Designing for Neurodiversity

British Council for Offices May 2022

DESIGNING FOR NEURODIVERSITY

The BCO is the UK’s leading forum for the discussion and debate of issues affecting the office sector. Established in 1990, its membership base comprises organisations involved in creating, acquiring or occupying office space, including architects, lawyers, surveyors, financial institutions and public agencies.

Daniel Akinola-Odusola is the lead data scientist at Centric Lab. His role is developing Centric’s software as well as ensuring all data is correctly gathered, interpreted and communicated. Dan holds an MSc in Neuroimaging from Kings College London.

The BCO recognises that offices don’t just house companies, they hold people and so what goes on inside them is paramount to workplace wellbeing.

Marie Müller is a PhD candidate at University College London on the Leverhulme Doctoral Training Programme for the Ecological Study of the Brain. Marie is supporting Centric in its programme of research for the Urban Health Council.

SPONSORS

PLP Architecture is an industry-leading collective of architects, designers and researchers who value the transformative role of ideas and the capacity for architecture to inspire. The practice is known for its innovative designs and ability to get projects built, and has conceived and delivered projects on six continents from its base in London. It has produced some of the world’s greenest, most intelligent and ground‑breaking designs through a profound commitment to social, economic and environmental values. The project team was led by PLP Architecture partners Ron Bakker with associate partner Alex Davidson and PLP Labs team lead Savannah Willits.

The BCO and the authors would like to thank the sponsors of this study: CBRE, Deloitte and Lendlease/IQL Stratford.

ACKNOWLEDGEMENTS The BCO and the authors would like to thank all those who contributed to this research through interviews and feedback.

ABOUT THE AUTHORS

Ron Bakker is the founding partner of PLP Architecture. He has a particular interest in the architectural techniques that influence the qualities of gathering places in our cities and buildings, together with genuine excitement about the role of new technologies in the built environment.

Centric Lab is a research organisation that uses neuroscience and geospatial data to understand how the places where we live impact our health.

Araceli Camargo is the lead scientist and director at Centric Lab. She is a cognitive neuroscientist focused on how people interact with urban environments and, and holds an MSc in Neuroscience from King’s College London, where her academic specialisation was autism. Araceli has worked on the subject of neurodiversity for many years, and is herself neurodivergent.

Alex Davidson is an associate partner at PLP Architecture, and runs the studio’s in-house research and innovation group, PLP Labs. Alongside his role in the Lab, he also works in PLP’s Marketing and New Business team.

Savannah Willits is the team lead of PLP Labs, in which she helps conduct research and encourage innovation. She is currently earning her MSc at the London School of Economics.

Josh Artus is the lead urban and business strategist at Centric Lab. His work involves directing the Lab’s research to achieve effective policy and business outcomes. He has worked in the built environment industries for over 12 years, and is an arts graduate.

Peer review of and advice on the content of this report. was provided by Luke Ward, a neurodivergent designer, innovator and experience strategist.

Charlotte Kemp is the community engagement lead at Centric Lab. She is a neuroscientist and researcher, with a BSc in

CITATION British Council for Offices (2022). Designing for Neurodiversity. http://www.bco.org.uk/Research/Publications/Designing_for_Neurodiversity.aspx

COPYRIGHT © BRITISH COUNCIL FOR OFFICES, 2022 All rights reserved by British Council for Offices. No part of this publication may be reproduced, stored or transmitted in any form or by any means without prior written permission from the British Council for Offices. The BCO warrants that reasonable skill and care has been used in preparing this report. Notwithstanding this warranty the BCO shall not be under liability for any loss of profit, business, revenues or any special indirect or consequential damage of any nature whatsoever or loss of anticipated saving or for any increased costs sustained by the client or his or her servants or agents arising in any way whether directly or indirectly as a result of reliance on this publication or of any error or defect in this publication. The BCO makes no warranty, either express or implied, as to the accuracy of any data used by the BCO in preparing this report nor as to any projections contained in this report which are necessarily of any subjective nature and subject to uncertainty and which constitute only the BCO’s opinion as to likely future trends or events based on information known to the BCO at the date of this publication. The BCO shall not in any circumstances be under any liability whatsoever to any other person for any loss or damage arising in any way as a result of reliance on this publication.

DESIGNING FOR NEURODIVERSITY

2

© BCO 2022

Copyright Ben Gilbert, Wellcome Images

Psychology and an MSc in Cognitive Neuroscience. Charlotte has over 6 years of professional experience of working with people with mental health problems, epilepsy and a variety of disabilities, in several settings.

COVER IMAGE

ABOUT THE BCO

CONTENTS INTRODUCTION TO THE PROJECT

4

TEN KEY LEARNINGS

5

METHODS AND RESEARCH PROCESS

6

INTRODUCTION TO NEURODIVERSITY

7

HEALTH AND PLACE

13

EQUITABILITY

22

THE OFFICE

23

OFFICE DESIGN AND INSIGHTS

27

Sheltered outdoor areas ‘In between’ spaces/courtyards Outdoor working areas Outdoor furniture Distraction-free work space Distinct design features Audio-visual navigation Variable lighting Combining multiple elements Biophilic design elements Reducing visual disturbance Variable lighting

DESIGNING FOR NEURODIVERSITY

33 33 33 33 39 39 39 39 42 42 42 42

CONCLUSION

44

REFERENCES

45

3

© BCO 2022

INTRODUCTION TO THE PROJECT In the way society is currently organised in the UK, employment is one of the key routes to accessing income, which, in turn, is the pathway to many wellbeing factors, such as healthcare, self-care, nourishment, housing, mobility and security.

Therefore, it is imperative that, as a society, we create an ecosystem that supports people through the employment life cycle. A significant part of this ecosystem is the office space, which still provides a key habitat for the execution of work. Given this significance, office spaces need to offer equitable access to a wide variety of people who will benefit from employment opportunities. This means creating physical spaces that are supportive of health and wellbeing, so that the office is a space where a wide variety of people can successfully complete their work.

disrupt productivity and confidence, which can lead to a person losing their job. In turn, job loss can lead to further depletion of self-esteem, depression and other poor health outcomes, making it even harder for a neurodivergent person to find employment and their place in society. It is easy to see how a poorly designed space can spiral into chronic unemployment and exclusion from society. Taking this into consideration, this report will integrate the health aspects of an office environment with how these affect access to employment for those who identify as neurodiverse. This is to anchor the report to one of the aims of the neurodiversity movement, which is to create equitable access to employment.

For over 20 years, epidemiologists have understood human health as an ecological phenomenon. This means that our health is directly linked to the places we live. Whether it is the quality of the air we breathe, the experiences we have in those environments, the social connections we form, the quality of shelter or the type of job we do, these systemic factors have an effect on all aspects of health. For example, if a person lives next to a roundabout, they are exposed to acute levels of air pollution, which will put them at risk of a wide range of diseases. Living in this environment can also be noisy, especially if a home is not well insulated. This noise can affect the person’s quality of sleep, which is essential for a well-functioning immune system and general health. The same factors apply to office spaces which are a key habitat for a wide spectrum of people, including those who identify as neurodivergent.

Those who belong to the neurodiversity community are currently underserved by and often unsupported in the current employment ecosystem. Neurodiversity is a movement and community that advocates for equitable inclusion in all aspects of society, including employment. Additionally, a person cannot be diagnosed with neurodiversity; instead, it is an identifier they choose to use. Many who identify as neurodiverse have been diagnosed with a specific condition, such as autism, dyslexia, dyspraxia, Tourette’s syndrome or any other diagnosis that includes a variation in how a person socialises, learns and attunes to their surroundings, regulates their mood, moves through an environment or processes sensorial information.

Neurodiversity also has a link to disability, as some on the autistic spectrum may experience learning disabilities, such as dyslexia. A significant principle of neurodiversity is the belief that it is not the pathology of the condition that causes barriers to societal inclusion or causes a disability; rather, it is the socio-cultural architecture of a society that is only equipped to support a small range of variability. For example, an urban environment that has poor wayfinding or transport links can be disabling to a person with dyslexia or dyspraxia as they may find it difficult to navigate. In turn, this can prevent them from accessing various services and opportunities. However, this is not due to a fixed inability to navigate a city; it means that there are barriers that impede ability.

This report discusses three core points: the role offices play in society, equitable access to employment, and the health of those in the neurodiversity community. This is to frame the future of work as equitable access to enabling work environments. An enabling work environment is one that supports the mental, social, psychological and physical health of those inhabiting the space. To anchor this research, we use neuroscience and epidemiology to help us understand and define the relationship between humans and the places they inhabit.

The report is divided into four core sections: defining neurodiversity (which includes the social and civil rights aspects), the link between place and health, identifying the principles of an enabling work environment, and design insights for a work-enabling environment. The report brings in research from the worlds of neuroscience, lived experience (from interviews conducted for this report) and design to create a holistic and ecological approach to the creation of enabling work environments.

Understanding this difference can help create a new framework for approaching design. Design has the ability to make society more just and inclusive, which is important in the case of neurodiversity, as, according to the UK national autism research charity Autistica, only 21% of people experiencing autism and only half of people who experience a disability are employed. There are many systemic reasons for this. One key factor is a work environment that is disabling for a person identifying as neurodiverse. For instance, a space that has poor acoustics can not only disable the focus and concentration of those who are neurodivergent, but it can also lead to poor health outcomes. Noise-based stress can also lead to sick days based on physiological changes, as this type of environment can create disruption to sleep patterns, which, in turn, can disrupt usual immune function. Requiring sick days can

DESIGNING FOR NEURODIVERSITY

The intention of this report is to look at how neurodiversity, employment and office spaces intersect to enact health and social justice. With the insights of neuroscience and the expertise of design we can set out new standards and regulations to create experiences of dignity and equitability for those who are neurodivergent.

Finally, this report is intended as an introduction to neurodiversity for those who are building and designing offices.

We are creating a starting point rather than a definitive guide, as the needs of the neurodiverse workforce are wide ranging, requiring specific solutions for specific work and health demands. ■

4

© BCO 2022

TEN KEY LEARNINGS This report can be summarised in the form of ten key learning points.

1. Neurodiversity is a movement and community, not a diagnosis.

2. The conditions that fall under the neurodiversity umbrella cover a wide spectrum, and the lived experiences of these conditions are all unique.

3. Neurodiversity does not equate to having a ‘special skill’ or a ‘savant’ intelligence. This stereotype is harmful for two reasons. First, it sets expectations that may not be able to be met, which can lead to a person feeling overwhelmed and stressed. Second, people should be seen as a human being not a commodity.

4. There are biological responses to disabling physical spaces, which can lead to burnout syndrome, the effects of which can be long lasting and debilitating.

5. Burnout syndrome is a highly prevalent condition among the neurodiversity community, and plays a key role in unemployment, both in the short and in the long term.

6. There is a pathway between a disabling space and health.

7. Design can participate in equitability, and should be functional and supportive across the intersections of neurodiversity, such as class, gender and racialisation.

8. Design is only one element of an enabling work environment; we must also consider the culture.

9. The physical office space is part of a wider employment ecosystem.

10. A key principle of making an environment enabling is to provide people with autonomy through choice and a variety of physical amenities. ■ Copyright LinkedIn Sales Solutions | Unsplash

DESIGNING FOR NEURODIVERSITY

5

© BCO 2022

METHODS AND RESEARCH PROCESS It is important to understand the various methods, limitations and processes we used to obtain the findings and create the narrative of this report.

• We undertook a review of the literature on the relationship between the biological stress response and the various diagnosed conditions within the neurodiversity community.

• We conducted interviews with a range of experts, from those in the medical professions to those with knowledge obtained from lived experience, in order to understand the phenomenon of burnout as it is experienced by many in the neurodiverse community in relation to employment and office spaces.

• We also conducted expert interviews to understand the experience of a neurodivergent person in an office.

This information was used as both research and phenomenological knowledge in this report.

• We held various roundtable discussions to discuss the research outputs in order to understand their design implications.

• We employed various people from the neurodiverse community to write this report, as it is important to bring lived experience to a highly phenomenological subject matter.

• All interviews were done anonymously to avoid pressure and stress for those being interviewed.

Courtesy of AECOM. Copyright Hufton+Crow

LIMITATIONS AND CAVEATS There are various limitations we would like to acknowledge to highlight the need for further research and work in this subject area.

community is not a monolith. Second, there are variances within a person on a day-to-day basis. Third, culture plays a key role in how a person feels in a space. Finally, a universal code deters the much needed dialogue that employers, developers and people need to have to make bespoke and emphatic design decisions.

• The interviewees did not include people from the essential worker (a key worker within a workforce) community, which are an important demographic working in office spaces. To correct this, we conducted research on essential workers in relation to neurodiversity, and have included design insights that will be supportive to their work environments.

• Every lived experience that we have included in this report is just one story and one perspective; there are millions of others. Therefore, this is just a sample, not a rule or an even profile of neurodiversity. ■

• This report is not intended as the setting of a universal design code because, first of all, the neurodivergent

DESIGNING FOR NEURODIVERSITY

6

© BCO 2022

INTRODUCTION TO NEURODIVERSITY In this section we introduce neurodiversity – what it is, how it is experienced and how it relates to the work environment.

Neurodiversity – the population, community or movement.

Neurodivergent – an individual.

The section covers five key learnings: • The relationship between neurodiversity and productivity is nuanced and should be cleared from stereotypes.

experiences they have had on that day. A universal design approach can also prevent neurodiverse people from voicing their concerns, as they are being told the space is already designed to help mitigate stressful sensorial experiences.

Even the most diverse space will still fall short, and those making these spaces need to recognise that limitation.

• There is a wide range of conditions in neurodiversity, and each of these conditions has unique requirements of the physical office space.

• There are aspects of the physical office space that impact on how a neurodiverse person navigates the social aspects of work.

• Creating a stereotype of a person can be harmful, as it impedes an individual from being seen as a whole. In addition, if the stereotypical expectation is not met this too can add to mental stress and link to burnout and further social exclusion.3

• A first-hand perspective of what it is like to be part of the neurodiversity community.

• It is important to understand that a person is not disabled; it is the spaces and the experiences within these spaces that are disabling.

• In the way that society is organised, employment is a route to acquiring various vital resources; therefore, including neurodiverse people in the workforce is not a matter of productivity or advantage but a matter of equity, health justice and social inclusivity.

PRODUCTIVITY IN RELATION TO NEURODIVERSITY

• The expectation of needing to produce beyond their peers or what is healthy for the neurodivergent person can have consequences for their self-esteem and self-worth, as well as contribute to burnout.

“I really love new experiences,

but for me they have to be small doses. I also need to feel rested and recharged. I also need to be able to take my time to engage with new things, not feel rushed.

”

• Finally, this type of framing of neurodiversity omits that many workspaces are harmful at a biological level, which can contribute to poor health outcomes. Therefore, we all must do this work, not merely to achieve inclusivity but to avoid causing harm.

Interviewee

In this report we have considered all of the above points in order to focus on the following reframings:

Before moving into the details of neurodiversity, it must first be considered how current aspects of productivity influence the expectations about neurodivergent people and even how they are perceived in the context of the work environment.

• Places of work are a necessity and a utility, as they provide access to employment. Therefore, they must apply a ‘no harm’ regulation, meaning that workspaces should not harm the health of people.

Many reports on neurodiversity and workspace (or work) focus on and propagate three main factors:

• Inclusivity is a human right, not a matter of productivity or the generation of capital. It is mentally harmful to put that weight on the shoulders of a community which already has to over-adapt to various societal prototypes just to survive.

• Creating the perception that the neurodiversity community is a monolith that can be supported through a set of universal design practices.

• A person does not carry a disability; it is an environment or situation that disables a person. Therefore, if a work environment, including its culture, does not support neurodiverse people, meaning they are not able to ‘perform’, it is the failing of the ecosystem (not the individual).

• Including neurodiverse people in the workforce is good practice because of their ‘special skills’ or ‘savant knowledge’.1 • How a neurodivergent person can help raise profits or create a competitive advantage.1, 2

• We will be referring to space as part of a wider ecosystem of employment and society, meaning that the onus of change is on the ecosystem, not on the individual.

These elements are not only scientifically inaccurate; they actively harm people in the neurodiverse community in various ways:

• Work and being able to experience your potential as a person at a capacity that supports your health and wellbeing are human rights.

