Hidden Disabilities: Is Your e-Learning Fully Section 508 Compliant?

While most of us may consciously design e-Learning for learners who have more “visible” disabilities such as those who are blind, deaf, or have mobility challenges, do any of us design for the more “hidden disabilities” such as Autism, Attention Deficit Disorder, Dyslexia, or Sensory Integration Dysfunction? Perhaps some of us do, depending on our experiences, but perhaps some of us wouldn’t know where to begin.

The Federal Government requires that electronic and information technology be made accessible to people with disabilities, but does this include both visible disabilities and hidden disabilities? Yes, it does. Instructional designers should consider both visible disabilities and hidden disabilities when designing courses.

“So,” you ask, “What do you mean hidden disabilities? Why should I care about hidden disabilities in my design? Which hidden disabilities should I consider when designing e-Learning? How much extra time will it take me to address these disabilities? What are some specific methods to incorporate into my e-Learning design in order to meet the needs of those with hidden disabilities?”

In this article I list some of the more common hidden disabilities, describe characteristics of these disabilities, and then discuss techniques you (as an instructional designer) can incorporate into your projects in order to better meet these hidden needs. You may find that you are already implementing numerous techniques, but by reading this article you will be able to state specifically how you are addressing the needs of those with hidden disabilities.

Section 508 overview

Section 508 is part of the Rehabilitation Act of 1973, which was amended in 1998. This amendment, Section 508, states that electronic and information technology must be made accessible to people with disabilities. This includes e-Learning. The purpose of Section 508 is to eliminate barriers in information technology, to make available new opportunities for people with disabilities, and to encourage development of technologies that will help achieve these goals.

It is important to note that not all agencies and organizations must comply with Section 508. If you work for the Federal Government, provide Federal Agencies with electronic and information technology, or work for a State Agency or provide electronic and information technology to a state agency in which that state mandates Section 508 compliance, then you do have to comply with Section 508. Many organizations and corporations in the private sector who are not required to meet Section 508 are doing so anyway, as they feel the requirements will “trickle down” to them in the near future, so they might as well be ahead of the game.

You may be thinking, “There seem to be too many disabilities for me to consider in my design! Are there specific ones covered under Section 508?” Section 508 simply refers to “people with disabilities.” Well, let’s first examine what a disability is considered to be. To find that answer, we need to turn to another law, the Americans with Disabilities Act (ADA).

ADA prohibits discrimination and ensures equal opportunity for persons with disabilities in employment, state and local government services, public accommodations, commercial facilities, and transportation. ADA states that a disabled individual is a person who meets at least one of the following tests:

• He or she has a physical or mental impairment that substantially limits one or more of his/her major life activities
• He or she has a record of such an impairment
• He or she is regarded as having such an impairment

Note that impairments may be physiological, psychological, or mental. So, in essence, the law considers a disability to be any one of a long list of items as long as the above criteria are met. Unfortunately, this definition does little to narrow down the list of disabilities we should design for, but don’t get discouraged! Read on and you may be surprised by what is revealed!

Visible disability vs. hidden disability

You may hear disabilities referred to as visible or as hidden. Visible disabilities are those that you can clearly observe. For example, a person with a visible disability may be blind, paralyzed, or deaf. Hidden disabilities are more difficult to observe. In other words, you cannot directly infer hidden disabilities. Examples of hidden disabilities may include dyslexia, low vision, autism, or visual perceptual deficit.

People with hidden disabilities frequently do not make their disability known to upper management,

coworkers, or colleagues. As an instructional designer, you most likely will not have knowledge of whether your target audience includes people with hidden disabilities. Thus, you should typically consider hidden disabilities as being a characteristic of your audience.

According to the U. S. Census Bureau, about 49.7 million Americans have a disability (this number includes people of all ages). The U.S. Department of Labor reported that there were 11.3 million workingage adults (18 to 64) with disabilities in the years of 1994-1995. It is difficult to obtain statistics on the exact number of working adults who have a disability. However, the statistics that are available are remarkable and emphasize the chances there will be those in your target audience with a hidden disability.

Why should you consider disabilities, especially hidden disabilities, in your design? Let us begin with the most obvious. If you design for the Federal Government, you MUST design to meet the needs of those with disabilities, hidden or visible, even if those individuals are not in the current target audience. On the other hand, you may not be designing for an agency requiring 508 compliance, but perhaps you would still like to know what steps you can take to make your e-Learning most effective in meeting the needs of those with disabilities.

Examples of hidden disabilities

There are many hidden disabilities, too many to list them all in this article. My focus in this article is to give you examples of hidden disabilities, describe characteristics of the disability, and then list techniques to address these disabilities in e-Learning. I’ll also discuss some of the more common hidden disabilities. It is important to note that people with hidden disabilities discussed in this article all have average to above average intelligence.

