Neurodiversity and Autism

Evidence shows that the wellbeing of people with neurodiversity and autism spectrum disorders is influenced by the environment in which they are cared for. Well-designed facilities can reduce challenging behaviours, reducing distress to patients, healthcare staff and carers. Our knowledge gained from extensive research, and collaboration with specialist clinicians and the National Autistic Society, has informed our design of exemplar facilities for this complex patient group.

In designing for patients with neurodiversity and autism spectrum disorders, the careful planning of spaces is critical. Ward layouts with looped circulation provide an alternative route for patients and staff to back away from escalating situations. Patients may have difficulty engaging with outside space, so the transition from inside to outside needs to be well designed and gradual.

Active circulation spaces with informal seating provide places to rest and connect with other patients and members of staff. These spaces should be sufficiently wide to provide plenty of ‘breathing space’ and broken up in length visually to prevent anxiety as they are navigated. Curving walls can be used to make circulation spaces appear ‘softer’ and to encourage the flow of movement.

For building users who may have heightened sensitivity to their environment, seamless details, an overriding sense of calmness, and careful design coordination are essential to prevent sensory overload and to remove distracting focuses for repetitive behaviour. Consistent light levels and temperature, and well-considered acoustics create a balanced environment. High level windows provide light without uncomfortable glare, and small picture windows offer direct, framed views into the immediate or distant landscape, without providing excessive stimulus and feedback.

The building’s fire strategy must be developed early as it may be necessary to avoid an audible alarm to prevent panic or sensory overload. In this case, strategies to keep patients safe for longer periods of time than usually necessary will be critical.

Mitford provides inpatient support and treatment for adults with severely complex autistic spectrum disorders. The first building in the UK specifically designed for this service-user group, this pioneering project is founded on the observed correlation between the environment and positive outcomes for people with autism. Single and shared flats are grouped within four ‘fingers’ of accommodation, linked at their southern end by a band of shared spaces

The design sensitively moderates the graduation from public to private space, addressing the vulnerability of each patient. The thresholds from each flat to the circulation space, and then progress from there to shared therapy spaces, are carefully considered to create an encouraging environment, whilst avoiding conflict with other patients. Wide, organically-shaped circulation spaces with ‘safe’ window seats, encourage movement but offer a measure of privacy. Each flat is oriented to the east for a comfortable internal environment, with direct access to the private gardens to support the therapeutic needs of individuals. Staff have reported a marked improvement in behaviour of patients. In the previous building there was one patient who used to live in self-imposed isolation and crawled everywhere. Within a week of moving into the new unit he was having a drink with staff in one of the offices.

Oakwood Autism Unit provides long term residential care accommodation for adults with severe autistic spectrum disorders who require 24-hour support. The building creates a therapeutic environment which is specifically tailored to focus on the wellbeing of autistic residents, to enrich their lives, encourage positive behaviour and offer support to carers and NHS staff. The building form helps occupants’ transition between communal and private areas and gently encourages gradual social interaction.

Wide thresholds outside bedrooms create niches for seats and sight lines provide long views into areas of communal activity and the landscape beyond, for residents who are more comfortable inhabiting a space at its periphery. The courtyard design provides inconspicuous security, where residents can enjoy autonomy and access outside space unescorted, while staff can monitor from a distance. Careful detailing helps to manage environmental stimulus, balancing robust materials and finishes with a domestic feel.