A Sensory Integration: Interior Design for Autism in Art Therapy Centers

A Sensory Integration: Interior Design for Autism in Art Therapy Centers.

A Thesis Submitted to the Faculty of the Interior Design Department in Partial Fulfillment of the Requirements for the Degree of Master of Fine Arts in Interior Design at Savannah College of Art and Design

Kacie Logan Anderson Savannah, Georgia May 2019

Ryan Hansen, Committee Chair Christina Gonano, Committee Member Amy Demuth, Committee Member

Dedication This thesis is dedicated to my husband for all his support and encouragement throughout every step of this journey. Thank you for being my sounding board for ideas and helping me accomplish this goal. It is to you that I own my success. I would also like to dedicate this thesis to my family and friends for all their support and encouragement.

Acknowledgments Thank you to my committee and their collective efforts to guide me through this process. Their guidance and support is what lead to the results of this study. A special thanks to Amy Demuth for taking the time to be a part of this thesis and giving her feedback; Christina Gonano for her feedback and advice; Ryan Hansen, for his guidance and encouragement.

In addition, I thank Rick Navarro for listing to my ideas and supporting me while working through this thesis. Along with Helena Moussatche for her guidance during the writing process.

Last, thank you to everyone who participated in online surveys, interviews, and observations.

Your feedback made this project possible.

TABLE OF CONTENTS LIST OF FIGURES .................................................................................................................1 ABSTRACT ................................................................................................................................3 INTRODUCTION ....................................................................................................................4 Thesis Statement ........................................................................................................................4 The Purpose of the Study ..........................................................................................................5 Justification of the Study ..........................................................................................................6

LITERATURE REVIEW .....................................................................................................7 Autism .........................................................................................................................................7 What is Autism? .......................................................................................................................7 Challenges Associated with Autism .........................................................................................9 Neurology of the Autistic Brain .............................................................................................10 Autism and Sensory Processing .............................................................................................11 Art Therapy ..............................................................................................................................12 What is Art Therapy? .............................................................................................................12 Art Therapy and Autism .........................................................................................................13 Art Therapy and Sensory Stimulation ....................................................................................14 Interior Design for ASD/ The Gap..........................................................................................15 Interior Issues and Suggested Guidelines ...............................................................................15 Sensory Design ..........................................................................................................................18 What is Sensory Design? ........................................................................................................18 Sensory Design and Autism ...................................................................................................19 Conclusion .................................................................................................................................21

METHODOLOGY .................................................................................................................23 Introduction to Methodology .................................................................................................23 Research Conduction and Population.....................................................................................23 Data Collection Methods ........................................................................................................24

RESEARCH FINDINGS .....................................................................................................26 Research Strategies ..................................................................................................................26 Survey .....................................................................................................................................26 Observation.............................................................................................................................28 Interviews ...............................................................................................................................30 Case Studies............................................................................................................................32 Discussion ..................................................................................................................................33

DESIGN PROPOSAL ..........................................................................................................34 Description ...............................................................................................................................34 Client and Users......................................................................................................................34 Site and Building Analysis .....................................................................................................34 Program ..................................................................................................................................36 Design Solutions.....................................................................................................................38 Concept ..................................................................................................................................39 Key Experiences .....................................................................................................................40 Conclusion ..............................................................................................................................46

DEFINITIONS .........................................................................................................................47 REFERENCES ........................................................................................................................49 FIGURE REFERENCES .....................................................................................................54

APPENDIX ...............................................................................................................................57 Appendix A.............................................................................................................................57 Appendix B.............................................................................................................................66 Appendix C.............................................................................................................................67 Appendix D ............................................................................................................................68 Appendix E .............................................................................................................................74 Appendix F .............................................................................................................................75

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LIST OF FIGURES Figure 1. Estimated Autism Prevalence 2018 ..................................................................................8 Figure 2. Eight Senses ...................................................................................................................11 Figure 3. ASD Design Guidelines ................................................................................................16 Figure 4. Sensory Model ...............................................................................................................19 Figure 5. Sensory Zoning and Circulation Schemes .....................................................................21 Figure 6. Kids Waiting Room Ideas .............................................................................................27 Figure 7. Waiting Room ...............................................................................................................27 Figure 8. Play and Art Therapy .....................................................................................................28 Figure 9. Fur and Soft Woven Textures ........................................................................................28 Figure 10. Calm Color ..................................................................................................................28 Figure 11. Sun Path Illustration ....................................................................................................35 Figure 12. User Journey ................................................................................................................37 Figure 13. Proposed Program .......................................................................................................37 Figure 14. Conceptual Sketches ....................................................................................................39 Figure 15. Stimulation Circulation Plan .......................................................................................40 Figure 16. Interactive Area ...........................................................................................................41 Figure 17. Play Area .....................................................................................................................42 Figure 18. Multi-sensory Waiting Room Render .........................................................................42 Figure 19. Quiet Area Wall Seating ..............................................................................................43 Figure 20. Technology Area .........................................................................................................43 Figure 21. Quiet Area of Multi-sensory Waiting Room Render ..................................................43 Figure 22. Bean Bag Seating Area ................................................................................................44

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Figure 23. Transition Area Wall Seating ......................................................................................44 Figure 24. Transition Area Render ...............................................................................................45

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ABSTRACT A Sensory Integration: Interior Design for Autism in Art Therapy Centers Kacie Logan Anderson May 2019 Currently, 1 in 59 children are diagnosed with autism in the United States. This is a 15% increase since 2014. This rapid increase has spiked a rise in facilities treating these children.

With the need for designers to design for not just neurotypical children in the built environment, but also for autistic children, the push to design, spaces for both types of children has risen as well. Research has shown that there are some current guidelines for designing a space with autism in mind. However, there are these guidelines do not adequately address the issues of sensory stimulation in the built environment. Sensory stimulation happens when one or more of the bodies senses is activated to engage with the surrounding environment. This thesis is meant to explore the integration of sensory design into current art therapy centers so children with autism will have a place they can feel comfortable and want to return to without apprehension.

Art therapy makes sensory regulation less stressful for the child by offering a way for autistic children to learn information in an unconventional, nonverbal, comprehensive, and expressive way using a variety of art materials to have a rich sensory experience. Art therapy and sensory stimulation incorporate the visual, tactile, and auditory senses. This is not always done with conventional art supplies, it is also achieved by using the built environment with techniques such as light play with shadows using natural and artificial light, or sound play with musical instruments, objects, or verbal using reflective and absorbent surfaces. Surveys and interviews revealed that more autistic-friendly spaces among the neurotypical world are desired. It is proposed that by creating a space that controls sensory stimulation, ways of understanding the unknown, and a space that is more autistic-friendly could increase the number of autistic children going to and benefiting from art therapy. The implementation of these research findings can help an autistic child to establish a sense of belongingness and identify art therapy centers as their own safe space. *Keywords: art therapy, sensory stimulation, integration, autism, sensory design, safe space.

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INTRODUCTION Thesis Statement In recent years there has been more attention brought to how interior spaces are affecting children with autism. This is based on the amount of newer information available from design sources researching autism versus older sources on autism. Autism is a fast-growing developmental disorder in the United States, and the comfort and well-being of these children should be carefully considered. This attention is starting to form guidelines needed to design for Autism Spectrum Disorder (ASD). Autism is a disorder that has many different aspects to it, but a prevalent issue is a sensitivity to stimulation of the senses. Uncontrolled sensory stimulation in the built environment can lead to an overload of the senses and cause significant discomfort to people with autism.

There is no known cure for autism; therefore, this is a condition that a person can have for their entire life. Consequently, managing the challenges associated with autism is critical for parents, caregivers, and therapist. Among therapies that can accomplish this management is art therapy. Art therapy is considered one of the top therapies that can improve children with autism's ability to imagine, think symbolically, communicate, and fine-tune their motor skills (Lacour, 2018). Just like most therapies, the younger the person starts it, the better. Due to the fact that these children are receptive to it, art therapy is no exception. With autistic children going to art therapy that rang in functionality levels, the interior of facilities that offer art therapy should support their various needs and not agitate them. Current art therapy centers have neurotypical, autistic, and children with other disorders attending them, and they are usually

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designed based on the standard design principles. However, these standard design principles do not take into account the specific needs of a child with autism.

Very few studies have been conducted to determine the design factors that bother a person with autism in art therapy centers' interiors. Although, there have been some studies conducted in classrooms, hospitals and home settings, which can give an overall idea of related agitators. Agitators such as sound, light, and odor along with many others are categorized as sensory agitators. According to Mostafa (2014), "‌ the key to design for autism seems to revolve around the issues of the sensory environment and its relationship to autistic behavior" (p.144). This idea leads to what is called sensory design. This type of design focuses on all five senses of a person within an interior space so that the appropriate amount of focus is placed on each sense.