Acquired Brain Injury

Acquired Brain Injury could be caused by lack of oxygen, poisoning, infection, or trauma to the head such as a strike by an object (most common type of brain injury). Over five million Americans today are living with a traumatic brain injury-related disability (www.healthsystem.virginia.edu). Cognitive as well as physical deficits may occur. Cognitive deficits include language and communication, information processing, memory and perceptual skill challenges. Physical deficits may include ambulation, balance, fine motor skills, strength, and endurance.

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is another neurobiological disorder in which the person displays developmentally inappropriate levels of attention, concentration, distractibility, and impulsivity. While all adults may exhibit one or more of the symptoms of ADHD, those with ADHD consistently display these characteristics and behaviors over a period of time and, most importantly, these symptoms impair a person’s daily living. These behaviors may include distractibility, impulsivity, inattention, difficulty staying on task, having many projects going on at one time and rarely completing any of them, irritability, difficulty falling asleep, and difficulty waking up.

Asperger’s Syndrome

Asperger’s Syndrome is a milder variant of Autism. Similar to Autism, individuals with Asperger’s Syndrome have serious deficits in social and communication skills and may isolate themselves socially and display eccentric behavior. People with Asperger’s Syndrome have impairments in two-sided social interactions and non-verbal communication, have difficulty in articulating due to abnormalities of inflection, may display repetitive speech, and typically have gross motor difficulties.

Auditory Perceptual Deficit

This means that a person has difficulty receiving accurate information through auditory means, even though there is not a problem with their hearing. The problem is in how the brain interprets what is heard. People may have challenges understanding and remembering oral instructions, differentiating between similar sounds, may hear inaccurately, or have challenges hearing one sound over a background noise.

Autism

Autism is a complex developmental disability, and affects each person differently and in varying degrees as it is a spectrum disorder. Adults with autism typically show difficulties in verbal and nonverbal communication and social interactions. People with autism may also process and respond to information in unique ways, display uneven gross or fine motor skills and may be non-responsive to verbal cues. Autistic individuals are also resistant to change, prefer being alone, display little or no contact, and may be sensitive to sound. According to Autism-Society.org, as many as 1.5 million Americans today have some form of autism, and this number is on the rise.

Bipolar disorder

Three million people in the United States suffer from bipolar disorder. Bipolar disorder is also known as manic-depression. It is an affective disorder that causes periodic mood swings in which the individual cycles from depression to mania. As with typical depression, the depression cycle may be characterized by having a lack of motivation, difficulty doing tasks, short attention span, decreased appetite, crying spells, difficulty in getting to sleep or sleeping too much, and in the more severe cases thoughts of self harm. When an individual swings to mania, they can suffer from one of two types of mania: Full mania and hypomania. Full mania may be characterized by a decreased need for sleep, decreased selfcontrol, overspending, increased sexual activity, irritability, rage, risk-taking behaviors, and in the more severe cases psychotic states. Hypomania is described as having the same behaviors, to a less extreme level.

Dyslexia

Dyslexia is a cognitive deficit in which a person's reading and/or writing ability is significantly lower than that which would be predicted by his or her general level of intelligence. People are diagnosed as dyslexic when their reading problems cannot be explained by a lack of intellectual ability, inadequate instruction, or sensory problems such as poor eyesight. Adults with dyslexia may have difficulty with word recognition that significantly affects acquisition of knowledge and ability to analyze written material. They may also display a slow rate of reading, difficulty with spelling and written composition, and difficulty taking notes.

In addition to the typical forms of dyslexia, there are numerous related disorders (taken directly from http://en.wikipedia.org/):

• Scotopic sensitivity syndrome — a form of dyslexia which makes it very difficult for a person to read black text on white paper.
• Dyxpraxia — a neurological disorder characterized by a marked difficulty in carrying out routine tasks involving balance, fine-motor control, and kinesthetic coordination.
• Verbal Dyspraxia — a neurological disorder characterized by marked difficulty in the use of speech sounds, which is the result of an immaturity in the speech production area of the brain.
• Dysgraphia — a neurological disorder characterized by distorted and incorrect writing. Causes difficulty with forming letters or writing within a defined space.
• Dyscalculia — a neurological disorder characterized by a problem with learning fundamentals and one or more of the basic numerical skills. Often people with this disorder can understand very complex mathematical concepts and principles but have difficulty processing formulas and even basic addition and subtraction. Dyscalculia causes people to have problems doing arithmetic and grasping mathematical concepts, more so than the average person who has difficulty in math.

