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Small changes to environment may improve care, education of children with autism
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Many children with autism exposed to certain sensory information, such as the brightness or certain colors of a pediatrician’s office or the sound of a classroom, have difficulties processing these environmental stimuli. These stimuli may overwhelm the child and can either positively or negatively impact their treatment and learning outcomes.
Addressing these difficulties with sensory processing is a primary objective of research conducted at Ball State University by Shireen Kanakri, PhD, Architect, EDRA, director of Health Design Environmental Research Lab, a member of the university’s Center for Autism Spectrum Disorder and assistant professor at the College of Architecture and Planning.
According to Kanakri, children with autism begin participating in the study as soon as they enter the waiting area of the Design Research Lab. These rooms include acoustic paneling to control the noise of the environment and provide an opportunity for the child to relax and play with activities such as painting, puzzles and playing with sand and sensory toys. Once an activity is chosen, Kanakri and colleagues move the child to the lab, where they conduct sessions that examine the child’s response to different levels of sound, exposure to multiple colors and responses to light.
“Each child is different, which is why we are still accepting more children [for the study] so we can understand more about the effects that different environments can create,” she said. “So far, we have found that there is a huge relationship between the environment and the behaviors of children with autism.”
Kanakri began the study in August 2017 and has assessed 85 children.
Acoustic exposures range from a quiet environment (approximately 40 dB), a noisy environment similar to a restaurant or a classroom (approximately 55 dB) and a loud environment (approximately 70 dB). Between each session, the child “resets” in a calm environment.
Kanakri and colleagues are further examining how children react to both LED lighting and fluorescent lighting, a topic she studied in a 2016 article published in Environment and Behavior. In this study, it was recommended that placing children with autism away from fluorescent lighting in a classroom may be beneficial because the sound emitted by the light may be too intense of a stimulus for the child. The researchers suggest that the most ideal environment would include an alternative that does not emit noise.
Research regarding the impact of environmental stimuli on children with autism conducted at Ball State University also found that behavioral changes are common in children when exposed to environments that are not conducive to easily processing information. When children were exposed to noises between 41 dB and 55 dB in Kanakri’s previous study, the most commonly observed behaviors included repetitive motor movement and speech, producing loud sounds, covering of the ears, blinking eyes, complaining and hitting others.
These behaviors, in addition to repetitive speech, were more frequently observed in children with autism when they were exposed to sounds between 55 dB and 70 dB, which the researchers claim is the typical range of a loud classroom.
“All children learn from the world around them, including sensory exposures such as light, sound, smell and touch,” Paul H. Lipkin, MD, director of the Interactive Autism Network, Kennedy Krieger Institute, and associate professor of pediatrics, Johns Hopkins University School of Medicine, told Infectious Diseases in Children. “Some children with autism are unusually sensitive, or hypersensitive, to some of the exposures, resulting in distress.”
“These episodes can cause a child to remove themselves from the situation (wandering) or avoid the activity or can result in more serious consequences, such as fleeing the situation (elopement) or harming themselves (eg, self-hitting or biting), sometimes resulting in injury or even death,” Lipkin, a member of the Infectious Diseases in Children Editorial Board, added.
Some children with autism have extreme sensitivities to certain aspects of their environment, whereas others have minor sensitivities or none at all, according to Shelby Haggard, an undergraduate research assistant who works with Kanakri at Ball State University.
“In our surveys and interviews with parents of children with autism, parental reports of negative behavioral reactions to lighting and sounds seem to be the most common,” Haggard said.
Kanakri mentioned that when examining exposure to colors, which included yellow, green, purple and red, children may exhibit more observable behaviors. According to her, some children have even cried when flipping between which colors are used within the room and the LED lights. To lessen the distress of the child, the researchers would alter other aspects of the environment, such as playing music they enjoyed.
Once the researchers observe the children in these environments, they provide recommendations to their parents on how they can best accommodate their child’s difficulties with sensory processing.
