-
Notifications
You must be signed in to change notification settings - Fork 34
/
add.html
367 lines (366 loc) · 35.8 KB
/
add.html
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
<section>
<h4>Attention deficit hyperactivity disorder (ADHD)</h4>
<p>Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting both children and adults. It is characterized by some persistent (lasting at least 6 months) symptoms of hyperactivity, impulsivity, and/or inattention that have a significant impact on daily life or typical development. For a diagnosis of ADHD, symptoms must frequently occur in more than one environment (e.g., in work and at home), and must not be appropriate for the age of the individual. The symptoms should also cause social, educational, or work-related issues [[APA-1]].</p>
<p>Review of the available literature suggests that ADHD is not viewed as a single impairment / disease entity, but people with ADHD can be considered as a heterogeneous group of individuals defined by a series of behavioral symptoms. The symptoms presented vary in type and intensity between individuals with ADHD, and may vary in type and intensity with time for a given individual. </p>
<section>
<h5>Cognitive functions</h5>
<p>No single cognitive impairment characterizes people with ADHD [[APA-1]]. Cognitive impairments, although secondary, feature in the diagnosis of ADHD [[APA-1]]; and are vital in determining the learning and cognitive needs of people with ADHD. </p>
<p>Studies have suggested that children with ADHD exhibit multiple deficits in working memory, related to spatial storage and spatial executive functioning, which are independent of any language-learning disorders presented by the same individual [[Martinussen-1]]. It has also been suggested that dysfunctional, neurological, parallel-processing pathways are a potential partial explanation of executive-dysfunction association with ADHD, but further research on cognition from a neurophysiological and developmental point of view are required to confirm this [[Castellanos-1]]. </p>
<p>Cognitive impairments associated with ADHD include [[Nigg-1]]: </p>
<ul>
<li> issues with executive functioning; </li>
<li> reading learning disabilities; </li>
<li> math disabilities; </li>
<li> handwriting disabilities; </li>
<li> non-verbal learning disabilities; </li>
<li> diminished visual-processing speeds not related to inattention [[Weiler-1]]; </li>
<li> developmental coordination disorder / motor clumsiness -Motor clumsiness may be less prevalent in older children (9 years and older), teenagers, and adults with ADHD (Meyer & Sagvolden, 2006). </li>
</ul>
<p>Context-dependent cognitive effects associated with ADHD include issues with [[Nigg-1]]: </p>
<ul>
<li> slow, careful behavior; </li>
<li> fast, accurate behavior; </li>
<li> rapid-decision making; </li>
<li> planning, and short-term recall; </li>
<li> reward cues; </li>
<li> time estimation. </li>
</ul>
<p>It is unclear if any of these context-dependent cognitive effects are unique to ADHD. However, evidence suggests they are not explained by co-occurring problems and, in most instances, are more-clearly associated with ADHD (the issue being more pronounced) than with other disorders exhibiting the same issues [[Willcutt-1]]. </p>
<p>Comorbidity with learning disabilities is common in people with ADHD. The literature reviewed shows a wide variance of the incidence of people with ADHD that also present with learning disabilities of between 20% and 60% [[Czamara-1]]. This highly-variable overlap has been previously attributed to inconsistencies in the definition of learning disabilities, and a general over identification of learning disabilities [[Semrud-Clikeman-1]]. However, comorbidity with reading disorder [[Germanò-1]], dyslexia, dyspraxia [[Pauc-1]], and dyscalculia [[Lindsay-1]] have all been reported, although the underlying functional processes remain unclear [[Czamara-1]]. </p>
<p>Comorbidity with behavioral disabilities (such as oppositional-defiant disorder and developmental-coordination disorder) has been shown to be extremely high (>70%) amongst young children (Kadesjö & Gillberg, 2001), suggesting that ADHD without comorbidity is atypical in children with ADHD. </p>
</section>
<section>
<h5>Symptoms</h5>
