Speaking text attribute changes in Word vs Thorium

In my ongoing experimentation with dealing with underline and strikethrough, I found a setting in my screen reader’s verbosity settings (I use VoiceOver, Apple’s built-in screen reader) to read out text attribute changes when they occur. Perfect, right??? Nope. While it does a wonderful job reading underline and strike-through in MS Word (it literally reads, e.g., “underline” or “strike through” before reading the text that is underlined or struck through, which is exactly what I want), it doesn’t work at all in Thorium. Weirdly, it works only partially in Apple Books—it will read bold, italics, and underline, but not strike-through.

Does anyone know why this is? Is there any way to set the settings so that it does read these things?

Also, regarding the title element: I can get the screen reader to read a title attribute if I read group by group, but it doesn’t read the title element on its own. Are there any setting I could recommend to make sure people notice these titles, if I use them?

Finally, I’m wondering if anyone has come across any ways to indicate to readers that it’s time to read in a different way—for example, character by character. I’m working on a book that requires readers to notice punctuation. I can ask people to set their verbosity to read all punctuation, but that’ll be annoying for the general reading experience. I was thinking it could be really slick if I could insert a tone or some kind of marker that will signal to folks that it’s time to read the punctuation.