• Setting a deterministic culture around design (where a design of X will lead to Y behaviour or reaction) can be harmful, as people are varied, and they vary on a momentto-moment basis depending on what they are doing and the

DESIGNING FOR NEURODIVERSITY

• The aim is for an environment that supports and nourishes the health of people, so that all people can flourish.

7

© BCO 2022

THE SPECTRUM OF NEURODIVERSITY Keeping the above listed considerations and reframings in mind, to provide a more nuanced understanding of neurodiversity we focus in this section on how the movement defines itself, the biological underpinnings of the conditions and how they can present in the workplace.

“The disability comes from the

prototypical beliefs set up by society; they set a specific way of doing things.

”

Interviewee

The term neurodiversity (a portmanteau of neurological and diversity) was coined in the late 1990s by Judy Singer, a sociologist who is on the autism spectrum herself, to describe conditions like attention deficit hyperactivity disorder (ADHD), autism and dyslexia.4 Singer’s intention was to shift the view of neurological diversity as being solely deficits, disorders and impairments, to one of neurodiversity being the result of natural variations in the human genome. Since then, the neurodiversity paradigm has been applied to conditions outside the autistic spectrum, such as bipolar disorder, ADHD, schizophrenia, schizoaffective disorder, sociopathy, circadian rhythm disorder, developmental speech disorders, Parkinson’s disease, dyslexia, dyspraxia, dyscalculia, dysnomia, intellectual disability, obsessive–compulsive disorder and Tourette’s syndrome.4 In this case, we will be following a current broader definition of neurodiversity that includes a wider range of neurological conditions, especially the ones that face similar dynamics of stigma and a similar need for understanding and accommodation in various settings of someone’s daily life.

Copyright Jason Goodman | Unsplash

foster the needs of neurodivergent people rather than structures that coerce them into ‘normality’ or clinical ideals. Advocates propose that a largely recognised part of this support system is the encouragement of inclusive, non-judgmental language.5 An example of inclusive language would be the difference between identifying someone as an ‘autistic person’ versus ‘a person with autism’. Neither of these is absolutely correct for the community or the individual, so it is recommended to, when possible, directly ask what the person being referred to prefers.

Neurotypical is another term that originated from the autistic community to describe non-autistic people, extending to the neurologically typical people who fall into the typical range of human neurology. Neurotypical people:6

“A natural variation in people’s

• may not have cognitive, learning or social difficulties that necessitate coping mechanisms

relationship to their environment – their perception of it.

”

• may not have a lack of speech or certain motor impediments • may have the ability to readily identify and respond to social cues

“Neurodiversity is a different

• may not experience sensory issues

perspective of experiencing the world or human experience.

”

• may hit all the mental (and some physical) developmental milestones.

Interviewees

In many cases, the current workplace tends to accept the neurotypical individual’s requirements as good enough, often to the detriment of neurodiverse people. There are two points two consider. First, many spaces also fail to support the health of neurotypical people. Second, when spaces are enhanced to lessen the harm to neurodiverse people, this will be good for everyone (i.e. also for neurotypical people).

Neurodiversity is not just a term for describing a set of people, it is also a movement to encourage human rights. The neurodiversity movement is a social justice movement that ‘seeks civil rights, equality, respect and full societal inclusion for the neurodivergent’.4 Current advocates of the neurodiversity movement promote support systems that acknowledge and

DESIGNING FOR NEURODIVERSITY

8

© BCO 2022

“It can be an overwhelming

experience, that led to eating disorders to cope with my feelings.

”

“A way of navigating conditions, a

different way of feeling the world, a different way of sensing the world.

”

Interviewees

One of the main criticisms within and about the neurodiversity movement is the equity of representation between ‘highfunctioning’ individuals with milder forms of a condition and the ‘low-functioning’ people who are often significantly impaired due to their condition and unlikely to function without assistive technologies. By the nature of being less impaired in daily activities, the ‘high-functioning’ individuals have an easier time shaping the narrative of the needs around neurodiversity in environments such as the workplace, communal or residential areas, and public transport. This overrepresentation can lead to the ‘erasure’ of those who cannot easily communicate or be seen when talking about neurodiversity as a whole. While this report focuses specifically on ‘high-functioning’ individuals in the workplace and their needs for feeling comfortable and confident in a professional environment, it is important to understand that there is a wider scope and discourse around neurodiversity.

The discourse around the lexicon of neurodiversity is as important as it is nuanced, and is impacted by the politics and culture of health accessibility. Within the neurodiverse community, there are people who see a great need for diagnoses to exist, while others may not feel comfortable with a diagnosis. People who do prefer official diagnoses may want access to resources or specialists that will help them understand what they need to request from their work environment or share about themselves in social settings to foster better understanding, safety and agency. Others, who are considered relatively ‘high-functioning’, may see official labels and diagnoses of neurodiversity as a potential obstacle to being seen as credible in a work environment due to stigma or company culture. This internal discourse within the neurodiverse community about labels shows that, even if you are up to date on the lexicon, it is best, if possible, to confirm your language usage with a neurodivergent individual when interpreting their needs in a particular environment.

DESIGNING FOR NEURODIVERSITY

Copyright Christin Hume | Unsplash

9

© BCO 2022

COMMON NEUROLOGICAL CONDITIONS UNDER NEURODIVERSITY

space. However, there is a distinction to be made: a person highlighting or celebrating their strengths should not be seen as an opportunity for the capital class to exploit that person, and should not be used to stereotype a neurodivergent person as a savant who can overproduce.

There is a wide range of neurological conditions that fit under the neurodiversity umbrella. Here, we look at ADHD, autism, dyspraxia and dyslexia to give an introduction to how these neurodevelopmental conditions manifest biologically, how they can present themselves in a work environment, and their potential health implications.

Table 1 highlights some conditions that fall under the neurodiversity umbrella to give an idea of the complexity of these types of condition. It is due to this complexity that it is difficult to create a ‘one size fits all’ design solution, and it is necessary that each workspace provides the opportunity to investigate who will be using the space and how their needs can be best met. The final column in the table provides an idea about how health interlinks with the experience of office spaces. We have included work culture aspects to give an idea of how the whole work environment can affect a person, and so provide another layer of understanding to practitioners.

The traits these conditions have in common are a combination of genetics, the places where people live or grow up, brain structure and brain function variations that, in the ‘higher functioning’, are only as much of an impairment as the environment’s inability to accommodate the individual. This is why many advocates choose to turn these variations into personal strengths at the same time as promoting the usual therapy and the making of reasonable adjustments in the office

Description

Presentation (work context)

Potential health implications

Attention deficit hyperactivity disorder (ADHD) Can affect the ability of the brain and body to regulate attention and emotions, which can result in hyperactivity and impulsivity, as well as organisation problems.7 Scientists do not fully understand the cause(s) and the symptoms of ADHD, despite having shown differences in the brain size, networks, neurotransmitters and brain development of children with ADHD.8 There is also a close link between ADHD and having sleep disturbances.9

• Tardiness on tasks.

• Poor time estimation on tasks.

• Hyperactivity.

• Poor concentration on certain tasks (often due to perceived distraction in an environment).

• Hyper-concentration on certain tasks.

• Fatigue or tiredness.

• If a person finds themself in an unsupportive environment (culturally and/or physically), this can lead to job loss or formal warnings, which in turn can lower self-esteem.

• ADHD often has comorbidities with anxiety and depression. A poorly designed physical space can exacerbate the symptoms of these comorbidities through various biological pathways.

• Hyper-concentration on tasks may look productive, but it can often mean neglecting personal tasks, such as eating, hydration or rest.

• Burnout can come from working long hours to make up for time lost, especially in a distracting office space.

• Burnout can also be linked to poor sleep quality, which can be exacerbated by biological stress arising from the office space.

Autism spectrum disorder (ASD) A highly prevalent neurodevelopmental condition that has a wide range of symptoms and presentations, such as impaired social communication, differences in sensorial perception, sensory motor differences, restricted and repetitive behaviours,10 digestive problems and altered immune function.11 Early white matter differences in the brain might explain atypically connected brain networks. Accelerated expansion of the cortical surface area of the grey matter in ASD seems to be associated with impaired maturation of the cortical white matter.10

ASD is a very wide spectrum with an array of comorbidities that include depression, anxiety, anorexia, dyspraxia and ADHD. These factors contribute to how a person experiences the condition and presents at work.

• Not being able to read and react to complex social interactions.

• Difficulty understanding unexpected changes, especially when stressed.

• Needing to keep routines can cause distraction in an office space that is inflexible.

• Tardiness with work due to an inability to concentrate in an office space that is not adapted to their sensorial needs.

• Worsening of comorbid symptoms due to heightened biological stress from external factors.

• Burnout due to working in conditions that are not supportive to mental and physical health.

• Poor sleep due to biological stress.

• Diminished immune function due to biological stress, which can lead to more viral and other illnesses.

• Panic attacks due to noise pollution or other overwhelming sensory experiences.

• Tardiness to the office due to navigation obstacles in the urban environment.

Continued Table 1 Some conditions that fall under the neurodiversity umbrella

DESIGNING FOR NEURODIVERSITY

10

© BCO 2022

Description

Presentation (work context)

Potential health implications

Dyslexia Individuals with dyslexia receive the same information as their neurotypical peers, but they process written language differently.12 This has led researchers to investigate the brain structures and networks involved in the multiple processes that lead to reading written text. Imaging studies show less grey matter and white matter in the left parietal area compared to those without dyslexia. Reduced grey matter in this area may affect how individuals with dyslexia process the different sounds of language, whereas the decreased white matter may impact the reading and processing efficiency of the brain.12 Less known is that dyslexia can affect working memory, navigation and coordination.13–15 Finally, dyslexia can contribute to different sensorial processing.16

• Variation in written language processing can often be misunderstood as a sign of low intelligence; thus, it is important to overcome the stigma associated with reading difficulties and to research dyslexia as a neurodiverse condition.

• Feelings of shame that affect self-worth if a person is not matching their own expectations or the expectations of their peers.

• Working memory is needed for most tasks, whether remembering directions, recalling a recently read paragraph or remembering a recently learned name. Therefore, without proper support, those with dyslexia can produce incomplete tasks or need a little longer to complete tasks.

• Feeling overwhelmed by tight deadlines.

• Writing, speech or the organising of thoughts can also be affected, especially under stress. This can make certain tasks more challenging.

• Frustration, anxiety and stress when being put on the spot.

• Exhaustion from overworking to compensate for slower reading and comprehension rates.

• Feelings of stress when disorientated due to poor wayfinding.

• Increased risk of accident due to unsuitable floor material or steep staircases.

• Discomfort and lack of concentration in noisy environments, which can lead to biological stress and longer work hours.

• Situations can become unmanageable if there is a change in environment, such as a new location, new role or communicating with a new team.

Dyspraxia/developmental coordination disorder (DCD)17 A neurodevelopmental disorder that can affect fine and/or gross motor skills. Symptoms vary and may include poor balance and coordination, vision problems, perception difficulties, mood regulation difficulties, difficulty with reading, writing and speaking, and short-term memory impairments.18 Recent imaging studies have shown that the connections between, and activity within, key motor and sensory areas of the brain appear reduced.19 These include frontal and parietal areas (responsible for movement and spatial relationships) and the cerebellum (responsible for balance, coordination and fine muscle control.20

• Potential tardiness due to inaccessible transport links or bad weather that makes mobility difficult.

• Navigating spaces with poor wayfinding can pose a challenge, which in turn can lead to sedentary behaviour.

• Tasks could take longer to complete if a person does not have the right work tools.

• Poor wayfinding in spaces could physically isolate a person, who could then feel lonely within the office.

• There could be reading and writing challenges if there is a long reading list or if documents are poorly laid out.

• Steep or poorly lit stairs can present a physical hazard.

• Certain floor materials can present a fall risk, as can poorly lit spaces.

• Not having rest areas or green spaces that are easily accessible can add to long hours of sitting and working without a break. This can have an effect on morale, alertness, fatigue and/or burnout.

Dyspraxia is commonly comorbid with other neurodevelopmental disorders such as ADHD and autism.17 Table 1 – continued Some conditions that fall under the neurodiversity umbrella

DESIGNING FOR NEURODIVERSITY

11

© BCO 2022

ANXIETY, DEPRESSION AND PTSD

The following are quotes from neurodiverse people interviewed for this report, describing some of their experiences in office spaces. ■

While these conditions do not lie under the neurodiversity umbrella, it is important they are mentioned, as they often are comorbid with many conditions in neurodiversity.21 For instance, 75% of adults with ADHD will also have other comorbidities, ranging from depression to anxiety.22 In addition, anxiety, depression and post-traumatic stress disorder (PTSD) can also affect how a person experiences an environment. The box below gives a brief breakdown of anxiety, depression and PTSD, and how they relate to the work environment.

“I have been told that I am too

sensitive, in patronising tones.

This is infantilising.

”

“I have to do autistic masking to

fit into the workplace on a daily basis, this is exhausting.

A key learning for office designers and builders is that including mental illnesses in the conversation highlights how designing for neurodiversity can help support the health of many others as well, in much the same way as a physical ramp helps make access to a building easier for everyone.

”

Anxiety, depression and PTSD, and how they relate to the work environment Anxiety

MDD patients, such as in the frontal lobe, hippocampus, temporal lobe, thalamus, striatum and amygdala.25

The limbic system is considered to be the emotional and core regulatory part of the brain, and it plays a large part in the development of anxiety through the abnormal activation of key structures, such as the amygdala.23 An individual with anxiety is put into survival mode based on certain internal and/or external triggers that can lead to shortness of breath, disorientation, changes in body temperature and other physiological changes through overactivation of the hypothalamic–pituitary–adrenal (HPA) axis (a system that mediates the stress response).

Depression in the workplace is yet to be understood; however, it is a major cause of disability, absenteeism, presenteeism and productivity loss among working-age adults.26 Diagnoses and the identification of specific stressors are important for creating an environment suitable for those with MDD. PTSD Both the amygdala and the mid-anterior cingulate cortex become overstimulated in people with PTSD. In contrast, the hippocampus, right inferior frontal gyrus, ventromedial PFC, dorsolateral PFC and orbitofrontal cortex all become hypoactive, sometimes to the point of atrophy.27 PTSD and anxiety have many similarities due to the involvement of similar brain structures and processes, but PTSD can often be attributed to a specific traumatic event or set of events that are recalled to some degree (when triggered).

Anxiety can be triggered by professionally or socially compromising or unpredictable situations, and being overwhelmed by deadlines and responsibilities. Examples include a lack of job security, a lack of perceived control over deadlines and workload, stressful personal relationships with colleagues and frequent ambiguous tasks. General anxiety disorder (GAD) can present as forgetfulness, loss of focus and an inability to meet deadlines, and can spill over into other commitments, such as friends and family.24

Along with the usual responses associated with anxiety, PTSD can lead to engaging in more high-risk activities, distorted recall and hypervigilance.27 An individual with PTSD will often, but not always, be aware of their triggers and likely needs support in making sure the workplace environment does not present these triggers and in becoming familiar with ways of immediate relief or removal from triggering environments. ■

Depression Major depressive disorder (MDD) is characterised by persistent low mood, often accompanied by cognitive dysfunction, physical symptoms and impaired social function.25 Numerous studies that focused on the grey and white matter found significant brain region alterations in

DESIGNING FOR NEURODIVERSITY

12

© BCO 2022

HEALTH AND PLACE THE STRESS RESPONSE

The previous section provided an overview of neurodiversity and how the office space can affect the health of neurodiverse people. In this section we discuss some of the biological aspects, to understand in more detail how the places we inhabit have an effect on our health. This is a crucial part of the report, as it cements the idea that spaces are not just an aesthetic experience, they are also experienced biologically.

In order to survive and function optimally, our body must maintain steady internal conditions, such as body temperature and fluid balance, irrespective of fluctuations in the environmental conditions. The ability or propensity to remain in a steady state that is within our individual acceptable range is called homeostasis (homo = same, stasis = status). In order to maintain homeostasis, several biological and behavioural systems or ‘buffers’ can be employed that enable us to adapt to the change in environment.

For example, entering a very warm environment would typically induce physiological changes (e.g. sweating and vasodilation) as well as behavioural adaptations (e.g. fanning and seeking shade) in order to maintain a steady body temperature (and thus maintain homeostasis). This process of adaptation in response to environmental changes is called allostasis.

