Secondary Research

Attitudes towards Accessibility

in Video Games:
Literature Review
Brian Duffy CDG2
Preface
The central premise of this literature review emphasises the importance of disabled people's experiences and
examines the practical implications of public and academic attitudes. In line with this objective, excluding direct
quotations the following paper is presented through identity-first language when referring to the social identity
of disability, informed by a growing consensus among the disabled community (Botha et al, 2021; Bury et al,
2020; OAR, 2020). Person-first language is used when referring to impairments as defined by the social model,
due to widespread negative associations with the term 'impaired' (The author’s reasoning for this decision is
further outlined in Appendix A).
Introduction
Video games exist at the forefront of modern culture and have risen to become among the most popular social
spaces, particularly among children (Fishman, 2019). Estimates for the number of regular gamers in Ireland range
between 26% and 40% of the population, however these statistics mean little as these social spaces were shared
with an estimated 2.69 billion other gamers worldwide in 2021 (Gilbert, 2021). However, access to these spaces
is often contingent on physical and mental dexterity or other significant challenges. This can present barriers to
people with impairments, which call for design consideration or assistive tools to overcome. While many of these
solutions exist, their implementation and availability to gamers who would benefit is limited, and the games
industry remains inconsistent regarding accessibility standards (Brown & Anderson, 2020).

It has been frequently remarked that within the field of video game accessibility discussion and research, there
is little focus on the experiences of disabled gamers, in favour of novel assistive technology or specialised games
(Liu, 2017; Scope, 2021). This approach is notably limited, as the history of the disability rights movement
demonstrates that progress is best achieved when the experiences of disabled people are at the centre of the
discussion both in academia and in public. This crucial idea inspired the movement’s famous slogan ‘Nothing
About Us Without Us’ (Charlton, 1998).

Informed by the importance of public opinion during the fight for widespread disability rights, this literature
review sets out to answer the question: “What are the common audience and developer attitudes towards
disability and how does this impact the accessibility of video games?” The review begins by establishing the
historical context of disability advocacy, before comparing a range of academic research and other media to
outline the current state of video game accessibility, emphasising contemporary research focused on the
experiences of gamers with impairments. Additionally, the review analyses broader attitudes towards disability
to supplement a holistic assessment of attitudes in the gaming community, concluding with a discussion of how
these attitudes may factor into the future of video game accessibility.

Models of Disability
"In our view it is society which disables physically impaired people. Disability is something imposed
on top of our impairments by the way we are unnecessarily isolated and excluded from full
participation in society" (UPIAS 1975:3).

The social model of disability, first presented by disabled academic Mike Oliver in 1983, was an elaboration of
the above quote, itself known as the social definition of disability. The social model emphasises the distinction
between impairments which are intrinsic to the individual, and disability, which is created when a society does
not accommodate for impairments. This stands in stark contrast to the individual model of disability, which
“locates the 'problem' of disability within the individual” and identifies the causes of these problems as
“functional limitations or psychological losses which are assumed to arise from disability” (Oliver, 1990:3). Prior
to the advent of a large-scale disability rights movement in the 1970s, the dominant framework for discussing
disability was a subcategory of the individual model known as the medical model, which emphasised attempts
to ‘cure’ physical and psychological impairments through medical intervention.

“The medical model of disability frames atypical bodies and minds as deviant, pathological, and
defective… Thus, disability is cast as a problematic characteristic inherent in particular bodies and
minds. Solving the problem of disability, then, means correcting, normalizing, or eliminating the
pathological individual...” (Kafer, 2013:5).

As Kafer describes, approaching disability as an aberrance to be corrected leads to prejudiced views of disabled
individuals, who were frequently subjected to medical treatments against their will and broadly disregarded due
to their perceived lack of value. By shirking this perspective and adopting the social model to explain the
challenges of disability, advocates were able to unify and empower the disabled community under this new
social identity. This movement grew throughout the 1980s and led to widespread change, as many nations
introduced crucial disability rights legislation such as the Americans with Disabilities Act in 1990, the U.K.’s
Disability Discrimination Act 1995, and the Disability Act 2005 in Ireland. These regulations typically required
businesses and other organisations make themselves accessible to individuals with a wide range of impairments
e.g., through the provision of ramps and elevators, and the modification of doorways and counter-tops to
accommodate wheelchair users (Disability Act, 2005:26; U.S. S.B.A., 1999:8-11).