A sensory environment, according to Lehman (2017), is one that can transform and uplift the quality of life in an entirely new way; meaning that sensory design although focused on children with autism, can help other children who are neurotypical or have other disorders. With the knowledge of how sensory stimulation in an environment affects autistic children and the importance of the needed focus in art therapy for these children to prosper, the design question becomes: how can interior design better integrate sensory based design elements into current art therapy centers?

The Purpose of the Study The purpose of this study is to identify and integrate sensory design elements into current art therapy centers in a way that can help autistic children to prosper in dealing with his or her specific challenges. This sensory integration will help an autistic child not to become

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overwhelmed by multiple senses being activated at once. This integration will instead introduce limited sensory stimulation at a time, so the child remains comfortable and calm. In order to accomplish this design idea, the following questions will be addressed: 1.

What current sensory stimulating interior elements provide comfort for an

autistic child in his or her own home or what would they consider a "safe space"?

2.

What design elements in a therapy center currently deter children from

wanting to go to art therapy?

3.

How does sensory integration at other types of facilities help an autistic child

to remain comfortable? Can these ideas also be used in art therapy centers, and for what purpose?

Justification of the Study D'Amico and Lalonde (2017) wrote: "In a recent study with 19 children ages 8 to 14 years using an art therapy intervention to help young children with autism recognize basic emotions, it was found that participants in the treatment group were better equipped to recognize emotions‌." (p.177).

This study is just one example of how art therapy can be used for an autistic child to learn how to function and read social cues out in the world. This design thesis' intention of integrating sensory design in art therapy centers can only further this knowledge by helping even younger, and lower functioning children focus more on their art therapy sessions. When an autistic child is comfortable, it is said that they are more receptive to what is around them, and they can focus on the task at hand.

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Therefore, the importance of this study is not only to increase the interior design body of knowledge on design for autism spectrum disorder in children, but also to create a safe space for art therapy that allows any child to work on his or her challenges and succeed in life.

LITERATURE REVIEW Autism What is Autism?

Autism is also known as autism spectrum disorder (ASD), and it is estimated to affect 13 per 10,000 people worldwide. According to the Center for Disease Control and Prevention (2018), it can impact 1 in 59 children in the United States. Autism is a developmental disorder; therefore, these children never look any different than a neurotypical child. However, autistic children may act differently when it comes to communication, interaction with others, learning, or behaving. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), autism is characterized by deficits in social communication, social interactions, and restricted and repetitive behaviors, interests, and/or activities., along with fine and gross motor skills deficits (Autism Speaks, 2012).

The signs/symptoms of autism become most notable between the ages of 2 and 3 but, it can be diagnosed as early as 18 months (Autism Speaks, 2012). The critical period for autism development occurs before, during, and immediately after birth. Diagnoses of autism is most of the time difficult due to the fact that there are no medical tests, such as blood work or scans, that can say a child has Autism. Doctors diagnose autism by going through a checklist of developmental milestones that monitor a child's behavioral developments. Autism is about four

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times more common among boys than girls. Figure 1, below, shows the 2018 estimated prevalence increase of autism.

Figure 1: CDC. (2018). Estimated Autism Prevalence 2018 [Online Image].

Retrieved from URL (https://www.autismspeaks.org/science-news/cdc-increases-estimateautisms-prevalence-15-percent-1-59-children) According to the Center for Disease Control and Prevention (2018), there is not one specific cause of autism. They did say, however, that "there are likely many causes for multiple types of ASD. There may be many different factors that make a child more likely to have an ASD, including environmental, biologic and genetic factors". One thing that scientists seem to agree about a person developing autism is their genes. This is based on the fact that autism tends to occur more often in people who have certain genetic or chromosomal conditions, such as fragile X syndrome or tuberous sclerosis. The Center for Disease Control also informs that there is currently no cure for autism, but research has shown that early intervention treatments can help improve a child's development.

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Challenges Associated with Autism The conditions that challenge children on the autism spectrum according to American Speech – Language - Hearing- Association (ASHA) (2018), can range from communication where the child may have trouble understanding, talking, reading, or writing, even going as far as being nonverbal. There are several social deficits that are ubiquitous in those with ASD. According to ASHA (2018), deficits in social communication can include issues with receptive and expressive language skills. Approximately 1/3 of those diagnosed with autism are non-verbal and use assisted communication devices, sign language, or other forms of communication systems in place of verbal language (Rudy, 2019). Other common deficits can be seen in areas such as social skills and social interactions, difficulty with transitions and routine changes, feeding, and processing sensory input.

Autistic children can also be oversensitive or under sensitive to environmental stimuli such as noise, light, material textures, and temperature (National Autistic Society, 2016). This means that they take in too much or too little information from their environment. These challenges bring up the concern with the fact that there is not one type of autism but many different types, each ranging with many differences.

Other conditions, according to Skokauskas and Gallagher (2012) who quoted Kielinen et al. (2004), that autistic people might have epileptic convulsions, which occur in 10-30% of them, along with neurofibromatosis, congenital rubella, hydrocephalus, impairments of ambulation, fetal alcohol syndrome and visual and hearing impairments. Depression is also associated with ASD and was somewhat common among autistic children.

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Neurology of the Autistic Brain Brains with autism are not only connectively different but can also be structurally different. Structurally, the brain of a child with autism can be larger than normal; the rapid growth of the head, due to this larger brain, can be an indicator of autism in children at a young age. Areas of the brain, such as the cerebellum, the brain stem, frontal lobes, parietal lobes, hippocampus, and the amygdala have been identified with anatomical abnormalities. According to Ha, Sohn, Kin, Sim, and Cheon (2015) "Several neuroimaging studies have examined other aspects of the cerebral cortex, such as cortical shape and sulcal patterns. Abnormalities in cortical folding might be caused by mechanical tension of axonal white matter fibers pulling force on the neocortex" (p.274). These studies explain another aspect of the abnormalities in a brain affected by autism.

According to Ha et al. (2015) "Brain connectivity can be divided into functional and structural connectivity: temporal similarities of brain activity in multiple regions and physical connections between the brain regions" (p.277). Very little is known about the connectivity of a child's brain with autism. However, a few studies have shown that children with autism show higher than normal connectivity and many neural networks (Supekar, Uddin, Khouzam, Phillips, Gaillard, Kenworthy, Yerys, Vaidya, & Menon, 2013). Due to this hyper-connectivity in the salience network of an autistic brain outside stimuli information gets combined with internal emotions of the child, which then allows the brain to choose the outside stimuli that they want to concentrate on. This phenomenon, explains the restricted and repetitive behaviors observed in autistic children, shown in the child's intense focus on something of interest. Research on structural connectivity of toddlers with autism, according to Ha et al. (2015), "demonstrated that frontal tracts displayed abnormal age-related changes with greater fractional anisotropy (FA) and

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volume than traditional developmental control" (p.278). This abnormality in the frontal fiber tracts has helped explain the underlying impairment of social and communication behaviors in autistic children. These brain abnormalities are what defines the challenges including sensory issues among children with autism. These challenges are what design standards need to be sensitive to, in order to help these children feel comfortable in the built environment.

Autism and Sensory Processing The mentioned behaviors of autistic children due to brain abnormalities are all part of a sensory processing disorder (SPD). Sensory processing disorder happens in the brain when information comes in through the senses, and the brain has trouble receiving and responding to it. Children with autism that have SPD react differently to sensations, and the disorder can cause over- responsiveness or under-responsiveness. This sensitivity can become an issue when these senses are distressed, and it can lead to self-injury and aggressive behavior. Figure 2 below shows the bodies eight sensory systems.

Figure 2: 8 Senses. (Created by Author, 2019)

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With sensory sensitivity, autistic people can experience what is called sensory overload when too many stimuli are presented at one time. According to the National Autistic Society (2016) "Too much information can cause stress, anxiety, and possibly physical pain. This can result in withdrawal, challenging behavior or meltdown."

Art Therapy What is Art Therapy?

Art Therapy is defined by American Art Therapy Association (2013) as "an integrative mental health and human services profession that enriches the lives of individuals, families, and communities through active art-making, creative process, applied psychological theory, and human experience within a psychotherapeutic relationship." Art therapy is mostly known for its use as a stress and anxiety reliever. However, in general, it can foster self-awareness and increase self-esteem, explore feelings, deal with emotional conflict, manage behaviors and addictions, develop social skills, and improve reality orientation. Art therapy sessions can take place in a group or individual sessions and are meant to enhance a person's well-being.

There are many institutions in which art therapy is practiced, such as hospitals, psychiatric and rehabilitation centers. According to American Art Therapy Association (2013), "Individuals who benefit from art therapy include those who have survived trauma resulting from combat, abuse, and natural disaster; persons with adverse physical health conditions such as cancer, traumatic brain injury, and other health disability; and persons with autism, dementia, depression, and other disorders."

