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Tizard Learning Disability Review Designing living environments with adults with autism C. Lowe K. Gaudion C. McGinley Alex Kew

Article information: To cite this document: C. Lowe K. Gaudion C. McGinley Alex Kew , (2014),"Designing living environments with adults with autism", Tizard Learning Disability Review, Vol. 19 Iss 2 pp. 63 - 72 Permanent link to this document: http://dx.doi.org/10.1108/TLDR-01-2013-0002 Downloaded on: 02 September 2015, At: 02:57 (PT) References: this document contains references to 13 other documents. To copy this document: [email protected] The fulltext of this document has been downloaded 617 times since 2014*

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Feature Designing living environments with adults with autism


C. Lowe, K. Gaudion, C. McGinley and Alex Kew

C. Lowe is based at BEING, London, UK. K. Gaudion is a Research Associate and Dr C. McGinley is a Senior Associate, both are based at The Helen Hamlyn Centre for Design, The Royal College of Art, London, UK. Alex Kew is a Junior Doctor, based at Queens Medical Centre, Nottingham, UK.

Abstract Purpose – The purpose of this paper is to explore how a people-centred, design-led approach to the different needs and aspirations of adults with autism could help inform the design of space, objects and activities for individuals in their own homes to enhance everyday life experiences. There are dozens of studies that have reported the health benefits associated with good design and the Kingwood Trust set out to research what that might mean for the adults with autism it supports. Design/methodology/approach – The paper describes three projects: Housing Design, Garden Design and Exploring Sensory Preferences whose design interventions were realised through a process of design ethnography, to include and work with the people that Kingwood support who have limited verbal speech and learning disabilities. Participatory observation, co-design workshops, interviews, visual probes and mapping tools were created to gather insights about how a person perceives and engages with the physical environment, with a particular focus on their sensory sensitivities and special interests. Findings – The outcome of the project is a holistic, design-led approach to identifying the sensory preferences and special interests of adults with autism to inform the design of residential accommodation. A second project will be published at a later date, which will test and evaluate the effectiveness of the design interventions described in this paper as part of a PhD by practice supported by Kingwood Trust. Originality/value – Autistic adults with limited verbal speech and additional learning disabilities, are often excluded from design research. This paper bridges this gap by selecting and adapting design methods that invite the people that Kingwood support to be active participants within the design process. The revised DSM-5 is an important milestone that puts the sensory environment back onto the roadmap within autism research, however the relationship between people with autism and the physical environment is a relatively under-researched area. This paper bridges this gap in research and illustrates how an autistic person’s interaction and reaction to their home environment, can create understanding, tangible insights and clues to inform the design and adaptation of environments to reduce triggers of anxiety, making them more comfortable, enjoyable and meaningful for that person. Keywords Adults with autism, Physical environment, People-centred design, Sensory preferences, Special interests Paper type Conceptual paper

Introduction Autism is a lifelong and complex neurodevelopmental disorder that affects the way a person communicates and relates to other people and the world around them. It is a spectrum condition so it affects people in different ways. People with autism might have rigid routines and special interests, they might be very sociable or find social relations difficult. Some have learning disabilities whilst others may possess high levels of intellectual ability. In addition to verbal communication difficulties, people with autism often display unusual reactions to sensory input. Everyday sensations can be experienced at unbearable levels or appear not to be noticed at all, compromising their ability to interact with the environment effectively and participate in daily activities (Bagby et al., 2012; Dickie et al., 2009).

DOI 10.1108/TLDR-01-2013-0002

VOL. 19 NO. 2 2014, pp. 63-72, C Emerald Group Publishing Limited, ISSN 1359-5474

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In 2008 the autism charity the Kingwood Trust was looking to refurbish one of its premises that provides residential accommodation for adults with autism. It could find very little guidance in either the academic or non-academic literature on how its facilities should be designed to best meet the needs and aspirations of the residents. The Living Environments for Adults with Autism programme brought together the Kingwood Trust with BEING Design Management and the Helen Hamlyn Centre for Design at the Royal College of Art in a research partnership to explore how a design-led approach to the differing needs of adults with autism might improve everyday life. The work has been generously funded by the Monument Trust, part of the Sainsbury Family Charitable Trusts. Now in its fifth year, the research is looking widely at how people are currently supported in their homes and daily lives and has so far produced four publications containing findings and recommendations that can be accessed at: www.kingwood.org.uk/kingwood-research. Interested readers are strongly recommended to review these publications which provide much more detail than it is possible to include in the current paper.

