Pediatricians should push for fewer seizures!

pediatricianThe pediatricians of this country, working with the American Academy of Pediatrics, are in a position to help reduce the continuing public health risk of video games and other media that can induce seizures. They should lobby the entertainment industry — something they already apparently do regarding other media matters — to produce games without seizure-inducing images.

As I’ve written previously, the AAP is rethinking its policy on media use by young children. Now it’s clear why: the American Academy of Pediatrics’ Council on Communications and Media published new data this month on media use by very young children. According to the study, there is “almost universal exposure to mobile devices, and most had their own device by age 4.”

The media landscape has changed significantly since the AAP drafted its 2011 policy statement discouraging media use in children under age 2. Mobile ownership has increased sharply–the authors note that tablets weren’t available yet when the 2011 recommendations were written.

As part of its updated policy statement on media use, the Academy will issue revised advocacy and research objectives. How about advocating for electronic entertainment that doesn’t provoke seizures?

AAP’s current advocacy priorities on kids and media

The AAP’s Council on Communications and Media policy statement on media use from November 2013 contains a variety of advocacy recommendations, including proposals that pediatricians and the AAP:

  • Advocate for a federal report within the National Institutes of Health or the Institute of Medicine on the impact of media on children and adolescents
  • Encourage the entertainment industry to “reassess the effects of their current programming”
  • Establish an ongoing funding mechanism for new media research
  • Challenge the entertainment industry to make movies without portrayals of smoking and without product placements

Proposed changes to above initiatives

Here’s how these points should be expanded to encompass the health risk to unknown numbers of children who experience seizures from flashing visuals:

  • Advocate for a federal report within the National Institutes of Health or the Institute of Medicine on the impact of media on children and adolescents, including the neurological impact of flashing screens
  • Encourage the entertainment industry to “reassess the effects of their current programming” – including the physiological effects of flashing and high-contrast patterns
  • Establish an ongoing funding mechanism for new media research that includes studies on the vulnerability of young people with ADHD, autism spectrum disorders, and mood disorders
  • Challenge the entertainment industry to make movies without portrayals of characters smoking and without product placements and to make video games without the flashing and pattern characteristics that can trigger seizures

Question for the AAP Council on Communications and Media

There are many angles and interests that must be considered in making your next policy statement. I have a lot to add to the conversation as far as reducing the risks to young people of screen-triggered seizures, many of which go undetected. Would you accept my assistance? I would be happy to help.

Pediatricians backpedalling on kids’ media use?


How much is the American Academy of Pediatrics retreating from its guidelines on media use in children? We’ll find out when the guidelines are in fact changed.

Is the American Academy of Pediatrics changing its recommendations to parents about children’s media use? Not really. Well, yes, in a way. But hard to say. It depends on what you think constitutes a recommendation.

As recently as 2013, the Academy’s official policy on media use discouraged any screen exposure for children under age 2 and recommended less than two hours of screen entertainment after that.

But in a piece in the October 2015 AAP News, after acknowledging that this advice already appears seriously out of step with today’s media environment, the Academy announced it intends to update its guidelines. No date for the update was provided.

Then, in the same article, the Academy proceeded to offer some advice for parents about children and media use, directing parents as follows:

“Play a video game with your kids. Your perspective influences how your children understand their media experience. For infants and toddlers, co-viewing is essential. [emphasis added]

So, what is going on here? This is kind of murky. Despite some headlines to the contrary, the Academy of Pediatrics does not have a new policy on children’s media use. Instead, concerned about its reputation and trying to stay relevant, the Academy has published a dozen so-called “key messages” regarding media use “to inform and empower families.” Messages, not guidelines.

Key Messages

The key messages are mostly commonsense things like using media alongside your child, setting (unspecified) use limits, creating tech-free zones at home, etc. The messages are decidedly laid-back. Apart from the acknowledgment that “like any environment, media can have positive and negative effects,” the only potential negatives mentioned are sexting, posting self-harm images, and limited participation in other activities.