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Thus, art therapy is something that can benefit many individuals, which helps to support this idea of integrating neurotypical and autistic children together into one art therapy center.

Art Therapy and Autism Children with autism demonstrate social skill deficiencies early on in their lives, which cause them to be differentiated from their typical peers and classmates (D'Amico and Lalonde, 2017). These authors determined that the use of art therapy to teach social skills, implemented during this critical developmental stage (early childhood), could potentially help the child's social dysfunction among these autistic individuals. It can be inferred, then, that a child with autism could have the potential to function normally or at least less different than the neurotypical children around them, consequently increasing their potential to make and keep peers. Art Therapy, according to Martin (2009), is viewed as complementary or adjunctive therapy in the field of ASD treatments, and it is equivalent to other types of therapy, such as music therapy, play therapy, and recreation therapy. Treatments used with autistic children include object relations, developmental approaches, developmental/ behavioral approaches, psychotherapy, and eclectic approaches. As stated before, autism presents many different challenges for a child and no two cases are alike; according to Martin (2009), "Art therapy has a unique ability to address several specific and difficult treatment goals by capitalizing on the desirable use of art materials that are compatible with ASD symptoms." (p.188). Art therapy offers a way for autistic children to learn information in an unconventional, nonverbal, comprehensive, and expressive way using a variety of art materials to have a rich sensory experience. Art therapy sessions make sensory regulation less stressful because of its ability to provide focus on the art project itself. The author suggests that working on an age-appropriate art

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project that facilitates socialization and communication skills, fine motor skills, and uses individualized visual tools, helps with achieving developmental growth.

Children with autism that may lack imagination and abstract thinking is one of the least addressed issues by a regular therapy. Therefore, the unique ability to improve these specific skills lies in art therapy too. The combination of art and therapy is desirable to families for reasons stated above and many more. Thus, the capacity to address psychological needs sets art therapy apart from other therapies.

Art Therapy and Sensory Stimulation Sensory stimulation is the impact the environment has on a person's body and mind when we receive information through our sensory organs, and our brains interpret this input (Bachand, 2014). With this idea, art therapy can be used in a sensory way that includes not just the conventional art supplies but also the built environment. This activity setting can be established by using such techniques as light play with shadows using natural and artificial light, or sound play with musical instruments, objects, or verbal using reflective and absorbent surfaces.

Dove (2012) explained sensory art therapy as following "Sensory Art is based on neuroscientific research, psychological theory, and expressive art therapy. Practicing sensory art focuses on the brain's capacity to adapt and develop pathways to learning through stimulation of the senses.

Sensory art activities have been shown to produce changes in the brain that reflect improvements in enhanced attention skills and cognition with participants often showing significant gains in emotional awareness, communication, coping, emotional awareness, creative thinking, and sensory information processing. The

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sensory art program also involves the fine-tuning of fine and gross motor ability, visual and olfactory integration."

Using sensory art therapy, then, along with regular art therapy could be helped by the integration of sensory design elements within the built environment to make it a full circle.

Interior Design for ASD/ The Gap Interior Issues and Suggested guideline Just like autism itself is different in every case, interiors for children with autism should be designed differently from the average interior. Interior environments can have a profound effect on a child with autism; many design elements have to be taken into account such as lighting, colors, textures, the arrangement of furnishings, floor coverings, window placement, and many others. (American Society of Interior Designers, 2014) McAllister and Maguire (2012) remind us that "Being sensory sensitive and unable to integrate or communicate fully with others means that those with ASD can find the world a disorientating and even frightening place." The distractions of background noise and the environment surrounding a child with autism, which most others can tune out, can impact severely upon the child’s ability to concentrate on the task they are trying to perform.

Mostafa (2014) said that "Despite the apparent possibilities of designing favorable architectural environments for autistic users, autism has generally been excluded from architectural design codes and guidelines." (p.143). Although there are no set principles for designing an autism-friendly space, there are some suggested guidelines that can be followed.

Each list examined varied, though. The following set of guidelines, proposed by Humphrey and quoted in Sanchez, Vazquez, and Serrano (2011) offers a variety of criteria to be considered

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when designing for autistic children. Figure 2, below, shows Humphrey's guidelines in a graphic manner:

Figure 3: ASD Design Guidelines. (Created by Author, 2019) based on Humphrey’s guidelines This list supports Williams and Vouchilas (2013) research that states: "Utilizing the physical environment to accommodate needs of autistic children can improve their social interactions." (p.34) The whole purpose of designing any space for a child with autism is to reduce stressors and create a "safe space" for them to focus on what they are doing in order to succeed in controlling and focusing on their own individual challenges.

The relationship between autism and the built environment is gaining more popularity among the built environment studies due to the increase of autism in the United States. Feeling comfortable in their own environment is one of the difficulties an autistic person faces every day.

According to McAllister and Maguire (2012), in a built environment, the design parameters are to be fluid and variable because children with ASD may exhibit different sensitivities and personal difficulties, but other severities of these can vary (p.103). These authors conducted a

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study on the classroom environment that implemented some of the previously stated guidelines.

Classrooms to autistic children can mean routine and schedule, and this fits in with how they like to live. For their study, the researchers did not work with the students, only with the teaching staff, and they meant to adapt existing conditions into autistic friendly accommodations for the students. The results of this study indicated that the guidelines followed should be utilized by every designer because these children need a space a little bit different in order to feel comfortable. The proximity to others and even the exterior and interior of the room needs to be addressed first, in order to make the child comfortable from the beginning. The lines of sight in the room need to be considered to avoid high-level gazing, and a visual time table is required to help them prepare for the tasks at hand. Control, just like in every other place for autistic children and neurotypical children, needs to be maintained to keep the children safe. These are just some of the main provisions the two scholars studied, and they explained how to handle them and why. McCallister and Maguire (2012) also stated that "School is surely an environment where every child should be supported and encouraged to fulfill their potential." (p.111).

It has been said earlier that design for autism can be split into two approaches: neurotypical and sensory design. The neurotypical approach was explained by Mostafa (2014) as "‌ the proposed immersion of the autistic users in as typical and stimulating an environment as possible, in order to encourage adaptation to the overstimulating so typical of the disorder and to replicate the level of stimulation found in the real world." (p.144) The second approach is called sensory design theory. Still, according to Mostafa (2014), this approach is "‌stipulating that favorably altering the sensory environments can be conducive to positive and constructive autistic behaviors, particularly in learning environments." (p.145).

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Sensory Design What is Sensory Design?

Sensory design has many different definitions; overall, it is the design of a space that focuses on and regulates all the senses that humans experience. It is a design theory that is becoming more frequently used for designing places such as hospitals, airports, retail stores, and the workspace, as opposed to its original uses at high-end resorts and spas only. According to Mostafa (2014), sensory design "presents a flexible and adaptable tool, which acts as a catalyst for architectural design criteria development for architectural environments based on their sensory qualities, and in response to autistic sensory needs" (p.145). This type of design style is achieved by creating a variety of stimulus zones that respond to the activities performed in the space and to the skills of the users. According to Mostafa (2014) "‌ it addresses the issues of generalization of skill by avoiding the "greenhouse" effect using graduated sensory spaces, from highly adapted to the typical, to allow for gradual skill development" (p.145). In this same line of thought, Warren Leone (2013) stated that "Design that speaks to the senses can evoke comfort and relaxation, causing end users – customers or otherwise – to want to spend more time in the space." Mostafa (2014) created a study that used what he called the "Sensory Model" (see Figure 4). He described this two-axis model as follows: "the horizontal axis represents the various sensory areas involved in perceiving the physical environment, or the sensory profile, while the vertical represents the architectural attributes that may be manipulated to accommodate various sensory needs for autism" (p.145).

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Figure 4: Mostafa, M. (2014). Sensory Model [Online Image].

Retrieved from URL (https://www.researchgate.net/figure/Sensory-Design-Matrix-SourceAuthor_fig1_285345281) Figure 4 shows a table based on the two axes model, which can have a variety of responses depending on the design situation for which it is being used. Mostafa's intent for this figure was to show the importance and impact of the built environment on autistic families by ranking the sensory issues most relevant amongst them Sensory Design and Autism Research conducted by Paron-Wildes (2005) explained that when designing children's environments, it is essential to consider the needs of children with neurological disorders and to think through the concept of space as an experience. There have been many guidelines suggested when designing for ASD; however, except for Mostafa's (2014), they did not include the idea of sensory design. Mostafa considered all senses when he proposed the Autism ASPECTSS Index, and he states that "The key to designing for autism seems to revolve around the issue of the sensory environment and its relationship to autistic behavior" (Mostafa, 2014, p.144). This Index

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has seven principles: Acoustics, Spatial sequencing, Escape space, Compartmentalization, Transition zones, Sensory zoning, and Safety. According to Mostafa (2015), "The Autism ASPECTSS™ Design Index is the first set of evidence-based design guidelines worldwide to address built environments for individuals with Autism Spectrum Disorder."

