Autism-friendly design

Characteristics of autism can be a poor fit with off the shelf housing stock
- At a glance:
  - Sensory and social characteristics of autism can create a mismatch between some autistics and the built environment
  - This mismatch can result in difficulty maintaining tenancy in rental housing, expensive repairs in ownership property, and increased support costs
Literature on autism-friendly design
- At a glance:
  - There is a robust literature on designing living environments to better fit the needs of people with autism. A cheat sheet of design techniques is based on the literature discussed below and on the experience of Autism Housing Pathways members.
  - Three significant publications are those by:
    - Ahrentzen and Steele: “Advancing Full Spectrum Housing: Design for Adults with Autism Spectrum Disorder” is a companion study to “Opening Doors”, discussed on the “Best practices” page. It outlines a set of design goals with companion design guidelines.
    - Andrew Brand: This handbook of design guidelines was the outcome of a project, “Living in the community”, that showed better outcomes in settings designed for autistic residence. Four design themes are identified.
    - Braddock and Rowell: “Making homes that work” provides a template for families to assess the needs of an individual and modifying the home to meet those needs.
The context of housing
- At a glance:

Characteristics of autism can be a poor fit with off the shelf housing stock

In 1979, Wing and Gould described autism as having a triad of impairments: rigidity (lack of flexibility and restricted interests), communication difficulties, and difficulties with social interaction. Sensory issues are usually added to this list. Some specific examples of how these characteristics can impact one’s relationship with the built environment (or with neighbors, landlords, or housemates), are:

Fluorescent lights can flicker and buzz, creating stress and anxiety
Reflections off windows can be distracting
Empty rooms can echo
Outgassing from fabrics and floor finishes can cause headaches
Sounds from neighboring units can be distressing
Sleep disorders can lead to difficulties with neighbors if a person engages in loud self-stimulatory activity at night
Poor sensory processing can lead to using too much force, breaking door handles or faucets
A desire to interact with the environment in unusual ways, such as water play, can cause property damage
The need to avoid uncertainty can create a desire to:
- Avoid areas (including entryways) that can’t be “previewed”
- Rigidly control the environment and the people in it
Difficulty understanding unwritten rules (the “hidden curriculum”) can threaten tenancy

These examples are just that. They do not apply to all people with autism, but they are sufficiently common that they need to be accounted for in creating autism-friendly housing. The 2011-2012 AHP housing survey indicated there were a number of modifications that were deemed helpful or necessary by a significant number of respondents, including over 50% who would benefit from sound-proof bedrooms, durable construction, and a fenced in yard, and over 20% who would benefit from unbreakable glass, and floor drains in bathrooms. Design that anticipates these needs will result in residents preserving tenancy, fewer stress-induced meltdowns, lower repair bills, and less need for costly support staff to facilitate interaction with the environment.

Literature on autism-friendly design

In the last ten years, a robust literature on autism-friendly design has developed. The goal is to accommodate the characteristics of autism in designing housing, with the goal of improving residents’ quality of life. We will look at three examples of the literature. The first two are aimed at elucidating design principles, while the third takes a more practical approach, providing a template for identifying specific modifications to address individual needs. Autism Housing Pathways has produced a summary presentation on autism-friendly design, and a cheat sheet of design techniques, based on the literature discussed below and on the experience of its members.

Ahrentzen and Steele
Sherry Ahrentzen and Kimberly Steele of Arizona State University were the lead authors on “Advancing Full Spectrum Housing: Designing for Adults with Autism Spectrum Disorders“. This was the companion study to “Opening Doors: A Discussion of Residential Options for Adults Living with Autism and Related Disorders“. In addition to drawing on existing literature on autism and design, they used information from visits to and interviews with a range of existing programs considered to be exemplary that were serving people with autism, intellectual disabilities, developmental disabilities, and other “special needs” populations. They derived 10 design goals:

Ensure safety and security
Maximize familiarity, stability and clarity
Minimize sensory overload
Allow opportunities for controlling social interaction and privacy
Provide adequate choice and independence
Foster health and wellness
Enhance one’s dignity
Ensure durability
Achieve affordability
Ensure accessibility and support in the surrounding neighborhood.