Chronic Fatigue Syndrome (CFS)

CFS affects between 500,000 and 800,000 Americans, and according to National Institutes of Health, CFS most commonly occurs in women ages 30 to 50. Individuals display profound fatigue that is not improved with bed rest and may worsen with physical or mental activity. Individuals with CFS may have difficulty concentrating, experience migraine headaches, photosensitivity, and temperature sensitivity.

Depression

Depression is one of the most common and most serious mental disorders. A depressive disorder involves the body, mood, and thoughts. Depression may be characterized by having a lack of motivation, difficulty doing tasks, short attention span, decreased appetite, crying spells, difficulty in getting to sleep or sleeping too much, and in the more severe cases thoughts of self harm. In any given 1-year period, 9.5 percent of the population, or about 18.8 million American adults, suffer from a depressive illness (nimh.nih.gov). Depression affects a person’s productivity, judgment, ability to work with others, and overall job performance.

Epilepsy

Epilepsy is a chronic medical condition produced by temporary changes in electrical function of the brain, causing seizures which affect awareness, movement, or sensation. While on the job, people with epilepsy might experience limitations related to memory, disorientation, disorganization, time management, performing or completing tasks, difficulty using office equipment including the computer, limitations in motor abilities, and limitations associated with photosensitivity including using the computer and alternative lighting.

Fibromyalgia Syndrome (FMS)

Depending on the source, it is reported that from 3 to 6 million (some report as high as 12 million) Americans suffer from Fibromyalgia. FMS is a chronic condition that causes an individual widespread pain and severe fatigue, either all over the body or in one particular region. Individuals with Fibromyalgia may have difficulty concentrating, experience gross and fine motor impairments, and fatigue and weakness.

Lupus

Lupus is a chronic, autoimmune disease that affects one out of every 185 Americans. It causes inflammation of various parts of the body, especially the skin, joints, blood, and kidneys. People with Lupus experience joint and muscle pain, fatigue, photosensitivity, fine and gross motor impairment, cognitive impairment, and fatigue.

Multiple Sclerosis (MS)

MS is a chronic disease of the central nervous system that causes destruction of a protein that forms a protective coating around the nerve cells. When this protein is destroyed, signals carried through the nerve cells are interrupted or delayed, resulting in various neurological symptoms occurring throughout the body. People with MS may have difficulty walking, experience numbness or feelings of pins and needles, have pain and loss of vision, undergo inflammation of the optic nerve, experience lack of coordination, and may have slurred speech. On the job, individuals with MS may face cognitive impairment, fatigue, fine and gross motor impairment, heat sensitivity, as well as vision and speech impairment.

Sensory Integration Dysfunction

Sensory Integration Dysfunction is a neurological disorder. This disorder refers to a person's ability to register and process information from their five commonly known senses (vision, auditory, touch, olfaction, and taste) plus their sense of movement and their positional sense. For example, a person with sensory integration dysfunction may be unable to filter out background noise to focus on their task at hand. As a result they may become hyperactive or distracted. People with sensory integration dysfunction may be extremely sensitive to lighting, or someone without positional sensitivity may not be aware of the boundaries of their body, like where the beginning and end of their arms are.

Visual Perceptual Deficit

About 40% of all Americans have functional vision deficits (www.vision-therapy.com). Visual perceptual deficit is just one of these many deficits. People with visual perceptual deficit have difficulty receiving and/or processing accurate information from the sense of sight, even though there is nothing wrong with their vision. These individuals may have challenges picking out an object from a background of other objects or seeing things in correct order. People with visual perceptual deficit may experience reversals of letters, for instance mistaking a “b” for a “d”, or lose their place frequently when reading.

Design techniques to address hidden disabilities

These fifteen disabilities are a very small subset of all the possible hidden disabilities. At first glance it may seem that designing for these fifteen would be out of the question or near impossible, let alone designing for the longer list of all disabilities. But let’s look more closely at common characteristics of the disabilities previously discussed. Are there any commonalities we can pull from the list of characteristics?

Let’s begin with Acquired Brain Injury. One common characteristic of this hidden disability is a deficit in information processing. What other hidden disabilities discussed have this characteristic in common with Acquired Brain Injury? Looking back through the discussion, we find that challenges in information processing are also common among people with Autism and Sensory Integration Dysfunction. Similarly, lack of motivation is a characteristic of individuals with Bipolar Disorder and Depression.

Gross and/or fine motor impairments are common among individuals with acquired brain injury, Asperger’s Syndrome, Autism, Fibromyalgia Syndrome, Lupus, and Multiple Sclerosis.