These principles were put to the test in a special needs full-time educational facility, which was said to have "Its ultimate goal of maximizing the independence of its students, and hence integration into society" (Mostafa, 2014, p.148). Looking at this particular project, it showed how the principles were utilized throughout the environment. The acoustics were being used by minimizing background noise along with echo and reverberation but was regulated by the level of user focus needed within that space. Spatial sequencing was addressed by organizing the areas in a logical order based upon the schedule of the spaces used. The Escape spaces principle is one that has shown to have a positive impact on users affected by overstimulation in the environment they are occupying. Compartmentalization of the spaces was used to display clearly defined functions and sensory quality throughout the building. Transitions are an essential part of designing for autism because they require this extra care to recalibrate their senses as they move throughout an environment. Sensory zoning goes along with Spatial sequencing in the way that it breaks up spaces, but this principle focuses more on the sensory quality of an area. Safety was not overlooked in this design application as it was used by avoiding sharp edges and corners, all for the concern of the child having an altered sense of their immediate environment. In Figure 5 one can see the overall plan used for this project and the way in which the principles were applied to the layout.

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Figure 5: Mostafa, M. (2014). Sensory Zoning and Circulation Schemes [Online Image].

Retrieved from URL (https://www.researchgate.net/figure/Sensory-Design-Matrix-SourceAuthor_fig1_285345281)

Conclusion The proposed question for this study of "how can interior design better integrate sensory based design elements into current art therapy centers?" has been the focus of the information provided to justify its need in the interior design body of knowledge. With this research and the use of already existing design theories such as Place Attachment Theory and Biophilic Design, this sensory integration can be achieved even further.

Place attachment theory is defined as, "a person's bond with the social and physical environments of a place" (Kopec, 2006, p. 62). In other words, place attachment is how a person perceives their environment and creates a bond to it. People usually establish this bond with an environment where they feel comfortable and are satisfied. Kopec also stated that "Place attachment theory is an important concept for designers because it affects both functional and

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meaningful aspects of space." The idea of place attachment can be used in a space with autistic children to encourage them to return to that space and know they can be comfortable in it.

Biophilic design theory seems to be utilized already in many places designed for ASD, since natural light, simplicity, and neutral color schemes are part of the ASD design guidelines.

Biophilic design theory is defined by Interface and Benyus (2016) as "surrounding ourselves with nature or with artifacts that remind us of being in the natural world, or with sensations that remind us of being in the natural world." The article goes on to say "biophilia is about creating spaces that make us feel as good as we do when we are in nature." Children who have autism according to the guidelines seem to benefit more from spaces like these. Meacock (2018) was asked what specific aspects of a biophilic design resonate with autistic students at a school and stated: "Visual connection to nature provides a positive impact on cognitive, psychological and physiological responses. It influences an individual's mental health, performance, and wellbeing." The use of biophilic design theory through selection of natural materials also provides sensory experiences that are calming and stimulation depending on their use in the space.

Sensory Design, to recap, is the design of a space that focuses on and regulates all the senses that humans experience. Leone (2013) stated that "Design that speaks to the senses can evoke comfort and relaxation, causing end users – customers or otherwise – to want to spend more time in the space." Therefore, sensory design combined with the other two theories should meet all the guidelines suggested for ASD interior design and create their "safe space."

This integration of sensory design into a current art therapy center will help to promote social interaction for children with autism. The art therapy programs that exist today can be enhanced and customized with the use of sensory integration, not just into the built environment,

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but also in the program itself with sensory-based art therapy. To help justify this integration of sensory design into current art therapy centers, where neurotypical or other children with disorders go, Raising Children (2017) stated that "Typically developing children have sensory sensitivities too, but they often outgrow them." This supports the idea that a space adapted for a child with autism would also help a younger neurotypical child. A quote by Lehman (2017) also reinforces this need for integration, "... adaptive sensory environments transform and uplift the quality of life in an entirely new way."(p.1). The use of this integration of sensory design into an art therapy center was further explored through the research methodology of this thesis.

METHODOLOGY Introduction to Methodology Research Conduction and Population This research is intended to find the issues in a therapeutic environment that affect a child with autism. The research was conducted through mixed methods of qualitative and quantitative nature. Mixed methods research is also known as multimethod research and was described by Schutz et al.(2009) as "based on the idea that using more than one method during the data collection or analysis phases of a study can be more useful than using a single method" (as cited in Muratovski, 2016, p.40). A constructivist worldview was used while research was being conducted. This view was chosen based on the fact that the autistic users would be the ones who would experience the space and realize the effect it has on them negatively or positively. With this constructivist worldview in mind, the population selected to conduct this research, overall, consisted of older people with autism, therapists, parents, teachers, and caregivers. The findings from this research would lead to design strategies to be applied to a project that shows the

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integration of sensory design into current art therapy centers. The data gathering took place over approximately seven weeks, starting in January 2019.

Data Collection Methods The first method used for data collection was a survey to gather surface information that would potentially reveal further issues in the therapy space needing to be considered. This was an online survey that was posted on social media to share, and distributed to multiple ASD support groups also through social media. The survey consisted of eleven questions that were broken down into eight multiple-choice questions and three free-response questions. The multiple-choice questions were general questions about the autistic child's experience at an art therapy center and their personal preferences of interior elements. The free response questions were asked to get a better idea of the unique issues and limitations that each autistic child has in an art therapy environment. This survey was offered to be taken anonymously by autistic children and anyone who was closely associated with an autistic child.

The next method used was observations, which have been conducted at two different therapy centers. Both offices observed gave prior authorization for the research to be conducted under specific privacy guidelines. During these observations, notes, pictures, and sound studies of the interior environment were recorded. Observation "A" was at an outpatient pediatric therapy clinic that offered speech, occupational, and physical therapy. They are specialized in treatment for a variety of disorders and delays, many of which children with autism have, including sensory processing disorder. The treatment of sensory processing disorder was the main reason why this facility was chosen to be observed. Observation "B" was an all-ages outpatient facility for chiropractic and limited physical therapy. This facility was chosen to

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explore what other therapeutic practices are doing to accommodate children with autism. Both observations took place over a few hours, and the sound observation took one hour in order to obtain sufficient data of sound changes in the space.

Interviews were conducted after the survey and the observation portions of the research, respectively. The first interview is labeled "Interview 1", and it followed up the survey responses of people who were willing to share their contact information and agreed to answer more indepth questions. These interviews were conducted by phone, email, or in person, and all data collected was entered into an online form for analysis. This interview had set categories to choose from in order to prompt the questions based on the respondent's relationship to the autistic person. This strategy allowed for more personal questions to obtain more specific feedback. These questions discussed in-depth and personal issues that an autistic person may experience within an art therapy environment.

The second interview is labeled "Interview 2," and it was conducted after Observation "A". It was only answered by the therapist from this observation. There were five specific questions, which were asked in order to get a better idea of the issues within the therapy room itself, along with the issues experienced during a typical appointment. The therapy office in Observation "A" treats all kinds of children with different disabilities and function levels. This in-depth interview was about the therapists’ experience with autistic children only, and gave them the opportunity of a comparison to other children with disabilities. There were a total of five questions formulated for this interview The last method employed was case studies of existing projects designed and built with autistic users in mind. These case studies were performed to analyze and compare design

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elements to help further the knowledge of how to improve the design of these types of interiors.

Based on the information from the literature review, the interior design elements documented showed how each case studied applied the design guidelines for a person with autism. These case studies were further analyzed under four categories: Floor plan/circulation, illumination, layout/furniture, and materials. These categories were selected for analysis because of their importance within a built environment for autistic children. Findings from all of these methods are discussed in the following section.

RESEARCH FINDINGS Research Strategies Survey As mentioned previously, the survey was intended to get a general knowledge of current issues in an art therapy center, along with personal autistic preferences of interior elements and layouts. The survey generated 34 anonymous responses and started by asking a basic question: "Has the autistic child ever been to an art therapy office?" Eighty-five percent of the respondents answered yes. This answer helped to ascertain the accuracy of the following questions in the survey, which were all about art therapy centers. The next sequence of questions was formulated in a specific order to get an accurate description of the issues within such facilities. When asked about spaces in the facility that made the child feel the most uncomfortable, 56% answered the waiting room, 27% answered the therapy room and, 17% answered the hallway. The responses to this question helped identify the most significant problem areas. When asked why they selected

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this particular area, the top answer was the occupancy, at 44%. The next most popular answers were sound at 24% and light at 12%. All these justifications follow the established impacting environmental issues for an autistic child mentioned in the literature review. These multiple-choice questions were followed up with two free response questions. The first question asked about improvements they would recommend to the

Figure 6: Sensory Edge. (2014). Kids Waiting Room Ideas [Online Image].