THE BIOLOGICAL STRESS RESPONSE The first part of this section will look at the biological stress response, and the second part will focus on burnout syndrome.

The change in temperature in this example is a stressor. A stressor is a chemical or biological agent, environmental condition, external stimulus or event seen as causing stress to an organism.32 Environmental stress encompasses a wide range of phenomena, but perhaps the most recognised in workplace settings are those stressors that are inherently social (e.g. unpleasant interactions with colleagues or clients) and heavy workloads. Intrinsically linked to social factors (because the physical environment influences social behaviour) are

In this first part we cover the following learnings: • Our health is dependent on the places we inhabit; this includes the office space.

• When a physical space is not designed to support health, it can be especially debilitating to neurodiverse people, to the point of developing burnout syndrome.

• Burnout syndrome can be the start of chronic or long-term unemployment.

Health is an ecological (rather than an individual) phenomenon, meaning that it is the places that we live and the experiences that we have within these places that affect our health, rather than just individual choices.28 For example, if a person lives in an area of high air pollution, it puts them more at risk of diabetes and obesity, even if they follow a good diet and take exercise.29, 30 In terms of the physical office space, it too will have an effect on the health of people. Whether it is through indoor air quality or, for those who are neurodivergent, how a space is sensorially organised.

Key terms associated with the stress response Stressor – Any event, force or condition that results in physical or emotional stress. Stressors may be internal or external forces that require adjustment or coping strategies35 on the part of the affected individual.36 Stress – The physiological or psychological response to internal or external stressors.37 Stability – The ability or tendency of the body or a cell to seek and maintain a condition of equilibrium – a stable internal environment – as it deals with external changes.38 (This can be thought of in two parts: homo = the same; stasis = status.)

This section explores the mechanisms by which physical elements of the physical office space can cause harm to the employees (whom it should serve and support). In particular, we explore the stress pathway as a throughline from workplace settings (and their broader socio-cultural context) to physiological and psychological harm and burnout of the individual, and how this pathway can be even more prominent for those who identify as neurodivergent.

Allostasis – The process of maintaining homeostasis through the adaptive change of the organism’s internal environment to meet perceived and anticipated demands.39 Allostatic load – The cumulative burden of chronic stress and life events. It involves the interaction of different physiological systems at varying degrees of activity, and can be identified using biomarkers and clinical criteria.40

“We are freshwater fish in a saltwater

pond, put us in freshwater and we’ll function just fine, put us in saltwater and we struggle to survive.

Allostatic overload – When environmental challenges exceed the individual’s ability to adapt and cope. 40 ■

”

HOK Network31

DESIGNING FOR NEURODIVERSITY

13

© BCO 2022

classical environmental stressors, which predominantly involve characteristics of the physical environment (e.g. temperature, and poor air quality or acoustics).33

Considerations for neurodiversity • Those who are neurodivergent may have different thresholds for particular stressors or occupy a specific range that lies closer to allostatic load.42

Stress is the body’s response to exposure to stressors. It is an adaptive response that is associated with physiological changes in the body (e.g. through the activation of the HPA axis, the sympathetic nervous system and the sympathoadrenal system).34 This response, which is sometimes known as the fight‑or-flight response (or fight, flight or freeze), directs the body’s resources to prepare it to do just that – to fight or to flee from the threat. This is achieved through the redirection of internal resources that contribute to the general ‘upkeep’ of the body (e.g. parasympathetic nervous system activity, otherwise known as the ‘rest and digest’ system, which controls functions such as digestion). Energy and attention are redirected from these ‘upkeep’ systems to systems that support action (e.g. the muscles).

• For those who are neurodivergent, social situations can be more stressful because of socio-communicative variances, causing a repeated activation of the stress response.

• The sensorial experience can produce a range of stressors depending on the sensory modulation of a person. This is another opportunity for the stress response to be overused, leading to allostatic load.

• For socio-economic reasons, a person who is neurodivergent may live in a place with high environmental stressors, which, again, can cause further engagement of the stress response. ■

MALADAPTATION TO MODERN LIFE STRESSORS Stress is a predictive adaptive response that is crucial to sustaining our stability and healing. However, repeated exposure to stress, and thus activation of the associated physiological pathway, can have harmful consequences. This is because the body remains in a constant state of physiological arousal and does not have an adequate chance to be in a state of restoration (i.e. activation of the parasympathetic nervous system activity). Over time, this results in allostatic load, or ‘wear and tear’, on the body and a dysregulation of several systems that are crucial to optimal functioning.40 Furthermore, this phenomenon can present as part of a negative feedback loop, wherein repeated exposure to stress leads to a depletion of internal resources with which to mitigate any new stressors, meaning that the impact of these new stressors is more pronounced and thus more likely to elicit the stress response; and so it continues.

Allostatic load and disease There is now a huge amount of evidence linking allostatic load to various non-communicable diseases such as depression, anxiety and PTSD. As we have learned, these conditions are often comorbid with conditions that fall under the umbrella of neurodiversity. It is important to point out that some of the places that neurodiverse people come into contact with can amplify their comorbidities. Therefore, it is of paramount importance to create environments that do not harm people. ■

Finally, we must also consider how our environment has changed through industrialisation and the development of digital technologies. A significant number of people now live in an environment that is characterised by a constant onslaught of stimuli that compete for our attention, such as a dense city with constant changes, activities and demands. This constant barrage of incoming information is very far removed from what we would have experienced even a century ago, and so we are constantly having to filter the information we are receiving.

For people who are neurodivergent, this can present a constant source of stress, especially for those who live with ADHD or autism (Figure 1). This is important, as the places where people live and their commute impacts the mental state a person brings to the office. If a person lives in a neighbourhood that does not provide them with the ability to get restful sleep, this can impact their ability to cope with new stressors during the day, such as a complex commute. In turn, this person could arrive at the office with elevated stress levels, potentially making them take longer to settle into the office space. Office design has to consider the various aspects of modern life and the role that design needs to play to help support people through it.

The problem we have is that the modern environment is likely to trigger the stress response at times when it is inappropriate.

The modern environment is markedly different to that in which we, as humans, evolved and adapted, and change has occurred in a very short period of time relative to a human life span.

This can lead to a mismatch between our environment and our response to it. The stressors that our ancestors experienced included, for example, coming across a sabre-toothed tiger as they went about their day. While, thankfully, situations such as this are much less likely to occur nowadays, capitalist systems are associated with a whole new range of stressors to which the stress response is not appropriate or adaptive. For example, a fight-or-flight reaction is not a useful response to being stuck in traffic, being late for a meeting or forgetting your homework.

Another output of modern life is the continual and acute exposure to environmental pollutants in urban spaces, such as air, noise and light pollution; this too can cause the stress response to be continually engaged.41

DESIGNING FOR NEURODIVERSITY

14

© BCO 2022

Stressors

Changes in the environment due to industrialisation and modern life that require adaptation

Environmental pollution Air, noise, light

Density Intense industrial and human activity in a small amount of space

Long working hours Shift work, multiple jobs, housework, family organisation

Financial anxiety Loss of job, cost of living rises, poverty, dependants

Stress adaptation Mitigated by APA axis

Increased adaptability Due to adequate resources: adequate housing, reliable social support, access to rest, economic security

Reduced adaptability Due to reduced resources: inadequate housing, poor social support, lack of rest, poor economic security

Stability Regular allostatic process

Maladaptation Allostatic load

Healing, being able to participate in society, dignity, health justice

Can make symptoms of conditions under the neurodiversity umbrella more acute and lead to increased exposure to stressors. This can increase risk of conditions such as depression and anxiety

Figure 1 How stressors can put neurodiverse people at risk of poor health as well as make their symptoms more acute if they do not get adequate support. It is important to note that this process would be the same for neurotypical people.

DESIGNING FOR NEURODIVERSITY

15

© BCO 2022

VARIANCES IN SENSORIAL PERCEPTION

other words, being able to see and feel the world in a different way from those considered neurotypical. These variations in a past world with normative amounts of stressors may not have led to maladaptive responses like allostatic load. However, in our current world, where there is a constant exposure to stressors, we have to consider the sensorial processing variations as potential drivers for stress. Table 2 describes two processes that have an impact on the sensorial and perception experiences in some neurodiverse people: sensory gating and habituation.

There are also indirect health pathways to consider, such as sensorial perception. This is especially significant for those who are neurodivergent, as their sensorial perceptive variations, if not well supported through place design, can be a source of stress. This highlights how the sensorial experience of a place can relate to health.

Those who we interviewed for this report all defined neurodiversity as having sensorial or perceptive variations; in

Sensory or perception mechanisms

Relation to neurodiversity and stress

Sensory gating The neural processes of filtering and separating redundant or irrelevant stimuli from meaningful stimuli.

It is an adaptive process in that it maximises our limited cognitive capacity and we can choose where best to focus on or use our energy.43 For example, if you are at a cocktail party, whomever you are speaking to has your attention and you have the ability to tune out the rest of the room.

If there are variances in sensory gating and a person with ADHD or autism is in a space where there are multiple unorganised stimuli (e.g. a co-working space), they may find it difficult to isolate which stimuli to attend to. In turn, this can require a lot of mental energy and create sensory overload.43, 44 Another point to consider is that this type of office environment can make it difficult to concentrate and pick up social cues, as the attention is not able to focus, but also the brain may not be able to coordinate interactions across different specialised regions, making it difficult to make sense of the stimuli, including social cues.

This is an interesting intersection between space and social cues, which can affect how a person bonds socially with their colleagues.45 This, in turn, can create feelings of loneliness and stress.

Habituation Another way in which we mitigate the incoming of several stimuli is through habituation. Habituation is defined as ‘a decrease in response as a result of repeated stimulation, not due to peripheral processes like receptor adaptation or muscular fatigue’.46, 47 Simply, you get used to something happening, and therefore respond to it less. This phenomenon can be observed in brain activity measured using tools such as electroencephalography (EEG). The brain shows a large neuronal response to a stimulus when it is first perceived, and there is a gradual reduction in neuronal activity in response to the stimulus the more times it is repeated. Eventually, brain activity is nearly undetectable.

The sensorial experience in autism is still being explored scientifically, but it is hypothesised that autism may be linked to sensory habituation variations. On the one hand, the reduction in habituation may contribute to an inability to detect novel stimuli in the presence of ongoing ones, leading to a lessened sensitivity to changes in the environment. Conversely, it could compromise the ability to habituate, which can reduce stimulus suppression and may lead to an oversensitivity to stimuli.48 For those with ADHD, there could be difficulty in habituation to visual stimuli.49 Habituation is an important part of attention processes; therefore, if a person is in an environment where they cannot habituate due to the organisation and intensity of the stimuli, they can have challenges in sustaining attention.50 This has two-fold consequences: first, not being able to mitigate the stimulation can cause stress; and, second, making up for lost time can lead to longer work hours.

Table 2 The impact of sensory gating and habituation on the sensorial and perception experiences in some neurodiverse people

DESIGNING FOR NEURODIVERSITY

16

© BCO 2022

SOOTHING STRESS

people may have to engage in these mechanisms more often to fit into prototypical societal practices.

Part of stress adaptation is how a person self-soothes or is able to bring themselves back to stability. Those who are neurodiverse have some specific behaviours and physicalities they engage in to help soothe stress and bring back a sense of comfort. These activities are a normal part of life; unfortunately, due to the way society is organised, neurodiverse

It is important to note that, while people can use these mechanisms to create comfort and an equilibrium in their physical systems, society should not expect this as part of ‘coping’.

In other words, we should normalise removing the harm, rather than expect people either to cope, mitigate or adapt to it.

Two strategies that neurodiverse people may use to mitigate stress Stimming

Masking

‘Stimming’ is short for ‘self-stimulating behaviours’. These can be repetitive motor movements or sounds, such as pacing, rocking or chewing on a pen.

Masking can be a conscious or unconscious suppression of a range of domains; it is a social survival strategy to appear more neurotypical.52 Masking can be used on a daily and regular basis to be able to lead a meeting, hold down an interview process, or to try to fit in within a physical space.

Stimming is a universal behaviour that exists on a continuum – everybody does it to some degree. However, it is typically much more pronounced in those who are neurodivergent. It is typically associated with ASD but is also often present in ADHD.

We currently think that masking includes things such as making eye contact even if it makes you feel uncomfortable, or not talking about your interests too much for fear of being labelled 'weird'.

Stimming can also be a healthy, instinctive, natural behaviour that can have benefits; for example, it can serve to help with concentration or to let out excess energy.

Pearson and Rose (2021)52

When neurotypical people see stimming, they may be judgemental. This, in turn, can lead people who identify as neurodiverse to try to hide their behaviours to avoid being socially ostracised or even fired. This is associated with an incredible amount of stress.51

DESIGNING FOR NEURODIVERSITY

While this phenomenon is more linked to autism, in our interviews, those who had ADHD also expressed that there are times when they mask.

Masking takes up energy and depletes internal resources, leading to prolonged stress, which can be both fatiguing and contribute to allostatic load.53 ■

17

© BCO 2022

BURNOUT SYNDROME

Burnout syndrome as a systemic (not individual) problem

The accumulation of acute and prolonged stress can result in burnout syndrome. It is the apex of where poor office design, health and access to employment intersect. Crucially, burnout syndrome is highly prevalent among the neurodiversity community, and it can lead to poor health outcomes and chronic unemployment.

From a systemic perspective, a researcher within the medical field describes burnout syndrome as ‘the failure of a system to adequately support an individual’s employment process’. The point of this statement is to shift the attention from the individual to the ecosystem, both in understanding the pathways to and the solutions to burnout.

This section is about understanding the significance of making offices that support the neurodiversity community.

It explores the various pathways in which physical aspects of the office space can contribute to burnout syndrome. Starting with an introduction to the syndrome, it then moves towards understanding how the syndrome manifests, and it ends with how the office space can contribute to it and what happens when burnout syndrome is not curtailed.

Many medical professions and human resources departments will focus on personal interventions, such as doing more yoga, exercise or meditation, or taking time off.69–71 However, as we know, burnout can affect the ability to engage in self-care or physical activity due to muscle pains, headaches and diminished self-esteem.

Therefore, these points of advice may not be realistic, and, in addition, essential workers may simply not have the time to engage in these activities. More poignantly, if a person has to go back to work in an environment that glorifies the ableism of working long hours, has ineffective management that does not understand neurodiversity, or creates unachievable work demands due to perpetuated myths related to neurodiverse people having an ability to provide a ‘competitive advantage’, they will continue down the burnout path (despite the personal mitigations they engage with).71–73 It is also worth considering that the various methods of personal mitigation or ‘coping’ can also exhaust mental and physical resources, which further depletes the neurodivergent person. ■

AN INTRODUCTION TO BURNOUT SYNDROME Burnout syndrome (often shortened to ‘burnout’) does not have a diagnostic category, for various reasons. For example, burnout syndrome is currently identified as occurring through only a single pathway – a person’s employment and its ecosystem, such as the physical space, culture and tasks.54 The study of burnout is still quite new, and further information is needed about its ecological aetiology: for example, does it make a difference where a person lives, whether they have other neurodevelopmental conditions, or whether they are exposed to toxins at work? Also, how is it related to allostatic load? Despite science still needing more time to understand ‘burnout’, it is a phenomenon that is experienced by one in five people.55 Therefore, it is worth discussing burnout syndrome in relation to the physical spaces people work in, which are likely to contribute to the phenomenon. Another reason we need to talk about burnout is its high prevalence in many people in the neurodiverse community. According to the UK National Autistic Society, autism can make it more likely for a person to experience burnout.56 In addition, in a study of 62 people who had been identified as taking long-term sick leave due to burnout, 52% had PTSD and 24% had ADHD.57

DESIGNING FOR NEURODIVERSITY

18

© BCO 2022

HOW DOES BURNOUT SYNDROME PRESENT AND FEEL?

Symptom Emotional exhaustion

Burnout syndrome has a long list of symptoms, and its presentation is unique to a person’s employment type, work culture and environment. Furthermore, as it is not a diagnosable disorder, it can be difficult for those experiencing the syndrome to articulate it in medical terms. In turn, this can leave room for being ignored by their employer or even prevent them seeking timely medical advice. Therefore, it is important for this report to explore some of the ways in which burnout syndrome can manifest and some of the feelings attached to it. This is to create more awareness and learn how to spot the syndrome before it spirals.

