By 
When it comes to misconceptions regarding disabilities, there are few disabilities as often misrepresented as ADHD. Often presented simply with images of young children, hyperactive, and restless, the condition is a lot more nuanced and complex than it is often presented to be.
ADHD is a lifelong condition that affects both children and adults, and covers a range of symptoms. People with ADHD often struggle with focus and attentiveness, have trouble forming memories, find it difficult to stick focused to a single task, and have difficulty with organisation. The disability can also cause a person to fidget uncontrollably, struggle with conversational timing, as well as at times act impulsively.
ADHD as a condition impacts a lot of areas of a person’s life, one of which is often playing video games.
So, this week on Access-Ability, we’re going to talk a little bit about playing video games as a gamer with ADHD. And, to do that, I thought I’d bring along a special guest who plays a lot of video games, and happens to have ADHD, my podcast co-host and friend James Stephanie Sterling.
Laura – While preparing to record this episode of Access-Ability, I spoke with a lot of gamers with ADHD about their experiences playing games. One of the most common points I heard, over and over, was difficulty keeping track of video game plots and mechanics if a break is taken from playing.
JSS – If I stop playing a videogame for more than a week, there’s a good chance I won’t know what’s going on when I get back. Then again, if I stop playing a videogame for more than a week, my struggles with object permanence may ensure it’s never even thought about for months. ADHD affects my memory to the point where I misplace things the very second I put them down, and may totally forget those things even exist until I see them again one random day. Remembering something, even something important, could take days, weeks, or months after it was supposed to be remembered. And usually even then I require prompting.
JSS – If a new season of a TV show comes out, I better hope I watched it in the last year. I won’t remember details, but my brain will retain enough residual memory to be jogged somewhat. Longer than that, and it becomes impossible to get back into Peaky Blinders without rewatching the whole thing, which my ADHD brain won’t allow because it won’t sit through something it’s already watched unless it’s one of the things it will obsessively want to sit through and rewatch.
Laura – While remembering the specifics of a story after taking a break from a piece of media is a common issue for people with ADHD, the issue is a little more complicated in video games, where it’s not just remembering plot that can be a barrier to jumping back in, but gameplay memory as well. Players with ADHD need to get through your tutorial while retaining focus, be able to revisit it later if needed, and in some cases need reminders about what abilities their character actually has at their disposal.
JSS – As you can imagine, jumping back into a game weeks or months after it was last played can be overwhelming. You not only have a plot to contend with, but your character’s objectives, location, where they were headed or where they were going. Look, I can’t play Carrion because I forget where I’ve been and everything looks the same and there’s no fucking map. Give me a fucking MAP! Anyway, I’m getting ahead of myself. The point is, Alan Wake doing those recaps between levels is pretty good, and we need more of it, for far more than a shorter and more linear game. Many is the time I’ve had to restart or simply abandon a long RPG because I no longer remember what the hell is going on unless there’s some sort of reminder in-game, such as The Witcher 3’s loading screens and extensively written quest logs, though I’ll admit ADHD brain doesn’t like reading a ton of text, which really sucks because I like books in theory.
JSS – As for a Metroidvania? Forget it. Even if they have maps unlike Carrion, remembering where to go, what does what, where I needed to head after I got the item that lets me do new stuff. I’m not asking for a game to be its own walkthrough, but those compasses and mission markers and glowing trails that people complain is spoonfeeding and handholding and casualization? To some of us, it’s the difference between playing a game and our brains locking up like a Bethesda game in launch year.
JSS – Oh god, right, lemme say this right now – if you’re one of those games, usually a JRPG or something, that have tutorials HOURS into the game, and those tutorials are mostly text boxes telling you what to do, I am not going to be thrilled. I mean, text-based tutorials are inherently and significantly more worthless to me than anything practical. To draw again from Monster Hunter as it’s what I’ve been playing recently, I like that there’s an area for you to take the game’s many weapons and play around with them while the game gives you onscreen button prompts to practice combos. Simply telling me what I can do won’t work. If that worked, I’d have done many, many important life changes by now instead of lolling around on the floor eating crisps and crying. A symptom of my ADHD is that I cannot adequately visualize results. If you tell me to, say, do something as simple as go to the shops, the concept of imagining myself at the shops can often just not occur, or feel so completely surreal to me that I cannot begin to believe I’m even capable of going to the shops. How could I? I can’t imagine being there, so I couldn’t imagine the steps required to take me there. Same with, say, cleaning up a messy room. Before I learned to just get rid of most of my shit, I could fill a whole house with junk and find myself unable to clean it because I wouldn’t know where to start. Not just a momentary “oh this is so messy, where to begin?” Most people think that, and then just start cleaning anyway. I can’t. It becomes too big in my head, too unknowable, I literally cannot comprehend where to start, so I don’t. I cannot, in essence, reverse engineer a scenario to work out how Point B was gotten to from Point A. I therefore stop being able to understand what Point A even is.