Retrieved from URL (http://blog.sensoryedge.com/decreasewait-times-doctors-office-waiting-room/)

currently used facility, and the top answers were: more autistic kid-friendly, sensory items, and more open space for the child to have their own space. The second question asked about their comfort items at home, which was intended to test the place attachment theory by giving them something familiar to relate to — the top answers were: sensory items like blankets; light controls; and their own

Figure 7: SBA. (2016). Waiting Room [Online Image]. Retrieved from URL (http://www.steffian.com/connect/blog/t wo-healthcare-projects-selectedrecognition)

space. The personal preference questions asked employed visual selections to identify the interior elements people with autism prefer. Option 1, shown in figure 6, was chosen by participants as the space children with autism would feel most comfortable in, and this supported the findings from the earlier survey that have shown that children want a more individualized and less clinical space. Multiple different seating options that included floor mats were chosen by 85% of participants as the space that a child would respond best as they waited (see figure 7).

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The answers chosen for a therapy room that would have the best response from an autistic child has changed during the duration of the survey. The choice was between multiple activities occurring in a neutral room that had all-natural wood furniture and a neutral color scheme. Alternatively, the modern room had a chalkboard wall, furniture that implemented pops of color, and more warm tones.

The results have shown the preference for the

Figure 8: Hope Sparks. (2015). Play and Art Therapy [Online Image]. Retrieved from URL (http://hopesparks.org/programs-fullwidth/healing-hearts/play-and-arttherapy/)

neutral room at 53% (see figure 8). With relation to tactile and visual sensory materiality, the soft woven texture and furry texture were the top choices at 32% each (see figure 9). Option 4 was the color palette preferred by 44% of participants, which supports the guidelines of a simplistic and calming shade range of cool and neutral colors. (see figure 10). This research

Figure 9: Freepik. (2015). Fur and Soft Woven Textures [Online Image].

Retrieved from URL (https://www.freepik.com/free-photosvectors/texture-hessian)

instrument can be found in Appendix A. Observation The observations were analyzed under the

Figure 10: Sherwin Williams. (2019) Calm Color [Online Image]. Retrieved from URL (https://www.sherwinwilliams.com/)

lenses of sensory design theory and included a sound study conducted to identify the overall noise factors in the spaces. Observation "A" had the sensory characteristics of calming and simplistic by having a cool color scheme along with the natural wood shown as the floor material. There was natural light from a few windows, but

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the primary light source was fluorescent lights that bother most children with autism. The circulation of the building was closed off due to the doors that blocked every way back to the therapy areas. This enclosed space caused hesitation in the children of not wanting to leave the person they came with because, in their minds, past the doors is an unknown space. There was a play area in the center of the room that was boxed in by partition walls and, although there were acoustic tiles as ceilings, the noise level from this area was high and not buffered well. The play area also did not accommodate older children that may come to the facility; it was observed that older children were restless because they had nothing else to do than sit and wait. The furniture layout allowed for direct circulation to the therapy doors without any blocking of the path. There was only one type of wood bench for seating; however, this type of seating did not allow for the individual space some autistic children need or want. This research instrument can be found in Appendix B. The facility used for observation "B" lacked many of the elements associated with designing for autism. The first thing observed when walking in was that there was a lack of natural light in the waiting area and that all seating was individual with too many textures and patterns. This space would cause overstimulation to a child with autism. This facility does have a better circulation pattern than the previous one because there are transition halls between the waiting area and the therapy rooms; there is a reasonably direct path towards them. In the therapy room, although it is open and offers proximity for the child, there is a lack of privacy, which may be needed. Along with this lack of privacy, all therapy activities take place in one room, so there is a potential for overstimulation caused by noise and crowding when the room is fully occupied. This research instrument can be found in Appendix B.

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The sound studies for both Observations "A" and "B" took place in the waiting areas and had very similar results. Both settings show a constant abundance of noise in the space while everyone waits. Observation "A" is a bit noisier than "B" due to the location of its play area and TV, which were located in the middle of the waiting area. The biggest noise problem observed for both facilities was during the time of the appointment transition. During this time, it was observed that children and adults came out of the therapy room and added to the occupancy of the waiting room. This increased density, along with more talking as the therapist informed parents or caregivers of the treatment done that day, can undoubtedly lead to overstimulation.

This assessment is supported by the observation of some children fidgeting a lot more during this time. This study suggests the appropriateness of using Autism ASPECTSS™ Design Index as a tool to minimize sensory overload within a current therapy center. This research instrument can be found in Appendix C. Interviews Eight interviews were conducted with people that have a strong relationship with an autistic person in order to get more in-depth and personal answers. The interview started by asking the person interviewed about their relationship to the autistic child; this answer would then prompt a specific set of related questions. When the doctors and the therapist were asked if a group or one-on-one therapy would be better for children with autism, they all responded that the type of therapy depends on the activity and the child. This answer was confirmed when asking the teachers about the best way for an autistic child to learn. Parents, however, had a different response, by saying that one-on-one therapy, is better because their children struggle in group therapy due to the distractions from their peers. The doctors and the therapist were then asked what in their care rooms helps the child feel comfortable, and the response was "having a

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room without intense lighting, minimalizing distractions and stimuli (too many random objects around that are easily accessible, clutter, loud noise, etc.) and having reinforcing items available is helpful." The teachers responded with very similar criteria and added the use of visuals like schedules, to keep them on a routine. Everyone was asked about their thoughts on the integration of sensory-based design into current facilities versus an ASD facility only. Most respondents were for the integration based on the fact that it allows socialization with neurotypical children.

However, the suggestion of broken up spaces was given to accommodate for those who have a severe problem with over stimulation. Some other individualized questions for the interviewees were, to doctors and the therapist, about things they would like to see in their facility to give better care to autistic children. The answer was to have items accessible for the kids to move around when they have difficulties remaining still, and sensory bins that contain items that help with sensory stimulation. Teachers were asked to share their thoughts on things that bother their autistic students in the classroom. The answers were mainly related to sensory design issues, such as light, color, and noise that were not addressed when their school was designed. This research instrument can be found in Appendix D. Interview 2 had ten respondents, and all had very similar responses to the questions asked. The first question asked to the therapist was the most significant issue faced when getting children to go with them into the therapy room. The most popular response was getting the children to leave their parents to go into the therapy room. This was attributed to the fact that the therapy rooms were located behind all the closed doors. The second question was about the therapy room itself and what in it was causing issues. This was an open-ended question so that they could give answers not just based on the elements in the room. The answer was the same for most, which concentrated on the task due to the distraction of room elements and the autistic

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child wanting their parents. The last question asked was about solutions that they thought would help to solve these issues. A transition area was the most frequent answer; this is an area where the therapist and child could interact while slowly breaking away from the parent. These answers should help to define the design program of future art therapy facilities. This research instrument can be found in Appendix D. Case Studies The case studies analyzed were different built environments designed specifically for autistic children. Case Study 1 is a school that demonstrates a strong use of the ASD design guidelines. It has natural light through big picture windows along with non-florescent artificial lights. The furniture selection varied with hard plastic seating for the areas that required more concentration. In the breakout areas, where focus is not the highest priority, soft seating was provided covered in a soft woven material. The furniture layout itself offers mostly group seating, but not for more than four individuals to a group. The school does offer individual break out spaces to help with sensory overload. The materials in the space followed a nature theme with color choices of greens, blues and neutrals textiles along with natural wood.

Case Study 2 is a therapy treatment center that also utilized the ASD design guidelines. In contrast to the first case study, it has more access to natural light than in Case Study 1. Each room has individual setups for therapy sessions. The interior design also utilized more color and the layout offers more breakout spaces with individual seating. The furniture selections include a more kid-friendly type of seating. Case Study 3 is of a hospital that was built to support autistic patients. Its design followed the same guidelines as the other facilities studied. However, this facility incorporated individual break out areas embedded in the walls. This design feature

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offered seating to those who need space out of the regular waiting area, but it is still visible in the main area. This research instrument can be found in Appendix E.

Discussion Each of the research methods came with their own set of challenges for collecting data.