Possible presentations A state where emotional regulation is no longer possible.58 It can feel like anxiety, panic, mental exhaustion, irritability, lack of control or complete disconnection.

It can also change appetite and sleep patterns, and cause headaches, nausea and physical pain.58

Table 3 lists some of the symptoms of burnout and the potential ways in which they can present. These symptoms can cluster and can amplify each other. Due to its wide-ranging symptomatology, it would be best practice to conduct periodic surveys that help monitor burnout syndrome within the office environment. This is to both adjust the work culture and the physical workspace.

“My self-esteem suffers, I am not able to communicate or engage with other people.

”

“I can’t step into the world with other people, because I feel so overwhelmed.

”

“Everything goes fragile – like everything is going to break.”

Depersonalisation

The experience of feeling unreal, detached and, often, unable to feel emotion.59

Panic attacks

‘A panic attack is a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause. Panic attacks can be very frightening. When panic attacks occur, you might think you’re losing control, having a heart attack or even dying.’60

Diminished self‑esteem

A state of mind where a person loses the mental ability to see themselves in a favourable light, is self-critical, and has trouble making social connections and engaging in self-care.61

Headaches

Pain in various regions of the head that ranges in intensity. Headaches can be mild or severe, and can include nausea and vision problems.

Muscle aches

Pain in muscle tissues.

Changes in digestion

Through the biological stress response, burnout syndrome can lead to gastro-intestinal problems, such as irritable bowel syndrome.62

Changes in immune function

Through the biological stress response, burnout syndrome can lead to systemic inflammation in the body, which can make people more susceptible to various illnesses.63

Table 3 Some of the symptoms of burnout and how they may present

Interviewees

This can affect the way in which they perceive themselves, as well as their self-worth and self-esteem.

THE ROLE OF THE OFFICE IN BURNOUT SYNDROME

• A person experiences sensorial overload due to:74

The physical office space can have direct and systemic effects that can lead to burnout through the stress response. A direct effect could be lack of regulation of glare leading to stress in real time as well as to stress due to the longer working hours required to make up for loss of concentration. A systemic effect could be a person not being able to concentrate for days due to increased noise levels and not being given any support, which, in turn, could impact interactions with people. This potential change in interaction could bring about stress from loneliness, feelings of social isolation or feeling misunderstood. It is also important to note that there is a link between the physical office space and social outputs.

– a space that is perceived as too loud – a space that creates many visual distractions due to the movement of people, patterns or cluttered sight lines – a space that does not offer thermal comfort (i.e. either too cold or too hot).

It is important to note that some people with autism or ADHD may need more sensorial stimulation, so they might prefer background noise. This is something that should be negotiated at an individual level, as the sounds will still need to be orchestrated (i.e. it is not just about ‘noise’).

Here is a list of potential factors or scenarios that may occur in the office space and contribute to burnout syndrome.

• A person perceives marginalisation and social exclusion due to:

• A person does not experience ‘feelings of fairness or support’ because they are:

– a space not having adequate physical amenities (e.g. ramps, railings or lifts) to allow for safe movement, isolating people with mobility variances

– not given the right digital tools to complete their work

– there not being adequate spaces for various activities (an interviewee mentioned that they were given a break space for themselves, but it was cluttered, poorly lit and not fit for purpose).

– not provided with a type of work area that suits their mental, physical and psychological needs – not listened to and are gaslighted when they express feelings of discomfort.

DESIGNING FOR NEURODIVERSITY

19

© BCO 2022

Burnout syndrome among essential workers The office space is not only used by desk workers. There are also essential workers such as cafeteria staff, hygiene specialists, security guards and receptionists.64 These types of workers should also be considered in office design. This is especially important for essential workers who are also neurodiverse, who are faced with navigating at least two types of marginalisation – classism and ableism – increasing their risk of burnout syndrome.

• Essential workers have less access to financial resources to mitigate stress after work, and less time for self-care.

Those living with ADHD or autism can already experience periods where self-care is difficult; therefore, these factors of essential work can only increase the risk of burnout.

• Due to social hierarchy, essential workers have less access to quality restorative spaces, such as rooftops, green spaces or breakrooms. Furthermore, this hierarchy can also mean these workers have less agency over when they take their breaks. When this is paired with various social and communication differences in neurodiverse people, obtaining adequate restorative breaks will be extremely challenging. All these factors can contribute to prolonged stress and, eventually, burnout syndrome.67, 68

Here we highlight some of the pathways of how neurodiverse essential workers can be more at risk of burnout syndrome, and the consequent necessary considerations for the office space.

• Essential workers who do shift work are especially vulnerable to burnout, as their working pattern can dysregulate the sleep–wake cycle, leading to fatigue and challenges with emotional regulation. Both of these effects can lead to burnout. This disruption to the sleep– wake cycle is in addition to sleep disturbances already experienced in many conditions in the neurodiversity spectrum.65, 66

• From the office-space perspective, there should be design considerations that can increase equity. These could be creating outdoor rest areas close to essential work areas, designing essential work areas with the same principles of dignity as desk work areas, or providing indoor rest facilities that are especially for essential workers. ■

POTENTIAL CONSEQUENCES OF BURNOUT

• A person is not being allowed to self-express or self-soothe.

– Some people may need to do stimming as part of their self-soothing practices, which may require them to have their own designated work area. Not being able to do stimming can lead to burnout syndrome.74

In this section we look at the consequences of burnout syndrome.

This is important, as it exemplifies the relationship between health and place, and its potential long-term consequences.

Among those we interviewed, burnout syndrome was mentioned as a pathway to unemployment. One person experienced a long road of recovery after burnout, from engaging in selfmedication to experiencing long bouts of depression, which left them unable to work for a long period of time. Others expressed that feeling stressed and fatigued had led to them taking sick leave, which their employers were not able to justify financially, and left them without a job. Burnout can require a long period of recovery, depending on how acute it is. Therefore, unless a person is within a financial ecosystem that enables them to pay for both time off work and the resources required for recovery, they may spiral into poverty. Poverty is a big concern for neurodiverse people due to the high rates of unemployment in this community.79 In addition, ‘one-third of autistic adults in the UK have neither employment nor access to benefits’, leaving them in a very dangerous financial situation.80

– If a person is in a space that does not allow them to adapt their sensorial experience to their needs, they can experience sustained stress and, eventually, burnout.

• A person is not being given dignity or autonomy.

– Sometimes a person is given support, but this support is not fully adequate. For example, one interviewee expressed how they had to spend time in the toilet because they had no other place to go to try to mitigate the stress that they experienced in the office environment. This lack of dignity and support can contribute to burnout. It also communicates that you are not cared for.

– This is especially important for essential workers, who may not be given the autonomy to take breaks when they need to or may not be able to access physical spaces due to the cultural organisation of the job.67

A great deal of research is still needed in this area to understand the link between burnout, long-term unemployment and how it leads to poverty. However, we can understand that most people will not have adequate resources to sustain long periods of rest, as many employers do not offer this cover. Furthermore, it can be very difficult for a person who is neurodivergent to start writing their CV and to engage in the interview process all over again, as this can require high levels of masking.

• A person is engaging in masking.

– Masking can be part of many conditions that fall under the neurodiversity umbrella, but it is more prevalent and pronounced in people with autism.75 In order to engage in masking, a person has to be in a constant state of self-monitoring or vigilance, which requires sustained attention. In turn, this can exhaust brain and body resources, and may lead to fatigue.76 Fatigue can lead to sleep disturbance, which in turn can lead to burnout syndrome.77, 78

DESIGNING FOR NEURODIVERSITY

The role of the physical space is to help create an employment ecosystem that is not only enabling but also helps nourish people. In turn, this could lessen the risk of burnout and play a role in achieving health justice for neurodivergent people.

20

© BCO 2022

Figure 2 shows an example of how a stressor (due to a physical office element) leads to burnout syndrome. This is only one example; in an office setting there will be multiple stressors at the same time. This cycle from stressor(s) to burnout can happen quickly or over a long period of time. At every stage, there is potential for intervention, prevention and stopping the burnout spiral. ■

Ethics We should question what type of society we want to create.

Are we OK with a culture that makes people sick to the point of causing a medical phenomenon like burnout?

What is the responsibility of everyone who creates offices in providing adequate spaces that support people? How do the people who create offices work together with human resources departments to create a nourishing environment and culture that prevents burnout? ■

Stressor

Poor visual orchestration

Potential consequences Emotionality Sense of frustration Feelings of anxiety

Physical Stimming Sweating Shallow breathing Circulation changes

Cognitive Lower concentration Lower attention Lower information retention

Potential work consequences Longer work hours

Isolation from coworkers

Less time for breaks/rest

Lowered work motivation

Potential health consequences Disrupted sleep

Lowered self-esteem

Change in appetite

Loneliness

Anxiety

Burnout syndrome

Potential long-term consequences

Unemployment, hospitalisation risk of long-term unemployment Figure 2 From a stressor – poor visual orchestration – to burnout syndrome.

DESIGNING FOR NEURODIVERSITY

21

© BCO 2022

EQUITABILITY In this section we focus on the importance of equitability through design. While design cannot solve all the problematic factors listed here, it can play a role by creating equitable employment ecosystems. It is important to understand how to create a just society across all domains and bring forward social inclusivity for the neurodiverse community. Some important terms and factors to consider when it comes to office space and neurodiversity are discussed.

about their conditions. This is specifically relevant to people working as essential workers in the office space or the delivery workers coming into the building. There may not be avenues set up to even be able to ask for a break room that suits their sensorial needs, or spaces to go for restoration. Furthermore, they may experience sensory overload from machinery that are told is ‘out of the control’ of management, thus ending the conversation and possibly a person’s employment. Therefore, those who make spaces should consider equitable design, meaning creating restorative spaces that are accessible to all people, supportive acoustics in all areas and comprehensible wayfinding, so all those who interact with the space can selforientate easily. If the office space is playing its part in the ecosystem, it can alleviate the burden on the neurodivergent person and help dismantle inequitable social hierarchies.

RIGHT TO EMPLOYMENT In our society, employment is an important avenue for people to create self-determination and identity, and to provide for themselves and others. Neurodivergent workers received an added, tangible means of protection in the UK with the passing of the Equality Act 2010, as they are likely to be considered ‘disabled’ within the meaning of the Act, and disability is a protected characteristic.81 Even though the definition of ‘disability’ in this legislation focuses primarily on conditions that affect a person’s ability to carry out their day-to-day activities, the important factor is how it provides legal protection against discrimination, harassment and victimisation that relates to a person’s condition. Employers also have a duty and responsibility to orchestrate an employment ecosystem that can support natural variances in human experience, as everyone has the right to employment.

WHO HAS THE JOB SECURITY TO TAKE DAYS OFF FOR RECOVERY? Not everyone is offered job security. For example, a person on a zero-hours contract will not be paid for sick days, or a person may be in a position with little autonomy. Such people may not have the ability to ask for days off to recover from stress, and may experience a sense of being overwhelmed, or even succumb to burnout syndrome. Therefore, office design needs to consider how those who have little or no agency can be supported.

INTERSECTIONS WITH RACE, GENDER AND CLASS

GASLIGHTING Gaslighting is a societal colloquialism that can be understood as a set of behaviours, actions and statements that make someone question their own reality.75 This, in turn, takes away the person’s agency and, with long-term exposure, can lead to lowered self-esteem. In the workplace, many individuals or organisations may not have a common understanding of how conditions under the neurodiversity umbrella manifest or feel. When this is paired with an absence of tools or resources to understand neurodiversity, it can lead to organisational gaslighting of a neurodivergent person. As we were told in the interviews, this can range between something as subtle as being told ‘you are being too sensitive’ to something more systemic such as ‘being talked over and ignored’ whenever a person brings up a complaint about the space. The gaslighting of neurodiverse people is not only incredibly mentally debilitating and harmful, but it can also prevent them from accessing services, either due to stigma about requiring support due to an undiagnosed or non-pathological condition, or due to financial implications for the workplace. A way to alleviate some of this social stress is to create varied and flexible spaces that neurodiverse people can adapt to their daily needs with little managerial intervention.

Neurodiversity can intersect with racialisation, gender discrimination or class marginalisation. Therefore, it is important to understand how these additional societal burdens can impact equitability.

WHO HAS THE JOB SECURITY TO ‘COMPLAIN’?

• Creating spaces that feel safe for everyone is an essential consideration in office design. Of course, to achieve such spaces requires a collaboration between the physical space and the work culture. ■

• Racialisation can play a role in how well a person is heard. A racialised person we interviewed mentioned that their race has played a role in how they are taken into consideration, and that they often feel ignored or diminished.

• People who are non-binary or identify as a woman may have to navigate highly complex social hierarchies. They may also experience sexual harassment, gaslighting of their identity, discrimination or not being promoted. All of this can be very difficult to manage, especially for those who are neurodiverse, creating a plethora of stress points and the risk that a person will leave employment.

• Due to the way in which society is organised, a person’s class can remove their agency to ask for help, to apply for a promotion or to express discomfort. In one of our interviews, a person who works at reception expressed how they were often patronised or spoken over, and how this had an effect on how they perceived themselves.

As many industries move towards contract work, third-party employment and more nuanced work environments, such as start-ups, workers who are not near the top of hierarchies may not receive the protections that allow them to complain

DESIGNING FOR NEURODIVERSITY

22

© BCO 2022

THE OFFICE So far, we have focused on understanding what neurodiversity is, how it is experienced, and how it relates to the work environment, health and equitability. We now move from understanding to practice. We will look at the trends of how we create office spaces, and highlight the common pitfalls encountered when designing for neurodiversity. In addition, we will look in more detail at what is an enabling or disabling environment. As each person will have a unique experience of a space, rather than provide specific guidelines, it is more effective to create a set of principles that leave room for bespoke defining elements depending on the users and type of office space. We will be moving past the harmful stereotypes and look at designing for the equitable inclusion of neurodiverse people in the employment ecosystem.

Mitigation against extreme weather events vs climate impacts It must be recognised that any design solution must both mitigate against an extreme weather event as well as have no further impact on the planet. For example, cooling and heating a space through innovative insulation solutions such as a green roof rather than installing an HVAC system. ■

with wayfinding and navigation in the workplace due to flooding?

– What transport alternatives can be provided by the employer when flooding impedes a person’s commute (e.g. the provision of a taxi if a person becomes stranded in the middle of their commute)?

– What provisions can the employer make for a person to work from home in the case of extreme weather conditions, and to ensure that a person’s home office is more adequate?

TRENDS

– What are the provisions made in the office building should it become flooded and inaccessible?

It is important to root the office environment in macro-societal trends that will have an impact on the lived experience of neurodiverse people and their experience of the office. Two key trends have been identified: the climate crisis and hybrid working.

– In the event of an inability to access transport to reach a workplace, what systems are set up that allow a person to readjust with ease and not experience undue stress that can take hours to recover from?

• Heatwaves will become longer and more prevalent in the UK, affecting people’s quality of sleep and personal comfort, as well as the office environment.86

THE CLIMATE CRISIS The climate crisis is the result of the changes in the climate patterns due to contamination that is depleting and changing the biodiversity of the Earth.82 For instance, it is predicted that 15% of species are at threat of extinction due to urbanisation and pollution, which are major contributors to the climate crisis.28 Climate change impacts all aspects of human life, including how we execute work. In the UK we are already seeing disruption to supply chains, energy supplies, housing stability and transport,83 and there are even predictions that entire coastal towns will become uninhabitable in the very near future.84

– How will it be possible to cool offices without relying too much on HVAC systems the use of which can add to the climate crisis?

– How can green spaces and other outdoor spaces be improved to provide shade and thus cooling during heat waves? It is important that people can use these spaces all year round.

– In the event of extreme heat on a given day, how do employers, building managers and place makers provide solutions that enable a person to keep to a routine that involves outdoor activities?

The various changes that will come from the climate crisis will affect the daily lives of people. Below we delineate a potential set of consequences.

• Extreme cold weather events will also increase. In the winter of 2021/22 alone, the UK faced three major storms that caused mass power cuts.

Extreme weather and mobility This intersection will pose the most significant changes for people who are neurodiverse, as extreme weather (flooding, heat, cold, wind) can change how a person navigates an environment and so affect their ability to access resources such as employment. Here are some examples of what this could look like.

– How will neurodiverse people working from home be supported when there is a power cut?

