Cognitively Accessible Self-Management: Picture Planner Icon-Based Personal Organizer

Background: Our development work focuses on cognitively accessible self-management software for users with significant cognitive disabilities, many of whom remain excluded from the benefits of information technology because commercial software is not accessible due to its complexity and dependence on the user’s reading ability. There is also a lack of cognitively accessible software targeting functional user needs such as activities of daily living (Burgstahler, 2003; Wehmeyer, 1999).
Objectives: Eugene Research Institute together with Cognitopia Software has recently produced a cognitively accessible personal activity organizer called Picture Planner (Keating, 2006), an icon-driven application whose objective is to enable users with autism and other cognitive disabilities to create activity schedules. It incorporates several design features to facilitate use by individuals with little or no reading ability and those for whom typical user interfaces are too complex:  the use of multi-modal icons providing image, text, and text-to-speech information; single-click operability; and metacognitive support for the information management challenges experienced by many users with cognitive disabilities.
Methods: Picture Planner's metacognitive interface design anticipates information management challenges experienced by individuals with autism. A typical user of a paper or electronic organizer might enter a word or two in a time slot, relying on that prompt to cue a set of related implications that is retained in memory and retrieved as needed to accomplish an activity. For our target users, competently constructing activities must be more explicit: processing not just “what” activity is scheduled, but making explicit the many elements of an activity that bear on its successful completion: What activities are available to choose from? How much money do I need? Who am I doing it with? When and where does it happen? How will I get there? What things should I bring? What clothes are appropriate? Many individuals benefit from having these choices explicitly prompted, with intelligently presented and accessible ways to choose among options in each domain. In this application, the user is systematically presented with and “stepped through” each of these considerations.
Results: A non-experimental post-test only evaluation was conducted in which users were taught how to use the software over a period of 8 weeks. They were then given a detailed activity to schedule and scored on whether they completed each step of the sequence and what kind of verbal or physical assistance was needed. The participants included transition students and young adults with autism, intellectual disabilities, and traumatic brain injury. A key finding was that with only limited instruction typical of a weekly classroom format (one half hour per week over 8 weeks) individuals with significant cognitive disabilities including autism averaged 54% successfully completed steps of a complicated activity planning task, with either no assistance or only nonspecific verbal prompts about activity details (N=28; Range=29-82%).
Conclusions: Individuals with autism and other cognitive disabilities can learn to use cognitively accessible self-management software. As important, the software served an important function in structuring the interaction between assistant and user in a way that enhanced self-determination, communication, and self-esteem.