“Parents should explore each environmental factor separately and over time. If they want to paint one of the children’s rooms, paint one color at a time on maybe one wall at a time and observe how the child reacts to that color,” Kanakri said. “I suggest observing this for about a month. These environmental factors can have a huge impact on different behaviors that the child may be struggling with.”
“Changes made in the environment do not need to be major. They can be little, easy changes that may impact a child very positively,” she continued. “Teachers and physicians should be also aware of these positive changes that they can do that will accelerate the learning, therapy and treatment process.”
Parents’ first priority should be to ensure the child’s safety and that they cannot wander away from home or school, according to Lipkin. “Then changes can be made in rooms to minimize the child’s exposure to the sounds, lights or sensations that can may trigger such reactions, as we would do for any child,” Lipkin said.
Changes could include minimizing loud noise or bright lights, according to Lipkin.
A psychologist or occupational therapist can use desensitization techniques with a child with extraordinary hypersensitivity, and they can also advise parents or school officials about ways to modify the setting, Lipkin said
Some of these findings, according to Kanakri, are applicable to pediatric health care settings that a child with autism may encounter, including pediatricians’ offices, psychiatrists’ offices and occupational therapy settings.
When implementing environmental changes in these settings, it is important to first get feedback from those who are using the space, Haggard said.
“This could be the children themselves, if possible, or the children’s parents,” she added.
“For health care providers who have environments that can be changed, we may change the artwork in a space to meet a child’s needs,” Kanakri said. “If we cannot change the environment, small things may help, like having the provider change what they are wearing so that they can avoid a color that the child is affected by. Physicians and therapists can also limit noise exposure and have the child avoid crowded spaces so that acoustic disturbances do not affect the child.”
Furthermore, she suggests that if colors need to be changed for a child who is having difficulties with sensory processing in the health care setting, a curtain of their preferred color may be added to the area. While the child is receiving treatment, they may have a less difficult time processing environmental stimuli when they are facing that curtain. Certain paint colors are also available that have been observed to calm patients in doctors’ offices whether the patient does or does not have autism.
“All children, including those with autism, have some degree of fear or anxiety when entering a health care setting,” Lipkin said. “Health care workers should ensure that the waiting room, triage areas and clinic rooms are visually pleasant, appropriately lit, and find a way to minimize the noises generated by equipment, other personnel, and other children or adults being seen in the facility.
“If the child being seen has hypersensitivity, the pediatric clinician should provide guidance to the family and to the school around minimizing exposures and adapting the home and school setting to minimize wandering and injury of the child. The clinician may choose to refer to the family or to a medical or developmental specialist or therapist when greater assistance or guidance is needed,” Lipkin said.
Accommodating children who have difficulties processing aspects of their environment may assist in allowing providers to deliver the care that a child with autism needs; however, Kanakri believes that this research should also be used to better the lives of children when they are exposed to environments that may not be preferred.
“My goal is not to keep these children’s lives under these conditions,” Kanakri said. “It is a matter of giving them the right behaviors and teaching them the actions we are looking for in these specific environments. These skills can be taught by a physician or therapist in the child’s ideal environment. Once they develop these skills, we can teach them how to cope once they are placed in an environment that is not ideal.” – by Katherine Bortz
- Reference:
- Kanakri SM, et al. Environ Behav. 2016;doi:10.1177/0013916516669389
- For more information:
- Shelby Haggard, can be reached at 2000 W University Ave., Muncie IN 47306. email:sehaggard@bsu.edu.
- Shireen Kanakri, PhD, Architect, EDRA, can be reached at the 2000 W University Ave., Muncie, IN 47306; email:smkanakri@bsu.edu.
- Paul H. Lipkin, MD, can be reached at the Kennedy Krieger Institute, 707 North Broadway, Baltimore, MD 21025; email:lipkin@kennedykrieger.org.
Disclosures: Haggard, Kanakri and Lipkin report no relevant financial disclosures.