– How will the usual support provided by the office space be altered during extreme cold weather?

– How will outdoor spaces be altered so that they are still accessible in periods of extreme cold weather?

• Flooding can affect transport routes, access to the office building or even the safety of a person’s home.85

– How will entrances to the building need to be changed to make it physically safe to enter the building and keep the cold out?

– What resources can be provided by an employer that can mitigate the stresses arising from difficulties

DESIGNING FOR NEURODIVERSITY

23

© BCO 2022

HYBRID WORKING

“I ask to work three days per week in

the office, the rest is done at home or other places like libraries that are quiet.

”

“Different days may require different needs, therefore considerations for working from home are necessary – this should be a standard.

”

Interviewees

Hybrid working is a model of workforce management that allows typically desk-based employees to work from a variety of locations and perform their work without disruptions.

Companies across the world have been embracing this method for many years, but the COVID-19 pandemic has turned a niche employee benefit into a mainstream work model. While some firms embrace a remote-first approach87 and others an office-first approach, hybrid working appears to be a solid middle ground that meets both employee life-satisfaction goals and business productivity, and there are no overt rules other than those designed between employees and management.

As a result, many companies have sought to reduce their office footprint and shift the style of work that takes place in the office.88 Currys, the global technology company, recently announced it was moving from its traditional headquarters in Acton, West London, to WeWork flexible office space in Waterloo, with the company’s CEO Alex Baldock quoted as saying, ‘We are really excited to unlock the potential of truly hybrid working and believe that being innovative today will prepare us for how we adapt to new ways of working in the future.’89 The use of office space is becoming increasingly intensive, with less square footage being used by more people for more tasks in a time-intensive manner. GoSpace has developed software that enables companies to make the most effective use of their office space by adjusting space allocations to meet individual and team needs, and so minimise their impact on the environment.90

Copyright Overbury

• Are amenities being introduced to buildings that are designed to cater for those who need to destress, as well as amenities for those seeking entertainment, culture and lifestyle?

Responding to the needs of neurodiverse employees means considering the negative externalities that can come with rushing to adopt innovative solutions.

Considerations • A neurodivergent employee should be given the option to have a digital walkthrough of a new work environment, so that they can prepare by creating their own landmarks and not having to guess on the spot.

• Occupier layouts should account for those who need to be in a place for longer than their ‘allocated’ time. For example, quiet workrooms that are located away from entrances and collaboration rooms could be provided. For smaller buildings, occupiers and property managers should discuss with employees the design and management of shared amenities such as rooftops or lounges.

This shift in the way people work poses key questions for real estate developers, managers, designers and occupiers.

• If a building/floor becomes busier in activity, its design should become more muted through aspects such as dimmer lighting, softer carpets (that absorb sound) and simpler colour palettes.

• Will this intensification of the use of office space make it an excluding environment for those with sensory sensitivities?

• Will the overt scheduling of people reduce the ability of neurodivergent (and normative) employee to destress and rebalance after a commute, and then prepare themselves to be productive?

DESIGNING FOR NEURODIVERSITY

24

© BCO 2022

HOUSING AND THE COST-OF-LIVING CRISIS The quality of the neighbourhood in which people live has an influence on their health and wellbeing. Environments with clean air and the absence of noise and light pollution can contribute to a neurodivergent person’s ability to restore their biological systems. This is important for those in the neurodiversity community as they need to rest and recover from the stressors of their commute and working day, and also creates a feedback loop back to the office ecosystem. A person who is more rested will have a higher capacity to mitigate the stressors at work; and, equally, a workspace with a lower stress burden will allow a person to rest better at home.

Another stressor is the ‘cost of living crisis’, which can have a psychological effect on people that triggers the physiological stress response. Many people are worried about being able to afford basic necessities, and this can have two consequences.

First, it can affect the agency a person has to voice their needs in the work setting, due to a fear of being fired or not being promoted. This can put people in the neurodiversity community in situations that cause high levels of stress.

Second, the mental stress that comes from financial worry can have an effect on sleep, digestion and general health, which can lead to sick days or contribute to burnout syndrome.

Lastly, as detailed in this report, there is great insecurity for neurodivergent people with regard to staying in employment in companies that have not made the necessary cultural changes, resulting in them being dismissed or feeling forced to leave.

Furthermore, a person may have moved to a particular area to take that role, and committed to a financial agreement for housing that puts them at risk of stress and ill-health unless their next employer offers similar financial opportunities.

means that employees must choose between increased Copyright Benjamin Elliott | Unsplash

commuting times or sacrifices in the quality of their homes?

• What is the role of employers and investors in setting standards for housing?

• How does an employer/investor ensure that good environmental, social and corporate governance (ESG) structures are in place to mitigate against the public risks of business and open markets?

On 13 April 2022, the UK government’s Committee of Public Accounts released a report91 stating that ‘Despite record rent increases, 13% of rented homes “pose serious threat to the health and safety of renters” – costing the NHS an estimated £340 million a year’. Due to market forces, the challenge of finding a safe, healthy, well-located home is tough for many, but the consequences of poor housing for neurodivergent and immunocompromised people are far worse. Ending up in a home that is unsafe and unhealthy, and in an area where there is air, noise, light and heat pollution poses a health risk that can be disabling for these people.

Considerations • Many large businesses and occupiers employ residential relocation consultants to support transitions to new areas. Can this service be introduced during employment procedures to support the wellbeing of employees?

• Micro-budgets and support for home improvements such as double insulation, black-out blinds and advice on home economics are simple fixes that mitigate against urban stressors.

Understanding how the housing and cost of living crises affect neurodiverse people can help contextualise the need for supportive office space. In other words, neither suitable housing nor a suitable working environment is merely a ‘nice to have’.

• Special travel allowances could be considered if an office is located in an area that has a low diversity of transport options. For offices in London, TfL’s WebCAT PTAL scoring system (a measure which rates locations by distance from frequent public transport services) can be used to identify whether this is an issue.92

This economic challenge poses a few key questions for the built environment sector: • Is locating a company’s office space in a central business district a suitable choice when the cost-of-living increases and the high cost of housing in or near to such an area

DESIGNING FOR NEURODIVERSITY

25

© BCO 2022

ENABLING AND DISABLING ENVIRONMENTS

Characteristics of disabling spaces • They curtail or impede the ability of the user.

• They create inequitability through creating obstructions to or reducing the ability of the user.

DISABLING ENVIRONMENTS

• They create unnecessary stress for the user.

Before looking at the principles of an enabling environment, we first identify the various factors that can make a space disabling to neurodiverse people. A disabling environment is one that does not offer adequate physical elements to support the work of neurodiverse people, resulting in a disabling of their abilities.

For example, a steep staircase that has no handrails will disable the ability of a person with dyspraxia to move freely up and down the staircase.

• They do not provide opportunities for self-autonomy, as they reduce choice.

• They reduce the dignity of the user, which means reducing their self-worth or value. ■ "I don’t like places that feel cluttered or where I can’t make any changes."

"An open-plan office – could not concentrate or focus, because of the lights, noise and all of the activity. It made me feel overwhelmed and needing a calming space."

ENABLING ENVIRONMENTS An enabling office space provides all users with the physiological, cognitive and psychological means to fairly participate in all aspects of employment.

"I don’t like ambiguity, where things are not properly or clearly laid out."

Interviewees

The boxes in the opposite column list the characteristics of disabling and enabling environments; the lists were compiled from the responses given by interviewees in the interviews. ■

Characteristics of enabling spaces Equity – A space that shows an understanding of the root causes that influence people’s needs.

Safety – A space that provides a sense of psychological safety to people that they will not be made vulnerable by poor decisionmaking.

Intuitive – A space that is created with intent rather than ego, that is clear to use and that does not leave a person guessing.

Healing • A space that lessens the biological stress burden through the design of comforts and physical elements, ensuring environmental consistencies and freedom for all people to use the space based on their personal needs.

• A space that shows an understanding of how various physical comforts can support mental and physical health.

Diverse – A space that is agile and intentionally offers a variety of options to meet the varying cognitive demands (social, restorative, concentration) on a given day.

Dignity – A space that allows a person to belong, to know that they are no longer othered or made vulnerable.

Ecological – Design solutions should not place any further burden on the Earth’s systems, and should play a role in mitigating the climate crisis. ■ "Create varied spaces or zones; do not create universal design practices."

"A space should be able to be altered and design should be iterative to adjust to the various users interacting with the space at various times."

"It would be great to have autistic pods, where I could go if I needed time away from the work area and where I could control the sensorial experience."

Interviewees

DESIGNING FOR NEURODIVERSITY

26

© BCO 2022

OFFICE DESIGN AND INSIGHTS In this section we take the learnings and understandings from the previous sections and put them into a design language, with practical tools, frameworks and insights. The section covers key definitions, design methods and insights, and ends with various best practice design examples.

Term Space

Parameters An office space contained within a lease; the concern is mostly with category B fit-out issues.

Interior designers Architects Specialist consultants Engineers Occupiers

Building

“Neurodivergent people can’t be held

at a constant – there is variance between people and within a person.

”

Interviewee

The architectural, engineering and asset management decisions when designing a building; the concern is mostly with amenities, category A fit‑out and mechanical and electrical (M&E).

Developers

A development that has outdoor and public realm space. This can range from a small courtyard to a multi-hectare site such as a campus or business park.

Developers

DEFINITIONS In this section we define terms used within the arena of the built environment in order to build a common lexicon and lay out a set of roles and responsibilities.

Place

BUILT ENVIRONMENT – DEFINITIONS

Investors Architects Structural engineers Mechanical engineers Property managers Consultants (acoustics, lighting, wayfinding, digital/interactive, furniture fixtures and equipment (FF&E), access, biophilic, etc.)

Investors Landscape architects Architects Civil engineers Property managers

Terms used for areas of the built environment, and the roles associated with these areas, are given in Table 4.

DESIGNING FOR NEURODIVERSITY

Relevant practitioners

Table 4 Definitions of terms used for areas of the built environment, and the roles associated with them

27

© BCO 2022

COMFORTS – DEFINITIONS

sensorial experience, and therefore there is crossover between them. The experience of each comfort varies from person to person, and for each person it varies and from day to day.

Therefore, the provision of these comforts needs to be wide ranging, and there should be some means for the personal control of these.

Comforts are a series of sense-based modalities, and a person should feel a sense of physical and psychological stability or a lack of burden arising from biological stress. The various comforts within an office space are listed in the box below.

All of these comforts are felt simultaneously as part of the full

Comforts within an office space Thermal

Touch

The temperature within a space. A sustained temperature that is biologically too hot or cold, or sudden temperature changes that can be perceived by a person’s biological stress response as too hot or too cold.

This relates to how a surface feels to the touch in terms of both its texture and its temperature. For example, a cold surface can be biologically uncomfortable for someone with a hypersensitivity to temperature changes, or a material can cause an allergic skin reaction.

Auditory

Navigation

Noise pollution, which is the exposure to unnecessary or excessive auditory stimuli. This can be people speaking, sudden sounds from human activity, music, sounds from machinery, etc.

• Light: Brightness of light sources (natural or artificial); glare on surfaces, including computer screens and walls; frequency of light; flickering light; too little light.

This relates to how a person moves within space. Wayfinding is a key element that can help a person feel orientated and that they belong in the space. There should be no physical obstructions, such as clutter, steep stairs, a lack of lifts or slippery surfaces. Navigation is also about space, especially for those with dyspraxia. There should be enough space for a person using physical aids to move easily, or to move their body freely and safely. Narrow paths or hallways, for example, can obstruct movement.

• Visual noise: People coming and going within the person’s visual sphere of gaze; clutter, visual obstructions and poor sight lines; patterns on the walls, floor, ceiling or furniture; etc.

Orchestration – The synchronicity of a space, how all the various stimuli come together to make one experience. The comfort or discomfort of a stimulus is perceived depends on how it fits within the wider ecosystem. ■

Visual There are two pathways: light and visual noise.

Olfactory There are two pathways: odours and air quality.

DESIGNING FOR NEURODIVERSITY

28

© BCO 2022

BUILT ENVIRONMENT TYPES AND ROLES The types of built environment practitioners and the roles they play in creating an enabling environment for neurodiverse people are listed in the box below.

Built environment practitioners and their role in creating an enabling environment Investors

solutions that do not make a sustainable building at the cost of sustainable human performance. The acoustic and lighting fit-outs require particular consideration in this regard.

Investors should include new guidelines and indicators in their ESG agendas. This will support institutional change throughout the industry.

Consultants

Clients/developers

Consultants, in their varied roles (acoustics, lighting, wayfinding, access, digital/interactive, FF&E, biophilic, etc.), have a responsibility to be mindful of end users and to educate others in the supply chain about the real-world impact of certain choices.

The client has the ultimate responsibility for setting the principles for the project and the guidelines for the product.

Developers have some of the greatest agency with regard to making change in how people experience cities. Instructing multi-disciplinary teams to follow new guidelines is key.

Building management

Planners

The role of building management comes into its own in the post-occupancy stage. Therefore, building managers have regular contact with tenants and their employees via surveys/engagement apps, and can identify what alterations could be made once the building is in use. Knowing that change is possible demonstrates that equity is being given to people who may otherwise feel the world is unwelcoming to, or ignoring, them.

Public planners should set criteria around the collaboration between developers, transport authorities and those who manage the public realm.

Private planners should liaise with local authorities to express their client’s and investors’ ambitions around the desire to have a neurodiversity inclusion urban area and discuss what collectively can be done.

Landlords

Designers

Landlords should have regular interaction with occupiers’ human resources teams and work closely with building managers to implement any alterations identified as necessary.

Designers (architects, interior designers/architects, landscape architects, etc.) need to consider the balance between design and experience, with the latter defining the occupier’s business concerns. Designers should consider how those who are neurodiverse may experience a certain design aesthetic. The small details can be everything in terms of whether a person feels that dignity has been given to them.

Occupiers and employers Occupiers and employers need to support their neurodiverse employees and ensure that the spaces they provide and the culture they foster are enabling. When considering taking a new office space, occupiers and employers should consider taking a diverse range of people to viewings. ■

Engineers Throughout the design and development of offices, engineers (civil/structural, M&E, environmental, etc.) need to find

DESIGNING FOR NEURODIVERSITY

29

© BCO 2022

DESIGN METHODS

Prototype stage Design concepts should be tested to ensure that they translate from concept to real-world application. This is also a good time to learn how to enable interactions and to address blind spots.

The main takeaway is that, like all communities, the neurodiversity community is complex and contains a wide range of people with a wide range of needs. Therefore, each office space is an opportunity to build a unique and nuanced relationship with the people who will inhabit that space. This starts with creating a set of methods that will delineate how the design team, client and employees will engage in an equitable collaboration with the purpose of creating an enabling environment.

• Method 1: Leave room in the designs for changes to be made after consulting with neurodiverse employees.

• Method 2: Create pathways for feedback from the users.

Maintenance stage Improvements can, and should, be made over the long-term management of the building, and there should be the flexibility to enable quick changes to be made to accommodate new people or to adjust to changes in the needs of people.

Suggested methods (a particular procedure) for each stage of the design are listed below.

Observation stage

• Method 1: Conduct periodic surveys to understand if the needs of those who are neurodiverse have changed.

Time should be set aside to observe people and place in order to fully understand the various and nuanced needs of the user.

• Method 2: Periodically, bring in a mental health expert to conduct workshops on burnout syndrome. The aim is to both educate staff about the syndrome, and thereby prevent it, and to identify employees who may already have symptoms and to avoid them spiralling into burnout.

• Method 1: Conduct a survey of potential or current employees.

• Method 2: Observe employees in situ across different times of the day, and on different days, to build up a ‘day in the life’ composite. This will provide a full understanding of the any obstacles and the nuances associated with the use of the space.

• Method 3: Create pathways of communication through which people can state their varying or changing needs of the space.

• Method 3: Hold ‘town hall’ meetings at which employees, employers and designers can discuss their needs and concerns.

DESIGNING FOR NEURODIVERSITY

• Method 4: Make iterative changes to the space based on feedback from workshops, surveys and communication pathways.

30

© BCO 2022

DESIGN INSIGHTS

stress relevant to each category, together with recommendations for design.

In this section we look at categories within places, buildings and spaces. Tables are given that list the elements, comforts and potential points of

The categories of design insights and their hierarchy are shown in Figure 3.