JSS – So, while I work out exactly what to do with all these boxes in my apartment, I really appreciate it when a tutorial allows me to be shown what to do, and then practically apply what I just saw. Without visualizing a result, you need to manually grasp the steps that take you to the end.
JSS – If trying to remember the plot of a game after time away is bad, try dealing with any game mechanics more complex than “Walk to a thing and hit a thing.” Games with many varied mechanics can be almost impossible to return to after any period of time, but it’s more than that. Remember all that stuff about lacking object permanence? Well, I’ve poured close to thirty hours into Monster Hunter World lately and I’ve fished once. I have not remembered to fish a single time, except yesterday when I forgot to bring anything to fish with. Just like I forget to bring a lot of things with me in that game, because there’s so fucking much of it.
JSS – There are games that offer frequent reminders of things you can do. I can’t remember any right now but I remember them all doing it. And sometimes that can be annoying, especially for those who DO have good information retention. For me? A game reminding me I can fish on the reg, or that I have gameplay options I can tweak, or that I recently unlocked a new ability or item, these can all be intensely useful. Games that allow for the option of turning tutorials, hints, and reminders off is a win/win scenario, even better if they can customize what you’re reminded of, be it mechanics, items you have, or where to go. This way, people who need the reminders can get them, and those who don’t can turn them off. Who loses? ADHDphobes. I don’t know if such a thing as an ADHDphobe exists, but these days? Probably.
Laura – Speaking to a lot of gamers with ADHD, a lot of the same issues and solutions came up repeatedly in discussions. For gamers with ADHD, reminders about what has been happening in the plot, tutorials which can be revisited, quest markers, maps, to do lists that can be referenced, and map markers leading to progression can be the difference between a game being accessible or not. Take Yakuza: Like a Dragon for example. Players can rewatch old cutscenes from the main menu for a reminder of where they are in the plot, check the map for easy colour coded main mission and side quest markers, and get the game to paint a line on the map showing exactly how to get where you are meant to be going. Or look at The Last of Us 2, which featured an optional setting where clicking in the left stick would point the player towards plot progression. These features all serve to remind the player what they were doing, and help them get back into the groove of progressing when they jump back into the game.
Laura – Carrion was a great game, but gosh did it badly need a map for accessibility for disabled players. I know I have said this in multiple recent episodes of this show, but it bares repeating.
Laura – For other examples of games that give players ways to remember what is happening in their plots, see visual novels such as the Phoenix Wright: Ace Attorney games, which allow players to read a summary of spoken dialogue in game menus to remind themselves where they are at in a given investigation, as well as a glossary of each important person and piece of evidence, to help them get their bearings. For some players with ADHD that can be really useful, but it’s not a catch all solution, as some players with ADHD have difficulty focusing on mentally processing long walls of uninterrupted text, and may need more dynamic ways to have that information recapped.
JSS – I mentioned earlier that I struggle with reading. This is something that’s gotten worse as I’ve gotten older, and it’s something I’m trying to fix, though a lifetime of worsening symptoms without diagnosis has made that tough. I find it far harder these days to play games with a lot of text such as visual novels. I love Phoenix Wright, but I’ve only played the first game and a bit of the second because I peter out. I petered out with Paradise Killer too, not because of anything it did, but because of, well, all of this shit. Still, Paradise Killer is one of those games that makes it easier on people with ADHD, since it allows you to scroll back through dialog text to see anything you missed while you spaced out for the fifteenth time in a minute. As someone who has to reread paragraphs multiple times a sitting just to get any information absorbed, I cannot tell you how useful this feature is. And it shouldn’t just be for text! If you have a ton of cutscenes, especially long ones KOJIMA, a rewind function would be absolutely stellar. I’m replaying the Metal Gear Solid games lately, and with my brain being worse than it was, lordy knows my mind wanders a million miles away while two men stand around talking about how the nanomachines made the nanomachines do nanomachines. It still baffles me that pausable cutscenes still aren’t obligatory. And I’m surprised that a company as in love with its own work as Kojima Productions hasn’t been doing rewinds for years.