<p>The most commonly used diagnosis of ADHD follows the guidelines outlined by the American Psychiatric Association (2013), and will be followed here. Three presentations (formerly called subtypes) of ADHD are recognized: </p>
<ol>
<li> Predominantly Inattentive ADHD </li>
<li> Predominantly Hyperactive-Impulsive ADHD </li>
<li> Combined ADHD </li>
</ol>
<section>
<h6>Predominantly Inattentive ADHD - symptoms</h6>
<p>Symptoms associated with Predominantly Inattentive ADHD include: </p>
<ul>
<li> failing to pay close attention to detail or making careless mistakes; </li>
<li> having difficulty sustaining attention; </li>
<li> not appearing to listen; </li>
<li> struggling to follow instructions to completion; </li>
<li> difficulty with organization; </li>
<li> avoiding or disliking tasks requiring a lot of thinking; </li>
<li> losing things; </li>
<li> being easily distracted; </li>
<li> being forgetful in daily activities. </li>
</ul>
</section>
<section>
<h6>Predominantly Hyperactive-Impulsive ADHD – symptoms</h6>
<p>Symptoms associated with Predominantly Hyperactive-Impulsive ADHD include: </p>
<ul>
<li> fidgeting with hands or feet or squirming in chairs; </li>
<li> having difficulty remaining seated; </li>
<li> running around or climbing excessively (in children), extreme restlessness (in adults); </li>
<li> difficulty engaging in activities quietly; </li>
<li> acting as if driven by a motor (adults will often feel inside like they were driven by a motor); </li>
<li> talking excessively; </li>
<li> calling out answers before questions have been completed; </li>
<li> difficulty in waiting or in taking turns; </li>
<li> interrupting or intruding upon others. </li>
</ul>
</section>
<section>
<h6>Diagnosis of ADHD</h6>
<p>To be diagnosed with ADHD using the above symptoms, a child should exhibit at least 6 of the symptoms. A late-teen or an adult should exhibit at least 5. The ADHD presentation exhibited depends upon the predominance of the symptoms, being: mostly-inattentive symptoms; mostly hyperactive-impulsive symptoms; or a relatively-equal mix of symptom types, resulting in Predominantly Inattentive ADHD, Predominantly Hyperactive-Impulsive ADHD, or Combined ADHD respectively. </p>
<p>ADHD presentations can be subdivided into mild, moderate, or severe depending upon both the number of symptoms exhibited, and the impact the symptoms have on the individual’s daily life. Presentations are not fixed. They can change throughout the lifetime of a person with ADHD, as can the severity of the individual symptoms. </p>
</section>
</section>
<section>
<h5>Their challenges</h5>
<p>Challenges for people with ADHD are dependent upon their presentation of ADHD and the symptoms associated with the individual. Due to the high incidence of comorbidity with learning disabilities, it is difficult to identify challenges that are unique to people with ADHD. As noted above, the number and the severity of the symptoms associated with a particular presentation of ADHD can vary with time [[CDC-1]]. A result of this is that the challenges for a person with ADHD can also vary in type and intensity as the individual ages. In general terms, the challenges associated with ADHD, highlighted by Nigg (2009), include the following. </p>
<ul>
<li>
<b>Issues with speed and attention to detail:</b> Tasks are often completed with excessive speed (Hyperactive-Impulsive), or excessively slowly due to lack of interest (Inattentive). In both cases, these behaviors are associated with inaccuracy. </li>
<li>
<b>Issues with rapid-decision making:</b> The ability to interrupt their responses often results in answers being blurted out and talking out of turn during meetings. </li>
<li>
<b>Executive Functioning and Working Memory:</b> The inability to follow instructions to their conclusion is common, especially when the instructions are presented in list form. This challenge can also extend to tasks that involve ordered steps, such as complex-arithmetical operations, or equation solving. Issues with working memory are often exhibited as forgetfulness. </li>
<li>
<b>Social Issues:</b> In addition to difficulty interpreting social subtexts, momentary lapses in attention are common. This can often result in missing important details if they are not repeated. Children with ADHD often have difficulty estimating the value of social contact, and consistently underrating the rewards associated with social contact when compared to control groups [[Demurie-1]]. </li>