Level of specification Low

High

Principles Principles are a foundational understanding of a subject.

They exist to guide thinking and the overall aim to be achieved.

Recommendations

Guidelines

Regulations

Principles are a foundational understanding of a subject.

They exist to guide thinking and the overall aim to be achieved.

Guidelines are cultural. They are a series of parameters for people to follow to achieve consistency. Readers of this report should apply the principles and recommendations in their own guidelines (e.g. a building owner should apply them to their branding and their cultural approach to placemaking).

Regulations are set by law to protect interested parties.

For example, health and safety regulations have existed for many years. The aim should be for the wider built environment industry to undertake research to encourage the making of regulations to protect the mental health of people.

What this report provides

What this report helps to work towards

Figure 3 The categories of insights and their hierarchy.

DESIGNING FOR NEURODIVERSITY

31

© BCO 2022

PLACE Type: Developers, investors, landscape architects, architects, civil engineers, property managers Areas of focus: Public realm, landscaping, building entrances Category Transport

Elements

Relevant comforts

Potential points of stress

Links

Auditory

Public works creating noise and obstructions

Public works

Visual

Confusing wayfinding between buildings and transport links (the experience of a building starts long before someone crosses the ‘red line’)

Navigation Orchestration

Roadworks that are loud or change access to paths and pedestrian throughways Crossings where the traffic is too fast

Applied design recommendations Landlords should create an audio-visual accessibility guide based on a digital twin that advises user journey experiences by permeability and navigation style.

Landlords and property managers should provide high levels of advice to occupiers when major works in the local area are due to take place, ensuring that those who may need to re-learn routes have the time and resources to do so.

Wayfinding designers should pay special attention to crafting clear pathways to essential public amenities and spaces.

Developers and landlords should investigate with local authorities and transport authorities whether timings on pedestrian crossings are inclusive of those who have mobility differences.

Landlords, occupiers and developers should work with local transport authorities or major train/bus station managers to discuss wayfinding signage.

General campus

Wayfinding

Thermal

Confusing wayfinding

Obstructions

Auditory

Obstructions impeding safe physical mobility

Hygiene

Visual

Uneven sidewalks

Crossings

Navigation

Noise from busy traffic

Signage

Touch

Rubbish on the pathways

Traffic

Orchestration

No rest areas

Involve accessibility consultants in the pre-design stages (not as an afterthought) to provide guidance on issues around surface materials.

Where possible, use natural materials and architectural engineering to reduce noise transfer from busy roads into campus areas.

Sidewalks

Rest areas located near high human or car activity

Ramps Pathways

Rest areas that do not have thermal comforts/do not offer shelter from weather

Rest areas

No bathrooms

Bathrooms

Bathrooms that are not visible or are poorly located Poor orchestration of physical and design elements, making the campus confusing, noisy and overstimulating

Provide a diversity of seating options that meet different needs, such as sitting alone or in groups.

For larger campuses, provide bathrooms located outside the main buildings, unless there are facilities that are a short distance from and can be easily reached from public realm space.

A microclimate analysis should be done to limit the occurrence of wind tunnels and heat islands.

Access that is not mobility friendly Uncomfortable or hazardous wind climate Natural spaces

Green environment

Thermal Auditory

Seating areas that do not have thermal comforts/do not offer shelter from the weather

Blue environment

Visual

Materiality that is not thermally comfortable

Navigation

Noise from human or car activity

Touch

Smoking areas that are too close to non-smoking areas

Olfactory

Poor orchestration (e.g. a play area next to a respite area)

Seating areas Access

Orchestration

Access that is not mobility friendly Wind tunnels

Communal spaces

Seating

Thermal

Shading

Auditory

Materiality that is not thermally comfortable (during extreme weather)

Configuration

Visual

No shelter from the weather

Access

Navigation

Noise and high visual activity from areas of high human and car activity

Touch Orchestration

Smoking areas that are too close to non-smoking areas Poor orchestration of physical and design elements (the campus feels confusing, noisy and overstimulating) Access that is not mobility friendly

DESIGNING FOR NEURODIVERSITY

32

Provide a range of ergonomic furniture that can be used by people to reside in green/blue environments.

Avoid the use of pesticides and chemicals on any surface that may come into contact with human skin (to reduce irritation).

Work with ecologists to ensure that the biodiversity supports the creation of a healthy microbiome.

Provide shelter from the weather.

Where possible, minimise the exposure to smoking areas and prohibit people from smoking near building entrances or within communal seating areas.

Provide a range of ergonomic furniture to support people with mobility differences.

Provide designated quiet outdoor spaces away from busy areas that have shelter against the weather.

Even smaller, older buildings may have a courtyard or small outdoor space; consider creating a mini green oasis that is designed as a calm space.

© BCO 2022

Examples

Sheltered outdoor areas

Outdoor working areas

Copyright Peter Bennett/Trilogy Real Estate LLP and LaSalle Investment Management

Copyright Lendlease Europe

The outdoor seating areas at Trilogy Real Estate’s Republic London development in east London is a good example of the provision of outdoor areas that are sheltered from the elements and away from main entrances.

At International Quarter London, Lendlease created outdoor working areas that are away from main entrances and nearby roads, surrounded by greenery and can be used throughout the day.

‘In between’ spaces/courtyards

Outdoor furniture

Copyright kmilomontes12 | Unsplash

Copyright Aurélien Langlais/Lendlease Europe

For smaller ‘in between’ spaces and courtyards, aim to add greenery and relaxed seating to allow for restoration at any time of the day.

DESIGNING FOR NEURODIVERSITY

At Elephant Park, Lendlease introduced a range of ergonomic outdoor furniture and considerations for wheelchair users, such as setting the furniture back from a path, allowing for inclusive seating environments.

33

© BCO 2022

BUILDING

“Supporting people with various disabilities through the built environment should be part of regulatory health and safety.”

Interviewee

Type: Developers, investors, architects, structural/mechanical engineers, property managers, consultants (acoustics, lighting, wayfinding, digital/interactive, FF&E, access advisors, biophilic, etc.)

Areas of focus: Entrance/exit, security, reception area, waiting area, atrium, shared circulation space, recreational space, parking/cycling areas, washroom facilities Category

Elements

Front of building thresholds

Entrance/exit

Thermal

Relevant comforts

Barriers

Auditory

Entrances that are not clearly marked and thereby cause confusion

Potential points of stress

Security

Visual

Entrances with no physical mobility access

Reception area

Navigation

Entrances that are not well lit

Touch

Waiting area

Olfactory

Entrances that are narrow with a lot of people movement

Atrium

Orchestration

Entrance barriers that require passes Poor orchestration making the entrance feel loud, cluttered and overstimulating Reception areas that are far from the entrance or not clearly defined Tall atriums, creating noise, visual noise and thermal extremes Confusing doors Doors that are too heavy or difficult to grasp Loud doors that create salient and unexpected noise/movement Waiting areas that are too open and feel noisy, cluttered or poorly orchestrated Poor access to bathrooms Obstructions to throughways Floor materiality that can cause mobility issues

Applied design recommendations For larger buildings, provide two entrances if there is a desire to have an active lobby space, thereby allowing building users to access office space without engaging with sensorially stressful environments.

Ground-floor lobbies should have a diversity of seating options, allowing people to find calmer spots and destress from potentially hectic urban commutes.

Designers and architects should consult with accessibility consultants early on to determine ideal movement patterns.

For larger buildings with high levels of street frontage, provide a distinct design that guides the person to the entrance.

Allow for self-check-ins through technology.

Instruct welcoming personnel to wait to be approached rather than vice versa.

Provide clear access to washroom facilities.

Prevent people from smoking in front of the building.

Where ceilings will be high, consider using softer materials on floors, walls and ceilings to prevent noise reflection.

Materiality of floors that creates glare can create visual impairments or confusion Smokers at the front of the building Continued

DESIGNING FOR NEURODIVERSITY

34

© BCO 2022

Category Circulation space

Elements

Relevant comforts

Potential points of stress

Applied design recommendations

Hallways

Thermal

Stairwells

Auditory

Poor signage that could make finding stairs or lifts confusing

Ensure consistency in your approach to designing circulation spaces and avoid unnecessary surprises.

Lifts

Visual

Digitally organised lifts that are difficult to decipher

Navigation

Lifts that do not have the capacity to carry a wheelchair user

Use colours or design to give spaces an easily recognisable identity.

Touch

Lifts that do not have handrails for those who use walking aids or have dyslexia Stairs that are not well lit Stairs that do not have a distinguishing fringe, thereby making it difficult to visually distinguish between steps Steps with no railings Steps with materiality that can make mobility challenging

Mechanical and electrical consultants/engineers, acoustic specialists, material specialists and lighting designers should be cognisant of providing well-lit and maintained areas, as well as inoffensive sensory experiences that are easily navigable.

Lifts • Consider implementing technologies that can give advance warning of how full a lift is.

Stairs • Do not make stairs too steep or shallow.

Stair materiality that creates unnecessary noise

• Provide adequate handles and bannisters.

Stairs that are poorly located in relation to the building flow

• Avoid using thermally conductive materials on elements that will need to be touched, such as bannisters. Where possible, use natural materials such as wood that are gentle to the touch and have indirect biophilic qualities.

Stairs that are too narrow can cause movement stagnation Stairs that are too steep and thereby present mobility challenges Stairs that are too shallow can be trip hazards, especially on the way down Electric staircases that are noisy due to poor maintenance Hallways that are poorly lit, thereby making navigation more challenging

• Design stair noses to be distinct and visible.

• Provide acoustic protection to avoid harsh, noisy stairwells • Avoid harsh lighting.

• Design clear wayfinding (floor numbers and signs indicating the location within the building).

Corridors

Hallways that are narrow, thereby creating poor movement

• Do not make corridors too narrow; ensure that there is space to pass someone else comfortably.

Hallways that create poor wayfinding within a building

• Avoid long corridors with repetitive elements.

Hallways that have materiality which creates unnecessary noise

• Keep design and signage simple, clear and muted to avoid unnecessary confusion and stress.

• Offer wayfinding markers adjacent to doors/ entrances, not just on them, to set a sense of place/context.

Continued

DESIGNING FOR NEURODIVERSITY

35

© BCO 2022

Category Shared amenities

Elements

Relevant comforts

Potential points of stress

WCs

Thermal

Showers/ changing rooms

Auditory

Toilets that are poorly located in relation to the flow of movement

Visual

Toilets that have heavy doors

Navigation

Toilets that have door handles that do not allow for a good grip or are difficult to open

Bike storage Rooftops Cafeterias

Touch

Toilets that are not well maintained or are out of order, forcing people to go to another floor, creating a mobility issue Toilets with materiality that makes them unnecessarily noisy

Applied design recommendations Ensure that the air circulation and climate control is similar to that of the office space or is adaptive/ smart to the levels of people in the space.

Consider more fixed furniture in places such as cafeterias in order to reduce the risk of unwanted noise.

Offer fixed and placed barriers, such as cubicles in changing rooms, instead of largely open-plan layouts.

Showers or changing rooms that cannot be used by those with mobility aids or wheelchairs Showers or changing rooms that have materiality that can make mobility challenging Bike storage facilities that are difficult to access either due to wayfinding difficulties or from a safety perspective Rooftops that do not offer clear non-smoking areas Rooftops that do not offer thermal comforts Rooftops with wind tunnels Rooftops that do not offer quiet spaces or sheltered spaces Cafeteria spaces that are loud due to materiality, spacing and/or poor sound orchestration Cafeteria spaces that make mobility difficult due to seating, access to food or overcrowding, or that are located in areas of the building that are difficult to access Cafeteria spaces that do not offer a variety of seating arrangements or shelter from human activity Continued

DESIGNING FOR NEURODIVERSITY

36

© BCO 2022

Category Breakout/ third spaces

Elements

Relevant comforts

Potential points of stress

Meeting rooms

Thermal

Meeting rooms that are poorly ventilated

Auditory

Phone booths

Visual

Meeting rooms that lack controls of harsh or low lighting

Restoration spaces

Navigation

Conference facilities

Touch

Meeting rooms that are located near quiet or overtly busy workspaces A space that does not have a place for phone calls No restoration spaces

Applied design recommendations Consider having ‘library’-style rooms as third spaces across the building that can be accessed by all but have an agreed work culture.

Ground-floor lobbies should have a diversity of seating options to allow for people to find calmer spots and destress from potentially hectic urban commutes.

Restoration spaces that cannot be sensorially manipulated

In larger buildings that offer event spaces, ensure that the fit-out has a diversity of lighting sources.

Question whether a space genuinely needs large overhead lighting.

Third spaces that are too exposed to busy throughways or environments

If there are high levels of natural light, use design applications that diffuse and/or control at source.

Third spaces with ergonomics that are too casual ergonomics (unable to work effectively in the space)

In larger buildings, provide dedicated restorative spaces for people to adjust and recover after their commute in preparation to start their workday.

These spaces should be:

Restoration spaces that are also storage spaces

• Private: – have a door to the space – include partitions to enable extra privacy within the space if it will be used by multiple people – access from the main circulation spaces without having to go through office space.

• Calm: – a modest design with muted colours – textures and materials that are relaxing and natural (quality and consistency is better than quantity) – biophilic elements that have restorative qualities (plants and open soil beds; natural materiality; views to the sky, if possible).

• Adaptable to personal requirements: – dimmable and moveable lighting; avoid overhead LEDs that use an alternating current system that results in flickering – personal control over the climate/environment either through digital interfaces that link to the building’s control system, or through adjustable radiators, fans, openable windows, etc.

– non-fixed seating that is easily moveable (on wheels or lightweight) – elements may be fixed yet allow for partial adaptions changes to the shape of the space by having some moveable partitions.

Continued

DESIGNING FOR NEURODIVERSITY

37

© BCO 2022

Category Engineering

Elements M&E

Relevant comforts

Potential points of stress

Applied design recommendations

Thermal

M&E facilities that produce noise and air pollution

Auditory

HVAC systems that do not work properly and thereby add to indoor air pollution

M&E consultants/engineers, acoustic specialists, material specialists and lighting designers should be cognisant of providing well-lit and maintained areas, as well as inoffensive sensory experiences that are easily navigable.

Visual Navigation Touch

M&E facilities that create fluctuation in environmental temperatures

Acoustic specialists and building control contractors can work together to separate heating and cooling operations to minimise noise pollution and maximise the efficiency of both units.

Acoustics specialists should pay special attention to large and enclosed areas, such as cafeterias, which may have many users and are prone to excessive noise levels.

Consider installing dynamic glass that automatically reduces glare from direct sunlight.

Ensure consistent yet programmable heating and cooling ‘zones’ with an adequate user-friendly interface.

Wayfinding

Entire building

Thermal

Physical obstructions impeding mobility

Auditory

Visual noise (e.g. glare, reflections or human activity) impeding mobility

Visual Navigation Touch

Materiality that creates auditory noise, and thereby disorientation Poorly placed mobility aids Auditory noise can cause stress, and thereby contributes to disorientation

Consider personal digital wayfinding aids and digital walkthroughs, rather than printed or onwall maps which can be very confusing.

Use digital twins or CGIs/renderings to produce a website-friendly digital walkthrough of the building to enable people to do a dry run of their route.

Provide clear alternative routes that allow the option to bypass particularly busy spaces, corridors and lobbies.

Occupiers can work with building management to create a digital walkthrough of the entire building that will enable people to prepare as much as possible for their journey and lessen the risk of feeling vulnerable.

Restrict the use of contrasting patterns for flooring and walls.

Provide heat maps of busy times.

DESIGNING FOR NEURODIVERSITY

38

© BCO 2022

Examples

Distraction-free work space

Audio-visual navigation

Copyright Ben Gilbert, Wellcome Images

Copyright BindiMaps Pty Ltd

The open library at the Wellcome Collection, London, is a great example of muted, distraction-free work spaces. Note the overhead lighting option and lightly shaded windows.

Australian start-up BindiMaps provides a smartphone audiovisual navigation app that supports navigation of large assets such as multi-tenanted office buildings with large floor plates and shopping centres.

Distinct design features

Variable lighting

Copyright Gooding Aluminium Ltd

Copyright domlafou | Unsplash

Provide distinct design features to support areas such as stairwells.

DESIGNING FOR NEURODIVERSITY

For larger shared spaces such as auditoriums, provide variable lighting.

