Posts Tagged ‘Environmental’

Using An Environmental Check For People On The Autism Spectrum (Part 1)

Introduction

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
Communication systems
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.

 Sight/Visual

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?

Current situation

There are a variety of colours in our

room.

Approximately half of the walls are

bright pink and maybe too vibrant

for someone with autism

Suggested solution

Re-paint walls with pastel green

and ask students with

autism to choose

the colour.

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”

(Nguyen, 2006)

 Current situation

Most of the room is uncluttered,

although

sometimes activities are

not tidied away properly and

materials are left out.

Suggested solution

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.

 Concluding comments

 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.

 References

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’

www.autismlondon.org.uk/pdf-files/bulletin­

_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

Environmental Checklist For Autism Spectrum Conditions (Part 2)

This is the Checklist which is described in Using an Environmental Check for People with Autism Spectrum Conditions(Part 1).

The categories for this checklist are divided into 4 areas-

1.Sensory

Touch/tactile
Sight/visual
Smell/olfactory
Hearing/auditory
Taste/gustatory
Balance/vestibular
Body awareness/proprioception

 2.Communication Systems

3.Escape

4.Other

Each area has a number of questions that will have a response yes or no

Decide to whether you believe the environment you are assessing fully addresses the issue raised.

Totalled up yes’ will give an overall friendly rating. It will be the analysis of each category however rather than the deficits of the environment which maybe of most benefit.

After each question there is a section named solutions. This is to be completed to indicate how you aim to change the current environment to address that particular question.

Solutions will always be specific to each area and individual therefore it is difficult to give generic solutions. Please refer to other sources

Sensory-Touch/tactile questions

1 Are there sensory materials available for individuals to touch

in the environment? e.g. sand, water play

Decide whether you have a variety of materials and enough needed for

each individual who seeks sensory stimulation

2 Are there opportunities for soft play/rough and tumble for individuals to access?

Consider how often and whether the opportunities are appropriate

3 Is there massage available to Individuals, if needed

Consider how often, by whom

4 Is there a body map on the wall where individuals can indicate

places they like/dislike to be touched?

Consider if no body map how you would determine where someone

likes/dislikes to be touched.

5 Are there small spaces where individuals can squeeze into, if they wish.

Consider if you could position furniture to facilitate this.

6 Are there indicators to point out where hot surfaces are?

Consider safety and how to manage this.

Solutions

Sight / Visual questions

1 Are the colours in the environment low arousal such as cream and pastel shades

and not red or vibrant.

Consider whether all rooms /spaces need

need a change of paint or wallpaper

2 Is the environment cluttered with furniture?

 “ 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”

(Nguyen, 2006)

3 Does the environment have many patterns, shapes and surfaces that may be sensitive to the eye.

Consider curtains, blinds and pictures etc.

Consider whether staff clothing or jewellery could be a problem.

4 Does the environment have fluorescent or harsh lighting, rather than dimmable or subtle lighting.

5 Have you considered sunlight from windows or skylights and where the light is at different times of the day?

Solutions

Smell / Olfactory questions

1 Have you considered the toxicity of paint or wallpaper paste used to decorate the environment

2 Have you considered the smells of cleaning materials used?

E.g. polish, air fresheners

3 Have you considered the smells of individuals (including pets) using

the environment? (e.g. deodorants, perfume and aftershave)

4 Do smells drift around the building from room to room and how might you isolate these?

Solutions

Hearing / Auditory questions

1 Have you considered the general noise level in the environment?

2 Have you considered hypersensitive hearing and looked at specific noises that may irritate such as clocks ticking, humming from lights, road noises or building/gardening work in the distance?

3 Is there noise from flooring and can this be deadened?

4 Have you considered noise levels at different times of the day?

5 Have you any specific quiet areas?

6 Have you considered the pitch of noise as well as the level?

Solutions

Taste / Gustatory questions

1 Do you have a wide range of foods available of

different textures and temperature?

2 Are there options to intensify the flavour of foods by adding seasoning or spices

3 Is there clear guidance on what to do when someone is mouthing or eating inedible food?

Solutions

Balance / Vestibular questions

1 Is the environment geared for people who seek movement?

 (e.g.  lots of space, soft play, swings, trampoline)

 2 Are there opportunities to move indoors and out?

3 Is the environment geared for people who are oversensitive to movement?

e.g. support equipment when moving to help with balance.

4 Are routines flexible to those who struggle with movement disorders?

For example enough time given for movement in the day

Solutions

Body Awareness / Proprioception questions

 1 Is the environment free of unnecessary obstructions?

 2 Have rooms been made easier to navigate?

 e.g. using colours to distinguish floors, walls and furniture, as well as

 from room to room

3 To what extent have you considered those who have fine motor

difficulties? ( e.g. locks, cutlery, door handles)

Solutions

Communication questions

1 Does the environment have clear signs to indicate the use of

each room?

2 Are there directional signs to each area?

 3 To what extent are communication systems supported by use of symbols, pictures, photos or objects?

4 Are rooms given one purpose only?

5 Are there photographs used to aid recognition of people

 (Staff/unfamiliar) if needed?

Solutions

Escape questions

1 Is there a system to know when a person with autism needs to escape from an environment?

 2 Is there a space/ room to escape to?

 3 Is this room /space used solely for this purpose?

 4 To what extent is this room / space low stimuli and safe?

 5 Is there an alternative to the escape room / space

(e.g. the garden)

 Solutions

 Other questions

 1 To what extent are you fully aware of each individuals sensory

difficulties?(see the sensory profile devised by Bogdashina, 2003)

 2 Are you able to make changes to the sensory environment?

(e.g. are there practical or financial restraints.)

3 To what extent is the environment safe for people on the autism spectrum?

 Solutions

 Maximum score is 44 x yes

 Your Score………………..

 Date to review and repeat the checklist……………………..

 References / further reading

 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

 Gillberg .C (2002) – A guide to Asperger syndrome. Cambridge. Cambridge University Press.

 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’

www.autismlondon.org.uk/pdf-files/bulletin­ _feb-mar_2005 accessed 16 March 2006

 Morgan.H (1996) –Adults with Autism; A guide to theory and practice. Cambridge, Cambridge University Press

Morton-Cooper (2004)-Health Care and the Autism Spectrum –A Guide for Health Professionals, Parents and Carers, London, Jessica Kingsley Publishers.

National Autistic Society (2006 a)-Information sheet: What is autism?  London. National Autistic Society.

National Autistic Society (2006 b) – Information sheet: What is Asperger syndrome?  London. National Autistic Society.

Nguyen.A (2006), Creating an autism-friendly environment, London. The National Autistic Society.

Plimley.L (2004) Analysis of a student task to create an autism-friendly living environment. BILD.Good Autism Practice Journal 5.2 Pp35-41

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. BILD Good Autism Practice Journal 7.1 pp31-9

 Wing.L (1996)-The Autistic Spectrum; a guide for parents and professionals. London. Constable and Robinson.