Design and autism Design is one of those words we all believe we know the meaning of but its detailed definition often proves elusive. It can be used as a noun, verb or even an adjective, all with different definitions revolving around beauty, desirability, functionality, creativity and innovation.


More and more, design is thought of as a universal process of creation, of bringing things into being that did not previously exist to solve some problem or answer some question. One can argue that everything made by humans has been designed; in other words someone sat down and thought about it, gave it form from imaginings and created it out of available materials. In this sense everything has been designed and everyone is a designer. However, not everything has been well designed and not everyone is a good designer. Over the last three years the research team has conducted three explicit projects on Housing Design, Sensory Preferences and Garden Design, each informing how the Kingwood Trust designs its facilities for residents and staff. When the research team from the Helen Hamlyn Centre for Design began to look at the design of domestic environments for adults with autism it was clear that many of the usual design research and investigation techniques were not going to be of assistance. This is because some of the characteristics associated with autism spectrum disorder make it difficult for a design researcher to conduct inquisitional type research. For example, some of the people that Kingwood support have learning disabilities with limited verbal communication, making it difficult to ask what they liked or did not like about their current living environment. An important part of the normal design process is prototyping and testing concepts to gauge how problems have been resolved and incorporated into a solution. Some people with autism spectrum disorder may have problems with situation projection making this difficult, i.e., producing pictures and plans of interior spaces and asking “do you like this?” is difficult as they may struggle to conceptualise and form a mental picture of an imagined three-dimensional space from a two-dimensional drawing. Before any design proposals could be considered, a research process had to be developed which would provide the insights into the daily lives of residents and staff needed for the foundation of a brief. There were two aspects to this: first, an extensive literature review and interviews with professionals working in the field of autism; and second, a form of ethnography involving the design team working directly with adults with autism and the staff that supported them through a series of finely tailored workshops that would allow meaningful data to be drawn about preferences. Success depended on the adults with autism being active participants in the process. This required some novel thinking in setting up and running the activities.

Project 1. Housing Design The environment in which an adult with autism lives can have a profound impact on their health and wellbeing. Providing the right setting can help enhance motivation, confidence and self-esteem. Housing Design for Adults with Autism (see also Brand, 2010) was a one-year project which explored how design could improve living environments for adults with autism,

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to better meet their specific needs. The project included visits to seven supported living residences for adults with autism on a number of occasions. These visits allowed the design team to observe how residents used and responded to their living environments, how support staff interacted with residents and to carry out contextual interviews. Findings were distilled into four key design themes, which created an important guideline and framework for further projects (see Figure 1).

Design theme 1 – growth and development The primary aim of the Kingwood Trust is to provide environments for its residents where they can lead as full and rewarding a life as possible. Such environments will harness residents’

Figure 1 Key design themes

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strengths and special interests to enhance motivation and confidence. In particular, well-designed environments which achieve this aim will support: 1.

Independence: giving residents choice in how they live and with whom they share their home is empowering. Enabling them to do things by themselves increases self-esteem.

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Social interaction: providing a variety of spaces allows residents to engage in social activities on their own terms. Home environments which can be adjusted to the desired level of social engagement or privacy can result in increased social interaction.

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Access: allowing access to the whole building, especially outdoor spaces, creates a sense of ownership and freedom. Offering good access to the local community can provide residents with purposeful activity.

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Affordability: offering a variety of affordable housing options with graduated levels of support can help residents progress from needing significant support to living semi-independently.

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Evolution: providing home environments that respond to the changing needs, interests and aspirations of residents can further their self-development.

Design theme 2 – triggers


A common difficulty for people with autism is heightened anxiety, frequently associated with interactions with the environment. Enhancing the following qualities through design may reduce triggers for anxiety: 1.