39

© BCO 2022

SPACE Type: Interior designers/architects, specialist consultants, facilities managers, engineers, occupiers Areas of focus: Office interior (category B), desk spaces, breakout/meeting rooms Category Office interior

Elements

Relevant comforts

Potential points of stress

Windows

Thermal

Materiality that adds to air pollution

Doors

Auditory

Materiality that adds to noise pollution

Ceiling heights

Visual

Flooring that can cause excess noise

Navigation

Layouts

Touch

Ceilings that create visual disturbances (e.g. glare or reflections) Ceiling heights that can add to noise levels Ceiling heights that are too low, which adds to poor thermal comfort, visual noise, poor ventilation, few or no windows, etc.

Poor lighting throughout the office Poor ventilation and poor air quality that can add to fatigue and lowered immune function Poor humidity regulation: humidity that is too high or too low can be problematic for the comorbidities of neurodiverse people (e.g. eczema)

Applied design recommendations Where possible, provide a diversity of lighting setups, such as desktop lamps, floor lamps, uplighting wall units and overhead lighting. Avoid LED lights, where possible, due to their tendency to flicker and cause headaches.

FF&E and acoustic specialists should locate noisy office equipment (e.g. printers, server rooms and coffee machines) and other possible sources of sudden noises within reasonable convenience but away from independent focused workspaces.

Use biophilic design elements (e.g. vine walls) to break up unnecessary visual sightlines.

Provide other options (e.g. semi-transparent panelling) to break sightlines to busy areas.

Minimise sensory overload by limiting the number of colours and patterns.

Poor acoustics (which increase decibel levels), making it difficult to hear, and elevating stress and blood pressure

In more open-plan environments, lower noise levels with acoustic buffering and through the choice of materials or furniture.

Windows that cannot be covered to reduce glare or provide thermal comfort

Provide the ability for employees to give non-verbal cues. This may be through providing badges or built-in indicators that suggest whether people are open to communication or would rather be left alone to work.

Workstations facing busy windows, thereby causing distraction or visual noise Workstations only in exposed or open-plan environments Doors that are loud Doors that cause mobility obstructions Doors that are difficult to open due to their weight or handles Floor plans that do not have intelligible wayfinding

Architects, interior designers, lighting designers and acoustics specialists should create serene and flexible arrangements, distanced from potential distractions.

Provide dedicated workspaces with a high degree of flexibility and adaptability so that an individual can change their sensorial environment.

Create spaces that allow people to work on their own without being completely isolated.

Provide furniture that is meant to be moved and adapted as per the specific requirements of employees.

Interior designers should provide varying and flexible arrangements for socialising and independent, focused work.

Where possible, reduce glare from windows that receive high levels of natural light by the use of either temporary means (e.g. semi-transparent shades or blinds) or dynamic glass.

Desk-top markers can help people non-verbally signify when they are happy to interact with others and when they would like to work without disturbance.

Continued

DESIGNING FOR NEURODIVERSITY

40

© BCO 2022

Category Amenity and breakout areas

Elements

Relevant comforts

Potential points of stress

Meeting rooms

Thermal Auditory

Break rooms can often feel too crowded, cluttered and noisy

Breakout spaces

Visual

Being subjected to sudden loud activities

Navigation

Being suddenly demanded to move elsewhere due to a lack of organisation or protocol

Touch

Applied design recommendations Do not patronise or infantilise through the design of breakout rooms. The overall design should be similar to other space but with a greater emphasis on comfort-level control.

Breakout spaces should offer varying degrees of sociability and privacy. Eating of food (mainly lunch) should, in principle, be allowed in all breakout spaces.

Provide places to rest that are separate from the main social spaces and kitchens. Rest spaces should be calm, uncluttered, have a door and, ideally, be highly adjustable.

Meeting rooms should have a diversity of lighting.

Strong overhead lights can cause headaches and be wasteful of energy when not needed.

Provide a clear indication of spatial programming, such as a booking system.

Office amenities

Kitchens

Thermal

Kitchens that bleed noise out into the work area

Printers

Auditory

Server rooms

Visual

Kitchens that are located in areas of quiet workspace

HVAC systems

Navigation

Kitchens that are small and overcrowded

Touch

Printers that are noisy

Provide sufficient insulation to prevent transfer of noise from machinery to working areas.

Printers located in areas where they cause trafficflow problems, adding to poor mobility and noise Printer rooms with no ventilation Printers that overheat a room Server rooms that spill out noise Server rooms near quiet work areas that create visual disturbance HVAC systems that do not work properly and thereby add to indoor air pollution HVAC systems that are loud

DESIGNING FOR NEURODIVERSITY

41

© BCO 2022

Examples

Combining multiple elements

Reducing visual disturbance

Copyright Rogojnikov&Sorokin

Copyright Christin Hume | Unsplash

This small office design by Studio RIS is good example of a small office combining multiple elements such as lighting choices, natural materials and semi-sheltered spaces.

A good example of a window frosting that is easy to apply and allows light in while preventing unnecessary visual disturbance.

Biophilic design elements

Variable lighting

Copyright Uncommon

Copyright Darren Carter | Morgan Sindall

An example of planting used to great effect.

DESIGNING FOR NEURODIVERSITY

For larger shared spaces such as auditoriums, provide variable lighting.

42

© BCO 2022

RECOMMENDATIONS FOR FUTURE REGULATIONS

7. The office floor plate should be designed to have a variety of possible spatial configurations in order to ensure maximum flexibility and adaptability throughout the building.

8. Secondary routes and entryways should be provided in addition to main circulation corridors and entry points. In these secondary routes:

This section proposes recommendations that should be adopted for elements of building design to make buildings more accessible to the neurodivergent community and to protect the mental and physical health of neurodivergent people.

a. long spans should be broken up by a variety of spaces b. in circulation routes, physical and visual stimulation, including sculptures, blockages and/or advertisements that clutter the space, should be kept to a minimum

1. Legislators should consider including in Part M of the Building Regulations suggestions and recommendations relating to neurodivergent users of the built environment.

c. building entry points should be designated as multi-use and for all users, rather than single-use (e.g. entries for bikes or deliveries).

2. Higher education courses should include modules on the neurodiversity movement and the lived experience of people who are neurodivergent. Educators have an instrumental role in setting agendas.

9. Areas of respite and relaxation should be provided in easily accessible areas on every inhabited floor, where possible.

3. A range of alternative routes/thresholds of entry with a sliding scale of restorative qualities should be designed into schemes, and should be available for use by all users. This is especially in the case for main entrances such as atriums or commercially activated spaces.

10. Schemes should provide a range of rooms with a sliding scale of different environmental and spatial qualities: a. all main working spaces must have adjustable lighting fixtures and shading to enable personalised regulation of both natural and artificial light

4. Wayfinding and building communications should be required to meet a defined set of similar standards, similar to the Web Content Accessibility Guidelines (WCAG) version 2.1 AA standard.

b. spaces with movable partitions that can be adjusted by the user should be provided to enable personalised regulation of privacy and control of noise.

11. Work spaces and meeting rooms should, where possible, have adjustable climate regulation.

5. Building management systems should effectively communicate with occupiers to provide accurate information on how densely populated spaces are throughout the building. This includes, but is not limited to, lifts, circulation spaces, working areas and meeting rooms.

These recommendations represent options for future research, which can then be used as the basis for the building industry to advocate the introduction of new legislation and regulations to protect the mental and physical health of neurodivergent people in the built environment. ■

6. Navigable floor plans and 3D building models should be created and be accessible to building occupiers to use on a daily basis through their hand-held devices.

DESIGNING FOR NEURODIVERSITY

43

© BCO 2022

CONCLUSION This report has focused on the physical work space, but we cannot ignore the role that office culture plays in the health and wellbeing of neurodiverse individuals. As one interviewee said:

“A team that is supportive to needs

and requirements makes it easier to cope with an office environment that is not enabling.

”

Interviewee

If a person feels socially secure and supported, they have more resources and capacity to mitigate other stressors. It must also be considered that there is a feedback loop between office culture and physical space. A physical space that is purposefully designed for equitable inclusion will set the tone for the office culture – ‘a place where people are treated with dignity’.

“The office environment feeds into

how much burden there is on the NHS, employer and society. It is part of the wider ecosystem of health.

”

Interviewee

Thinking of the office space beyond employment, as part of a wide societal ecosystem, we can begin to shift the narrative from productivity to healing. When labour and its physical conditions put people’s health at risk it can have a wide societal impact, placing a burden on the NHS, impeding people from developing to their full potential, and even playing a role in future health inequities. ■

DESIGNING FOR NEURODIVERSITY

Copyright The Friday Project

44

© BCO 2022

REFERENCES Experimental Neurobiology 24(4): 273–284. Available at: https://doi.org/10.5607/en.2015.24.4.273 (accessed 23 April 2022).

1. Hofman N (2020) How You Get the Benefits of a Neurodiverse Workforce. Ernst & Young. Available at: https://www.ey.com/en_gl/forensic-integrity-services/ how-to-get-the-benefits-of-a-neurodiverse-workforce (accessed 23 April 2022).

11. Delgiudice-Asch G and Hollander E (1997) Altered immune function in autism. CNS Spectrums 2(5): 61–68.

Available at: https://doi.org/10.1017/S1092852900004909 (accessed 23 April 2022).

2. Austin RD and Pisano GP (2017) Neurodiversity as a competitive advantage. Harvard Business Review, May– June: 96–103. Available at: https://hbr.org/2017/05/ neurodiversity-as-a-competitive-advantage?msclkid=1432a 89eaf4011ec8add174ad4ab713a (accessed 23 April 2022).

12. The Dyslexia Resource (2020) Dyslexia and the Brain.

Available at: https://dyslexiaresource.org/dyslexia-andthe-brain/?msclkid=5bd3932ea5f511eca5db51bc72202 7a7 (accessed 23 April 2022).

3. Draaisma D (2009) Stereotypes of autism. Philosophical Transactions of the Royal Society B 364: 1475–1480.

Available at: https://doi.org/10.1098/rstb.2008.0324 (accessed 23 April 2022).

13. Smith-Spark JH and Fisk JE (2007) Working memory functioning in developmental dyslexia. Memory 15(1): 34–56.

Available at: https://doi.org/10.1080/09658210601043384 (accessed 23 April 2022).

4. Disabled World (2022) What is: Neurodiversity, Neurodivergent, Neurotypical? Available at: https://www. disabled-world.com/disability/awareness/neurodiversity (accessed 23 April 2022).

14. Wolff PH, Michel GF, Ovrut M and Drake C (1990) Rate and timing precision of motor coordination in developmental dyslexia. Developmental Psychology 26(3): 349–359.

Available at: https://doi.org/10.1037/0012-1649.26.3.349 (accessed 23 April 2022).

5. Baumer N and Frueh J (2021) What is Neurodiversity?

Harvard Health Publishing. Available at: https://www. health.harvard.edu/blog/what-is-neurodiversity202111232645#:~:text=Neurodiversity%20describes%20 the%20idea%20that%20people%20experience%20 and,behaving%2C%20and%20differences%20are%20 not%20viewed%20as%20deficits.?msclkid=64ab8e59a549 11ec9728906925d561b7 (accessed 23 April 2022).

15. Benton AL (1984) Dyslexia and spatial thinking. Annals of Dyslexia 34: 69–85. Available at: https://doi.org/10.1007/ BF02663614 (accessed 23 April 2022).

16. Cell Press (2016) Dyslexics show a difference in sensory processing. Science Daily, 21 December. Available at: www.sciencedaily.com/releases/2016/12/161221125517.htm (accessed 23 April 2022).

6. XanFree Nutrition (2021) Is Anxiety Neurodivergent?

What Does the Science Say? Available at: https://xanfree. com/blogs/research-resources/is-anxiety-neurodivergentwhat-does-the-science-say#:~:text=%20According%20 to%20the%20National%20Symposium%20on%20 Neurodiversity,concepts%29%205%20Autism%206%20 Tourette%20Syndrome%20More%20?msclkid=9affb37ba5 4811ec90db6a6cb2bcbbad (accessed 23 April 2022).

17. Dyspraxia Foundation (2015) Adult Diagnosis of Dyspraxia/Developmental Coordination Disorder (DCD).

Available at: https://dyspraxiafoundation.org.uk/wpcontent/uploads/2013/10/Adult-diagnosis-factsheetfinal-august-20151.pdf#:~:text=Dyspraxia%20is%20 a%20common%20disorder%20affecting%20fine%20 and%2For,on%20the%20situation%20and%20the%20 person%E2%80%99s%20life%20experience.?msclkid=96e d2b3aab9811eca419e39546e93329 (accessed 23 April 2022).

7. Sinfield J (2021) The ADHD vs. Non-ADHD Brain.

Available at: https://www.verywellmind.com/the-adhdbrain-4129396#:~:text=The%20Structure%20of%20the%20 Brain.%20This%20finding%20is,smaller%20in%20the%20 brains%20of%20people%20with%20ADHD.?msclkid=a42ba f80abb011ec8ef0a2a7245f80ee (accessed 23 April 2022).

18. Gibbs J, Appleton J and Appleton R (2007) Dyspraxia or developmental coordination disorder? Unravelling the enigma. Archives of Disease in Childhood 92(6): 534–539.

Available at: https://doi.org/10.1136/adc.2005.088054 (accessed 23 April 2022).

8. American Academy of Child and Adolescent Psychiatry (2017) ADHD & the Brain. No. 121. Available at: https://www.aacap.org/AACAP/Families_and_Youth/ Facts_for_Families/FFF-Guide/ADHD_and_the_Brain.as px?msclkid=a42f01a8abb011ecafca7273af2cf37e (accessed 23 April 2022).

19. Dewey D and Bernier FP (2016) The concept of atypical brain development in developmental coordination disorder (DCD)—a new look. Current Developmental Disorders Reports 3: 161–169. Available at: https://doi. org/10.1007/s40474-016-0086-6 (accessed 23 April 2022).

9. Konofal E, Lecendreux M and Cortese S (2010) Sleep and ADHD. Sleep Medicine 11(7): 652–658. Available at: https://doi.org/10.1016/j.sleep.2010.02.012 (accessed 23 April 2022).

20. The Conversation (2016) Explainer: What is Dyspraxia and How is it Different to Clumsiness? Available at: https://theconversation.com/explainer-what-isdyspraxia-and-how-is-it-different-to-clumsiness64540#:~:text=These%20include%20frontal%20and%20 parietal%20areas%20%28responsible%20for,reduced%20

10. Ha S, Sohn IJ, Kim N, Sim HJ and Cheon KA (2015) Characteristics of brains in autism spectrum disorder: structure, function and connectivity across the lifespan.

DESIGNING FOR NEURODIVERSITY

45

© BCO 2022

brain%20activity%20in%20these%20motor%20learning%20 regions.?msclkid=e008574ba5f611ec968eeffd9a7379df (accessed 23 April 2022).

34. Science Direct (n.d.) Stressors. Available at: https://www.sciencedirect.com/topics/psychology/stressors (accessed 23 April 2022).

35. APA Dictionary of Psychology (2022) Coping strategy.

Available at: https://dictionary.apa.org/coping-strategies (accessed 23 April 2022).

21. Lewis M (2022) Neurodiversity and Mental Health.

Library News, University of Surrey. Available at: https://blogs.surrey.ac.uk/librarynews/2022/03/23/ neurodiversity-and-mental-health/?msclkid=e0d60c9baba 011ec8debc4d8ae0616f3 (accessed 23 April 2022).

36. APA Dictionary of Psychology (2022) Stressor. Available at: https://dictionary.apa.org/stressor (accessed 23 April 2022).

22. The ADHD Clinic (2022) Adult ADHD at Work. Available at: https://adhdclinic.co.uk/adhd-at-work/?msclkid=ae07c8f9 abad11ecb5c8593a8dfbc0ed (accessed 23 April 2022).

37. APA Dictionary of Psychology (2022) Stress. Available at: https://dictionary.apa.org/stress (accessed 23 April 2022).

38. Biology Online (2022) Homeostasis. Available at: https://www.biologyonline.com/dictionary/homeostasis (accessed 23 April 2022).

23. Neurologic Wellness Institute (2022) Parts of the Brain and Anxiety. Available at: https://neurologicwellnessinstitute. com/parts-of-the-brain-and-anxiety/?msclkid=0e668fbdab a311ec8b151f4534514203 (accessed 23 April 2022).