Soon after, further unifying concepts emerged from the social model movement, such as ‘neurodiversity’ which
aims to non-pathologically describe variations in human brain function, such as those on the autism spectrum
(Blume, 1998). Through this seismic shift in attitudes towards disability and by identifying the true social barriers
that people with impairments face, advocates and legislators successfully reassigned and enforced the
responsibility of accessibility onto the state and crucially, onto the businesses who profit from the inclusion of
disabled people.

Accessible Computing
When the first generation of personal computers debuted in the mid-1970s their future remained highly
speculative and uncertain even among industry pioneers (Smith, 1971). However, even in those early days many
recognised the potential of personal computing for disabled users who faced difficulty engaging with common
services such as education and banking. Advocates promoted the idea of accessible computing, acknowledging
that the value of the computer as a tool relies on its accessibility to as many users as possible, and calling for
assistive tools to become standard within the tech industry. (Liu, 2017)

These concerns led to the Johns Hopkins First National Search in 1981, a United States-based competition which
aimed to “inspire computer-based applications aimed at meeting the educational, vocational, recreational, and
daily living needs of disabled persons” (Hazan, 1982:226). Over 900 entries were received and resulted in the
predecessors of modern accessibility tools, such as eye-tracking and TTS (Text to Speech) software, on-screen
keyboards, and many alternative input devices. This inspired a wave of small businesses to produce these
prototypes for the growing PC user base (Russell et al., 1997).
Today, many of these features are included as standard on computers and mobile devices, and the market for
assistive technology has moved mainstream with products like Microsoft’s Xbox Adaptive Controller (Morris,
2021). As internet use became commonplace, the Web Content Accessibility Guidelines were established in 1999
(later updated in 2008) and are widely enforced as the basic requirements for websites in accessibility legislation
(W.A.I., 2018). While these advances have undoubtedly provided access to key elements of modern life such as
e-commerce and social media to many people with impairments, the video game industry has not kept pace
with this progress.

Accessible Gaming
To date, video games have mostly avoided accessibility legislation owing to their vague legal status between
goods and services (Powers et al., 2015), as well as the difficulty in generalising such a varied range of products.
Despite advances in recent years regarding certain common features such as subtitles, accessibility features are
inconsistent and often poorly implemented (Brown & Anderson, 2020). Gaming has grown to become the largest
entertainment market, particularly in western culture, with an estimated 67% of Americans playing video games
regularly (Snider, 2021) and global revenue far surpassing the Hollywood film industry (Witkowski, 2021).
Similarly, the cultural impact of modern games cannot be overstated, which function as both social spaces and
cultural touchstones; In 2020, a series of virtual concerts held in Fortnite attracted over 27 million attendees
(Goslin, 2020).

“For a person with a disability that is unable to leave his or her home on a regular basis, a video
game can be a tool to interact with the outside world, meet new people, and learn about new
subjects” (Powers et al., 2015).

The Process of Progress

Exclusion from these virtual social spaces clearly evokes the limitations imposed on disabled people throughout
society prior to the rise of the social model. Limited accessibility features are often justified through the potential
expense to the developers, and it has been suggested that further research into the disabled gamer market
could present a useful cost/benefit analysis (Yuan et al., 2011). However, no industry or market can be relied
upon to self-enforce accessibility, “because it is all but impossible to measure the economic benefits of doing
so” (Powers et al., 2015). While Powers et al. argue strictly for legislation as the way forward and conclude that
the debate around video game accessibility will most likely be settled through legal means, the recent history of
disability rights shows a clear progression: First, a shift occurred in the perception and discussion of disability
through the dissemination of the social model through academia and the public, followed by legislation informed
by subsequent research and advocacy. Mike Oliver himself outlines this process in his 2013 article The Social
Model of Disability: Thirty Years On:

“[The social model] soon became the vehicle for developing a collective disability consciousness
and helped to develop and strengthen the disabled peoples’ movement that had begun to emerge
a decade earlier. Armed with the idea that we needed to identify and eradicate the disabling
barriers we had in common, the disabled peoples’ movement forced the media to change their
 images of us, transport providers to open up many of their services to us, public buildings to
become much more accessible and the legal system changed to make it illegal to discriminate
against us” (Oliver, 2013:1024-1025).