For the record, I strongly disagree with one of the messages: “The quality of content is more important than the platform or time spent with media.” No, no, no. This assertion runs counter to plenty of research on adverse neurological effects of screens. Platform matters: big screens, flashy images, and extended exposure all increase the risk of seizures and other manifestations of nervous system overload!

Predictably, this month’s key messages are being hailed in some quarters as validation of the safety of electronic media and repudiation of concerns about such safety. For example, in a Forbes piece with the misleading title “The American Academy of Pediatrics Just Changed Their Guidelines on Kids and Screen Time,” Jordan Shapiro writes, “It is about time…the AAP guidelines seemed like they were the result of familiar technophobic paranoia that always accompanies new technologies.” He cites his own words from a previous post:

“At this point, worrying about exposure to screens is like worrying about exposure to agriculture, indoor plumbing, the written word, or automobiles. For better or worse, the transition to screen based digital information technologies has already happened and now resistance is futile.”

It’s easy for Shapiro and others to be dismissive of any health concerns related to media, when the American Academy of Pediatrics’ “key messages” fail to include reminders that there still are health issues to be concerned about. Issuing these bland recommendations may do more harm than good by creating the impression for parents there’s nothing really serious to worry about.

Not So Fast…

The AAP’s key messages around media use resulted from an invitation-only symposium of researchers held in May. An article reporting on the proceedings of that symposium shows that—to their credit—the presenters in fact voiced concerns in a number of areas and called for more investigation of:

  • Problematic/addictive media use that is often associated with mental health conditions such as depression and anxiety
  • The relationship between media violence and aggressive/violent behavior
  • The adverse effects of screen media on sleep
  • The need for cultural diversity to be reflected in digital media

In addition, researchers:

  • “urged the AAP to not shy away from unpopular recommendations and to formulate policy guided by the best available research”
  • Noted that “one size doesn’t fit all with respect to digital interactions…the diversity of youth, families, and communities will influence resilience factors and vulnerabilities”

Unfortunately, few families are likely to know about these concerns, because very few will read the article summarizing the symposium’s presentations and recommendations. They’ll just hear the key messages and relax about it all.

Looking Ahead

One can hope that the next round of formal media use guidelines will thoughtfully incorporate these and other health issues related to digital media use by young people. The account of the proceedings suggests that the guidelines themselves will be more nuanced than the so-called key messages.

In particular I would like to see media guidelines for kids with mood disorders, ADHD, and autism spectrum disorders (ASD), whose brain physiology leaves them more vulnerable to adverse effects. Given government estimates that 13 to 20 percent of children ages 3 – 17 have a diagnosable mental health disorder, these children’s needs should figure prominently in any policy recommendations by the AAP.

“The mission of the American Academy of Pediatrics is to attain optimal physical, mental, and social health and well-being for all infants, children, adolescents and young adults.” — from AAP Facts

Reclaiming a child’s brain from video games

Reset Your Child's Brain book coverMany parents sense that media use affects their children in vague, unseen ways. They’re not imagining it. I have an excellent book to recommend if you’d like to understand more about the way children’s brains–and therefore all aspects of daily function–are stressed by video games. Three years ago I cited a piece by child and adolescent psychiatrist Victoria Dunckley about the effects on the nervous system of interactive screen time. Dr. Dunckley outlined a syndrome of dysregulated mood, attention, executive function, and arousal that develops in response to exposure to video games and other interactive, screen-based applications.

I’m delighted that last month she published a comprehensively researched, clearly and compassionately written book explaining how interactive screens affect children’s mood, thinking, and arousal, with a lot of practical guidance on how to restore their children. In Reset Your Child’s Brain: A Four-Week Plan to End Meltdowns, Raise Grades, and Boost Social Skills by Reversing the Effects of Electronic Screen-Time, Dr. Dunckley validates parents’ concerns, pulling together research from a range of scientific fields, and in clear language explains screen-time’s effects on the nervous system.