39. Science Direct (n.d.) Allostasis. Available at: https://www.sciencedirect.com/topics/immunology-andmicrobiology/allostasis#:~:text=Allostasis%20is%20 defined%20as%20the,meet%20perceived%20and%20 anticipated%20demands (accessed 23 April 2022).

24. Cuncic A (2021) How to Deal with Anxiety at Work.

Available at: https://www.verywellmind.com/cope-withgeneralized-anxiety-disorder-at-work-4125397 (accessed 23 April 2022).

40. Guidi J, Lucente M, Sonino N and Fava GA (2021) Allostatic load and its impact on health: a systematic review. Psychotherapy and Psychosomatics 90: 11–27.

Available at: https://doi.org/10.1159/000510696 (accessed 23 April 2022).

25. Zhang FF, Peng W, Sweeney JA, Jia ZY and Gong QY (2018) Brain structure alterations in depression: psychoradiological evidence. CNS Neuroscience & Therapeutics 24(11): 994–1003.

Available at: https://doi.org/10.1111/cns.12835 (accessed 23 April 2022).

41. Camargo A, Hossain E, Aliko S, Akinola-Odusola D and Artus J (2020) Neuroscience, urban regeneration and urban health. Journal of Urban Regeneration & Renewal 13(3): 280–289.

26. CDC (2020) Depression. Available at: https://www.cdc.gov/ workplacehealthpromotion/health-strategies/depression/ index.html?msclkid=3db2fd7eabe511ec9e601029bb612999 (accessed 23 April 2022).

42. Constantino JN (2021) New guidance to seekers of autism biomarkers: an update from studies of identical twins.

Molecular Autism 12: 28. Available at: https://doi.org/10.1186/s13229-021-00434-w (accessed 23 April 2022).

27. Maynard E (2020) How Trauma and PTSD Impact the Brain. Available at: https://www.verywellmind.com/whatexactly-does-ptsd-do-to-the-brain-2797210 (accessed 23 April 2022).

28. Hossain E, Aliko S and Camargo A (2022) Health as Ecological. Urban Health Council. Available at: https://www.urbanhealthcouncil.com/reports-playbooks/ health-as-ecological (accessed 23 April 2022).

43. Science Direct (n.d.) Sensory Gating. Available at: https://www.sciencedirect.com/topics/neuroscience/ sensory-gating#:~:text=Sensory%20gating%20is%20a%20 process,are%20observed%20in%20schizophrenic%20 patients (accessed 23 April 2022).

29. Kemp C, Akinola-Odusola D and Camargo A (2022) Obesity & Trauma. Urban Health Council. Available at: https://www.urbanhealthcouncil.com/reports-playbooks/ obesity-and-trauma (accessed 23 April 2022).

44. Micoulaud-Franchi J-A, Vaillant F, Lopez R, et al. (2015) Sensory gating in adult with attention-deficit/hyperactivity disorder: event-evoked potential and perceptual experience reports comparisons with schizophrenia. Biological Psychology 107: 16–23. Available at: https://doi.org/10.1016/j.biopsycho.2015.03.002 (accessed 23 April 2022).

30. Camargo A and Hossain E (2022) The Environmental Factors of Diabetes. Urban Health Council. Available at: https://www.urbanhealthcouncil.com/reports-playbooks/ the-environmental-factors-of-diabetes (accessed 23 April 2022).

45. Oranje B, Engeland H, Kahn RS and Kemner C (2009) Cross-sensory gating in schizophrenia and autism spectrum disorder: EEG evidence for impaired brain connectivity?

Neuropsychologia 47(7): 1728–1732.

31. HOK Network (2020) Neurodiversity and Workplace Inclusivity (video). Available at: https://www.youtube.com/ watch?v=KoGdEqZIn8M (accessed 23 April 2022).

32. Deckers L (2018) Motivation: Biological, Psychological, and Environmental, 5th edn. Routledge, New York.

46. Science Direct (n.d.) Habituation. Available at: https://www.sciencedirect.com/topics/medicine-anddentistry/habituation (accessed 23 April 2022).

33. Halpern D (1995) Social environmental stressors. In Mental Health and the Built Environment. Routledge, New York.

47. Science Direct (n.d.) Muscular Fatigue. Available at: https://www.sciencedirect.com/topics/psychology/ muscular-fatigue (accessed 23 April 2022).

DESIGNING FOR NEURODIVERSITY

46

© BCO 2022

48. Jamal W, Cardinaux A, Haskins AJ. et al. (2021) Reduced sensory habituation in autism and its correlation with behavioral measures. Journal of Autism and Developmental Disorders 51: 3153–3164. Available at: https://doi.org/10.1007/s10803-020-04780-1 (accessed 23 April 2022).

60. Mayo Clinic (2022) Panic Attacks and Panic Disorder.

Available at: https://www.mayoclinic.org/diseasesconditions/panic-attacks/symptoms-causes/syc20376021#:~:text=A%20panic%20attack%20is%20 a,heart%20attack%20or%20even%20dying (accessed 23 April 2022).

49. Massa J and O’Desky IH (2012) Impaired visual habituation in adults with ADHD. Journal of Attention Disorders 16(7): 553–561. Available at: https://doi.org/10.1177/1087054711423621 (accessed 23 April 2022).

61. NHS (2022) Raising Low Self-esteem. Available at: https://www.nhs.uk/mental-health/self-help/tips-andsupport/raise-low-self-esteem (accessed 23 April 2022).

62. Huerta-Franco MR, Vargas-Luna M, Tienda P, DelgadilloHoltfort I, Balleza-Ordaz M and Flores-Hernandez C (2013) Effects of occupational stress on the gastrointestinal tract.

World Journal of Gastrointestinal Pathophysiology 4(4): 108–118. Available at: https://doi.org/10.4291/wjgp. v4.i4.108 (accessed 23 April 2022).

50. Massa J and O’Desky IH (2012) Impaired visual habituation in adults with ADHD. Journal of Attention Disorders 16(7): 553–561. Available at: https://doi.org/10.1177/1087054711423621 (accessed 23 April 2022).

63. Mommersteeg PM, Heijnen CJ, Kavelaars A and van Doornen LJ (2006) Immune and endocrine function in burnout syndrome. Psychosomatic Medicine 68(6):879–886.

Available at: https://doi.org/10.1097/01. psy.0000239247.47581.0c (accessed 23 April 2022).

51. Kapp SK, Steward R, Crane L, et al. (2019) ‘People should be allowed to do what they like’: Autistic adults’ views and experiences of stimming. Autism 23(7): 1782–1792.

Available at: https://doi.org/10.1177/1362361319829628 (accessed 23 April 2022).

64. Asperger/Autism Network (AANE) (2022) Workers with Autism on the Front Lines. Available at: https://www.aane.org/workers-with-autism-on-the-frontlines (accessed 23 April 2022).

52. Pearson A and Rose K (2021) A conceptual analysis of autistic masking: understanding the narrative of stigma and the illusion of choice. Autism in Adulthood 3(1): 52–60.

Available at: https://doi.org/10.1089/aut.2020.0043 (accessed 23 April 2022).

65. James SM, Honn KA, Gaddameedhi S and Van Dongen H (2017) Shift work: disrupted circadian rhythms and sleep implications for health and well-being. Current Sleep Medicine Reports 3(2): 104–112. Available at: https://doi.org/10.1007/s40675-017-0071-6 (accessed 23 April 2022).

53. Holmans L (2021) How Neurodivergent Masking and Burnout Can Become a Perpetual Cycle. Neurodivergent Rebel. Available at: https://neurodivergentrebel. com/2021/10/20/how-neurodivergent-masking-andburnout-can-become-a-perpetual-cycle (accessed 23 April 2022).

66. Cannizzaro E, Cirrincione L, Mazzucco W, Scorciapino A, Catalano C, Ramaci T, Ledda C and Plescia F (2020) Night‑time shift work and related stress responses: a study on security guards. International Journal of Environmental Research and Public Health 17(2): 562.

Available at: https://doi.org/10.3390/ijerph17020562 (accessed 23 April 2022).

54. Bianchi R, Schonfeld IS and Laurent E (2015) Is it time to consider the ‘burnout syndrome’ a distinct illness?

Frontiers in Public Health, 8 June. Available at: https://doi.org/10.3389/fpubh.2015.00158 (accessed 23 April 2022).

55. Mental Health UK (2022) Burnout. Available at: https://mentalhealth-uk.org/burnout (accessed 23 April 2022).

67. WHO (2022) Occupational Stress, Burnout and Fatigue.

Available at: https://www.who.int/tools/occupationalhazards-in-health-sector/occup-stress-burnout-fatigue (accessed 23 April 2022).

56. National Autistic Society (2022) Autistic Fatigue and Burnout. Available at: https://www.autism.org.uk/adviceand-guidance/topics/mental-health/autistic-fatigue/ autistic-adults (accessed 23 April 2022).

68. Center for Employment Equity (2022) Stressed, Unsafe, and Insecure: Essential Workers Need a New, New Deal. University of Massachusetts Amherst, MA, USA. Available at: https://www.umass.edu/employmentequity/ stressed-unsafe-and-insecure-essential-workers-need-newnew-deal (accessed 23 April 2022).

57. Brattberg G (2006) PTSD and ADHD: underlying factors in many cases of burnout. Stress & Health 22(5): 305–313.

Available at: https://doi.org/10.1002/smi.1112 (accessed 23 April 2022).

69. Davis P (2021) Why you can’t yoga your way out of burnout.

Forbes, 2 March. Available at: https://www.forbes.com/ sites/pauladavis/2021/03/02/why-you-cant-yoga-your-wayout-of-burnout/?sh=1c94cfe4aa1f (accessed 23 April 2022).

58. Mayo Clinic Health System (2020) Emotional Exhaustion During Times of Unrest. Available at: https://www.mayoclinichealthsystem.org/hometownhealth/speaking-of-health/emotional-exhaustion-duringtimes-of-unrest (accessed 23 April 2022).

70. Mitchell S (2014) How meditation brought me back from burnout. The Guardian, 9 June. Available at: https://www.theguardian.com/women-in-leadership/2014/ jun/09/how-meditation-brought-me-back-from-a-breakdown (accessed 23 April 2022).

59. Anxiety UK (2022) Depersonalisation Disorder.

Available at: https://www.anxietyuk.org.uk/anxiety-type/ depersonalisation (accessed 23 April 2022).

DESIGNING FOR NEURODIVERSITY

47

© BCO 2022

71. Valcour M (2016) Beating burnout. Harvard Business Review, November, 98–101. Available at: https://hbr.org/2016/11/beating-burnout (accessed 23 April 2022).

83. Wedawatta G, Ingirige B and Amaratunga D (2010) Building up resilience of construction sector SMEs and their supply chains to extreme weather events.

International Journal of Strategic Property Management 14(4): 362–375. Available at: https://doi.org/10.3846/ ijspm.2010.27 (accessed 23 April 2022).

72. Mayo Clinic (2021) Job Burnout: How to Spot it and Take Action. Available at: https://www.mayoclinic.org/healthylifestyle/adult-health/in-depth/burnout/art-20046642 (accessed 23 April 2022).

84. Wall T (2019) ‘This is a wake-up call’: the villagers who could be Britain’s first climate refugees. The Guardian, 18 May. Available at: https://www.theguardian.com/ environment/2019/may/18/this-is-a-wake-up-call-thevillagers-who-could-be-britains-first-climate-refugees (accessed 23 April 2022).

73. Geneva Centre for Autism (2022) Trauma and Burnout in Autism: A Conversation (audio). Available at: https://hopin.com/events/traumaandburnoutinautism/ registration (accessed 23 April 2022).

85. Ward B and Kyriacou G (2021) How is Climate Change Affecting River and Surface Water Flooding in the UK? Available at: https://www.lse.ac.uk/granthaminstitute/ explainers/how-is-climate-change-affecting-river-andsurface-water-flooding-in-the-uk/#:~:text=Climate%20 change%20is%20increasing%20the%20risk%20of%20 both%20flooding%20and,may%20occur%20as%20a%20 result (accessed 23 April 2022).

74. National Autistic Society (2022) Autistic Fatigue – A Guide for Autistic Adults. Available at: https://www.autism.org. uk/advice-and-guidance/topics/mental-health/autisticfatigue/autistic-adults (accessed 23 April 2022).

75. Raymaker DM, Teo AR, Steckler NA, et al. (2020) ‘Having all of your internal resources exhausted beyond measure and being left with no clean-up crew’: defining autistic burnout. Autism in Adulthood 2(2): 132–143.

Available at: https://doi.org/10.1089/aut.2019.0079 (accessed 23 April 2022).

86. Met Office (2022) Met Office Heatwave Thresholds are to be Updated Ahead of Summer 2022 as the UK sees Impacts Due to Climate Change. Available at: https://www.metoffice.gov.uk/about-us/press-office/news/ weather-and-climate/2022/heatwave-threshold-changes (accessed 23 April 2022).

76. Kaplan S (2001) Meditation, restoration, and the management of mental fatigue. Environment and Behavior 33(4): 480–506.

Available at: https://doi.org/10.1177/00139160121973106 (accessed 23 April 2022).

87. Soper T (2020) Why this Seattle-Area Startup Ditched its Physical Office – And What it Means for the Future of Work. Available at: https://www.geekwire.com/2020/ seattle-area-startup-ditched-physical-office-means-futurework (accessed 23 April 2022).

77. Stewart NH and Arora VM (2019) The impact of sleep and circadian disorders on physician burnout. Chest 156(5), 1022–1030. Available at: https://doi.org/10.1016/j. chest.2019.07.008 (accessed 23 April 2022).

88. Johanson M (2021) Hybrid Work: What the Office Could Look Like Now. Available at: https://www.bbc.com/ worklife/article/20210713-hybrid-work-what-the-officecould-look-like-now (accessed 23 April 2022).

78. Van Laethem M, Beckers DGJ, Dijksterhuis AP and Guerts SAE (2017) Stress, fatigue, and sleep quality leading up to and following a stressful life event. Stress & Health 33(4): 459–469. Available at: https://doi.org/10.1002/smi.2730 (accessed 23 April 2022).

89. Wright G (2022) Currys closes HQ in favour of WeWork flexible office space. Retail Gazette, 28 March. Available at: https://www.retailgazette.co.uk/blog/2022/03/curryscloses-hq-in-favour-of-wework-flexible-office-space (accessed 23 April 2022).

79. Cusack J (2021) Autistic People Still Face Highest Rates of Unemployment of All Disabled Groups. Available at: https://www.autistica.org.uk/news/autistic-peoplehighest-unemployment-rates (accessed 23 April 2022).

90. Go Space (2022) https://www.gospace.com (accessed 23 April 2022).

80. Jones SR (2016) Autism and Homelessness: The Real Crisis. Available at: https://rootedinrights.org/autism-andhomelessness-the-real-crisis (accessed 23 April 2022).

91. House of Commons Committee of Public Accounts (2022) Regulation of Private Renting. HC 996. Available at: https://committees.parliament.uk/publications/9608/ documents/162544/default (accessed 23 April 2022).

81. GMB Union (2010) The Law and Neurodiversity at Work.

Available at: https://www.gmb.org.uk/sites/default/files/ neurodiversity-law-guide.pdf?msclkid=9abcd929af7c11eca 7aff71929b8e0ec (accessed 23 April 2022).

92. Transport for London (2022) Planning with WebCAT. Available at: https://tfl.gov.uk/info-for/urban-planningand-construction/planning-applications/planning-withwebcat (accessed 23 April 2022).

82. Hess JJ (2019) Another piece of the puzzle: linking global environmental change, plant phenology, and health.

The Lancet – Planetary Health 3(3): e103–e104.

Available at: https://www.thelancet.com/journals/lanplh/ article/PIIS2542-5196(19)30044-0/fulltext (accessed 23 April 2022).

DESIGNING FOR NEURODIVERSITY

48

© BCO 2022

78-79 Leadenhall Street London EC3A 3DH info@bco.org.uk 020 7283 0125

www.bco.org.uk Follow us @BCO_UK or @BCO_NextGen British Council for Offices – Join the Debate: BCO online or BCO NextGen facebook.com/British Council for Offices /British Council for Offices /British Council for Offices /BCO_UK Sign up for our newsletter on www.bco.org.uk