Oliver identifies employment rights as an area in which progress has remained limited, describing how “although
it has identified many of the disabling barriers in the international labour market and with the behaviour of
employers, the solutions offered have usually been based on an individual model of disability” (Oliver,
2013:1025). This is a remarkably similar situation to contemporary video game accessibility, in which industry-
side accessibility standards are resisted to align with the profit motive, and emphasis is placed on users with
impairments acquiring their own hardware and software solutions.

The State of Accessible Gaming

Scope, a U.K.-based charity organisation, carried out a survey of gamers in December 2020 to identify key
difficulties faced by those with mental or physical impairments. 66% of disabled respondents reported facing
barriers related to gaming, with the most reported issues being the affordability, awareness, and availability of
assistive technology, followed by inaccessible games and games consoles. Furthermore, the report identified
that 41% of disabled gamers had purchased games they were unable to play due to poor accessibility within 12
months, leaving 1 in 7 total respondents unable to claim a refund (Scope, 2021).

These figures highlight the poor current state of accessibility in video games: Disabled individuals are required
to bear significant costs and efforts to implement assistive technology, meanwhile many of the largest studios
limit their accessibility features to reduce their own costs. Furthermore, disabled gamers cannot rely on games
being accessible to them, as the standards for these features remain inconsistent even within the catalogue of
one publisher (Brown & Anderson, 2020).

Oliver never viewed the social model of disability as an “all-encompassing framework”, and he acknowledges
that the model has been criticised for overly generalising the challenges faced by people with varied
impairments. However, the subsequent disability rights movement was evidently strengthened by sharing a
unified understanding of disability which significantly altered public attitudes around the issues they faced and
importantly, perception of where those issues originated. It follows then, that progress in video game
accessibility may similarly require a broad shift in both the audience and developer understanding of disability
as it relates to gaming, and the responsibility of the industry to establish a reliable baseline of accessibility.
Attitudes towards Disability
In 2017, the National Disability Authority conducted their regular Public Attitudes to Disability Survey in Ireland,
polling disabled and non-disabled people for their opinions on disability rights and the experience of people with
impairments in various aspects of society (NDA, 2017). These results can then be compared to similar surveys
from 2011 and 2006 to identify trends and shifts in public attitudes. The 2017 survey noted a decline in
respondents who agreed that ‘people with disabilities are treated fairly in Irish society’, from 44% in 2011 to
36%, however agreement that ‘people with physical disabilities can participate fully in life’ increased significantly
from 31% in 2011 to 46%. Only 18% of respondents believed that disabled people receive equal employment
opportunities, while just 3% said they would feel uncomfortable working with people with physical or mental
disabilities. These figures show that while there is widespread acceptance and awareness of the issues faced by
people with impairments, particularly in employment, there is also a growing perception that disabled people
no longer face exclusion or limitations due to societal barriers.

Through the social model of disability these opinions appear contradictory, as full participation in society
requires that disabled people are treated fairly. This may hint at a subtle shift away from the social model
towards identifying the ‘problem’ of disability as stemming from individual discriminators and relating to
specific impairments, which reinforces the stratification of disability and undermines the collective power of
disability advocacy. Mike Oliver warned of this backsliding in 2013, referring to social welfare cuts in the wake
of the 2008 recession:

“The disabled peoples’ movement that was once united around the barriers we had in common
now faces deep divisions and has all but disappeared… As a consequence of this, most of the
political campaigning that has taken place in defence of our benefits and services have forced
disabled people back into the role of tragic victims of our impairments and has involved others
undertaking special pleading on our behalf. In fact it has taken us back more than 30 years to the
time before the social model came into existence” (Oliver, 2013:1026).

Furthermore, the experiences of disabled people in Irish society do not align with this perception as the report
later reveals, by comparing responses to questions of social participation:

“Respondents who had a disability were significantly less likely than those without a disability to
have taken a holiday at home (36% vs. 53%) or abroad (28% vs. 50%) in the past 12 months, gone
on a day trip (55% vs. 75%) or had a hobby (67% vs. 82%). They were also significantly less likely
to access the internet (66% vs. 88%) or own a mobile phone (85% vs. 96%)” (NDA, 2017:13).