JSS – A lot of the feedback I was routinely given by gamers with ADHD was that helping them engage with games was largely a matter of not penalising forgetfulness, and offering interactive practical ways to learn. Let a player with ADHD experience interactive tutorials rather than information filled text boxes. Offer the ability to pause, rewatch, or rewind cutscenes. Offer optional reminders, and the ability to customise reminders, so a player can be prodded about mechanics they might not remember they have available. Let players reread text, and set up proper map markers leading to where the plot goes. These fairly basic types of accommodations go a long way to helping.
Laura – Additionally, a lot of gamers I spoke to while preparing the script for this video noted that one major way to help make games more accessible to them was to ensure the barriers to jumping back into a game after failure were minimised. A lot of gamers I spoke to cited regular checkpoints and the ability to quickly jump back into the game after failure were important to them, as lengthy portions of backtracking over content that has already been played was often a trigger for them to lose focus and lose interest in the game they are playing.
Laura – In a similar vein, a lot of players I spoke to noted that a big part of them being able to start, and get into games as a player with ADHD was that games needed to have a certain degree of immediate engagement. If a game expects you to play for a few hours before it becomes good, a lot of players I spoke to with ADHD simply stated they would be likely to drop off, long before the game ever really hit its stride.
Laura – Additionally, a lot of players I spoke with noted that subtitles were really important to them when playing games, as having dialogue written on screen helped reduce the risk of them zoning out during a conversation and missing what was being said. An additional method of conveying the plot makes it just a little less likely it’ll be missed out by a wandering mind.
Laura – I wanted to finish today’s episode by throwing the discussion back to JSS, to talk about a very serious aspect of ADHD and how it relates to game design, predatory exploitation of compulsive behaviour.
JSS – A significant number of videogames are designed to exploit illness. This is a fact. Utilizing the very techniques found in the wider gambling industry, big budget and mobile games have spent years manipulating vulnerable customers for money. The randomized loot boxes and microtransactions are predatory. There is no fairer description of them. They are predatory.
JSS -Given all that we’ve discussed so far, it should be quite clear that issues with concentration, memory, patience, and attention can impact one’s experience with even the most benignly designed games. With that in mind, imagine how easily an ADHD brain can be swayed by a predatory in-game economy. This is the very basis of the “time saver” style microtransaction – a game that makes progress sluggish, grinding, and unrewarding in the hopes a player’s patience will be tested and they’ll be a “booster” of some kind to speed up the game. As microtransactions have become more virulent, games have become grindier and more exasperating. Items that used to be part of the basic game experience are now locked away behind random boxes, full of stuff you don’t want so you consistently feel disappointed and might buy more to chase your sunk costs.
JSS -I once interviewed those with various mental struggles about their relationship with videogames, and the stories are frankly heartbreaking. People who feel the games they used to help cope with the bullshit of life started to turn on them, started turning around and exacerbating their problems. There are games I cannot keep playing once microtransactions are introduced, because the way in which they’re designed to poke at my consciousness, to constantly remind me that the boring parts my ADHD brain hates can be knocked out with a quick purchase, the way my impulsive and addictive personality can be very tempted by the rush of a gamble, is horrifyingly effective. If not for my job and my professional awareness of how vile these economies are, I would have been a lot worse at resisting. Hell, if I get too into a mobile game, even for a brief window of time, there’s a chance even I could still fuck up and spend money on something without even thinking of it. That is scary. But to a videogame publisher, it’s a gift. And to anyone with a sense of integrity, it should be absolutely disgusting.
Laura – As is often the case when writing scripts for episodes of Access-Ability, the solutions for making games more accessible for players with ADHD are not terribly complicated, and mostly just need developers to understand the condition, and keep it in mind during development.
Plot recaps, the ability to scroll back and check dialogue you missed, proper map functionality, interactive tutorials that can be revisited,and a lack of predatory microtransactions go a long way towards making games more accessible to gamers with ADHD.
Basically, remember that not every player has your same ability to focus on your narrative, and remember how to play your game. Keep in mind ADHD’s impacts on memory and focus, as well as maintaining options for players to not have to replay big chunks of your game, and you’re well on the way to making your game more accessible for gamers with ADHD.
An estimated 3% of adults worldwide live with ADHD, and that’s a pretty sizable number of gamers who you could make gaming more accessible for.
By 
