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autism, inclusive design, waiting room design, healthcare access


Presentation: 25:11

Presentation completed in partial fulfillment of a Post Professional Occupational Therapy Doctorate degree at Thomas Jefferson University.


Introduction: Autistic children attend an annual average of 41.5 outpatient visits, while typically developing children attend an average of 3.3 visits (Liptak, Stuart, & Auinger, 2006). Autistic children generally experience sensory processing and self-regulation differences. Outpatient therapy waiting rooms are frequented by autistic children for outpatient services. These settings consist of unpredictable and uncontrollable stimuli that may be difficult for children with different sensory needs to tolerate, leading to high stress levels and struggles with self-regulation impacting their experience (Higuera-Trujillo et al., 2020; Schaaf et al., 2011). However, there is scant occupational therapy research informing the design of supportive waiting room environments for autistic children in the outpatient therapy setting (Pfeiffer et al., 2017). Due to the increased prevalence of autism and significant differences in sensory and self-regulation needs it is essential to design inclusive healthcare environments to improve the experience of outpatient settings and improve access to healthcare for this population (Pfieffer et al., 2017; Tola et al., 2021).

Purpose: This study aimed to better understand the experience of a pediatric outpatient therapy waiting room for autistic children and to identify facilitators and barriers in the environment’s design that impact the child’s ability to transition to and from and participate in their therapeutic services.

Methods: Data collection included participant observations, semi-structured interviews with the participant and their family, administration of parent surveys, and the Sensory Processing Measure™, Second Edition (SPM-2, Parham et al., 2021). Multiple data sources allowed for data triangulation to capture the impact of the environmental design on the participants’ experience of the outpatient therapy waiting room. Data analysis followed Kiger and Varpio’s (2020) six-step recursive method to arrive at themes and subthemes.

Results: Three children and their families participated in this study. Three qualitative themes emerged: waiting room triggers, facilitating regulation, and supported inclusion. Specific barriers and facilitators of the current waiting room design that impacted the participants’ and their families experience were identified.

Conclusions: Findings indicated that the current design and features of the outpatient therapy waiting room did not always meet the sensory or regulatory needs of the participants. A multi-disciplinary collaboration between designers and occupational therapy practitioners would be beneficial to design inclusive outpatient therapy waiting rooms to support a positive experience for autistic children and their families and to improve access to healthcare.


Higuera-Trujillo, J.L., Millán, C.L., Montaña i Aviñó, A., & Rojas, J. (2020). Multisensory stress reduction: a neuro-architecture study of paediatric waiting rooms. Building Research & Information, 48(3), 269-285.

Kiger, M. E., & Varpio, L. (2020). Thematic analysis of qualitative data: AMEE guide no. 131. Medical Teacher, 42(8), 846-854.

Liptak, G.S., Stuart, T., & Auinger, P. (2006). Health care utilization and expenditures for children with autism. Journal of Autism and Developmental Disorders, 36, 871-879. doi: 10.1007/s10803-006-0119-9

Parham, L. D., Ecker, C. L., Kuhaneck, H., Henry, D. A., & Glennon, T. J. (2021). Sensory Processing Measure, Second Edition (SPMTM-2) [Manual]. Western Psychological Services.

Pfeiffer, B., Coster, W., Snethen, G., Derstine, M., Piller, A., & Tucker, C. (2017). Caregivers' perspectives on the sensory environment and participation in daily activities of children with autism spectrum disorder. American Journal of Occupational Therapy, 71, 7104220020.

Schaaf, R.C., Toth-Cohen, S., Johnson, S.L., Outten, G., & Benevides, T.W. (2011). The everyday routines of children with autism. Autism, 15(3), 373-389. doi: 10.1177/136231310386505

Tola, G., Talu, V,. Congiu, T., Bain, P., & Lindert, J. (2021). Built Environment Design and People with Autism Spectrum Disorder (ASD): A Scoping Review. International Journal of Environmental Research and Public Health, 18(3203).

Synopsis: This study was an important step towards understanding the impact of the outpatient therapy waiting room design through autistic children’s lived experiences. Findings from this study inform designers of potential facilitators to create a positive experience when designing future outpatient therapy waiting rooms to maximize children’s ability to access therapeutic services. This study also highlights the unique skillset of occupational therapy practitioners to address sensory processing, self-regulation, and the person-environment fit. A collaboration between designers and occupational therapists is warranted to create environments that enable children to participate more successfully in healthcare environments.

Acknowledgments: Thomas Jefferson University, Children’s Specialized Hospital, D. Jill Harris