You and I have different definitions of 'built in'. MS has chosen to have 3rd party deal with much of the accessibility functionality which is a reasonable choice for them, but it's not directly a windows feature. Want a screen reader use Jaws, etc etc.

OS X has the same APIs (Accessibility). AppleScript doesn't use them, but VoiceOver and Xcode's UI testing do.

AppleScript can and does use the accessibility APIs to drive UIs, it's just not very well documented (like much of AppleScript in general :( ).

Pretty much anything used to drive a UI on OS X is going through the accessibility APIs to do so.

AppleScript has been the absolute saviour for me on multiple occasions, the amount of scripts I have that trigger at the click of one button is getting to be a bit outrageous.

So for instance I will have a button on my switch control on-screen keyboard, and when it's pressed it sends a request To If This Than That, which communicates with my LIFX lightbulbs and flashes all of them in the house blue notifying my carer that I need assistance. That's just one of many. I love AppleScript.

To be clear I control my computer with my right index finger which gives me left mouse click, a small reflective doton my glasses which gives the cursor movement and voice dictation software which enables you to leave comments on Hacker News.

Thanks for sharing your setup. It's been a pleasure to discuss the issue with you. You've inspired me to check out AppleScript a bit more in detail.

On Windows, Autohotkey is my goto for automation