Sensation: designing consistent, low arousal environments with appropriate lighting, acoustics, ventilation and use of colour and material can minimise sensory overload. Providing controlled stimulation in specific environments for residents with under-developed sensory sensitivities can reduce seeking behaviours and, if employed well, promote personal development.

2.

Perception: designing navigable environments can help residents to orientate themselves both physically and socially. Clear sensory cues as to the function of specific spaces can help them to understand the intended purpose of the space and so what is expected of them. Rooms that can be seen into from other rooms and circulation spaces increase the predictability of social interactions and provide residents with choice.

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Withdrawal: offering private spaces that can be personalised by residents, as well as withdrawal spaces peripheral to communal areas, allows residents to retreat from group situations when overwhelmed.

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Empowerment: designing environments in which residents can calibrate the level of sensory stimulation provides a sense of control and empowerment.

Design theme 3 – robustness The specification of safe, durable environments needs to be balanced with the aim of providing comfortable and personalised accommodation. Enhancing the following qualities through design can reduce risks and lessen the impact of heavy, unintended use or misuse:

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Safety: controlling access to areas of risk and using safety materials and technologies can protect residents and staff from injury.

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Durability: using durable materials can reduce the impact of heavy behaviour such as jumping, banging, running and fiddling.

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Ease of maintenance: designing environments so they can be easily maintained helps staff to spend more time supporting residents, who are more likely to get involved with household tasks like cleaning.

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Tolerance: designing environments that can tolerate unintended use can lessen the physical and emotional impact for residents when they make mistakes such as spilling liquids or dropping breakables.

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Design theme 4 – support tools Whilst supported-living accommodation is first and foremost someone’s home, it is also a place of work. As such, designing environments that support staff in their work, that provide opportunity for scheduled rest and retreat, and clearly separate administration and residential activities will have a positive impact on the quality of service provided. Enhancing the following qualities through design can support these outcomes: 1.

Communication: providing visual tools for spontaneous non-verbal communication for residents and between residents and staff can increase reciprocal communication, interaction and enhance confidence. Embedding information in the environment about how it should be used can motivate residents to take on household tasks.

2.

Personal support: providing appropriate environments for one-to-one life-skill training and assisting with personal hygiene care can help staff deliver better quality support. Providing facilities for staff to record observations and capture what residents like, enjoy and respond to can improve continuity of support.

3.

Unobtrusive monitoring: embedding strategies and assistive technologies in the home environment allows staff to safely monitor residents from a distance.


Project 2. Exploring Sensory Preferences The research on Housing Design was extended into an explicit one-year project on Exploring Sensory Preferences (Brand and Gaudion, 2012), which looked at the interior of home environments. This project was based on the notion that adults with autism often live in environments that do not address their individual and sometimes extreme sensory preferences, methods for the identification of which are not readily available to a person with autism spectrum disorder, service providers, family members, support staff or designers of residential accommodation. The project proposes that understanding of a person’s sensory preferences can influence the design and adaptation of interior environments to make them more comfortable and enjoyable to live in. The colour of the wall, the feel of a sofa, lighting, smells, the sound of our feet walking along the floor, the breeze from the open window are sensations that we typically experience every day. Most people are able to process and integrate these sensations or take action to modify their environment to support their individual sensory preferences. People with autism may find it difficult to interpret, perceive or regulate sensory information around them, and may be over- or undersensitive to particular kinds of sensory information (Kanner, 1943; Wing, 1969; Grandin, 2006; Kranowitz, 1998). For example, some people with autism experience adverse reactions to the presence or absence of certain textures, visual details, colours, noises and aromas. They can find it difficult to focus and concentrate on certain activities as they become distracted or fixated with the sensory information that surrounds them. In the kitchen a person may become distracted by the rumble of the dishwasher, the texture of the flour on their hand, the sound of the radio, people passing by or the various smells that are present. It is therefore essential for the designers, providers and managers of supported living accommodation to provide settings in which the quality of stimuli relating to sight, sound, smell and touch can be modulated to suit a person’s sensory preferences. Sensory profiling It was recognised that, in the time available, it would very difficult to observe, learn or interpret each individual’s unique modes of verbal or non-verbal communication to determine their sensory preferences. Support staff were therefore invited to complete with the person they supported the Adult/Adolescent Sensory Profiles (Dunn, 2002) and the Sensory Perceptual Profile Checklist (Bogdashina, 2003). Although these questionnaires were created for psychologists and therapists, it was noted that information garnered from responses might also be useful to designers. Dunn and her colleagues anticipated this type of wider application: “Service providers can use results of the Adult Sensory Profile to design more effective interventions. Such interventions might include environmental adaptations to support performance” (Brown et al., 2001, p. 81). These questionnaires were used to help establish individual preferences and inform new methods for designing domestic environments. To verify the accuracy and usefulness of results

