Designing for Neurodivergence in Healthcare Settings: A Conversation with Dr. Alessandro Morganti

Designing for Neurodivergence in Healthcare Settings: A Conversation with Dr. Alessandro Morganti MD, PhD

©LS3P 2023

Meet Dr. Alessandro Morganti, MD, PhD Dr. Alessandro Morganti, MD, PhD, is a medical design research consultant working with LS3P’s Healthcare team. Dr. Morganti earned his MD from the Università di Milano-Bicocca and his MS from Politecnico di Milano. Over the course of his medical studies, he became interested in the ways in which space impacts the patient experience, leading him to pursue a PhD in architecture after medical school. He served as a visiting scholar in Stanford Medicine’s Psychiatry and Behavioral Sciences Department in 2021-2022, and was recently selected for a Joseph G. Sprague New Investigator Award by the Center for Health Design. His research project will study evidence-based design strategies for autism-friendly design at two different medical campuses.

Neurodiversity is a broad term, and one that seems to be gaining in popularity. What does it mean, and how is it different from ASD? The concept of neurodiversity assumes that people experience the world in various ways which are influenced by genetics, brain development, and environment. Autism Spectrum Disorder (ASD) is one subgroup under the umbrella of neurodivergence, but it’s important to note that many people who don’t meet all the criteria for an ASD diagnosis may still experience some related traits. Other neurological differences such as dyslexia and attention deficit hyperactive disorder (ADHD) can be considered neurodivergent as well.

Neurodivergence encompasses many gradients. My research has primarily focused on people with ASD, though design strategies that improve the patient experience for people with autism can also improve the patient experience for many people – both neurotypical and neurodivergent.

We sat down with Dr. Morganti to talk about neurodivergence, autism spectrum disorder (ASD), and the ways in which the healthcare environment can impact the patient experience.

You’ve had an interesting academic and career path to date.

Can you tell us a little bit about what led you to medicine, and then what led you from medicine to architecture?

How common is ASD? Is designing for people with neurodivergence a significant issue for healthcare systems, and if so, why?

ASD is actually fairly common. The worldwide prevalence of autism has been estimated at 65 out of 10,000 people.1 In the US, the Centers for Disease Control (CDC) reports that approximately 1 in 36 children are diagnosed with ASD, and the diagnosis impacts almost 4 times as many males as females.2 It’s important to note that early

I have been interested in pediatrics for the biggest part of my medical career with

intervention and treatment yield substantial benefits. In 2015, the cost of care for

internships in different countries. Also, psychiatry and mental health fascinated me,

people with ASD was $268 billion. Without effective therapies and support, however,

as there is an extreme variability between patients and we have to deeply understand

that cost would have risen to $$461 billion by 2025. Helping patients, their families,

each patient’s issues to find the effective treatment.

and healthcare providers navigate the sensory environment in supportive ways makes a significant difference for a large population of people.

When I transitioned into healthcare design, autism was the perfect challenge for research: combining pediatrics and psychiatry, in a moment of patient’s life where brain plasticity really allows for improvements, if we are able to touch the right buttons. An

What is it like to experience neurodivergence?

additional challenge is that every autistic patient is very different from another, but

People with ASD process visual, auditory, olfactory, and tactile stimuli differently. A

spaces are normally designed as “one size fits all.” Using space flexibility to make the

person with a neurotypical brain may be able to moderate stimuli – we can acclimate

environment therapeutic for each patient is fascinating for me.

to distractions like the noise from an air conditioner or background chatter in a coffee

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shop. We can also process more than one stimulus at a time, and we can tune out sensory information that’s not needed. A person with a neurodivergent brain, however,

So stressful. How do we make the waiting room better?

may experience sensory inputs differently, suffering from the so-called sensory-

The first thing we can do is to compartmentalize the space as much as possible.

modulation disorders. They may perceive lights as being much brighter or sounds as

Instead of having people in a big open space, facing other people seated in rows

being much louder than neurotypical people, which can be jarring and confusing. They

of chairs, we can break the waiting room down into smaller spaces with clusters of

may also experience “cross-contamination” of stimuli – for example, loud noises can

furniture. We can remove some of the stress of having to interact visually or verbally

cause distortions to vision. People with ASD may have difficulty processing multiple

with strangers, and provide freedom for people to self-select and use the space in a

sensory inputs at once and can easily experience sensory overload.

way that is most comforting to them. Controlling noise in the waiting area is another helpful strategy. We can add more vertical partitions, integrate sound absorbing panels,

People with ASD may use different coping mechanisms to self-regulate. Some have a

and include soft furnishings which help to dampen distracting sounds.

lower ability to perceive stimuli, or hyposensitivity. These people may exhibit sensory seeking behaviors, such as rocking, jumping, fidgeting, or opening and closing things.