Dr. Dunckley suggests thinking about the stress on the brain from the stimulation of electronics use as not unlike caffeine, amphetamines, or cocaine. She makes a compelling case that the nervous system’s hyperarousal (fight-or-flight response) that kicks in while playing video games sets in motion an array of biological mechanisms that lead to significant functional impairments. She says that seizure activity, along with other tangible symptoms including migraines and tics, is at the extreme end of a continuum of nervous system dysfunction due to the brain’s hyperarousal. Irritability and general nervous system dysfunction are at the other end of the continuum. Other symptoms on that spectrum include mood swings, poor executive functioning, poor impulse control, anxiety, depression, body clock disruption, and immune system suppression.

Dr. Dunckley stresses that the impairments from screen-time are not limited to screen-addicted kids or those who play violent video games, and that playing “in moderation” can still affect a child’s nervous system. Exposure tolerance varies greatly, so some children can resume limited screen use without relapses in behavior and functioning. Those with ADHD or autism spectrum disorders have a greater likelihood of becoming dysregulated by screen exposure. In general, though, the more stimulating the sensory experience, from vivid colors, rapid movements and scene changes, and multi-modal sensory input, and the more frequently the child is exposed to it, the greater the accumulated strain on the nervous system. The greater that strain, the more difficult it becomes for children to control their emotions and behavior.

“Whatever the subject manner, the style or manner in which content is delivered has its own impact. Research indicates that movement, zooms, pans, cuts, and vividness…contribute to repeated fight-or-flight reactions. Screen size affects arousal levels as well, with larger screens producing higher levels of arousal.”

On to the good news: if given respite from overstimulation, the nervous system can restore itself. Dr. Dunckley has treated hundreds of patients whose mood, behavior, and cognitive abilities have been restored after an electronic “fast,” in which electronic screens are set aside for 3 to 4 weeks for an initial evaluation period. In many cases serious limits or total abstinence from screens is necessary to sustain the remarkable improvements in daily functioning that occur. The majority of the book is devoted to practical guidance for parents on how to undertake the daunting task of disentangling a young person from daily screen use.

This book is done extremely well. It begins with a thoughtful synthesis of non-industry-funded research from widely dispersed fields, connecting the dots to show what the body’s response is to environmental stressors. Dr. Dunckley shows considerable respect for parents’ conflicted feelings and their guilt about their own screen habits:

“Let’s face it. Hearing that video games, texting, and the iPad might need to be banned from your child’s life does not fill one with glorious joy. Rather, for many, it creates an immediate urge to find a way either to discredit the information or to work around it…the inconvenience of what I’m proposing can seem overwhelming…some folks feel as though their parenting skills are being judged, or that their efforts or level of exhaustion are underappreciated.”

Victoria Dunckley, MD

Victoria Dunckley, MD

Dr. Dunckley provides cases from her own practice that show how life-changing the difference can be when a child’s nervous system is given a respite from electronic screens.  This is serious business:

“The goal of screen limits is not merely to get rid of bothersome symptoms but to optimize a child’s development over time. All children benefit from screen limits, which have a compounded effect on functioning later in life.”

She is spot on. As some of you know, I’ve been there. Eight years ago it was a bittersweet revelation to see my daughter’s potential reemerge after a long period of impairments and health problems brought on by video game seizures. She lost several years of optimal learning, social development, and health because of frequent seizures we were unaware of during her daily video game use. We didn’t realize just how severely she’d been affected until she swore off gaming and made dramatic gains.

For the record, I don’t hate video games. But I am very disturbed that they can be so damaging to kids’ everyday functioning and potential. Read this book! Share it with your friends, too.

Note: I’ve linked to the book’s page so you can see the very enthusiastic reviews posted there. I am not endorsing Amazon, nor do I have a financial stake in any purchase you may decide to make.


