We adore the Resources Library at Neurodiverse Connection. It’s very well curated. Their collection of therapeutic approaches lists three great resources that we’ve recommended often and recommend again here.

Three Therapeutic Approaches to Supporting Autistic People in Healthcare Settings:

• Autistic SPACE: a novel framework for meeting the needs of autistic people in healthcare settings — Neurodiverse Connection
• Improving the sensory environments of mental health in-patient facilities for autistic children and young people — Neurodiverse Connection
• ‘It’s Not Rocket Science’ report on inpatient sensory environments — Neurodiverse Connection

We quote these resources all over our website. Here are some featured quotes from each.

Autistic SPACE: a novel framework for meeting the needs of autistic people in healthcare settings

SPACE is a great mnemonic and heuristic for supporting autistic people in all kinds of settings. We love the inclusion of physical, temporal, and emotional space.

Autistic people experience significant health disparities and reduced life expectancy. Barriers to accessing healthcare are associated with adverse health outcomes. Autism training and healthcare professionals’ knowledge about autism is variable, and heterogeneity among autistic people leads to additional educational and clinical complexities. Autism remains nebulous for many practitioners, who are unclear about communication differences, access needs or life experiences common to autistic people. Healthcare environments can be challenging for all patients but autistic people may require specific accommodations to allow equitable access. The authors have developed a simple framework which may facilitate equitable clinical services at all points of access and care, using the acronym ‘SPACE’. This encompasses five core autistic needs: Sensory needs, Predictability, Acceptance, Communication and Empathy. Three additional domains are represented by physical space, processing space and emotional space. This simple yet memorable framework encompasses commonalities shared by autistic people.

Autistic SPACE: a novel framework for meeting the needs of autistic people in healthcare settings | British Journal of Hospital Medicine

The authors’ aim was to create a simple framework promoting accessibility without adding to current clinical burdens. This is called ‘Autistic SPACE’, shown in Figure 1:

• Sensory needs.
• Predictability.
• Acceptance.
• Communication.
• Empathy.

Autistic SPACE: a novel framework for meeting the needs of autistic people in healthcare settings | British Journal of Hospital Medicine

The term Autistic SPACE, first used in 1992 (Sinclair, 2005), colloquially refers to places and events where autistic needs are prioritised, such as the annual autistic-led conference ‘Autscape’ (http://www.autscape.org). The authors have adapted the term to provide a memorable acronym which encompasses the breadth of autistic experience and healthcare access needs, offering a potential solution to address knowledge gaps.

Autistic SPACE: a novel framework for meeting the needs of autistic people in healthcare settings | British Journal of Hospital Medicine

For more quotes as well as a couple helpful tables, visit “Stimpunks Guide to the NeurodiVerse Issue #2: Healthcare Access“.

Improving the Sensory Environments of Mental Health in-patient Facilities for Autistic Children and Young People

Over the past year there has been an increasing institutional awareness of and focus on sensory environments within healthcare settings.

Full article: Improving the Sensory Environments of Mental Health in-patient Facilities for Autistic Children and Young People

Many autistic children and young people will also have single attention: otherwise known as monotropism (Murray, Citation2018, Citation2020; Murray et al., Citation2005). The typical cognitive styles of non-autistic individuals tend to comfortably entertain multiple simultaneous interests, each moderately engaged, whereas those of autistic individuals tend to maintain only very few simultaneous interests: each one highly engaged and intensely focused upon. In terms of learning and developing passionate interests and skills, a monotropic attention style is very useful (Grove et al., Citation2018; Milton & Sims, Citation2016; Wood, Citation2019). When mixed with existing sensory processing differences it can create a situation where an intense sensory environment is experienced as a barrage of information competing from different channels, unable to be processed together. In a bright ward, for example, under a flickering overhead light—imperceptible, perhaps, to a non-autistic staff member—an autistic young person’s processing capacity may be used up, resulting in an inability to properly process auditory input, i.e. something being said to them. The sensory load that an autistic young person or child is able to manage at any one time may therefore be considerably less than that of a neurotypical peer.

Full article: Improving the Sensory Environments of Mental Health in-patient Facilities for Autistic Children and Young People

A recent thematic review (Hollins & Wood, Citation2021) found that not only was there a lack of sensory and environmental assessments, but there was also a general lack of understanding about autism in many hospitals. 

Full article: Improving the Sensory Environments of Mental Health in-patient Facilities for Autistic Children and Young People

Sound is the most significant source of sensory input in CAMHS inpatient environments for most people. The autistic young people who contributed to the “It’s Not Rocket Science” report (NDTi, Citation2021) spoke in particular to the panic caused by alarms going off. Autistic children and young people were distressed each time the alarms sounded—often multiple times a day—but were also waiting anxiously in anticipation for the next alarm. People also reported challenges with noise carrying between spaces, with the restrictions of inpatient services and the common locking of doors meaning it was difficult or impossible to move away from noise.

Full article: Improving the Sensory Environments of Mental Health in-patient Facilities for Autistic Children and Young People

Artificial lighting was a major source of sensory distress identified in CAMHS inpatient environments.Good natural light, a view of outside, natural space, user-controlled switches and a range of lighting options can all support self-regulation in the sensory environment.

