Harmonizing the seen and unseen when designing for neurodiversity

In our design for the Autism Treatment Center of San Antonio and the Burkhart Center, we developed a series of strategies for design that would make the space as comforting and functional as possible. Studies say 30% to 90% of people with autism either overreact to or ignore ordinary sights, sounds, smells, and sensations. Among the key characteristics that shaped our design were the desire to create a pervasive sense of calm and order, healthy levels of natural light and ventilation, secure and easily observed spaces, a balanced color palette, indirect lighting rather than overhead fluorescents, mitigation of disruptive scents and sounds, and uncluttered classrooms and exam rooms.

Security is a major consideration for spaces serving young people on the spectrum. By creating extra turns in interior spaces and transitional spaces, such as vestibules, in the building we can delay egress and require decision-making. Delayed egress, a security feature interwoven in the design, can mitigate running.

We thoughtfully employed color, pattern, and texture to enhance wayfinding and to demarcate certain areas while avoiding hard lines and arbitrary distinctions that could suggest a barrier. Elsewhere, we employed tunable light fixtures that allow care teams to control light temperature in occupied spaces. We defined engaging interactive areas and zones for activities. Outdoor activity areas are designed for security and to limit visual distraction from beyond the courtyards—this supports feelings of comfort and safety. We positioned and isolated mechanical areas to minimize hum and vibration, which can be intensely distracting for some of those on the autism spectrum.

Artificial lighting

Anecdotally, we have seen that when certain elements are out of balance it can be disruptive to those on the spectrum. For example, when corridor lighting was brightened for an event, occupants judged it as too harsh and avoided that public area. We also know that around half of individuals on the spectrum exhibit fluorescent sensitivity. Qualities from electric lighting such as flickering, excessive brightness, and humming can be distracting or even debilitating. Designers should use LED fixtures that have tunable white light and dimming controls to provide the highest flexibility and success for these environments.

When we design for neurodiversity, we must also consider nonvisual sensitivities—we take extra care to think about acoustics, vibration, odors, texture, and tactility. Through the lens of design for neurodiversity, we have come to see how the nonvisual elements of design should be important design principles for any project.

Design for harmony and all the senses

The strategies we employ in autism centers are not always easily adaptable, in a literal sense, to other design projects. The needs and sensitivities of the occupants of a senior living center or surgical clinic are simply not the same as design for people on the spectrum. However, the lesson we can take is that the harmony we seek to achieve in good design that listens to users must account for design elements that are barely perceptible but still powerful. We may not use the same guidelines but there are some similarities in how thoughtfully we apply design strategies to populations with the building experience in mind.

Transition spaces

Designs for autism centers recognize the value in transition spaces in slowing egress and by providing a gradual transition between low and high activity. Transition spaces, however, have a variety of applications in other project types, beyond being the places that keep the wind and elements at bay, that are not always obvious.

They can help control sound, provide a layer of security, and give building users a moment to pause before or after their appointment—which can, in a healthcare setting, be a stressful or emotional event.

Sound reflection and finishes

People on the spectrum may have complex and profound auditory processing difficulties and can be particularly sensitive to sound. Speech accompanied by noise can make voices virtually unintelligible. But it isn’t only people on the spectrum who experience this auditory challenge, we’ve all had similar experiences in a noisy restaurant or lobby space full of hard surfaces and lots of voices and music.

Design strategies should focus on dampening extraneous sounds and work to eradicate echoes. Interior finishes should be chosen with high noise-reduction coefficient values such as acoustic paneling, resilient rubber flooring, and high-quality ceiling tiles to reduce sound reverberation.

Designers should also work to reduce conflicting auditory stimuli by thoughtfully placing mechanical units away from occupants, design duct runs and air velocity to limit noise, and minimize use of electric hand dryers. We already know that acoustics are important. As designers we know that decibel levels matter, which is why we work with acousticians and use sound-transmission class ratings for partitions to control sound. We can think about sound more holistically, however, and look at our choices for flooring and finishes and consider their sound-control qualities for a space—how reflective, for example, industrial materials and finishes can be.

Air/sound/mechanicals

Mechanical and ventilation systems can rumble, vibrate, and whirl, so we must carefully consider their placement, insulation, and their adjacencies in places like exam rooms. And the increasing use of video-call technology means that acoustics in our workspaces are going to be more noticeable than ever.

Olfactory

Individuals on the spectrum may be highly reactive to changes in their environment. Designers should work to adequately ventilate and provide proper air flow to minimize unwanted smells—at autism centers and everywhere else.

Cues for wayfinding

In design for places that primarily serve those on the spectrum, color can be used to create a sense of place and identify activity areas differently from circulation. Corridors should have minimal detail to eliminate distractions and thresholds should be used throughout the facility to aid navigation and delineate accessible areas.

Likewise, we can and do use color, pattern, and texture as clues for wayfinding, letting the user know which department they are in, marking certain types of rooms with graphics and color. We shouldn’t forget that color and simple graphics are often much clearer to a wider audience (multicultural, visually disabled, geriatric population) than generic text signage in larger institutional settings.

Designers should make an individual’s journey through the building navigable by visual cues in a clear and self-guiding manner with minimal distractions.

Natural light control

Designers can also look at natural light and its control in environments focused on supporting autism as an example of the delicate balance that requires thoughtful design. While designers have sung the praises of more ample natural light for years, we must now recognize its limitations. In autism centers, for example, if direct sunlight casts stark shadows on the floor it causes a distinct pattern that can create distraction, even debilitating fixation. Therefore, we try to use more indirect light, creating softer transitions in areas with natural light.

More generally speaking, in health, education, or workplace, we must also enable occupants to control that important natural light especially in classrooms, conference rooms, and other areas where they regularly access technology.

Visibility/stimuli

Mitigating and controlling outside visual stimuli is a key component in design for autism centers. But we also see visual connection and transparency used in these settings for security and safety. We must deploy these elements just as carefully in education and health settings.

Care team areas, for example, can be designed with visual connection to patient rooms. And transparency is a key component in our designs for the workplace and educational spaces today. But are we creating enough space for contemplation, free of stimuli, with privacy for one-on-one or small group collaboration?

Low vision

What about design for senses that are limited? We know that a portion of our users in many settings may have limited vision. We also know that with our aging population, visual impairment in the US is expected to double by 2050.

Today, designers have access to a variety of technologies for auditory communication that improve accessibility. These sound beacons help people navigate space and can make the spaces we design more accessible to people with limited vision. Above all, considering neurodiversity in our work reminds us that good design is anticipatory design that’s informed by our understanding of our client’s needs and sensitivities.