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from these sensory questionnaires, three design activities were planned for four people that Kingwood supported. In each activity, a physical space and various sensory props were created to suit each participant, using the information gathered from the questionnaires. This process of interpreting the results of the questionnaires, the translation of individuals’ sensory profiles into experimental design outputs and the responses of the individuals to the design experiments was documented carefully. The aim was to identify discrepancies, ambiguities and successes in each step of the process, in order to develop a sensory profiling tool that designers or service providers could readily and reliably use. The design activities revealed that an important limitation of the questionnaires was their “wordy”, tick box format, which made it difficult for people without reading or writing skills to express their preferences. In response to this the project developed a set of 72 cards to facilitate the identification of individual sensory preferences. Each card showed a distinct sensory experience which was both described in simple words and illustrated by photographed images. The cards acted as visual prompts to help the individual express whether he or she liked, disliked or was neutral about the subject of each card. This activity aimed to involve adults with autism in the sensory profiling as active participants rather than relying on family members or support staff to express preferences on their behalf.


Once categorised into groups of likes, dislikes and neutrals the cards enabled a visual sensory profile of the participant that could be used to make decisions about both the manner in which they were supported and their interior design choices. For example, if a card selection revealed that a person preferred his home to be neat and tidy, that he was sociable, liked being with people and listening to music, then his/her living space could be adapted to meet these preferences. Using this information, simple changes could be made to the home environment to improve everyday experiences. For example, in communal spaces, specifying seats that provided different seating positions and could be repositioned to create smaller seating areas might have encouraged the individual in question to participate in social activities with other people. Photographs were used for card images rather than drawn illustrations so that the cards looked more suitable for adults. The art direction for each card image aimed to make it easier for individuals with communication difficulties to understand the accompanying questions. This was achieved by making images literal and, where feasible, placing them in the context of a domestic setting. Over-sensitivity to visual information is a characteristic of some people with autism. As a result individuals may develop coping strategies to reduce the amount of visual stimuli they must process, which may manifest as “fragmented perception”, “singular attention” or “monotropism”. The card images tried to accommodate this by reducing the amount of visual information and by amplifying through use of colour, contrast, composition, line quality and line intensity the characteristic that was the focus of the card. On the reverse of each card family members, service providers or design professionals can find additional information on how to ascertain, interpret or respond to specific sensory preferences. Additionally, cards are coded by the sensory system to which they relate. In some cases, the individual may not know or have revealed his or her preference to a particular experience. When this happens, the facilitator is charged with helping the participant to create the sensory experience and discover together whether he or she likes, dislikes or is neutral about that form of stimulation. This process may lead to ideas for conducting activities.

Project 3. Garden Design The work on Exploring Sensory Preferences (Brand and Gaudion, 2012) was extended into an explicit one-year project on garden design under the heading Outdoor Environments for Adults with Autism (Gaudion and Ginley, 2012). Of particular interest was how gardens could have a significant role to play in addressing the principle of growth and development. The restorative qualities of gardens and benefits of interacting with nature are widely documented. However, there is a lack of guiding principles within the context of design for those with autism and, in particular, on how to support their special interests and hobbies.

