Working in the field of autism for many years, it has continually surprised me that many practitioners and carers had not fully considered the impact of the environment on people on the autism spectrum. Some had thought the only sensory difficulty in autism was hypersensitivity to noise. Other professionals such as teachers or occupational therapists knew environments were not ideal, but were not sure where to start looking to change this.
Whilst visiting a school one day I had a conversation with a teacher who was very knowledgeable about the needs of children on the autism spectrum and very aware of the environmental impact on her class of eight children. She told me that she had been slowly completing sensory profiles on all her pupils using Olga Bogdashina’s book as a basis (Bogdashina, 2003). We agreed that these individual profiles were excellent and very thorough, although they took a long time to complete.
We discussed how the classroom was not ideal in sensory terms. Space was at a premium, noise and other distractions were numerous, and I admired how she coped and was able to get any teaching done at all. I therefore decided to consider how the environment might be assessed.
Review of the literature
Attwood (1998) argues that
“…40% of children with autism have some sort of sensory sensitivity…the incidence may be the same for Asperger syndrome”
and there are a number of other books that focus on the sensory issues for children on the autism spectrum (e.g. Godwin, Emmons and McKendry, 2005). There appears to be less literature on the impact of the sensory environment. The leaflet by Nguyen (2006) for the National Autistic Society entitled Creating an autism-friendly environment was probably the most accessible and easy to read for carers and professionals Morton-Cooper (2004) also has a chapter highlighting the clinical environment, although this was tailored particularly for health professionals.
Whitehurst (2006) described the design of a new building for children on the autism spectrum and Humphreys (2005) looked at this topic. This literature provides good background knowledge but none had an assessment tool that I could use to determine how suitable a setting was. I therefore decided to develop a checklist myself.
How to do it?
The main purpose of developing the environmental checklist was to create a tool that was quick and easy to use. It needed to be accessible by all parents/carers, professionals and people on the spectrum. I wanted it to be used to improve or enhance good practice.
The categories addressed in the checklist needed to reflect the frequently reported issues. I wanted the checklist to indicate how friendly the environment might be to someone with on the autism spectrum, and a catalyst for change.
I decided to divide the checklist into four areas:
Sensory -The sensory areas covered include touch, sight, smell, hearing, taste, balance and body awareness
Escape (how and where can people escape from stressful situations)
Other (factors such as financial constraints)
Each of the four areas has a number of questions that need to be answered
Yes or No
Not all questions are relevant to all environments. I decided that after each question, examples could be given and solutions suggested.
I decided not to give too specific solutions and for these to be generated through discussion. For example, carers may need to look at the mix of needs of other children or adults. Teachers may need to consider learning and the practicalities of a school day.
Everyone is an individual
There has been some criticism that each individual on the autism spectrum is different so how can you create an environment totally ASC friendly?
I would recognise this however think a check to see if all is being done to recognise the effects of the environment can only be beneficial.
In saying this however I would recognise that on occasions there can be opposing sensory preferences and sensitivities experienced by 2 or more people making the creation of an ideal environment more difficult.
An example of a completed section of the checklist is given below to illustrate its use.
Are the colours in
the environment low arousal,
such as cream and pastel shades
and not red or vibrant.? Yes or No
Consider whether all rooms /spaces need
need a change of paint or wallpaper?
There are a variety of colours in our
Approximately half of the walls are
bright pink and maybe too vibrant
for someone with autism
Re-paint walls with pastel green
and ask students with
autism to choose
Is the environment cluttered
with furniture? Yes or No
” It has been suggested that people
with ASD find it helpful if furniture is
kept to the sides of a room and the
central space is kept clear”
Most of the room is uncluttered,
sometimes activities are
not tidied away properly and
materials are left out.
Ensure room is left tidy at all times.
Implications for practice
As a nurse myself I can see the impact of an unfriendly environment on the wards and in the community. Patient care can be compromised and people on the autism spectrum can suffer as a result. In education, teaching staff can find themselves unable to teach and more importantly, students on the autism spectrum may be unable to learn. An environmental check has the potential to empower carers and professionals to assess their homes, wards, classrooms and other settings in relation to the individuals with autism they are living and working with to consider whether changes may be beneficial.
*There has been an initial pilot of the checklist which has been used in schools and community health teams with very positive feedback. This will continue and be further evaluated over the coming year.
It would be very useful to conduct a small study to evaluate the use of the checklist and its effects. For someone on the autism spectrum, the sensory environment can have a profound effect on behaviour, stress levels, learning and task performance. Sensory profiles on the children and adults on the autism spectrum are recommended in addition to this environmental checklist, such as that provided by Bogdashina (2003).
The very nature of autism means that changing the environment may be upsetting for some people on the spectrum. However, this should not deter staff and carers from change if it is felt to be beneficial, as disruption to the environment may be minimal and short lasting. There will be practical considerations (e.g. money, time) and sometimes a clash of individual sensory profiles that need to be discussed and resolved (e.g. a person who likes the light and someone who likes the dark sharing a room). I hope this paper will prompt others to consider the environments they create and the effects on those who live and work within these.
Attwood.T (1998) Asperger syndrome: a guide for parents and professionals, London. Jessica Kingsley publishers.
Bogdashina. O (2003) Sensory perceptual issues in autism: different sensory experiences – different perceptual worlds, London. Jessica Kingsley Publishers.
Clements, J. and Zarkowska, E. (2000) Behavioural concerns and autistic spectrum disorders: explanations and strategies for change. London Jessica Kingsley Publishers
Godwin Emmons, P. and McKendry Anderson, L. (2005) Understanding sensory dysfunction: learning, development and sensory dysfunction in autism spectrum disorders, adhd, learning disabilities and bipolar disorder. London. Jessica Kingsley Publishers.
Howlin, P (1998) Children with autism and Asperger syndrome: A guide for practitioners and carers. Chichester. Wiley
Jordan .R (2001) Autism with severe learning difficulties: a guide for parents and professionals. London. David Fulton
Humphreys, S (2005) ‘Autism & architecture’
_feb-mar_2005 accessed 16 March 2006
Morton-Cooper, A. (2004) health care and the autism spectrum –a guide for health professionals, Parents and Carers, London, Jessica Kingsley Publishers.
Nguyen. A (2006) Creating an autism-friendly environment,London. National Autistic Society.
Plimley. L (2004) Analysis of a student task to create an autism-friendly living environment. Good Autism Practice Journal 5, 2, 35-41
Schopler. E (1995) Parent Survival Manual; A guide to crisis resolution in Autism and related Developmental disorders. New York and London, Plenum Press
Whitaker.P (2001) –Challenging Behaviour and Autism-Making sense, making progress; A guide to preventing and managing challenging behaviour for parents and teachers. London. National Autistic Society.
Whitehurst, T. (2006) The impact of building design on children with autistic spectrum disorders, Good Autism Practice Journal, 7, 1 31-39
Wing.L (1996)-The Autistic Spectrum; a guide for parents and professionals. London. Constable and Robinson.
Stephen Simpson B.Phil (Autism) RNLD
Stephen is an Autism specialist based in the UK.