The main challenge is due to the fact that this thesis is about designing a space for children with autism, which makes it impossible to get firsthand information directly. Talking to the children is not permitted; therefore, information had to be obtained from the child's parents, teachers, or therapists. Along with not being able to talk to the autistic children directly, the other challenge is that some of the children's function level may render them unable to talk at all, making it even difficult for the people who interact with them to determine many things that bother them. The other issue that limited data retrieval had to do with the confidentiality of therapy centers. Most of the centers contacted did not allow observations, which forced me to look into other types of therapy centers. Nevertheless, all data collected through the methodology used, even with the challenges encountered, indicate a connection with sensory design and the existing ASD design guidelines as a means to create an integration of design elements into a current art therapy center.

The data obtained supports this approach by showing the approval others have given to the idea of an integrated facility. This proposition is also supported by the findings showing that, in order to cater to autistic individuals in a facility, we must consider the design elements within and their effects on the sensory processing of children with autism.

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DESIGN PROPOSAL Description Client and Users This proposed design for an art therapy facility would be implemented to meet the sensory needs of children with autism, all the while integrating these children into an inclusive setting. This makes the primary user of this facility the children with autism that are seeking art therapy with a sensory aspect integrated into the program. This child can be of any function level and between the ages of 5 and 12. This facility would be limited to this age group simply because this seems to be when a child with autism can be most influenced by therapy to help them with their challenges. The secondary user of this facility would be the parents, therapist, and neurotypical children who also participate in art therapy. These are children who are not on the autism spectrum, but who face other challenges or similar challenges. With this list of primary users considered, the client who would be likely to sponsor this facility is a hospital willing to be more autistic-friendly and has acquired sponsored grants for improving their current interiors for the users.

Site and Building The proposed site for this integrated art therapy center is a current pediatric therapy floor at a children's outpatient center that is part of a large hospital campus. It is located in the mountainy southeast area of the United States. This site was chosen because it is centrally located among a larger city. This city also features an airport, multiple bus line stops, and call car services which makes the location easily accessible. The building itself was chosen because it features a current therapy facility that can be altered into an art therapy center with integrated sensory design. The

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building being located on the northwest edge of the campus gives unobstructed views of the mountain area.

This location allows for the interior of the building to feature many windows providing natural sunlight and nature views. This exposure is ideal for biophilic design as it can help children with autism feel calmer and allows for the natural light to be used instead of relying exclusively on artificial illumination. Because this building site is sloping off the back side going down a mountainside, occupants enter the front of the building on the second floor. The current therapy rooms are located on the first floor so the patient would take the stairs or elevator down to the space. The sloping of the building has allowed for the harsh afternoon sun to hit the south side of the building meaning that the first floor, which only has access to outside on the back, is exposed just to the more diffused morning sun. The shape of the building allows for a direct circulation path to be formed between all main areas used by the autistic child.

Figure 11: Sun Path Illustration. (Created by Author, 2019)

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Program The proposed design program for this facility is based on the information gathered through the literature review and research. This information has led to the idea of creating a sensory experience throughout the facility, from the time one enters it to the time of departure.

The first space is the entry, which leads into the waiting area. The waiting area is critical to the design as it is the first main area that will feature the integration of sensory design. This space will be subdivided in a way that activates only the senses needed for a particular task. The next space to be experienced is the transition area, which features an environment where the therapist and child can interact and connect before therapy in order to maintain that sense of security a child with autism needs. This is the space where the child will become more familiar with their therapist, while the parent is eased back into the waiting room. The next space is the art therapy rooms that will be individually designed to control the senses used in art therapy. These spaces must feature elements that keep the child focused while performing the task that will help them to succeed when dealing with individual challenges. After therapy, the next space is a cleanup area that features individual clean up stations and a reward area to give the children an incentive for doing well in their following session. Next, the caregiver will meet the child and therapist in the conference room. This space is responding to the sound study, for when the therapist needs to inform the parent of their child's daily activity. The conference room will feature private areas for every group to sit and have a semi-private conversation, and to schedule their next appointment. Figure 12 shows the user journey of a typical session that an autistic child will go through. It demonstrates graphically the way in which the child and accompanying adult will travel throughout the space.

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Figure 12: User Journey. (Created by Author, 2019) Other areas included in this program are the restrooms, which are located near all major areas for quick access. There is also a sensory hall that features paths of number, colors, and symbols that the child and parent can follow out during their departure. The employee areas needed for this facility are the front office, administration office, therapist work area, and breakroom. Supportive areas in this space are the storage closets, janitors' closet, and the restrooms. Figure 13 shows the proposed program for this facility in a diagrammatic format.

Figure 13: Proposed Program. (Created by Author, 2019)

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Design Solutions To answers the question of “ how can interior design better integrate sensory based design elements into current art therapy centers?”, the research concluded that many different design elements that need to be addressed and was broken down into design strategies. These strategies are: to control sensory overload, promote a sense of safety, and establish an autisticfriendly environment. The first strategy of controlling sensory overload was established because of the need for comfort during high occupancy and attention brought to elements of light, sound, and smell. This strategy’s goal is to break spaces up into sensory areas that will only allow for certain senses to be activated at one time. Promoting a sense of safety in the space was established based on the research suggesting the autistic child's fear of the unknown. One goal for this strategy is to create a sense of place attachment through the comfort of the space that will spark the bond needed to feel safe in the space. Another goal is the integration of a transition area to establish trust with the therapist and the safety of going with them. The last strategy, to create an autistic-friendly environment, was established through the needs of less clinical spaces and of focus. This strategy is linked with the previous one by the use of sensory elements and the establishment of comfort. However, these strategy’s other goal is to focus on the biophilic design by incorporating a nature inspired scheme to help invoke serenity within the space. The color scheme will relate directly with the materiality that is intended to increase the child’s likelihood of having a positive experience or creating a reinforcing environment. All these strategies are implemented into the design of key experience areas of the art therapy facility.

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Figure 14: Conceptual Sketches. (Created by Author, 2019) Concept The normal response to the word atypical is negative, but this is not always the case. The Japanese aesthetic that focuses on finding beauty within imperfection is known as wabi-sabi.

Looking at it this way, the word atypical takes on a positive meaning of belongingness because the imperfection is integrated into whatever one applies the aesthetic to. In this sense, the concept of atypical integration is to show how something atypical can be incorporated into space cohesively and beautifully. This concept connects with the research question of this thesis project by integrating sensory design into an already existing art therapy center. This place will encourage the integration of autistic children into the art therapy center with neurotypical children. Thus, the design concept is pushing the idea of belongingness by introducing something atypical in a space and it being a perfect fit.

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Key Experiences The floor plan laid out in this space was designed to allow direct access from one space to another creating a sensory experience throughout the child's journey through the art therapy center. It follows a plan to transition the autistic child from a high stimulation, low focus area into a low stimulation, high focus area.

Figure 15: Stimulation Circulation Plan. (Created by Author, 2019) The presence of biophilic design continues throughout the rest of the space. It is applied in the color scheme by using cool blue and green tones on the walls and pops of brighter colors found in nature in the blending areas. Natural wood tones were used for furniture and structural elements, helping the nature views from outside transition into the interior, creating a nature integration. Most furniture and materials are eco-friendly and were selected based on the sensory stimulation to be achieved in each area. The floor changes throughout the space are intended to

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give a sense of separation. This change is most important where the carpet blends from a neutral color into the spaces where pops of color are added for wayfinding and enhanced sense of belongingness.

When first entering the art therapy center, the reception area is front and center. The placement of this area is to enable the staff to monitor the doors leading out, to ensure the safety of the children due to that fact that some autistic children are known to wander off. This reception area has the first significant impact on the autistic child; its design shows off the biophilic references of the space by featuring a simulated green wall and a natural wood reception desk that has an atypical circular shape. They will be checked in by either having their picture taken or picking a character, which will then be displayed in color on the schedule screen located on the wall behind the desk. The schedules will be featured on screens throughout the space, so the autistic child can maintain the sense of time and stability they need.

The multi-sensory waiting area is the next space the child experiences, and it was designed to separate spaces by sensory needs. Acoustical tiles and floor patterns help to create this separation without putting up physical barriers, by blending different colors for each area. The first area, when walking into the left side, is the interactive area. This area consists of interactive boards on the wall and mats on the floor that the children can use to play learning games by themselves

Figure 16: Interactive Area.

(Created by Author, 2019)

or with others or to digitally paint and draw. These boards are placed at a level accessible for the young children and a wheelchair user. They also feature sets of sound canceling headphones for each board; they can listen to the board sounds only or to nothing at all. This feature is to prevent sensory overload and it makes this space for use with only the senses the child wants to use. The

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next space, located to the right, is the play area; this space features small floor mats and child size tables and chairs. This space is intended to provide an individual comfort that can result in the child's attachment to the space. It has the regular blocks, cars, and other toys that a standard play area has but, it also has sensory toys like rain tubes, tangle snake with texture, along with many others.

Figure 17: Play Area.