Epilepsy Action Tweet protects Twitterverse

Epilepsy Action Twitter 2

Fantastic what Epilepsy Action accomplished the other day with one tweet! The UK-based epilepsy advocacy group addressed a Tweet to Twitter UK asking for removal of 2 video advertisements with quickly changing colors that had the appeared as flashing images. Within an hour Twitter UK responded graciously that it had deleted the offending ads.   

A major bonus–the exchange resulted in news stories in dozens of media outlets, including the Los Angeles Times, Yahoo TechFortune, and the BBC News, raising awareness of the problem and showing Twitter UK as a responsive corporation. 

Epilepsy Action followed up with gracious words, too:

Epilepsy Action Twitter 3

Using the same Twitter strategy, Epilepsy Action succeeded again yesterday in getting an unsafe ad removed by media giant Virgin Media. (See Twitter exchange further down.) For some time I have been admiring Epilepsy Action’s diligence regarding photosensitive epilepsy awareness and their outreach to organizations whose products/services place the public at unnecessary risk of seizures.

Why don’t we see this kind of advocacy in the US?

  • It’s not a priority of US epilepsy advocacy organizations to proactively protect the public from seizure-inducing images.
  • Unlike the UK, we have no regulations barring images that could trigger seizures. In the UK both online and broadcast advertising are bound by the following rule:

“Marketers must take particular care not to include in their marketing communications visual effects or techniques that are likely to adversely affect members of the public with photosensitive epilepsy.”

  • Broadcast TV in the UK is governed by a rule that, in addition to protecting against seizure-inducing content, frequently reminds the public of the risk of photosensitive seizures. No equivalent reminder exists here that raises awareness among the entire public of photosensitive epilepsy:

“Television broadcasters must take precautions to maintain a low level of risk to viewers who have photosensitive epilepsy. Where it is not reasonably practicable…and where broadcasters can demonstrate that the broadcasting of flashing lights and/or patterns is editorially justified, viewers should be given an adequate verbal and also, if appropriate, text warning at the start of the programme or programme item.”

  • Because the public is often reminded of the potential for images provoking seizures, and because the government has chosen to enact regulation of moving images, it’s not an out-of-the-ordinary event for people to notice and report problem images.

Could individuals use Twitter to ask video game companies to remove potentially harmful images?

It certainly seems like something we should try. On the other hand, there are some major differences between reporting seizure-triggering online ads and bringing seizure-triggering images in a video game to the developer’s attention. For starters:

  • Removing/altering problem sequences from a video game is much more technically complex than removing or fixing a seconds-long video ad from an online platform. Many popular video games are built over a period of years, using huge amounts of code, and allowing lots of variation in what images might appear onscreen, depending on how the game is played.
  • An individual asking for a modification from a corporation doesn’t carry nearly the same weight as an organization such as the Epilepsy Foundation.
  • Consumers’ communication about specific games typically occurs within members-only user forums that aren’t seen by the general public–thus no pressure from outside the user community.
  • These user forums can be quite hostile when the topic of seizures comes up. Here’s one quote from within the gaming community.

“…(also, if you have epilepsy (knowingly), and you try to play a videogame, you don’t deserve a seizure, you deserve to be hit by a truck, and if you discover epilepsy when playing a game, that just means you have a very very sucky medical condition, its not like the game GAVE you epilepsy, just the seizure associated with your condition, its not the games fault, blame the DNA, DAMN DNA!)”

So…I will try contacting some game companies on their official Twitter page to let them know their game has failed the Harding Flash and Pattern Analyzer in my tests. Has anyone reading this tried to contact a video game company to report that a game triggered a seizure? I will let you know how I do!!

Best games of E3 2015: how many look risky?

RIBBONS-BLUE-1ST-PLACE-ROSETTESGames industry websites and journalists have announced their picks for the best new video games demonstrated at this month’s annual Electronic Entertainment Expo (E3).