<li>
<b>Self-worth Issues:</b> Anecdotal evidence from teachers and parents suggest that children with ADHD exhibit low self-esteem and lack of confidence. This may be a result of peer rejection, due to actions by a person with ADHD being considered inappropriate. Self-worth issues can result in tasks being abandoned earlier than would be the case with a control group, and a perceived lack of commitment to group and/or team activities. </li>
</ul>
</section>
<section>
<h5>Some persona with use case that address key challenges</h5>
<section>
<h6>Buying a book online</h6>
<p>Scenario A: "Paula" has been diagnosed with ADHD presenting as predominantly inattentive. She is 19 years old, with low self-esteem, and is easily discouraged. Her attention to detail is poor, and her attention span is low. She has a tendency to forget things quickly, and to give up in frustration. She has both younger and older siblings who do not present with ADHD. She does not receive medication.</p>
<p>She is trying to buy a book using an online retailer, for her father, as a birthday present. Paula has never used an online retailer before. She has decided that a book on Indian Cooking would be an appropriate gift. Her father does not read books in electronic format.</p>
<table>
<caption>
Table of Steps and Challenges
</caption>
<tbody>
<tr>
<th scope="col"> Step </th>
<th scope="col"> Challenge </th>
</tr>
<tr>
<td> 1. Search for an online book retailer. </td>
<td> <p>Minor challenges.</p>
<p> Some care must be taken when searching for a retailer. Depending upon the wording, the search may return a list of retailers of online books, rather than an online store that sells books. This can be mitigated by searching for a well-known retailer.</p>
<p>Auto suggestion returns meaningful results, and is relatively forgiving of typing errors. This helps mitigate any exhibited lack of attention to detail.</p>
</td>
</tr>
<tr>
<td> 2. Navigate the home page.</td>
<td> <p>Significant challenges.</p> <p>The home page of a typical retail site tends to promote multiple products. This adds a significant degree of distraction, and can result in the loss of focus on the task at hand. If the retailer sells multiple types of products, this challenge will increase markedly. There is little that can be done about this because the distracting information is an intrinsic part of the site design, and cannot be disabled by add-blocking settings.</p> <p>The search features, although towards the top of the screen, are not particularly prominent. Not being able to find them quickly may leave Paula frustrated; and may increase the likelihood of her giving up and trying a different vendor. As most vendors use a similar homepage layout, she may eventually abandon the attempt completely.</p> </td>
</tr>
<tr>
<td> 3. Search for books on Indian Cookery.</td>
<td><p>No significant challenges.</p> <p>The search engines are relatively robust with regard to typing errors. The resulting lists, although extensive, typically do not contain suggestions for other items not directly related to the search. Any advertising, if present, is discrete.</p></td>
</tr>
<tr>
<td> 4. Select a suitable book.</td>
<td> <p>Minor challenges.</p> <p>Most books are available in multiple formats (hardcover, paperback, or e-formats). Care must be taken in ensuring that the correct format is chosen. The type of format selected is not always obvious.</p> <p>When reviewing a book, there are often suggestions of similar books prominently presented and situated before customer reviews. This may cause distraction, and loss of focus, leading to navigation away from the page.</p></td>
</tr>
<tr>
<td> 5. Add the purchase to the shopping cart.</td>
<td> <p>No significant challenges.</p> <p>The call to action is standard across retail sites. The buy button is clearly displayed, and is positioned within the logical flow of the page. It will often maintain a fixed position if the page has been scrolled through.</p></td>
</tr>
<tr>
<td> 6. Create an account.</td>
<td> <p>Significant challenges.</p> <p>This step requires an attention to detail because e-mail addresses are typically required, and passwords created. Security requirements for passwords are not clearly explained. Often, errors are not captured until all of the information is submitted. This may present a significant challenge due to the required attention to detail, and to frustration that may result from poorly-managed error capture and correction.</p> </td>
