For those on the autism spectrum, the design of the physical environment plays an important role in their mental well-being.
Architecture affects its users. This is not — or should not — be news to anyone connected with the profession. What might not occur to people as often, however, is that architects could have a significant impact on the experiences and quality of life available to people living with autism spectrum disorder (ASD).
The American Psychiatric Association defines ASD as “a neurodevelopment disorder that is characterized by difficulties with social communication and social interaction and restricted and repetitive patterns in behaviors, interests, and activities.” The use of the term “spectrum” in the name references the wide range of types and severity of symptoms that may present in someone with the disorder, among which the 2013 edition of the Diagnostic and Statistical Manual of Mental Disorders lists “hyper- or hypo-reactivity to sensory input.”
Visual, tactile, auditory, and olfactory stimuli are integral components — due either to their presence or their absence — of any designed space. Architects, by definition, consider and control these factors. We also manage the layout and detailing of buildings, which can likewise influence social behavior (e.g., the ongoing debate around the benefits of open versus private offices). While designing for autism may not need to be the defining element of every project, the nature of our work does place helping people with ASD within our realm of influence. The prevalence of the disorder also makes it something we can no longer ignore: One in 160 children worldwide fall somewhere on the spectrum, while 1 in 54 8-year-olds in the United States do. Architects cannot fully claim to be making the world more equitable and accessible without considering the needs of the millions of people living with ASD.
So, how do we do that?
Much of the available data is still theoretical and requires more study before actual outcomes can be evaluated. But a central theme of adaptability has emerged: adaptability between projects, adaptability of individual spaces, and adaptability in our own mindsets.
This brings us back to the spectrum aspect of autism. Researchers are quick to point out the range of symptoms, severities, and needs among people with ASD — and even in a single individual over the course of his or her life. New information is also being discovered and published every year. This makes creating a one-size-fits-all approach impractical and potentially inappropriate.
What architects can do is talk to users about the specific needs of their projects and consider the information researchers are publishing within that context. This could mean going so far as to create a space that borders on a sensory deprivation chamber. More often, though, research indicates that designing spaces for people with ASD can take the form of something resembling a “quiet room” in an open office situation. Architects should consider soft finishes to temper sounds, natural or LED lighting to reduce flickering, and biophilic materials with their soothing textures. When possible, creating spaces whose lighting level, furniture arrangement, and temperature settings can be changed throughout the day or between different users is ideal.
This last example forms one of the central findings of a study that came out of The University of Texas at San Antonio earlier this year. In the paper, Neda Norouzi and Cristina Michelle Garza looked at pediatric therapy spaces, surveying therapists with the hope of finding ways that architects can help improve autism-related patient outcomes through better informed design decisions. Eighty percent of respondents highlighted flexibility and adaptability as the most important features of a therapy room.
This is not overly surprising. As regards the spectrum nature of the disorder, autism therapy programs aim to teach people with ASD how to better cope in the world at large, where they will have limited control over their surroundings. This requires that therapists have the ability to alter the level of sensory stimulation — sounds, colors, views, textures, objects — both between different patients and for the same patient as they progress through treatment.
Autism therapy also involves a number of different types of therapies that might all take place in the same room but require completely different setups. For example, an occupational therapist might need to turn a room into an apartment-like setting to work on life skills. A different therapist might need to convert it into an open floor space or set up exercise equipment to work on motor skills. Having an enlarged space with everything set up from the beginning could cause problems for a patient unable to cope with the distraction of extra equipment in the room. As such, therapists need to be able to drastically reconfigure the rooms between appointments.
In addition, giving patients themselves the ability to adapt the rooms to their needs during the session can help them progress in their treatment. While this must be balanced against their own safety as well as that of their therapist, allowing for an appropriate level of agency over their surroundings can give patients a greater sense of control and help them learn how to adjust and self-regulate. This might include access to dimmer switches, the option to change between different lighting sources, or the ability to access “escape spaces” within the larger therapy room.
Architects are only just beginning to understand the important role they can play in opening up the world to people with neurodevelopmental disorders like autism. Missteps may be made along the way, but to build a more equitable, inclusive, and fully functional society, it is important that those initial steps be made.
If past experience provides any guidance, progress in this area is also likely to lead to improvements for society overall. Much the way wheelchair curb ramps also made it easier for parents to navigate cities with strollers, we already know that some of the advice for autism-friendly design — biophilic materials, natural light, escape spaces — contribute to improved mental health in general. Architects impact people’s lives through their designs. That creates the responsibility to let people’s needs inform our work.
Pamela da Graça, AIA, is an architect at The Arkitex Studio in Bryan and president of AIA Brazos.