That lets me get to work assessing those games for seizure risk, so I can identify which popular titles in the next crop of releases are less likely to trigger seizures. (I suspect I’m one of very few on the planet who tunes in for this purpose to the annual “best-of” video game lists. I want to see if the development studios are doing more to cut down on image sequences that can set off seizures in people with photosensitive epilepsy.)

I tested the winners chosen by Hardcore Gamer in 9 game categories. Five of the winners—including the Best Game of Show winner, Deus Ex: Mankind Divided—contained seizure-provoking flashes and/or patterns.

Here are my results, using the Harding Flash and Pattern Analyzer to check for images likely to trigger seizures in individuals with photosensitive epilepsy. Please remember that there are no guarantees your results will match mine and that many factors affect a person’s susceptibility to visually induced seizures.

 Cuphead NHL 16 Unravel Horizon: Zero Dawn No Man's Sky Street Fighter V Battleborn Need for Speed Deus Ex: Mankind DividedTesting methodology 

I run downloaded gameplay clips, cinematic clips, and promotional trailers for each game and submit the sequences to the Harding Flash and Pattern Analyzer. The FPA is widely used by producers and networks in the UK—including by the BBC—to ensure seizure safety of all material on broadcast TV.

The analyzer examines video sequences for very specific and measurable image qualities that researchers have found can trigger seizures:

  • rapidly alternating light and dark images (flash/flicker)
  • certain stripes and geometric patterns with high contrast
  • large areas of very bright (“saturated”) red
  • problem images take up more than one quarter of the total screen area

If the first clip I test of a game fails the safety test, I note that and move on to test the next game. If no safety violations are found, I typically test at least 4 or 5 additional clips of that game–sometimes more, if I have a hunch due to the game genre and/or overall look of the sequences that there might be unsafe “footage” that I haven’t yet found.

The image analyzer found Deus Ex: Mankind Divided contained images that can provoke seizures.

The image analyzer found Deus Ex: Mankind Divided contained images flashing at a rate that can provoke seizures.


Games I’ve listed as safe could have seizure-provoking sequences that I was unable to locate. I don’t do this testing while actually playing these video games. Instead I work with video clips available online, some of which are official marketing and gameplay trailers; others are cutscenes and gameplay sessions posted by reviewers or fans. I avoid clips showing games that have been modified with other software.

Each person’s seizure threshold can be affected by a number of factors apart from the visual stimulus itself, including illness, hunger, stress, fatigue, alcohol, medications, length of play, and the player’s menstrual cycle, among others. So a game that seems OK may trigger a seizure in that same player under different conditions.

Researchers on a mission ignore seizure studies

Cherry-Picking-400x300A big reason seizures induced by video games aren’t more widely known is the absence of new research findings about the problem. There continues to be a lot of misinformation out there, and meanwhile we get farther away in time from the studies showing there’s good reason to take the seizure risk very seriously. Without announcements of new results or a concerted education effort by advocacy organizations, it’s tough to keep this issue alive for the public. When today’s researchers of video games miss the opportunity to remind readers of the seizure studies, they perpetuate the public’s disregard for the seizure risk. Here’s why this happens:

  1. The research showing video games can trigger seizures is old news! Many studies on video games and photosensitive epilepsy have already been published, beginning in the early 1980s. The findings and methods have been refined over time, but the results have been fairly consistent. Since there wasn’t much controversy about the studies, the research community has largely moved on from what was already considered a niche subject. More recent studies by these same specialists in photosensitive epilepsy aren’t the type to be appreciated outside the scientific community: research methdologies, specific genes, and the place of reflex seizures in the spectrum of seizure disorders. Not very newsworthy for the general public.
  2. Most studies today on the effects video game use are about long-term influence on skills, behavior, and attitudes, and on their use in education and health-related applications. These studies are typically done by social scientists, who in general are not including medical issues in their analyses. Studies like this are looking at a different body of previous work–studies done by other social scientists–and the authors may not be familiar with the photosensitive epilepsy research.
  3. There’s a real backlash these days against studies warning about negative influences of video games. Video games are clearly here to stay; researchers and game developers are eager to demonstrate games’ potential for good. Unfortunately, people who write about video games’ beneficial effects and purposeful applications tend to treat with suspicion (or worse) any earlier studies showing problems attributed to games. Or the seizure issue is omitted altogether from summaries of previous findings.

