If you have already gone through the Acrobat accessibility settings  setup, there is one more setting you should fix to ensure PDF documents are accessible with a screen reader, and that is turning off protected view. David Kingsbury covers this in his book _The Windows Screen Reader Primer_, which can be downloaded here

https://carroll.org/the-windows-screen-reader-primer/

I will add that there are a couple of other PDF accessibility issues with screen readers which David also discusses in his book, one of which is a reading order issue. If you have an issue where it sounds as if words are being smooshed together with no spaces between them, post again and I will explain about how to potentially fix that issue, also.

Here is the section heading and the instructions:

10.1.1

There is one more change to make. Disabling Protected view is absolutely crucial. Until you do this, you simply will not be able to read PDF’s with your screen reader. Steps are:

1.            Press Alt to open the menu, Right arrow once to the Edit menu, Up arrow to Preferences, and press Enter.

2.            This opens a categories list. Press S until you get to Security enhanced.

3.            Tab once to the Enable Protected view at startup checkbox and press the Spacebar to uncheck it.

4.            Tab to the OK button and press Enter.

5.            Pres Alt F4 to close Acrobat Reader and then reopen it. The application must be closed for this change to take effect.

Kestrell