Designing Post-Trauma Self-Regulation Apps for People with Intellectual and Developmental Disabilities
Krishna Venkatasubramanian, Tina-Marie Ranalli · 2022 · Proceedings of the 24th International ACM SIGACCESS Conference on Computers and Accessibility (ASSETS '22) · doi:10.1145/3517428.3544798
Summary
This paper explores how to design mobile apps that help people with intellectual and developmental disabilities (I/DD) engage in post-trauma self-regulation (PTSR) — activities that help manage negative emotional effects like anxiety, grief, and stress that arise from traumatic experiences. People with I/DD in the US are among the most likely groups to experience trauma, yet no existing self-regulation app has been designed specifically for this population or accounts for the trauma they experience. The authors interviewed eight practitioners at a US trauma services organisation who regularly help people with I/DD learn self-regulation techniques. Three key findings emerged from the interviews: PTSR for people with I/DD should promote empowerment and include diverse activities (not just meditation); people with I/DD already use various "ersatz" apps for self-regulation (YouTube, Spotify, social media, colouring apps) but none are well-suited to their needs; and PTSR app design must promote autonomy, be accessible, and enable social connections. Commercial self-regulation apps were seen as unsuitable due to cognitive overload, abstract meditation instructions, reading-heavy content, and lack of personalisation. Based on these findings, the authors developed 12 design guidelines organised around the five criteria of trauma-informed care (TIC) from social work practice: safety, trust, choice, collaboration, and empowerment.
Key findings
The 12 design guidelines, grounded in trauma-informed care principles, provide a comprehensive framework. Under safety: mitigate known negative trauma effects (e.g., abstract visualisations can be distressing rather than calming for people with I/DD), be actively supportive of diverse lived experiences (inclusive of different languages, cultures, gender expressions, sexualities), and assume that potentially anything can trigger a user — use non-judgmental language and offer diverse activity choices including offline options like gardening, crafting, or walking. Under trust: ensure authentication to protect personal data, and never penalise — only recognise prior successes. Under choice: design activities at multiple difficulty levels for varying cognitive abilities, guide users through decision-making with recommender systems that limit options to reduce cognitive load, and provide easy-to-understand ways to express current emotions (avoiding abstract scales). Under collaboration: provide ability to interact with others (peers, family, support groups) and tools that converse directly with users like peer-like chatbots. Under empowerment: provide accessible information about trauma using images, videos, concrete icons, and audio descriptions rather than reading-heavy content, and deliver customised, pithy affirmation messages. A critical insight is that PTSR need not involve engaging with the trauma itself — it is about managing dis-ease in the moment through whatever activities work for the individual.
Relevance
This paper fills an important gap at the intersection of disability, trauma, and technology design. The concept of diagnostic overshadowing — where trauma effects in people with I/DD are misattributed to their disability rather than recognised as trauma responses — has direct implications for how accessibility practitioners think about cognitive accessibility and mental health support. The trauma-informed care framework offers a transferable design approach applicable beyond PTSR apps: its emphasis on safety, choice, and avoiding re-traumatisation through design decisions is relevant to any technology serving vulnerable populations. The finding that existing commercial self-regulation apps are fundamentally unsuitable for people with I/DD — due to cognitive overload, abstract content, reading demands, and lack of personalisation — underscores how "mainstream" accessibility often fails people with cognitive and intellectual disabilities. The intersectional design approach advocated (accommodating diverse identities, not just disability) provides a model for truly inclusive design practice.
Tags: intellectual disability · developmental disability · trauma-informed care · self-regulation · mental health · mobile apps · inclusive design · cognitive accessibility