Seizure research swept under the rug

axe grindingPeople who grew up using computers and video games from an early age now comprise a sizeable segment of the research community. Many of them feel there has been a consistently negative bias in studies about video games and they are eager to show another perspective. Here’s an example. Prof. Mark Griffiths in the UK wrote a piece last year entitled, “Video Games Are Good for Your Brain – Here’s Why” that he begins this way:

“Whether playing video games has negative effects is something that has been debated for 30 years, in much the same way that rock and roll, television, and even the novel faced much the same criticisms in their time. Purported negative effects such as addiction, increased aggression, and various health consequences such as obesity and repetitive strain injuries tend to get far more media coverage than the positives.”

Prof. Griffiths had greater difficulty getting his own papers published when they showed positive positive influences of games than when they addressed difficulties such as video game addiction. The article points out positive outcomes using video games for social engagement, therapeutic applications, and education, and then concludes with this irresponsibly inaccurate statement:

What’s…clear from the scientific literature is that the negative consequences of playing almost always involve people that are excessive video game players. There is little evidence of serious acute adverse effects on health from moderate play.” [However, there is extensive evidence of seizures–a pretty serious acute adverse effect–that can occur even with very brief exposure. — JS]

Social scientists pick and choose

Earlier this year a piece titled “Video games can be good for you, new research says” (no link because it’s behind a pay wall) appeared in the Chicago Tribune. The reporter opens the piece by putting video game research into historical context.

“Researchers have done thousands of studies on gaming since the 1980s, often with unmistakably negative results. Some associated video games with an increased risk of epileptic seizures, while others cautioned that the games could provoke dangerously elevated heart rates. Many studies also linked violent games to aggression and anti-social behavior.”

to tell the truthThen the article turns to a psychology professor whose new study forms the basis of the article. Prof. Christopher Ferguson has done dozens of studies on effects of video game use. Prof. Ferguson, who’s found that violent video games do not contribute to societal aggression, reasons that early research into any new technology is often flawed. Studies that aim to find negative effects get funded and promoted, while those with more benign findings are unpublished and forgotten, he explains.

“When a new generation of scholars more familiar with the technology comes along, different results often appear — and that’s what is happening with gaming. We’re just not seeing the kind of data emerge that would support the techno-panic that was common in earlier years.”  

There is no further mention in the article of studies about the video game seizure problem–as if all the video game seizure research was part of the so-called “techno-panic.”

I contacted the Tribune reporter to point out that the seizure problem is for real and hasn’t gone away. He said he was aware of this fact and was interested in writing about it sometime. However, without a piece of news tied to it, such as results from a new study, other stories are obviously much more compelling for a newspaper to cover.

P.S. I’m on a mission, too 

I’ve chosen to focus on the seizure risk from exposure to video games, and on the after-effects these seizures–even small ones–can have. If you’ve read other posts of mine, you’re aware I believe there is still some research on video game seizures that needs to be done and it’s on issues that could produce newsworthy results:

  • the higher risk of visually induced seizures in specific populations, such as young people with autism. One small, unpublished study found 25 percent of young people over age 15 with autism spectrum disorders are photosensitive, but more study is needed.
  • the real prevalence of photosensitive seizures, which researchers admit are probably underdiagnosed because they aren’t noticed or reported.