</tr>
<tr>
<td> 7. Purchasing the item.</td>
<td><p>Minor challenges.<p> <p> Although the purchasing call to action is typically prominently positioned, the page itself often contains significant distractions in the form of suggestions for additional purchases. This may lead to loss of focus. This is part of the intrinsic design of the site. Little can be done to mitigate it.</p> <p>The options to add gift wrapping and individual messages may not be prominently displayed. The options may not be available later in the purchasing cycle. These options can easily be overlooked. Any error checking associated with the individual message is controlled by the browser.</p></td>
</tr>
<tr>
<td> 8. Adding a delivery address.</td>
<td><p>Significant challenges.</p> <p>This step may prove challenging because accuracy and attention to detail are required. Error capture and correction are minimal due to the nature of the information being captured. As the address details may be used to pre-populate a billing address at a later stage, errors at this stage may have additional impact.</p></td>
</tr>
<tr>
<td> 9. Add payment card details.</td>
<td><p>Significant challenges.</p> <p>This step presents challenges because the information must be entered accurately. The error handling may not be immediate, and may return somewhat cryptic responses. This may cause Paula to give up at this point. </p></td>
</tr>
<tr>
<td> 10. Confirm purchase.</td>
<td><p>No challenges.</p> <p>The successful completion of the order relies on the information provided at steps 8 and 9. While there is significant control at stage 9, if the details are incorrect, the payment will not be processed. Any errors due to lack of accuracy / attention to detail at step 8 may result in the book not being delivered to the correct address.</p></td>
</tr>
</tbody>
</table>
</section>
<section>
<h6>Booking train tickets online</h6>
<p>Scenario B: "Ian" is 34. He has been diagnosed with ADHD, presenting predominantly Hyperactive-Impulsive. He lives alone. Despite his outward appearance, social exclusion as a child has led to Ian having low self-esteem. Ian has a strong grasp of technology. He is not afraid of trying out new things.</p>
<p>Ian is planning a holiday in Ireland, where he has never visited. He wishes to book a return-train journey from Dublin to Galway.</p>
<table>
<caption>
Table of Steps and challenges
</caption>
<tbody>
<tr>
<th scope="col"> Step </th>
<th scope="col"> Challenge </th>
</tr>
<tr>
<td> 1. Search for online information.</td>
<td><p>No significant challenges.</p>
<p>Search engines are robust with respect to spelling and semi-ambiguous search terms. The highly-ranked, returned results are relevant. However, some high-ranking results attempt to plan routes, and require local geographic knowledge, which may result in some confusion.</p></td>
</tr>
<tr>
<td> 2. Select a suitable site.</td>
<td><p>Some challenges.</p>
<p>The sites returned are clearly labeled. The layout is clear and free of distractions. The official site of Irish Rail (<a href="http://www.irishrail.ie/">http://www.irishrail.ie/</a>) is close to the top of the list of returned sites, and will be used for the rest of the use challenge.</p>
<p>The first site returned, "Dublin Galway Fares - Irish Rail", is a beta site for a fare calculator. It is confusing to use. It requires the user to know which Dublin stations service Galway. The page contains a great deal of information that is not relevant to the task at hand. The function of the site is not clearly labeled. The information returned from a search is overwhelming. This could easily lead to loss of focus and confusion.</p></td>
</tr>
<tr>
<td> 3. Navigate the home page.</td>
<td><p>Minor challenges.</p> <p>The information on the home page is relevant to finding and booking train journeys. The navigation features are clear and typical of other websites. The form fields used in finding train times and booking tickets are prominently displayed. Any additional offers and information, which are not directly relevant, are mainly located in a position that does not detract from the primary information.</p></td>
</tr>
<tr>
<td> 4. Select route.</td>