These figures highlight a significant disconnect between the lived experience of disabled people and the 46% of
respondents who believe disabled people can participate fully in modern life. The effect that this exclusion from
society has on individuals is particularly clear, with disabled respondents reporting consistently lower levels of
overall satisfaction and happiness, and far more frequent accounts of feeling tense (19% vs 4%), lonely (16% vs
4%), and depressed (18% vs 4%).
Attitudes in the Video Game Audience
It has often been noted that the field of video game accessibility lacks research into the experiences of disabled
gamers (Scope, 2021; Liu, 2017), and there has been no games-related research into general attitudes akin to
the 2017 NDA survey. However, there are an estimated 2 million active gamers in the Republic of Ireland, some
40% of the population, meaning common attitudes likely align with the general public though there may be
discrepancies related to age and gender distribution. In 2017, researcher Yiyi Liu surveyed common sentiments
from disabled gamers across the online gaming community, including their interactions with their non-disabled
peers:

“It should be noted that when disabled gamers ‘out’ themselves in more general gaming spaces,
typically forums for a specific game or franchise, the reaction of their able-bodied peers is primarily
that of innocent curiosity. When the idea of accessibility features are [sic] introduced, players of
networked games will often voice concerns regarding competitive integrity. Once these concerns
are allayed, however, able-bodied gamers tend to be welcoming of their disabled peers, and
players of competitive games in particular will express admiration that the disabled player is able
to be ‘that good’ despite their disability” (Liu, 2017:71).

These sentiments seem to echo those of the broader public, in demonstrating acceptance of people with
impairments, and acknowledging the value of accessibility features. However, the tendency of gamers to praise
players who demonstrate high skill ‘despite their disability’ suggests that the limitations of disability are not
widely seen as stemming from a lack of universal design, and rather from the individual’s impairments. It appears
that the social model of disability may not be the dominant perspective within the gaming community. As the
recurring debates around video game difficulty demonstrate, overcoming a challenging game like Sekiro is held
as a point of pride by many gamers, who reject arguments for broader accessibility. (Rosenberg, 2019) If a player
is unable to complete a game or compete with others, that is widely viewed as a shortcoming of the player,
rather than the game.

"Historically, gaming communities have been centred on competition and elitism, as a result of
being a cultural subgroup… Games now cover as many different topics as other art forms do, but
the taste of elitism and exclusion has persisted” (Scheurle, cited in Handrahan 2020).

Contrary to Liu’s assessment of the gaming community as “welcoming”, the recent Scope survey found that “2
in 5 gamers have experienced negative attitudes from other gamers relating to a disability, impairment, or
condition in the last 12 months” (Scope, 2021). Similarly, 31% of respondents want gaming platforms to make a
commitment to tackle “negative attitudes and bullying”, ahead of concerns about representation (25%) and
assistive technology (20%). These negative attitudes have a clear impact on disabled many gamers who feel
excluded due to their impairments.
Attitudes in the Video Game Industry
Generally, the same attitudes regarding accessibility are not found within the video game industry. In a talk titled
Ditch the Difficulty Discussion, senior game designer Jennifer Scheurle outlines how rather than emphasising
challenge, modern game studios tend to design for a variety of player types. She remarks: “I believe many players
would be surprised to learn that the elitism that tends to take hold in player-led discussions is largely absent
from design conversations” (Scheurle, cited in Handrahan 2020).

In recent years there has been a significant push towards broader accessibility in video games, following the
2012 release of both the International Game Developers Association’s Game Accessibility Guidelines and
advocacy group AbleGamers’ Includification. These both aim to guide developers towards including basic
accessibility requirements, with Includification encouraging developers to understand the impairments players
might face and design with those in mind (Barlet & Spohn, 2012). While these guidelines were widely ignored
by the mainstream game industry, many smaller developers soon adopted extensive accessibility features, the
success of which led to extensive improvements to game accessibility (Shin, 2021).

Through a recent survey of accessibility design in popular games, researchers found that “almost every major
game in 2019 included some kind of accessibility option or even a full accessibility menu” (Brown & Anderson,
2020:716). However, many of these features were poorly implemented or insufficient, and accessibility practices
remain entirely inconsistent across the industry. Their conclusion that the games industry could benefit by
establishing a consistent baseline of accessibility is mirrored in other studies (Aguado-Delgado et al., 2018)
alongside calls for a standardised accessibility rating system (Liu, 2017; Yuan et al., 2011). While attitudes
towards disability may be more positive among game developers, the industry does not share a unified
understanding of how to design games to sufficiently meet the needs of people with impairments and remove
disabling barriers.