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It is clearly important to be mindful of a person’s sensory sensitivities and enable individual sensory references to be incorporated into the planning, layout and general flow of a garden space. In addition, the layout of a garden space can be designed to reflect and encourage the nurturing of a person’s special interest. Many adults with autism have a special interest involving strong attachment to a specific object, phenomenon or activity (e.g. spinning objects, maps, Thomas the Tank Engine). Someone who likes to jump up and down may benefit from a trampoline. Someone fascinated by moving water is likely to enjoy a water feature. Clearly the starting point for creating a personalised garden is to identify a person’s interests and hobbies. This informs the choice of specific features and may greatly increase the likelihood of active engagement with the garden. Mapping special interests


A series of interest and hobbies booklets were created to help map a person’s special interests and pastimes. The booklet was a visual extension of the questionnaire and taxonomy of special interests in which 18 topics of popular special interests relating to people with autism had been catalogued (Baron-Cohen and Wheelwright, 1999). The pocket-sized booklets were simple in design, each containing 20 pages dedicated to one of the 18 interests. Each page was designed with ample room for the participant to describe or draw their interests with visual prompts that represented the subject of interest. The aim of the booklet was to gain, in a non-intrusive way, some insight into the kinds of things the people that Kingwood support like to do in their free time. Tree of opportunity Responses to the booklet revealed an exceptionally broad range of special interest topics ranging from kangaroos to washing machines. To help identify patterns and correlations each response was visually represented using the image of a tree (see Figure 2) sporting Figure 2 Special interest tree

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18 colour-coded branches each representing a broad area of interest. Leaves were added to respective branches to identify more specific points of interest. The choice of the tree as an image was intended both as a metaphor for growth and as a device that encouraged the person represented to add more leaves to a branch so introducing the idea of identifying related interests that might be worth exploring.


As ideas emerged, co-design workshops were organised and these were attended by adults with autism, their parents and Kingwood staff. These, together with the insights gained from a better understanding of an individual’s preferences, were used to inform garden design themes. Key themes were identified as follows: 1.

leisure: giving people choice as to how they would like to spend their free time in the garden is empowering and providing a variety of connected but defined activities and spaces allows them to engage in physical and social activities on their own terms;

2.

occupation: offering a spectrum of activities that start at the simplest level and gradually grow in complexity enables residents to do things by themselves and increases confidence and self-esteem;

3.

exercise: accommodating vestibular and proprioceptive activities such as swinging and jumping on a trampoline may help calm or activate a resident; and

4.

special interests: providing structured activities that relate to personal interests in the garden environment responds to changing interests and aspirations and can help develop confidence, social interaction and provide pleasure.

These themes combined with the insights gained from the residents’ special interests were turned into a design brief and concepts were developed and visualised to test the ideas. This led to useful understanding of how garden layouts night best cater for the needs and special interests of people in shared supported accommodation. Many of these features were incorporated into the design of a garden at Kingwood College, a transition unit for young adults with autism, to see how the residents responded (see Figure 3).

Discussion and concluding comments While it is too early to make any pronouncements as to the impact of the design solutions being applied to Kingwood residences, and in particular Kingwood College, the very process of engaging Figure 3 Kingwood College garden design

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the people that Kingwood support, their support staff and family members in the research and design process has produced some noteworthy, if anecdotal, outcomes. The researchers and support staff observed that, in general, residents showed reduced levels of anxiety and increased levels of concentration, social interaction and communication when involved in the design activities. Support staff say they have learned more about the person they support and become more motivated and engaged in providing structured, people-centred activities. Of course, the work done to date has many limitations that mean it may not be universally applicable. The outcomes are purely anecdotal and have not been substantiated by robust research. The whole programme is limited to the people that Kingwood support who may not be representative of the full spectrum of autism and the design outcomes are incorporated into existing buildings with all the compromises, both physical and budgetary, that this entails. The design outputs have also tried to walk a careful line between creating autism specific environments tailored to the needs of their residents and ones that are more domestic in look and feel, erring on the side of domestic rather than institutional wherever possible.