16 design guidelines, referencing the goals, address: neighborhood; floor plan strategies; outdoor spaces; living/community rooms; kitchens; hallways, stairs, and ramps; bedrooms; sensory rooms; bathrooms; laundry room; technology; visual cues; ventilation; lighting; materials; acoustics; appliances and fixtures.

Brand
“Living in the Community: Housing Design for Adults with Autism” by Andrew Brand presents the results of a 2010 British collaboration between an autism charity, The Kingwood Trust, and Helen Hamlyn Centre of the Royal College of Art. Researchers reviewed the literature on autism, sensory processing and the built environment; consulted biographies of people with autism; interviewed autistics and professionals; and visited supported residences. They derived concepts and got feedback from focus groups of autistic adults. The group produced four design themes (Brand, p. 15):

Growth and development: facilitating personal growth through environments that encourage exploration and development of interests and skills. Qualities addressed were:
- Independence, social interaction, access, affordability, and evolution
Triggers: minimizing triggers by creating environments adapted to individuals’ sensory need. Qualities addressed were:
- Sensation, perception, refuge, empowerment
Robustness: creating environments that can safely tolerate unintended use. Qualities addressed were:
- Safety, durability, ease of maintenance, tolerance
Support tools: providing spaces that facilitate person-centered support. Qualities addressed were:
- Communication, personal support, unobtrusive monitoring

Brand then produced a design guide, divided into five “layers”: planning; massing and layout; mechanical and electrical; furniture, fabric, and finishes; fixtures and fittings.

Braddock and Rowell
George Braddock is a veteran general contractor and housing consultant with over 25 years of designing and modifying homes for people with disabilities. He roots his work in a person-centered planning approach. With John Rowell, of Rowell Brokaw Architects and the University of Oregon, he produced “Making Homes that Work: A Resource Guide for Families Living with Autism Spectrum Disorder and Co-occurring Behaviors“. Braddock and Rowell’s approach is to engage in an environmental assessment and develop an action plan, through five steps:

Identify caregiver challenges
Involve the individual
Assess the home and identify what isn’t working
Learn about common home modifications and strategies for specific challenges
Make an action plan for the unique situation and circumstances

Braddock and Rowell identify six most common home modifications for autistics with intensive support needs:

An autism-friendly home that reduces risks and anticipates activities
A connected home, with clear lines of sight to provide unobtrusive monitoring
Essential bathroom modifications
A walking loop to relieve stress
Places of control and layers of freedom provide individuals with control and independence
Tools for housekeeping to address common problems

They also provide strategies to cope with the specific challenges of elopement, self-injury and seizures, property damage, aggression, and neighbor relations.

The context of housing

Autism has sometimes been described as involving “context-blindness”, or difficulty with processing the context surrounding a situation. Like everything else, housing exists in a context. Physical design can help provide clues to that context, but additional supports are frequently needed to translate the social context of the housing environment. These can include explicit explanations of what is expected of a tenant, a neighbor, and a housemate. Clear strategies for addressing conflict need to be provided. Similarly, a readily understood version of the lease can be an important tool, in addition to guides to maintaining tenancy and receiving reasonable accommodations for disability. While many of these tools are not yet commonly available, a few resources are out there, including “Keep Your Housing! A Guide to Helping Massachusetts Tenants with Mental Health Issues Maintain Their Housing“, and housing workbooks that touch on the hidden curriculum. Common issues that arise that threaten tenancy are housekeeping and hoarding. A technique that worked with an individual facing eviction was having a biweekly housekeeping inspection paired with a housecleaning rubric. Similarly, hoarding has been addressed by having a clear understanding that items must be kept on shelves. Periodically, the individual would identify items to be removed, but the actual removal would be done by support staff at an agreed upon time, during which the tenant chose to be absent.