Inclusive Design For Patients With Autism Spectrum Disorders
Designers of pediatric facilities have improved the healthcare journey of many families, creating rooms with sleeper sofas, playscapes for young patients and their siblings, and common areas decked with color and whimsy that make hospitals and clinics less scary. But many of these facilities strain to adequately respond to children on the autism spectrum, a rapidly growing patient group. These children have challenges with sensory processing, manifesting as hyper- or hyposensitivity to sensory stimuli such as sounds, smells, and sights that can interfere with their daily lives.
The prevalence of autism spectrum disorders (ASD) has been increasing over the past two decades since the Centers for Disease Control and Prevention (CDC) began collecting data. According to the CDC’s study, Prevalence of Autism Spectrum Disorder Among Children Aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 sites, one in 59 American children has ASD. In addition to atypical sensory processing, many children with ASD also struggle with overlapping medical conditions, such as gastrointestinal problems, sleep disorders, and psychiatric diagnoses.
Just as the prevalence of ASD has grown, so has awareness. Restaurants, airports, and NFL stadiums are making headlines for incorporating sensory rooms that help people with sensory disorders decompress. While these efforts are commendable, pediatric healthcare facilities need to accommodate patients with ASD in a more comprehensive way, from the moment they arrive on campus. This calls for a holistic view of the parent-child visit, which involves services and processes that support the whole family, including patients’ siblings, for example.
Guidelines for autism-friendly design have emerged in recent years, but our industry still lacks standards specific to pediatric facilities and the ASD population. We must look at our healthcare spaces as areas of respite in what can often feel like a world full of triggers. With each step, we should ask, “How would this feel for someone with ASD? How can we design for them? What impact would an ASD-influenced design have on the overall patient population?”
Here are some design principles to guide projects:
- Predictability and intuitive navigation: The journey through a healthcare facility can often feel like navigating a maze guided by nothing more than signage. Moving through the space should be intuitive, with each area providing glimpses into the next, both guiding and sequencing one’s path from entry to exit. It’s critical to avoid blind corners because knowing what (and who) is ahead can give people a sense of safety, especially those with ASD. And instead of relying on signage to navigate tight corridors, envision a reception area in an outpatient building where the patient, standing at the front desk, can see the stairway to the clinics and a clear path to get there.
- Prospect and refuge: Spaces that echo our natural evolutionary environmental preferences offer the opportunity to see without being seen. Imagine looking out over a park while leaning against a tree, grabbing a corner booth at a crowded restaurant, or finding a reading nook in a library or waiting room. As you plan the different areas in a facility, carve out smaller spaces that make patients feel safe and aware of their surroundings, so that they can choose if and how much they want to engage with others.
- Personalization and choice: Sensory issues and preferences are unique to each person on the spectrum, which has led to experimentation with “tunable” environments. For example, a sensory well-being hub was created at Chicago’s Lane Tech College Prep High School in partnership with HKS’s pro-bono arm, CitizenHKS, and its non-profit research arm, CADRE. The “sensory cocoon” features light and sound separation plus customizable color-changing lights and an interactive media wall with simulated nature scenes. It was built as an adaptable prototype for the unique needs of diverse learners as a part of a year-long living lab to help the design community better understand how to create inclusive spaces, including understanding patterns of use, most-frequently used sensory interventions, and associations between children’s sensory profiles and their sensory intervention use. These findings have many implications for pediatric design, demonstrating that, to the extent possible, patients should be allowed to personalize spaces so they can control some of the stimuli. An example would be in exam rooms where patients can choose the color and intensity of lighting.
- Sensory moderation and respite: Sights (lighting, colors, strong patterns), smells (pleasant and unpleasant) and sounds (music, HVAC, lighting buzz, beeping, adjacent conversations) can be strong sensory inputs that might overwhelm patients. Minimize the use of elements like fluorescent lights (which can irritate any patient with their flickering and buzzing noises) and look for ways to decrease sources of noise. Have optional plain or low-stimulation rooms for patients who feel better in unadorned spaces but preserve the choice to customize the rooms with lighting and technology. And throughout the patient journey, design spaces to minimize potential congestion at key points of transition and flow. For example, check-in spaces can be designed with an offset from the busy flow of incoming visitors.
- Joy and engagement: Providing enough positive distraction for children while not overwhelming others who have sensory sensitivities often involves a delicate balance. In many ways, exposure to nature can help meet both needs, and we see that many children’s facilities are integrating nature themes and colors. At Our Lady of the Lake Children’s Hospital in Baton Rouge, La., each department is themed according to one of the ecosystems found throughout the state using its own color palette, graphic feature walls representing the local flora, and “animal ambassadors.” While neutrals comprise the bulk to the material palette, pops of color and watercolor patterns highlight destinations like family lounges or nurse stations. On the unit, each patient room has a “front porch” following the color palette of the unit, nurse stations are outfitted with wall protection printed with watercolor imagery in matching colors, and PPE cabinets located between pairs of patient rooms feature nature-themed artwork.
As patients with ASD and their family members move through their healthcare journeys, designers can help create experiences that can ease their stress, reduce triggers, and provide joy by providing areas of respite, an easily navigable environment, and opportunities for selective sensory stimulation and play. These changes benefit the patient experience but also support clinical excellence by allowing patients to focus and be receptive to care during the finite time clinicians have with them, which is vital to good outcomes.
Erin Peavey, AIA, NCARB, EDAC, LEED AP BD+C, is architect and design researcher, vice president, at HKS, Inc. (Dallas ). She can be reached at email@example.com. Rachel Knox, AIA, ACHA, EDAC, LSSGB, LEED AP, is pediatric practice leader and principal at HKS, Inc. (Dallas). She can be reached at firstname.lastname@example.org. Evelyn Reyers, AIA, EDAC, LSSGB, LEED AP, is senior pediatric planner and principal at HKS, Inc. (Dallas). She can be reached at email@example.com.