsistently named or do not remain available throughout the application
• Many external links, references, or “more information” callouts which pull attention away from the core content and messaging*

*Author’s note: I realize that blog posts like you are currently reading are absolutley riddled with this exact issue! It is important, however, to provide context for and confidence in the material you are reading.

Challenges with time perception and management, struggles with decision-making, as well as low stress or overstimulation tolerance can make other common experiences difficult for many users with ADHD. These can include:

• Strict session times for long and complicated forms or services with many options to decide between (such as booking a flight or hotel)
• Strong messaging around limited quantities, “only x left!”, or other manipulative tactics to increase impulsive purchases
• Unclear or inconsistent labelling and instructions when user action or input is required, especially for government, banking, or other important processes
• Requiring detailed information or other records which may not be immediately on hand without ample warning and instructions for the user
• Completing an action or transaction without clear success, error, or status messaging for the user - such as notification, email, or a popup modal

How do we design an accessible experience for ADHD?

Because ADHD (along with other Neurodivergent conditions) is a disability, it will fall within your existing accessibility compliance, organisational requirements, and inclusive design practices.

There are a handful of Web Content Accessibility Guidelines (WCAG) criteria which apply directly to many of the considerations listed in the previous section, including pause/stop controls, unexpected context changes, and consistency for labelling and descriptions. The World Wide Web Consortium (W3C), the maintainers of WCAG, have also put together detailed descriptions, storytelling, and further resources related to Neurodivergence under their "Accessibility Fundamentals" documentation. This includes specific user scenarios on the subject:

Preety is a middle school student with attention deficit hyperactivity disorder with dyslexia. Although she has substantial difficulty reading, she particularly enjoys her literature class.

“Stories of Web Users” from W3C

WebAIM, another trusted online accessibility resource, has also collected helpful guidelines and considerations for designing and testing an ADHD-friendly digital product.

In many ways, it's hard to define when a page is "accessible" to users with cognitive disabilities. How simple is simple enough? For the most part, cognitive web accessibility is one of those "you know it when you see it" things. Common sense, holistic evaluation, and user testing should predominantly guide cognitive web accessibility evaluation.

“Evaluating Cognitive Web Accessibility” from WebAIM

Taking the first step

ADHD, among many other “invisible disabilities”, can often be overlooked as we design and build digital products. Rapidly developing medical and psychological understanding, diagnostic criteria, and social recognition means we are breaking new ground in many ways. As with any accessibility effort, it is important to remember that progress trumps perfection.

Many small improvements and considerations rolled out regularly will always help more people than a perfect product that never ends up getting released!

When it comes to accessibility, I encourage taking that first step. Don’t wait until you get the website, product, or whatever just right. Don’t wait until you launch something.

No matter how small it is, it’s a step forward.

“Accessibility: Why You Need to Work Toward Progress Over Perfection” by Meryl Evans