<td> <p>No significant challenges.</p> <p>The fields used to select the starting point and the destination are robust with regard to typing errors. No local geographic knowledge is required to make the selection, although this can be used to refine the search. Date and time fields default to a calendar for selection when the field is selected. This negates any confusion caused by date formats.</p></td>
</tr>
<tr>
<td> 5. Select journey.</td>
<td> <p>Minor challenges.</p> <p>Although selecting the individual parts of the journey is straightforward with the amount of information presented, it is somewhat distracting. If the legend is displayed, each item has a link to more information that is loaded, without warning, in a new browser window. This is disorienting. It has the potential to cause a loss of focus.</p> </td>
</tr>
<tr>
<td> 6. Buy ticket.</td>
<td> <p>No challenges.</p> <p>Buying ticket opens a new secure area of the site where passenger details are added. The layout is clear. Options are kept to a minimum. The form is easy to fill in. </p></td>
</tr>
<tr>
<td> 7. Select seats.</td>
<td>
<p>Minor challenges.</p>
<p>Although the interactions on this page are fairly intuitive, there are no instructions on the usage of the page. The buttons to complete the seat selection require the user to scroll to the end of the page. This has potential to result in distraction and a loss of focus.</p> </td>
</tr>
<tr>
<td> 8. Initiate account creation.</td>
<td>
<p>No challenges.</p>
<p>The page is simply laid out with clear instructions.</p> </td>
</tr>
<tr>
<td> 9. Add personal details.</td>
<td><p>Significant challenges.</p>
<p>Most of the fields are free-form text that require accuracy and attention to detail. With the exception of the password confirmation, all error checking is done after the form is submitted. Although there is a confirmation dialog to check the address details, and messages give an indication of the error, there is a significant possibility of this step resulting in user frustration. This would likely lead to task abandonment.</p> </td>
</tr>
<tr>
<td> 10. Add payment and collection details.</td>
<td> <p>Significant challenges.</p>
<p> The page contains a number of features, which are not enabled, and which may cause confusion. Attention to detail is required when entering card details. Any errors are only returned when the form is submitted. Errors other than formatting errors, such as invalid card numbers or empty mandatory fields, are returned at step 11 rather than at this step. As step 11 is performed on a different site, manual error correction is both difficult and frustrating. This results in a likelihood of loss of focus, and / or abandonment of the task.</p>
<p> Two processes (payment details and delivery method) are combined on the page, which adds unnecessary complication and distraction.</p></td>
</tr>
<tr>
<td> 11. Card confirmation.</td>
<td><p>Minor challenges.</p> <p>The two-step verification process, used by the card vendor, introduces a second password requirement. Accuracy and attention to detail are required to complete this step.</p></td>
</tr>
<tr>
<td> 12. Close transaction.</td>
<td> <p>No challenges.</p> <p>The page clearly displays the reservation number with instructions on how to collect the ticket. It is clearly communicated that this information will be sent to the e-mail address supplied during step 9.</p> </td>
</tr>
<tr>
<td> A confirmation e-mail will be sent to Ian. He can use it to set up a reminder of the journey dates and times in a calendar.</td>
<td> </td>
</tr>
</tbody>
</table>
<p>This site presented Ian with few challenges due to the error checking at individual key steps. It is easy to focus on the task at hand and the fact that the activities can be achieved rapidly. </p>
</section>
<section>
<h6>Scenario: Researching and presenting a school project</h6>
<p>"Anne" is a 13 year old school student who has been diagnosed with ADHD presenting as Combined. She needs to conduct an online research project on the extinction of the dinosaurs. She is expected to consult multiple sources, which need not be academic papers. They will enable her to prepare a 15-minute PowerPoint presentation to be delivered to her class. She has one month to prepare. </p>
<p>[[Unlike the previous scenarios, this scenario does not concentrate on the individual-processing steps, but on the overall effect of the presentation of information.]] </p>