(Created by Author, 2019)

The play area is meant to stimulate the senses the child wants to activate by having headphones available as well as different surfaces to sit on.

Figure 18: Multi-Sensory Waiting Room Render. (Created by Author, 2019) The quiet area and technology area make up the back section of the waiting area and it is situated behind a felt acoustic partition. The partition has small holes to eliminate the unknown factor of the other side and it is intended to control the acoustics between the louder areas and quiet areas. The back two walls are curved in a way to create an embracing factor in this area.

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These two walls feature the quiet holes that are recessed into the wall.

These holes are designed to allow the child to climb into in order to be alone, and they are lined with felt to provide acoustic support to quiet any unwanted noise along with ensuring comfort. The technology part of this area consists of a series of docking stations with tablets the child can take out and read, draw, stream shows, etc. These

Figure 19: Quiet Area Wall Seating.

(Created by Author, 2019)

tablets sound only works with the accompanying headphone, so they mix well in this space where the quiet activity area is located. The quiet activities part of this area has a mixture of books and magazines for many levels of reading. The furniture in this quiet zone area of the waiting room consists of a mixture of furniture from adult to child size. The textures vary from hard plastic chairs to

Figure 20: Technology Area.

(Created by Author, 2019)

soft bean bag chairs; this is done to accommodate all the autistic children's tactile needs. All design elements in this area were chosen for the autistic children to have choices in order for them to create their own safe space. This helps the child to create that sense of belongingness, so they are comfortable while continuing with their treatment.

Figure 21: Quiet Area of Multi-Sensory Waiting Room Render. (Created by Author, 2019)

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Once the child is called and they see on the schedule that it is their turn, they are guided to the transition area with their caregiver. This area is meant for the child to transition from being with their caregiver in the high stimulation waiting areas into an in-between area, where they can get to know their therapist. The front of the transition area contains a curtain wall that looks to the outside, letting in natural light and views of nature into the area. There is a large cubby there, where the Figure 22: Bean Bag Seating Area.

(Created by Author, 2019)

child can trade in their waiting room toy or gadget for a new stimulation toy or book. This area is where the parents

start to break away, as the therapist helps the child pick something new. The child and therapist will then move into the transition area, which is surrounded by acoustic panels that allow the child to still see through the small opening but helps to absorb the sound from the transition area away from the

Figure 23: Transition Area Wall Seating.

(Created by Author, 2019)

therapy room. This is the place where the child can choose from many different furniture types to sit on. These pieces, like in the quiet area vary to allow the child to have a choice that accommodates their sensory sensitivity. The furniture pieces are set up in sets of two with attention paid to the proximity of others, so it is just the child and therapist interacting with limited distractions. The acoustic panels on the ceiling mimic the acoustic panels void shapes, and they get lower over the areas where the child and therapist interact. This change in heights is creating a more intimate space for them to connect. There are schedule displays on the wall so the child still has that connection and remains consistent even though the change of space. This area of powerful interaction supports the need for the autistic

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child to connect with the therapist and not be afraid to leave their caregiver so they can focus better during the actual therapy.

Figure 24: Transition Area Render. (Created by Author, 2019) With a connection formed between child and therapist it is time to move to the art therapy room. In order to allow this transition to go smoothly, the carpet and acoustic panels blend into a different color in front of the therapy room door. To maintain the connection and the sense of belongingness, this is where the color assigned during check in comes into play with this color matching the door they are to go for therapy. This is also an easy wayfinding tactic for those who are of a lower functioning level. The door is surrounded by glass that allows the child to see into the room to minimize the unknown factor. With the connection made in the transition area and the lowering of stimulation, the autistic child can now move into the low stimulation, high focus art therapy rooms.

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Conclusion This thesis studied the way sensory design could be integrated into current art therapy centers in order to make them more autistic-friendly. This design approach is something that helps to integrate autistic children into a neurotypical environment where they do not usually feel comfortable. The research findings established that combining the already existing design strategies of ASPECTSS design index and ASD design guidelines with the design strategies laid out for this project would make it possible to achieve this integration. The design proposal took this knowledge and applied it by creating a multi-sensory waiting room and a transition area in a biophilic design solution. The project intent for creating a sense of belongingness among these autistic children was to design this space to promote individual choices for the child to establish their own safe space according to his or her needs.

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DEFINITIONS Art Therapy- therapy based on engagement in artistic activities (as painting or drawing) as a means of creative expression and symbolic communication especially in individuals affected with a mental or emotional disorder or cognitive impairment.

Autism Spectrum Disorder (ASD) - any of a group of developmental disorders (such as autism and Asperger's syndrome) marked by impairments in the ability to communicate and interact socially and by the presence of repetitive behaviors or restricted interests Constructivist Worldview - posits that learning is an active, constructive process. The learner is an information constructor. People actively construct or create their own subjective representations of objective reality.

Fragile X Syndrome- A genetic disorder means that there are changes to the person’s genes. FXS is caused by changes in the fragile X mental retardation 1 (FMR1) gene. The FMR1 gene usually makes a protein called fragile X mental retardation protein (FMRP). FMRP is needed for normal brain development. People who have FXS do not make this protein.

People who have other fragile X-associated disorders have changes in their FMR1 gene but usually make some of the protein.

Neurology- the branch of medicine or biology that deals with the anatomy, functions, and organic disorders of nerves and the nervous system.

Neurotypical- not displaying or characterized by autistic or other neurologically atypical patterns of thought or behavior.

Spectrum- reflects the wide variation in challenges and strengths possessed by each person with autism.

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Tuberous sclerosis - is a genetic disorder that affects the skin, brain/nervous system, kidneys, and heart, and lungs. The condition can also cause tumors to grow in the brain. These tumors have a tuber- or root-shaped appearance.

Sensory Processing Disorder- condition in which the brain has trouble receiving and responding to information that comes in through the senses.

Sensory Design- is designing things by considering the total experience related to the human senses of vision, hearing, taste, smell and touch. The term also extends to designing things by considering sensations that extend from senses such as temperature, vibration and pressure.

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REFERENCES American Art Therapy Association. (2013) Art Therapy Retrieved January 14, 2019, from https://arttherapy.org/ American Society of Interior Designers. (2014, April 30). Impactful Design: Creating Spaces for Individuals with Autism. Retrieved May 27, 2018, from http://icon.asid.org/index.php/2014/04/30/impactful-design-creating-spaces-forindividuals-with-autism/ American Speech – Language - Hearing- Association. (2018). Autism (Autism Spectrum Disorder). Retrieved May 27, 2018, from https://www.asha.org/public/speech/disorders/Autism/ Autism Speaks. (2012, May 31). What Is Autism? Retrieved May 27, 2018, from https://www.autismspeaks.org/what-autism Bachand, D. (2014). Art Therapy Using Sensory Stimulation for Low Functioning Developmentally Disabled Adults. Retrieved January 14, 2019, from https://minds.wisconsin.edu/bitstream/handle/1793/69011/Dnna Bachand Masters Paper.pdf?sequence=1&isAllowed=y Center for Disease Control and Prevention. (2018, May 03). Autism Spectrum Disorder (ASD).

Retrieved May 27, 2018, from https://www.cdc.gov/ncbddd/autism/facts.html Center for Disease Control and Prevention. (2018, May 17). Fragile X Syndrome (FXS).

Retrieved May 27,2018, from https://www.cdc.gov/ncbddd/fxs/facts.html

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Damico, M., & Lalonde, C. (2017). The Effectiveness of Art Therapy for Teaching Social Skills to Children With Autism Spectrum Disorder. Art Therapy: Journal of the American Art Therapy Association,34(4), 176-182. Retrieved May 27, 2018, from https://0www.tandfonline.com.library.scad.edu/doi/abs/10.1080/07421656.2017.1384678 Dove, C. (2012). What is Sensory Art Therapy. Retrieved January 14, 2019, from http://www.sensoryart.ca/about.php Ha, S., Sohn, I. J., Kim, N., Sim, H. J., & Cheon, K. A. (2015, December 16). Characteristics of Brains in Autism Spectrum Disorder: Structure, Function and Connectivity across the Lifespan. Retrieved January 14, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/26713076 Interface, & Benyus, J. (2016, November 01). What is the Difference between Biophilia and Biomimicry? Retrieved March 14, 2019, from https://www.youtube.com/watch?v=oI9bM8tdMmY Kopec, D. A. (2006). Environmental psychology for design. New York: Fairchild.

Lacour, K. (2018, October 01). The value of art therapy for those on the autism spectrum.

Retrieved January 14, 2019, from https://the-art-of-autism.com/the-value-of-art-therapyfor-those-on-the-autism-spectrum/ Lehman, M. L. (2017). Adaptive Sensory Design. New York, NY: Routledge.