The point is that many hidden disabilities share common characteristics. As a matter of fact, hidden disabilities are typically grouped together based on type. For example, the hidden disabilities listed above could be grouped into three categories: those related to cognition, chronic health problems, and psychological disorders. Disabilities within each group often share common characteristics; therefore a single design strategy may be helpful for more than one hidden disability. Interestingly, there may also be strategies that can be shared among groups of disabilities. For example, fine and/or gross motor impairments are characteristic of many cognitive related disabilities as well as several disabilities falling under chronic health problems. Therefore, there are some techniques that could be used in all, such as providing alternative navigation techniques for users.

Let’s look even more closely at disability characteristics and design strategies that would be helpful to those individuals who have the particular disability. For individuals who display fine and/or gross motor impairments, helpful design strategies may be to provide an audio version of text so they do not have to scroll through pages of text, or design the course so that tabbing can be used for navigation instead of requiring the use of a mouse. You may also provide opportunities for individuals to skip repetitive navigation links.

Possible design strategies for persons who display information processing deficits, limitations in memory, a short attention span, or slow rates of reading may be to chunk information into smaller pieces, rather than displaying long strings of information. You should make sure the content in your course is simple, clear and to the point. You may also supply supplemental illustrations.

Bipolar Disorder, Attention Deficit Hyperactivity Disorder, and Chronic Fatigue Syndrome all display lack of motivation, difficulty concentrating, or difficulty staying on task. Design techniques to assist in overcoming these issues may include using a multimodal presentation (e.g. text, images, audio, etc.), provide opportunities for frequent practice and feedback, organize information well (e.g., use headings and chunk information), and provide clear and simple writing in your courses. For these characteristics it is also useful to use a high contrast between text and background.

To address visual deficits such as those that are characteristic in Visual Perceptual Deficit, Sensory Integration Dysfunction, Dyslexia and Multiple Sclerosis you may implement the following design strategies. First, use white space well. Make sure content is visually separated from page borders or embedded images or graphics. Be aware of the use of color, make sure there is a high contrast between text and background and do not use a background image unless it has learning significance. Also, watch the use of italicized text as this form of text can often appear to “dance” to people who have visual deficits. Lastly, be aware of the font type you use. Typically sans-serif fonts should be used, such as Arial or Verdana.

The information in Table 1 summarizes descriptions of each hidden disability and lists certain design techniques that are helpful to individuals with each disability. While this is not a comprehensive list of design techniques, it can give you a general sense of what techniques to incorporate. (For more information refer to the resources.) You will notice that many of the techniques are repeated among disabilities, but as discussed previously, disabilities share common characteristics therefore techniques can also be shared among disabilities.

Summary

Not only does Section 508 require that electronic and information technology be made accessible to people who are blind or deaf, but it also requires accessibility for people who may have less visible, or hidden, disabilities. This article listed and discussed characteristics of some of the more common hidden disabilities and provided examples of design techniques that, when implemented, help to address specific needs of people who have hidden disabilities. What is exciting is that you may already be implementing these design techniques! Contrary to what some might fear, designing for hidden disabilities most likely will not increase your workload at all. If you walk away from this article with nothing else, walk away with these four points:

1. Section 508 applies to both visible and hidden disabilities.
2. Disabilities can be grouped, thus a single design strategy will typically meet the needs of numerous disabilities in one group.
3. Characteristics are sometimes shared between groups of disabilities, thus a single strategy may meet the needs of a cognitive related disability as well as a disability categorized as a chronic health problem.
4. You may already be implementing design techniques that address hidden disabilities, making your course more accessible by individuals with disabilities.

Resources

Acquired Brain Injury (and other topics at UVA Health System)
http://www.healthsystem.virginia.edu/uvahealth/adult_pmr/braininj.cfm

American Fibromyalgia Syndrome Association
www.afsafund.org/

Conforming e-Learning to 508
http://www.access-board.gov/sec508/e-learning.htm

Disabilities Defined
http://www.teachersfirst.com/sped/prof/dis-search2.html

Dyslexia
http://www.dyslexia.org

Learning Disabilities Association: For Adults
http://www.ldanatl.org/aboutld/adults/index.asp

National Institute of Mental Health
http://www.nimh.nih.gov/

Section 508 Website
http://www.section508.gov

Vision Deficits
http://www.vision-therapy.com/About_Vision.htm (Editor's Note: As of December 18, 2009, this article appears to have been removed from the Web.)

Visual Perceptual Deficit
http://www.audiblox2000.com/learning_disabilities/dicv02.htm

VisCheck — Simulates Colorblind Vision
http://www.vischeck.com/

WebAIM: Articles on Cognitive Disabilities
http://www.webaim.org/techniques/cognitive/
http://www.webaim.org/techniques/articles/cognitive_too_little/

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