<table>
<caption>
Table of Steps and Challenges
</caption>
<tbody>
<tr>
<th scope="col"> Step </th>
<th scope="col"> Challenge </th>
</tr>
<tr>
<td> Search for information online.</td>
<td> No challenges. Search engines are robust with respect to spelling and typing errors. The auto suggest returns useful results. </td>
</tr>
<tr>
<td> Select sites for investigation.</td>
<td> This step presents a significant challenge to Anne due to information overload. </td>
</tr>
</tbody>
</table>
<p>[[As part of this scenario, 4 sites will be consulted. They will be assessed from Anne’s point of view as a person with ADHD.]] </p>
<table>
<tbody>
<tr>
<th scope="col"> Step </th>
<th scope="col"> Challenge </th>
</tr>
<tr>
<td> Consult about.com Dinosaur extinction. <a href="http://dinosaurs.about.com/od/dinosaurextinction/">http://dinosaurs.about.com/od/dinosaurextinction/</a></td>
<td> The site presents significant challenges to staying focused, and to relating to different parts of the article. This is due to the number of links to material unrelated to the topic in question; and to a series of advertisements that distract from the flow of information. Although the sub-pages are clearly defined with short summaries, they are not presented in a logical order. </td>
</tr>
<tr>
<td> Consult BBC NATURE Cretaceous-Tertiary mass extinction page. <a href="http://www.bbc.co.uk/nature/extinction_events/Cretaceous%E2%80%93Tertiary_extinction_event">http://www.bbc.co.uk/nature/extinction_events/Cretaceous%E2%80%93Tertiary_extinction_event</a></td>
<td> The site presents few challenges. The information flows logically. It is clearly laid out. The content is also presented in a less-passive manner than is usual. All of the links on the page are relevant. The linked pages present a challenge with respect to navigation because they are independent articles, and because there is no bread-crumb trail. The only way to retrace steps is through the browser's back button. </td>
</tr>
<tr>
<td> Consult Wikipedia - Cretaceous–Paleogene extinction event. <a href="http://en.wikipedia.org/wiki/Cretaceous%E2%80%93Paleogene_extinction_event">http://en.wikipedia.org/wiki/Cretaceous%E2%80%93Paleogene_extinction_event</a></td>
<td> The site presents challenges due to the volume of information presented, and due to the density of the text. Maintaining focus may prove challenging. </td>
</tr>
<tr>
<td> Consult Smithsonian National Museum of Natural History – Dinosaurs Why did they go extinct? <a href="http://paleobiology.si.edu/dinosaurs/info/everything/why.htm">http://paleobiology.si.edu/dinosaurs/info/everything/why.htm</a></td>
<td> The site presents significant challenges due to the volume of information, and due to the way that the text is structured. The site is designed to be navigated sequentially. This may prove a challenge to Anne. The lack of a bread-crumb trail and page titles may make orientation within the site difficult. </td>
</tr>
</tbody>
</table>
</section>
</section>
<section>
<h5>How they use the Web to include: email, apps, voice systems, IM.</h5>
<p>There is no apparent body of evidence that people with ADHD use the web in a particular way. The prevalence of other learning disabilities presenting with ADHD makes determinations of special-usage activities, which are unique to ADHD, problematic. However, anecdotal evidence [[Smith-1]], [[Tartakovsky-1]] suggests that the use of recurring e-mail tasks and voice mail; as well as automated reminders based on timers; are used to help people with ADHD to stay focused and "on task". </p>
</section>
<section>
<h5>How people with cognitive disabilities use optimized content and special pages</h5>
<p>There is no apparent body of evidence of special pages or content specifically-optimized to support people with ADHD. </p>
</section>
<section>
<h5>Characteristics of content optimized for this group</h5>
<p>Before content can be optimized to support users with ADHD, further research is required into the challenges presented by ADHD that are not a result of other learning disabilities. </p>
</section>
<section>
<h5>Specific technologies</h5>
<p>There are no specific assistive technologies for people with ADHD. There are, however, several iPhone and Android Apps that have proved useful to people with ADHD [[Watson-1]]. Anecdotal evidence [[Cummins-1]], [[Duffy-1]] suggests that tools and assistive technologies, which have proven useful for adults and students with ADHD, include: </p>