Martin, N. (2009). Art Therapy and Autism: Overview and Recommendations. Art Therapy,26(4), 187-190. Retrieved May 27, 2018, from https://0www.tandfonline.com.library.scad.edu/doi/abs/10.1080/07421656.2009.1012961 6.

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Mcallister, K., & Maguire, B. (2012). Design considerations for the autism spectrum disorderfriendly Key Stage 1 classroom. Support for Learning,27(3), 103-112. Retrieved from http://0-web.b.ebscohost.com.library.scad.edu/ehost/detail/detail?vid=0&sid=4217bdc05cc542b6a890c66cdf3beb69@sessionmgr101&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY 29wZT1zaXRl#AN=80026290&db=pbh Merriam-Webster. (2018). Art Therapy. Retrieved May 27, 2018, from https://www.merriam-webster.com/dictionary/autism spectrum disorders Mostafa, M. (2014). ARCHITECTURE FOR AUTISM: Autism ASPECTSS™ in School Design. International Journal of Architectural Research: ArchNet-IJAR, 8(1), 143. doi:10.26687/archnet-ijar.v8i1.314 Mostafa, M. (2015). ASPECTSS. Retrieved February 14, 2019, from https://www.autism.archi/aspectss Muratovski, G. (2016). Research for designers: A guide to methods and practice. Los Angeles: SAGE. National Autistic Society. (2016, March 18). Sensory differences. Retrieved December 14, 2018, from https://www.autism.org.uk/about/behaviour/sensory-world.aspx Paron-Wildes A. J. (2005). Sensory stimulation and autistic children. Implications by Informe Design, volume 06, issue 04. Retrieved from http://www.informedesign.org/_news/apr_v06r-pr.pdf Raising Children. (2017, June 01). Sensory sensitivities: Children and teenagers with autism spectrum disorder. Retrieved February 14, 2019, from https://raisingchildren.net.au/autism/behaviour/understanding-behaviour/sensorysensitivities-asd

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Rudy, L. J. (2019, March 21). Why Doesn't My Autistic Child Use Words to Communicate?

Retrieved March 30, 2019, from https://www.verywellhealth.com/what-is-nonverbalautism-260032 Sรกnchez,P., Vรกzquez, F., & Serrano, L. (2011). Autism and the Built Environment. Autism Spectrum Disorders - From Genes to Environment, InTech, 363-380. Retrieved May 27, 2018 from: http://www.intechopen.com/books/autism-spectrum-disordersfrom-genes-toenvironment/autism-and-the-built-environment School Construction News, & Meacock. (2018, December 27). How Biophilic Design Helps Autistic Students at Bancroft. Retrieved March 14, 2019, from http://schoolconstructionnews.com/2018/05/04/biophilic-bancroft-autism/ Skokauskas, N., & Gallagher, L. (2012). Mental health aspects of autistic spectrum disorders in children. Journal of Intellectual Disability Research,56(3), 248-257. Retrieved April 13, 2018, from http://0-web.b.ebscohost.com.library.scad.edu/ehost/detail/detail?vid=0&sid=836cbebc8c5c4435a810d58ec92638a6@pdcvsessmgr01&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZz Y29wZT1zaXRl#AN=71546473&db=pbh Supekar, K., Uddin, L., Khouzam, A., Phillips, J., Gaillard, W., Kenworthy, L., Yerys, B., Vaidya, C., & Menon, V. (2013, November 14). Brain Hyperconnectivity in Children with Autism and its Links to Social Deficits. Retrieved March 14, 2019, from https://www.cell.com/cell-reports/fulltext/S2211-1247(13)005706?_returnURL=https://linkinghub.elsevier.com/retrieve/pii/S2211124713005706?showall =true

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Warren Leone, C. (2008, March). Come to Your Senses. Retrieved January 14, 2019, from https://www.iida.org/content.cfm/come-to-your-senses Williams, M., & Vouchilas, G. (2013). Residential Design for Families with Children on the Autism Spectrum. Journal of Family & Consumer Sciences,105(3), 33-43. Retrieved April 13, 2018, from http://0web.b.ebscohost.com.library.scad.edu/ehost/detail/detail?vid=0&sid=6d27417b4ef34906831a020cf175ff1c@sessionmgr101&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY 29wZT1zaXRl#AN=91027625&d

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FIGURE REFERENCES Figure 1. Autism Speaks. (2018, April 26). Estimated Autism Prevalence 2018 [The new estimate represents a 15 percent increase in prevalence nationally: to 1 in 59 children, from 1 in 68 two years previous.]. Retrieved January 14, 2019, from https://www.autismspeaks.org/science-news/cdc-increases-estimate-autisms-prevalence15-percent-1-59-children Figure 2. Anderson, K. (2019) 8 Senses [visualization of the sensory system, created with Adobe photoshop] Figure 3. Anderson, K. (2019) 8 Senses [visualization of the sensory system, created with Adobe photoshop] Figure 4. Mostafa, M. (2014). Sensory Model [Sensory issues and architectural attributes for a study.]. Retrieved January 14, 2019, from https://www.researchgate.net/figure/Sensory-Design-Matrix-Source Author_fig1_285345281 Figure 5. Mostafa, M. (2014). Sensory Zoning and Circulation Schemes [Entry-level plan and Sensory Zoning]. Retrieved January 14, 2019, from https://www.researchgate.net/figure/Entry-level-plan-and-Sensory-Zoning-SourceAuthor_fig3_285345281 Figure 6. Sensory Edge. (2014). Kids Waiting Room Idea [Waiting room design to help waiting times]. Retrieved January 11, 2019, http://blog.sensoryedge.com/decrease-wait-times-doctors-office-waiting-room/

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Figure 7. SBA. (2016). Waiting Room [The Children’s Specialty Center is filled with joyful diversions, such as the interactive fish pond, to distract from what could potentially be a stressful experience.]. Retrieved January 11, 2019, http://www.steffian.com/connect/blog/two-healthcare-projects-selected-recognition Figure 8. Hope Sparks. (2015). Play and Art Therapy [Our play and art therapy room are designed for children! We want children to feel that this is their world to explore. All toys are therapy specific and create a safe place for children to heal.]. Retrieved January 11, 2019, http://hopesparks.org/programs-full-width/healing-hearts/play-and-art-therapy/ Figure 9. Freepik. (2015). Fur and Soft Woven Textures [Brown furry texture and blue soft woven texture]. Retrieved January 11, 2019, https://www.freepik.com/free-photos-vectors/texture-hessian Figure 10. Sherwin Williams. (2019). Calm Color [Multiple colors taken from calming colors recommended.]. Retrieved January 11, 2019, https://www.sherwin-williams.com/ Figure 11. Anderson, K. (2019) Sun Path Illustration [Exploration of proposed site sun path, created with Sketchup and online sun path generator.]

Figure 12. Anderson, K. (2019) User Journey [visualization user journey through space, created with Adobe Illustrator.]

Figure 13. Anderson, K. (2019) Proposed Program [visualization of proposed program, created with Adobe photoshop and Adobe Illustrator.]

Figure 14. Anderson, K. (2019) Conceptual Sketches [visualization of proposed interiors, created with sketching app.]

Figure 15. Anderson, K. (2019) Stimulation Circulation Plan [visualization of stimulation areas and circulation, created with Adobe Illustrator.]

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Figure 16. Anderson, K. (2019) Interactive Area [rendering, created with Revit and Adobe Photoshop.]

Figure 17. Anderson, K. (2019) Play Area [rendering, created with Revit and Adobe Photoshop.]

Figure 18. Anderson, K. (2019) Multi-sensory Waiting Room Render [rendering, created with Revit and Adobe Photoshop.]

Figure 19. Anderson, K. (2019) Quiet Area Wall Seating [rendering, created with Revit and Adobe Photoshop.]

Figure 20. Anderson, K. (2019) Technology Area [rendering, created with Revit and Adobe Photoshop.]

Figure 21. Anderson, K. (2019) Quiet Area of Multi-sensory Waiting Room Render [rendering, created with Revit and Adobe Photoshop.]

Figure 22. Anderson, K. (2019) Bean Bag Seating Area [rendering, created with Revit and Adobe Photoshop.]

Figure 23. Anderson, K. (2019) Transition Area Wall Seating [rendering, created with Revit and Adobe Photoshop.]

Figure 24. Anderson, K. (2019) Transition Area Render [rendering, created with Revit and Adobe photoshop]

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APPENDIX Appendix A

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Appendix B

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Appendix C

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Appendix D Interview 1

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Interview 2

1. What makes the child apprehensive about going with you to therapy room?

2. What issues in the therapy room makes the autistic child uncomfortable?

3. What do you think might help solve the issues you listed above?

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Appendix E Case Studies

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Appendix F

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