Conclusion
Recent progress in video game accessibility presents an undeniable success for the disability rights movement
overall, allowing many players to access more social spaces and engage with popular media. However, gamers
with impairments still face many disabling barriers and frequently report hostile attitudes in the broader gaming
community. While advances in assistive technology have the potential to eliminate certain barriers, prohibitive
costs preclude many from investing in the technology (Liu, 2017; Scope, 2021). Similarly, the rise of accessible
design practices significantly benefits players with impairments, however these features are typically
inconsistent, unreliable, and poorly advertised, leaving disabled gamers unsure whether they will be able to play
a game before purchase, often facing further difficulty in claiming refunds if not (Brown & Anderson, 2020;
Scope, 2021).
Much of this progress is due to the tireless advocacy from groups such as AbleGamers to raise awareness of
accessibility needs within the industry and advise on projects such as the Microsoft’s Adaptive Controller
(Takahashi, 2021). While this has influenced many developers to consider accessible design, this has little effect
on large studios who hesitate to invest resources in accessibility features without a clear economic incentive
(Powers et al., 2015; Yuan et al., 2011). Furthermore, there appears to be a disconnect between contemporary
game designers and the elitist attitudes of many in the general gaming audience, suggesting this advocacy has
not had the same impact on the community at large (Scheurle, 2020).

The power and influence of public opinion has been widely documented throughout history, and the growing
ubiquity of consumer-side activism evidences the significant impact that unified social attitudes can have on
industry practices (Lightfoot, 2019). Similarly, shifts in public opinion have proven crucial to influencing social
policy, particularly relating to disability rights (Oliver, 2013). In the absence of applicable legislation (Powers et
al., 2015) or enforced accessibility standards similar to the ESRB or PEGI age-rating systems (Yuan et al., 2011),
public attitudes may present the clearest motivator for industry change. This would require reducing negative
attitudes towards disability in the gaming community by disseminating a more unified understanding of
accessibility and disabling barriers, as the social model achieved in general society. However, the relationship
between social policy and culture is typically reciprocal. Cultural beliefs, while influential, are generally
malleable, often subject to “manipulation, negotiation, variety and change” (van Oorschot, 2007:137). Should
legislation or industry regulations instead lead future progress in video game accessibility, it follows that
attitudes towards disability may improve too, with more gamers exposed to the concept of universal design and
the social responsibility to limit the barriers faced by individuals with impairments.

Most research into video game accessibility centres around design practices and assistive technology, typically
emphasising technological solutions to remove disabling barriers. However, disabled gamers instead highlight
negative social attitudes and limited representation as greater concerns. Further research regarding attitudes
towards disability within the gaming community is required and may present a first step towards changing these
attitudes. Additional research should also be carried out into developer attitudes beyond merely identifying
design best practices. Through a greater understanding of how the recent industry trend towards more
accessible design propagated, particularly among smaller developers, a similar approach may be devised to
effectively shift audience attitudes.
Appendix A
Throughout modern academia, there exists a heated debate around the use of language when discussing
disability, between person-first terminology (e.g., "individual with disabilities”) and identity-first (e.g., "disabled
individual"). Following many disability advocates and researchers decrying person-first prescriptivism (Dunn &
Andrews, 2015; Vaughan, 2009; Callahan, 2018), some mainstream institutions no longer enforce person-first
language (PFL) within their publications. (APA, 2020). While person-first language aims to emphasise the
humanity of the individual, doubt has been cast upon the practical effectiveness of person-first language in
reducing insensitivity (Collier, 2012a). Additionally, it is commonly argued that the use of person-first language
only when referring to disability may increase stigma and further the perception of disability as abnormal
(Gernbacher, 2017; Liebowitz, 2015; Collier, 2012b).

Crucially, it has been widely documented that the movement away from identity-first terminology is not
supported by a significant majority of disabled people, particularly in the autistic, deaf and blind communities,
who are considerably more likely to be offended by person-first language (Botha et al, 2021; Bury et al, 2020;
OAR, 2020). As stated in the preface, this literature review emphasises the importance of centring disabled
people's experiences when discussing disability rights, and the research process revealed that even prominent
disability advocates and scholars, including professors Mike Oliver and Alison Kafer, appear to ignore PFL
prescriptivism despite its widespread promotion (Kafer, 2013; Oliver, 2013). While the author acknowledges the
meritorious intent behind person-first language, ultimately the primary purpose of language should be to
achieve effective and inoffensive communication, rather than idealistic semantics.
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