Of course, it’s not just the waiting room. We have to consider every step of the visit

Others may feel stimuli too intensely, which is hypersensitivity. These people may tend

from a sensory perspective. What is the entrance like? Is the check-in area easy to

towards sensory avoidance, and will prefer to avoid distracting inputs such as noisy

use and calming? How do we treat the clinical spaces, and the connections along the

environments or flashing lights. Some people may employ both sensory seeking and

journey, both vertical and horizontal? Every piece of it matters.

sensory avoiding strategies in different situations.

What design strategies can we use in any space to support people with ASD or neurodivergence?

If everyday events can generate stress for people with ASD, it’s easy to imagine that navigating a healthcare environment would be extremely difficult for these patients and their families. How can we help?

To help people with ASD manage the sensory environment, it helps to understand

Visting a doctor’s office or a hospital can be stressful for all of us. Think of how you

smell and touch.

which senses can be most impacted in various settings. Hearing is paramount when it comes to sensory design strategies; vision is the next most important, followed by

feel when you sit in a waiting room: you’re already in an unfamiliar environment and probably anxious about what’s coming next – an invasive procedure, a diagnostic test,

To mitigate unwanted sounds, we have to think about the height of the room, the

an uncomfortable conversation – and you’re surrounded by other anxious people.

materials of the ceiling, sound absorbing panels or furnishings, and nearby spaces

You don’t know exactly how long you’ll be waiting or when you’ll be called. Adults,

which may also be generating noise. For example, if a restroom is close enough to an

especially those who are neurotypical, have a lot of practice managing our feelings

exam room to create noise from toilets and hand dryers, those sounds can impact the

and dealing with this kind of stimulation. It’s much more difficult for children, and more

patient. It’s also important to consider items in the room. For example, a hyposensitive

difficult still for children with ASD who may struggle with new settings.

patient seeking stimulation to combat anxiety might bang on a metal shelf and produce excessive noise which could overstimulate other patients. Any furnishings

As part of my research, I conducted a statistical analysis of a lot of data, and found

accessible to patients that make noise opening and closing can contribute to the same

that the space which most impacts patients and their families is the waiting area.

problem.

People tend to spend the most time in this area, they don’t know how long they’ll be there or when their name will suddenly be called, and it’s full of stimuli. It can also

Direct lights are not ideal for people on the autism spectrum (and are rarely preferred

set the tone for the rest of the visit: if a patient is struggling in the waiting room, they

by neurotypical people either). Natural light is the best choice for most situations,

might not be at their most receptive by the time they get to a therapy room, and this

and effective shade systems are important for minimizing glare and reflections off

can strongly impact the outcomes of diagnosis and care.

materials such as flooring and furniture. Curtains and shading devices should be Designing for Neurodivergence in Healthcare Settings // 3

designed for patient safety. Artificial lights, when necessary, should be dimmable, non-

application: architects, engineers, healthcare staff and managers, everybody providing

direct, and LED lights are preferable to neon lighting.

a piece of expertise that is essential to any researcher to transform scientific findings into a tangible impact on many people’s life.

It’s best for healthcare spaces to have a neutral smell. Some odors are controllable and others are not; careful selection of cleaning products may help to minimize distracting

In this new phase of applied research, we’ve also introduced a parallel investigation:

scents, though some medical products (such as disinfectants) are necessary. Though

can neurotypical users benefit from this autism-friendly design as well? To what

it may be challenging to eliminate scents such as perfume, this element provides a

extent? I’m extremely excited to look into results and understand if these design

teachable moment: educating providers, patients, and families and inviting people

strategies can have a positive impact on wider populations of users, and can support

not to use fragrances when entering a medical setting encourages compassion and

designers to rethink better, evidence-based spaces for our future.

engagement around solutions.

The sense of touch comes into play when we talk about materials and furnishings. We must think about both sensory seeking and sensory avoidant patients when we choose

1 Zeidan et al., 2022 2 Maenner et al., 2023

furnishings like seats. The materials might feel hot or cold, depending on the weather, or be scratchy or squeaky. We can also think about the height and sides of chairs; anything that will make a space cozier and provide a sense of safety and enclosure for the user can be helpful and helps mitigate stimuli from sound, vision, and touch.

These design strategies seem to be critical in healthcare settings in helping patients with diagnosis and therapies.

Are there other situations where these would work?

Absolutely! For people with ASD or any form of neurodivergence, designing for a better sensory environment can be helpful in a range of environments. Schools, personal spaces, and workplaces can all be adjusted to help people manage sensory inputs and encourage success for people with many different ways of experiencing the world. It’s worth noting that the same strategies that help people navigate neurodivergence can make spaces better for everyone else, too – good design benefits us all.

What excites you most about your upcoming research project for the Center for Healthcare Design’s New Investigator Award?

Most of the time research conducted in academia is not transferred into real applications: it’s often a matter of competencies, funds, and time. I’m so excited that right after the conclusion of this first research I’ll have the opportunity to test its effectiveness on real users, supporting and validating the analysis conducted so far. I’m also very lucky to have a great multidisciplinary team supporting me in this

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