Game accessibility and the seizure problem

disability-symbolsMomentum is growing to eliminate the barriers that make it difficult or impossible for people with disabilities to play video games. An assortment of game accessibility specialists and organizations are advocating with and educating game developers on how to adapt their offerings for gamers with physical, sensory, and/or cognitive impairments many types of disabilities. In addition some of these organizations work with individuals to resolve specific accessibility issues.

Q: How might this trend bring about progress on the seizure hazard that persists in many games?

A: Remains to be seen because game-induced seizures don’t typically receive a lot of advocacy attention amid so many other disabilities.

Some advocacy efforts focus on modifying the user interface to accommodate certain types of disabilities—such as mobility limitations that make a typical game controller too challenging. There are also two well-established game accessibility groups—both founded more than 10 years ago—that address all sorts of disabilities and could therefore actively promote the development of games that are unlikely to trigger seizures.

The leading advocacy players (as it were)

The Able Gamers Foundation is a non-profit, staffed by volunteers, that is supported by donations from individuals and some big names in the industry, including Sony, Harmonix, the Steam storefront, and others. Able Gamers advocates with and provides free consulting to game developers in order to open gaming up to individuals with disabilities. The organization published a set of game accessibility guidelines written by developers and by gamers with disabilities. The guidelines appear under the title Includification (I love that term). Accommodations for mobility impairments make up the largest category in the Includification booklet: remappable keys, compatibility with specialized input devices, and so on. Accommodations for hearing, vision, and cognitive disability are outlined as well. Able Gamers says that flash and flicker guidelines, not currently in the document, will be added in a revision scheduled for later this year.

Able Gamers does a lot of community outreach to gamers with special needs and tours the country demonstrating assistive technology devices that make game play possible for individuals who cannot use conventional controllers or other standard input/output technology. The group reviews games for accessibility features, and it provides online forums where disabled players can connect with each other. Able Gamers also provides grants to individuals who need customized assistive technology for gaming.

The Game Accessibility Special Interest Group of the International Game Designers Association, founded by a member of Stockholm University’s Department of Computer and Systems Sciences, is comprised of game developers and academic and industry experts in accessibility. The group presents at conferences, surveys developers, and organizes accessibility competitions for game design students. The goals of the SIG include advocacy, cross-industry cooperation, and creating a curriculum on accessible design that can be incorporated into existing post-secondary game design courses. The SIG is embarking on an ambitious multi-faceted agenda to move the accessibility agenda forward.

For developers seeking references on how to make games more accessible, the SIG recommends Able Gamers’ Includification and, a document that received an award from the Federal Communications Commission (FCC). The guidelines detail 100 accessibility features and include a remarkably clear outline of how to reduce the risk of flash- and pattern-induced seizures. The SIG also promotes a list of 14 accessibility features–such as easily readable closed captioning and colorblind-friendly design–that would have the most impact on gamers with disabilities. (Seizure risk reduction didn’t make the top 14 list.)

How photosensitive epilepsy is unlike other disabilities

I exchanged emails with London-based Ian Hamilton, an accessibility specialist and user experience (UX) designer active in the SIG. Hamilton was instrumental in organizing and producing He respects the importance of seizure safeguards. “…even though epilepsy is relatively uncommon compared to things like colourblindness or dyslexia,” he wrote, “it’s one of the only accessibility issues that can result in physical harm, so it’s absolutely critical to get right.”

