How Online Tests Contribute to the Support System for People With Cognitive and Mental Disabilities
Qisheng Li, Josephine Lee, Christina Zhang, Katharina Reinecke · 2021 · ASSETS '21: The 23rd International ACM SIGACCESS Conference on Computers and Accessibility · doi:10.1145/3441852.3471229
Summary
Approximately one in three people worldwide experience a cognitive or mental disability at some point in their lives, yet significant barriers — cost, lack of insurance, transportation, stigma, family resistance, and not knowing where to seek help — prevent many from obtaining professional diagnoses. Li et al. investigated how online cognitive and mental health tests (available on platforms like TestMyBrain.org, LabintheWild.org, and various self-assessment questionnaires) fill gaps in the healthcare support system for people with these conditions. The researchers conducted semi-structured interviews with 17 adults recruited from Reddit communities (r/anxiety, r/autism, r/BPD, r/dyslexia, r/dyscalculia, r/TBI) and the Wrong Planet forum. Thirteen participants had been professionally diagnosed with conditions including autism, ADHD, borderline personality disorder, bipolar disorder, dyslexia, dyscalculia, and traumatic brain injury, while four suspected they had a condition but lacked formal diagnosis. Using constant comparative analysis and affinity diagramming, the researchers identified four overarching themes about how online tests function within the broader support ecosystem for people with cognitive and mental disabilities.
Key findings
The study revealed four key themes. First, online tests provide critical pre-diagnosis support by lowering barriers to professional diagnosis. Participants used online tests as a first step when professional help was inaccessible due to cost, family resistance (particularly parents denying their children's conditions), or not knowing how to navigate the diagnostic process. Several participants used test results to build confidence before seeking a professional evaluation, or to convince reluctant family members. Second, online tests supplement professional diagnoses by filling information gaps that clinicians often leave — participants frequently reported receiving diagnoses with little explanation of what the condition means for their daily lives, describing it as a "lifetime sentence of failure." Online tests helped them understand nuances, track changes over time, and explore which specific cognitive functions were affected. Third, online tests facilitated communal attachment by giving people a reason to connect with others in online communities like Reddit and Wrong Planet, where sharing and comparing results created a sense of belonging and supported disability identity formation. Fourth, significant challenges limit the utility of online tests: trust issues (difficulty determining which tests are scientifically valid), over-interpretation or confirmation bias in reading results, and the absence of actionable next steps or connections to professional resources after receiving results.
Relevance
This paper reframes online cognitive and mental health tests as an important, previously unrecognized component of the disability support ecosystem rather than merely supplementary tools. For practitioners and designers building online assessment tools, the five design implications are directly actionable: integrate validated tests into healthcare pathways with pointers to professional resources; develop standardized guidelines for test design and result communication; include representative baseline data so users can compare their results to specific populations; align with the affirmative model of disability by highlighting strengths rather than only deficits; and link results to relevant online communities for peer support. The finding that online tests support disability identity formation — helping people move from suspicion to acceptance of their conditions — has broader implications for how we design digital health tools. For accessibility professionals, this research highlights that cognitive and mental disabilities represent a large population whose support needs extend beyond interface accessibility to encompass the design of information and assessment tools that can meaningfully contribute to their understanding and management of their conditions.
Tags: cognitive disability · mental health · online tests · self-diagnosis · disability identity · ADHD · autism · dyslexia · dyscalculia · self-assessment
Standards referenced: DSM-5