Problem: many autistic kids are super sensitive to the sight, sound, and feel of their environment. So when New York-Presbyterian decided to build an early intervention center for autistic children, they needed it designed with their needs in mind.
One in 68 American children have been diagnosed with autism, according to the Center for Disease Control. Early intervention is the most effective treatment, requiring dedicated centers, but autistic children's hypersensitivity to their surroundings makes designing such facilities difficult.
To design the new Center of Autism and the Developing Brain (CADB), an outpatient early intervention center for autistic children as young as eighteen months, New York-Presbyterian turned to their long-time design partners at DaSilva Architects. Although DaSilva had never designed for autistic children before, principal Jacques Black tells me they worked to convert a ramshackle gymnasium into a comfortable environment for autistic kids. How? By paying close attention to texture, acoustics, and lighting conditions—lessons just as applicable to the rest of the world when it comes to designing autism-friendly spaces.
From the beginning, the space chosen for CADB by New York-Presbyterian provided unique challenges. First built in 1924, the Rogers Gymnasium "looked like an old high school gym," says Black, replete with yellow brick walls, cages over the windows, and a tendency to cavernously echo. It was kind of scary. "This was the environment where we were supposed to be building a facility for kids who are ultra-sensitive to their environments," he says. "It was a conundrum."
With the help of CADB's new director Cathy Lord, DaSilva's solution was to turn the entire inside of the gym into a colorful village. Self-contained treatment rooms, offices, and other enclosed space exist as bright little huts, houses, and pavilions, positioned among open streets, paths, and other central gathering spaces. There's an artificial sky and clouds, and the inside of the center also contains its own parks, benches, and even gardens.
Given the sensitivity many children feel to their surroundings, these kinds of familiar design elements were essential. The endless institutional hallways of many hospitals and clinics, stretching down a corridor of indistinguishable doors, can spark confusion and even terror in young patients, according to DaSilva's background research. Comparatively, CADB feels almost like a "Disney village," says Black—a smaller, more manageable version of a city with familiar details like street and parks—creating an environment where kids feel comfortable.
For many autistic people, acoustics can be problematic. For example, the seemingly normal hum of fluorescent lights can be extremely agitating. Same with the sound of air-conditioning or heating. Even the sound of footsteps, kids playing, or a garbage truck passing by can be distracting to some CADB patients.
To keep the center quiet, DaSilva Architects employed a number of tricks. Treatment rooms were designed to be as soundproof as possible, with absorptive carpeting to dampen clamor and sound-dampening panels on the walls. In areas where the floor couldn't be carpeted, like in areas near sinks, DaSilva used soft rubber flooring to achieve a similar effect. As for public areas, the architects specified cork flooring to deaden the sound of people walking across the floor. Black and his team even moved all of the building's air conditioners, boilers, and ventilation into a hut connected to the main building—totally eliminating their ambient sounds.
Lighting is an important consideration in any space, but for CADB's patients, it was even more critical. For some people with autism, light is a Goldilocks problem: it can't be too warm, too cold, too bright, too dim, too harsh, too artificial, or even too natural. It needs to be just right.
For CADB, DaSilva Architects made the choice to light the space with a mixture of natural and artificial sources. For the natural lighting, the former gymnasium's huge windows became an asset. "A lot of literature about autism warns against having too much natural light," Black says, but that's mostly because big ground-level windows provide plenty of distractions. The Rogers Gymnasium's windows, however, were located six feet off the ground, giving children a gentle feeling of the outdoors, without actually exposing what's happening outside.
For artificial lighting, DaSilva Architects opted against the total use of overhead lights like those you find in many office, selecting a diverse mixture of sources instead. True, there are still some overhead lights, but there's also substantial use of side lighting from a variety of sources. All of these lamps can be dimmed in case a patient reacts strongly against them. The result is a center that's lit more like a living room than an institution.
"Just like they're hyper-sensitive to sound, noise, and light, many autistic children are hyper-sensitive to the feel of physical objects, and physical input" Black says. That can be both good and bad. One child might be attracted to shiny, slippery surfaces, while another might find a slightly abrasive surface unbearable to touch.
There's no sweet spot between these two extremes, but Black says that favoring natural textiles and materials can help strike a happy medium, which is why the CADB uses materials like cork, rubber, porcelain, and wool. Another good rule of thumb is to gravitate toward materials that feel good to non-autistic people, too. Most people would rather touch a wooden surface than a metal one, or walk on a flat woven carpet than linoleum, and that's usually true of kids on the autism spectrum too.
"There's a joke that if you know one autistic person, you know one autistic person," Black says. "Each autistic person is very different: it's a whole spectrum of different conditions." That can make designing for those with autism challenging, but as the Center for Autism and the Developing Brain's new facility shows, not impossible. The trick is to be sensitive to stimulus and sensation—because the people you're designing for will be even more so.