<ul>
<li> digital pens (such as Livescribe) that help with note taking when lack of concentration may lead to main points being missed; </li>
<li> word-prediction software (e.g., Co:Writer); </li>
<li> screen readers; </li>
<li> mind-mapping software; </li>
<li> speech-recognition software; </li>
<li> talking calculators (MathPad / Math talk), especially if they have timers/alarms to help students progress steadily; </li>
<li> timers and to-do lists; </li>
<li> using e-mail and voice mail as reminders. </li>
</ul>
<p>All of the above tools / techniques are designed to provide support with issues around accuracy and concentration, which are common to people with ADHD. </p>
</section>
<section>
<h5>Summary Existing research and guidelines</h5>
<p>ADHD was first clearly described by George Still in 1902. It may have been partially recognized as early as the late 18th Century [[Wikipedia-1]]. The symptoms associated with ADHD are listed above. The current diagnosis of the condition is defined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) published by the American Psychiatric Association [[APA-1]]. Hyperkinetic disorders, as defined by the World Health Organization (World Health Organisation, 2014), exhibit similar symptoms to ADHD. For the purposes of providing Web support, they can be considered along with ADHD. </p>
<section>
<h6>Causes of ADHD</h6>
<p>The cause of the majority of ADHD cases is unclear. A number of factors may be involved in each case. Current research suggests that genetic factors are important in the development of ADHD [[CDC-3]]. ADHD appears to have a very-high heritability, independent of geographic location, associated with the Latrophilin 3 gene (LPHN3) (Arcos-Burgos, et. al., 2010). ADHD is commonly inherited from one or both parents. Children with siblings are 3 to four times more likely to develop ADHD than siblings of children without the disorder. Genetic factors are also thought to determine if the condition persists into adulthood (Franke, et al., 2012). Studies of the heritability of ADHD in adult populations are much-less common than studies in children. </p>
<p>In cases where heredity does not seem to be a factor, difficulties during pregnancy, prenatal exposure to alcohol and tobacco, premature delivery, significantly-low birth weight, excessively-high body-lead levels, and postnatal injury to the prefrontal regions of the brain, have all been found to contribute to the risk for ADHD to varying degrees [[NRC-1]]. In addition, exposure to organophosphates may result in symptoms similar to ADHD, but the results are unclear (de Cock, et. al., 2012). </p>
</section>
<section>
<h6>Pathophysiology</h6>
<p>It is widely recognized that ADHD is a neurodevelopmental disorder associated with functional impairments in some of the neurotransmitter systems of the brain, particularly those involved in the transmission of dopamine and norepinephrine [[Wikipedia-1]]. </p>
<p>Children and adolescents with ADHD have brains that are 3-4% smaller than those of a control group. Basic neuroimaging research is being conducted to further delineate the pathophysiology of ADHD, determine diagnostic utility of neuroimaging, and elucidate the physiological effects of treatment. However, the research is currently not definitive enough for the practical application of neuroimaging [[NRC-1]]. </p>
</section>
<section>
<h6>Management</h6>
<p>The management of ADHD typically involves counseling, medication, or a combination of both. Medication typically involves the use of psychostimulants, to boost and to balance levels of neurotransmitters present in the brain, and antidepressants [[Mayo-1]]. Significant and varied side effects may be associated with medication programs for ADHD. These side effects may vary as the patient ages [[Mayo-1]]. </p>
<p>While treatment may reduce the effect of some of the symptoms associated with ADHD, it has not been shown to suppress all of the symptoms [[Mayo-1]]. </p>
</section>
<section>
<h6>Guidelines</h6>
<p>Although there are no specific guidelines produced by a governing body, there are several non-medical ways to help an individual cope with effects of ADHD with respect to ICT. These are listed in the section: Specific technologies. </p>
</section>
</section>
<section>