Full article: Improving the Sensory Environments of Mental Health in-patient Facilities for Autistic Children and Young People

In addition, of the many hospitals our sensory reviewers have visited, and from the feedback of the young autistic people with experience of CAMHS inpatient services, dining rooms are often described as the most challenging sensory environments.

Full article: Improving the Sensory Environments of Mental Health in-patient Facilities for Autistic Children and Young People

Autistic children and young people we spoke to shared that it was hard to identify their own internal state when they were in busy, noisy, brightly lit environments and surrounded by other people in distress. In addition, they reported that the self-soothing responses and mechanisms they had developed to support emotional and interoceptive regulation are often not available to them in hospital.

Full article: Improving the Sensory Environments of Mental Health in-patient Facilities for Autistic Children and Young People

Autistic children and young people often possess divergent sensory experiences of the world that can, in the right circumstances, bring great joy: but, in the wrong ones, cause great distress. Spiky sensory profiles—including increased sensitivity to one sense and decreased sensitivity to another—are common. When the sensory load from a particular environment or situation becomes too high, an individual’s ability to process new information dramatically reduces, often resulting in overwhelm and emotional dysregulation. As autistic children and young people get older they often learn to mask their distress responses or autistic behaviours: to the detriment of their mental wellbeing.

Full article: Improving the Sensory Environments of Mental Health in-patient Facilities for Autistic Children and Young People

“It’s Not Rocket Science”: Considering and meeting the sensory needs of autistic children and young people in CAMHS inpatient services

Ensure there is quiet space and outdoor space that people can access at any time

.IT’S NOT ROCKET SCIENCE: CONSIDERING AND MEETING THE SENSORY NEEDS OF AUTISTIC CHILDREN AND YOUNG PEOPLE

Outside space. Many people find being outside and in natural very calming. Space to move away from other people, internal noises and distractions can be a good way to self-regulate. 

“I think things that are useful for autistic people would be beneficial for everyone. It would have stopped a lot of distress for a lot of people if they can take themselves away and calm down.”
Emily 

A sensory room or de-stress room. Easy access to a quiet space to de-stress can be an enormously helpful tool for people to be able to self-manage. Ideally, this room will be away from areas where there is heavy footfall or other outside noise. Many people find neutral spaces beneficial, with the option of lights and other sensory stimulus. 

“I think you should just be able to walk into the sensory room instead of asking staff and waiting for them to unlock it.”
Jamie 

It’s Not Rocket Science: Considering and meeting the sensory needs of autistic children and young people

“Inpatient environments are not right for most people – but it’s especially bad if you’re autistic.”

—Charli

It’s Not Rocket Science: Considering and meeting the sensory needs of autistic children and young people

Being placed in an inappropriate environment can be damaging and creates a pattern of distress, restraint and seclusion, which often cannot be broken. In many cases, we found that the impact of the environment on people, such as the noise, heating and lights of the wards, had not been considered. In many cases staff did not understand people’s individual needs and the distress that being in the wrong environment could cause, particularly for people with sensory needs. This could lead to people expressing their distress in a way that others find challenging, leading to staff resorting to using restrictive practices (CQC, Citation2020, p. 13).

It’s Not Rocket Science: Considering and meeting the sensory needs of autistic children and young people

Predictability and structure have a major impact on every aspect of an autistic person’s care in a Tier 4 CAMHS facility, from admission to discharge. Upon admission, children and young people are removed from everything they know – from the meals they eat to the place they live and the people who surround them. Even changes in small things which people may not consider to be significant, such as having to change the deodorant you wear, can cause huge anxiety (National Development Team for Inclusion – NDTi, Citation2021, p. 46)

It’s Not Rocket Science: Considering and meeting the sensory needs of autistic children and young people

This report introduces autism viewed as a sensory processing difference. It outlines some of the different sensory challenges commonly caused by physical environments and offers adjustments that would better meet sensory need in inpatient services.

It’s Not Rocket Science: Considering and meeting the sensory needs of autistic children and young people

We have five external senses and three internal senses. All must be processed at the same time and therefore add to the ‘sensory load’.

It’s Not Rocket Science: Considering and meeting the sensory needs of autistic children and young people

Understanding the sensing and perceptual world of autistic people is central to understanding autism.

It’s Not Rocket Science: Considering and meeting the sensory needs of autistic children and young people

Autism is viewed as a sensory processing difference. Information from all of the senses can become overwhelming and can take more time to process. This can cause meltdown or shutdown.

It’s Not Rocket Science: Considering and meeting the sensory needs of autistic children and young people

Small changes that can easily be made to accommodate autism really do add up and can transform a young person’s experience of being in hospital. It really can make all the difference.

.It’s Not Rocket Science: Considering and meeting the sensory needs of autistic children and young people

Related Reading

• Stimpunks Guide to the NeurodiVerse Issue #2: Healthcare Access – Stimpunks Foundation
• Autism in Care Settings: Managing Sensory Load – Stimpunks Foundation
• Healthcare Access: They don’t take Disability Studies classes. They don’t socialize with us. They don’t listen to us. – Stimpunks Foundation
• We Need Human-Centered Healthcare – Stimpunks Foundation
• Changelog: Nature and Multiple Multisensory Rooms – Stimpunks Foundation
• Neuroception and Sensory Load: Our Complex Sensory Experiences – Stimpunks Foundation
• Enable Dignity: The Accommodations for Natural Human Variation Should Be Mutual – Stimpunks Foundation