As he so rightly pointed out, the stakes (that include the potential for serious medical issues and life-long limitations) in the case of photosensitive epilepsy are quite apart from the frustrations of being unable to play because of, say, inadequate captioning. While photosensitive epilepsy absolutely belongs in any set of game accessibility guidelines, it differs in some other significant ways from the other conditions/disabilities that need accommodations:

  • It is particularly important to proactively reduce the seizure risks to all consumers since many people aren’t aware they have the condition and are therefore at risk. They’ve either not yet been triggered or they aren’t aware of seizures they’ve already had. Nobody really knows how many people are affected by photosensitive epilepsy, but awareness is low, diagnostic methods are unreliable, and estimates of how common it is are very conservative.
  • Advocates say many developers are responsive to specific requests for modifications that help those with a particular disability, because many accessibility issues stem from a lack of awareness by product designers of accessible design practices. Although it’s true that accessible design isn’t typically included in the game design curriculum, this argument doesn’t really hold up when it comes to seizure-inducing images. Game publishers have acknowledged for more than 20 years that their games could pose a risk to individuals with photosensitive epilepsy. The legal departments of game publishers should communicate with their own designers and developers about making games less likely to spark seizures. Many popular games continue to contain seizure-inducing images.
Just 340percent of games recommended by GamesBeat passed the seizure safety test.

In my tests, just 40 percent of games recommended in GamesBeat’s 2014 holiday guide were unlikely to trigger seizures.

  • Advocates encourage the involvement of individuals with disabilities in the design and testing of games for the benefit of all parties. For people with visually induced seizures, this isn’t feasible, nor is it necessary. Testing needs to be done without placing people at risk, using existing analysis applications that utilize research-based image specifications. For these consumers there is little chance of developing an ongoing collaborative relationship with the industry.
  • Despite a 2005 consensus paper by the Photosensitivity Task Force of the Epilepsy Foundation of America identifying seizures from visual stimulation as a significant public health problem**, there has been no organized advocacy to reduce visual stimuli in our everyday environment that can trigger seizures. Advocacy efforts (in the USA, anyway) to improve the lives of people with photosensitive epilepsy appear to be practically non-existent. In contrast, the interests of people with vision, hearing, and movement impairments are represented by organizations that proactively take on quality-of-daily-life issues.

Under the heading “Ways to further accessibility in the games industry” Ian published a comprehensive list of steps required for making video games accessible to people with disabilities. In addition to game developers and disabled gamers, the stakeholders involved would include educators in game design, game publishers and distributors, platform manufacturers, government bodies, trade groups, development tool builders, and so on. Among the recommendations: “Include basic access requirements in publisher certification requirements, such as subtitles and avoidance of common epilepsy triggers (both of these examples are required at a publisher level by Ubisoft).” Ian notes in his preface to the list that bringing about this accessibility within the game industry amounts to “wide-scale cultural change.”

Moving forward

I applaud the work of the Games Accessibility SIG, the Able Gamers Foundation, and other groups addressing of accessibility. They are making strides on an important issue while faced with the task of convincing the industry that design changes for accessibility will pay off in improved overall game design and a larger customer base.

But in order to make possible the massive and broad-based cultural change that’s needed, I believe these talented and dedicated advocates need significantly greater resources, buy-in, and recognition. The industry needs to declare publicly that it is committing itself to making gaming more inclusive of people with disabilities. In the face of frequent challenges about the contents of video games and their influence on young people, the accessibility issue offers a win-win public relations opportunity for video games. The Entertainment Software Association is just the organization to proactively announce an industry-wide goal of providing people with disabilities easier access to video game entertainment and learning. The ESA should establish and contribute major resources to a game indistry consortium for promoting and achieving accessibility education, standards, learning, and collaboration, leading to a more inclusive—and larger—customer base.

** “The Photosensitivity Task Force of the Epilepsy Foundation of America believes that a seizure from visual stimulation represents a significant public health problem. No known method can eliminate all risk for a visually induced seizure in a highly susceptible person, but accumulation of knowledge about photosensitivity is now at a level sufficient to develop educational programs and procedures in the United States that substantially will reduce the risk for this type of seizure.

— from Robert S. Fisher et al., “Photic- and Pattern-induced Seizures: A Review for the Epilepsy Foundation of America Working Group.” Epilepsia Volume 46, Issue 9 (September 2005), pages 1426–1441.


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