It seems particularly important to note the heterogeneous nature of autism and the consequent impossibility of creating a generic set of guidelines and design outputs. The work done relates to the needs and aspirations of the specific people that Kingwood supports and may not be easily transferable to other people on the autism spectrum. What may work for one person may not work for another. Having said this, it seems likely that many aspects of the processes we have used to involve adults with autism and identify their preferences are likely to be applicable more generally. The Kingwood Trust’s work with BEING and the Helen Hamlyn Centre for Design is ongoing. The next design project aims to extend our understanding of sensory preferences and special interests into the area of everyday activities, with a view to helping the people that Kingwood support become more actively engaged within their own homes. Kingwood Trust is also supporting one of the authors (Katie Gaudion) through a PhD by practice, which will test and evaluate whether the design outputs, implemented at Kingwood Trust and described in this paper, have enhanced everyday life experiences for the people they support. Design is a universal process of creation that puts the person at its heart and forms a solution around them. If applied well it can bring joy and meaning to life and solve previously insurmountable problems. This is true whether it is applied to the creation of new buildings, computers, telephones, services or indeed living environments for adults with autism. The Kingwood Trust, along with its design and research partners, is a fundamental believer in the power of design to bring alternative perspectives and approaches that can enrich the lives of the adults with autism they support.

References Bagby, M.S., Dickie, V.A. and Baranek, G.T. (2012), “How sensory experiences of children with and without autism affect family occupations”, American Journal of Occupational Therapy, Vol. 66, pp. 78-86. Baron-Cohen, S. and Wheelwright, S. (1999), “Obsessions’ in children with autism or Asperger syndrome. Content analysis in terms of core domains of cognition”, The British Journal of Psychiatry, Vol. 175 No. November, pp. 484-90. Bogdashina, O. (2003), “Sensory perceptual issues in autism and Asperger’s syndrome; different sensory experiences – different perceptual worlds”, Jessica Kingsley Publishers. Brand, A. (2010), Living in the Community; Housing Design for Adults with Autism, The Helen Hamlyn Centre for Design, The Royal College of Art, London. Brand, A. and Gaudion, K. (2012), Exploring Sensory Preference; Living Environments for Adults with Autism, The Helen Hamlyn Centre for Design, The Royal College of Art, London. Brown, C., Tollefson, N., Dunn, W., Cromwell, R. and Filion, D. (2001), “The adult sensory profile: measuring patterns of sensory processing”, The American Journal of Occupational Therapy, Vol. 55 No. 1, p. 81. Dickie, V.A., Baranek, G.T., Schultz, B., Watson, L.R. and McComish, C.S. (2009), “Parent reports of sensory experiences of preschool children with and without autism: a qualitative study”, American Journal of Occupational Therapy, Vol. 63 No. 2, pp. 172-81.

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Dunn, W. (2002), Infant/Toddler Sensory Profile Manual, Psychological Corporation, New York. Gaudion, K. and McGinley, C. (2012), Green Spaces; Outdoor Environments for Adults with Autism, The Helen Hamlyn Centre for Design, The Royal College of Art, London. Grandin, T. (2006), Thinking in Pictures: And Other Reports from My Life with Autism, Vintage Books, New York, NY. Kanner, L. (1943), “Autistic disturbances of affective contact”, Nervous Child, Vol. 2, pp. 217-50. Kranowitz, C.S. (1998), The Out-of-Sync Child: Recognising and Coping with Sensory Processing Disorder, Perigee, New York, NY. Wing, L. (1969), “The handicaps of autistic children: a comparative study”, Journal of Child Psychology and Psychiatry, Vol. 10, pp. 1-40.

About the authors C. Lowe is a Design Management Expert with experience in interiors, products, graphics and branding in both public and private sectors from large national organisations to small private consultancies. C. Lowe is the corresponding author and can be contacted at: [email protected]


K. Gaudion holds a Master of Philosophy in Textiles Design from the Royal College of Art and has several years experience working with people with learning disabilities in multisensory environments. Gaudion is currently a Research Associate at the Helen Hamlyn Centre for Design and studying a PhD at the Royal College of Art on Design and Autism. Dr C. McGinley is a Senior Associate at the Helen Hamlyn Centre for Design. He holds a PhD in design research from Brunel University and masters degrees in product design engineering from the University of Strathclyde and in industrial design engineering from the Royal College of Art. Alex Kew is a Junior Doctor currently completing his second Foundation Year at the Queens Medical Centre in Nottingham. He hopes to specialise in hospital medicine and has an interest in the field of autism.

To purchase reprints of this article please e-mail: [email protected] Or visit our web site for further details: www.emeraldinsight.com/reprints

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