<h5>Extent to which current needs are met</h5>
<p>There is no apparent body of evidence to indicate the extent to which current needs are met with respect to ADHD. </p>
<p>Until further research is done to identify how content can best be optimized for people with ADHD, it will be difficult to determine the extent to which the needs of people with ADHD are being met. </p>
<p>Given the high coincidence of learning disabilities and ADHD [[Czamara-1]], it may not be possible to disentangle the needs associated primarily with ADHD on the basis of the disabilities presented. A user-centric approach with a series of personas may be more realistic. With further research, user needs associated primarily with ADHD may be identified. These are likely to be general rather than specific in nature due to the relatively-high coincidence of learning disabilities and ADHD [[Czamara-1]]. </p>
</section>
<section>
<h5>Potentials and possibilities</h5>
<p>Issues associated with ADHD, which do not have analogous issues associated with other learning disabilities, tend to be associated with: </p>
<ul>
<li> accuracy; </li>
<li> working memory; </li>
<li> sequencing; </li>
<li> focus; </li>
<li> rapid response. </li>
</ul>
<p>This suggests that designs beneficial to people with ADHD should emphasize: </p>
<ul>
<li> clarity; </li>
<li> concise content; </li>
<li> distraction-free layout; </li>
<li> consistent, simple-processing steps; </li>
<li> robust error correction where forms are involved. </li>
</ul>
<p>Anecdotal evidence [[Sinfield-1]], [[Smith-1]] suggests that people with ADHD find easier to process and remember: visual representations, color coordination, and lists. However, color discrimination may be impaired in people with ADHD [[Banaschewski-1]], so color coordination must be used carefully. These features may prove useful in designing "ADHD friendly" content. </p>
<p>Much of the evidence to date, of the effectiveness of assistive technology and design techniques, with respect to ADHD, is anecdotal. In order to provide robust guidelines for supporting people with ADHD, more rigorous, evidence-based investigations, into which assistive technologies, tools and design techniques prove beneficial to people with ADHD, are required. </p>
<p>These investigations need not, however, meet the strict criteria of a clinical trial. Surveying people with ADHD, with regard to assistive technologies and design techniques that they find useful, combined with a series of product-preference tests, may provide insight on the criteria that should be used in recommending how content should be optimized for people with ADHD. </p>
</section>
<section>
<h5>Prevalence</h5>
<p>The prevalence of ADHD worldwide is 5.29% of the population. There is significant geographical and gender variation, with diagnosed incidences of ADHD being lowest in Africa and the Middle East; and higher in individuals of 18 years or younger [[Polanczyk-1]]. The cause of this variation is unclear. It may be a result of different attitudes to reporting and diagnosing the condition, rather than any actual variation in the prevalence of ADHD [[Bussing-1]], [[Faraone-1]]. If ADHD is under reported in females; Africa and the Middle East; and in the adult population; the worldwide incidence of ADHD must be higher than 5.29%. </p>
<p>The percent of school-aged children diagnosed with ADHD in the USA is estimated at 11%. The prevalence in males is slightly more than twice that of females [[CDC-2]]. While the number of females diagnosed may be significantly under represented, this figure is likely to be a more-accurate representation of the global prevalence of ADHD. The percentage of children (4-17 years of age) diagnosed with ADHD in the USA has increased from 7.8% in 2003, to 11.0% in 2011, with an average annual increase of 5%. This represents an estimated increase of 2 million children diagnosed with ADHD in the USA between 2003 and 2011 [[CDC-2]]. It is unclear if this represents an increase in the prevalence of ADHD, an increase in the reported incidences, or a combination of both. </p>
<p>The prevalence of ADHD in adults aged 18-44 in the USA in 2006 was estimated at 4.4% [[Kessler-1]], suggesting that a significant number of cases of ADHD diagnosed in childhood may continue through adulthood. This may be an underestimation due to historic reporting biases. </p>
</section>
</section>