Date of Award
12-2025
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Department
Architecture and Health
Committee Chair/Advisor
Anjali Joseph
Committee Member
David Allison
Committee Member
Dina Battisto
Committee Member
Desmond Peyton Kelly. MD
Abstract
In the U.S., outpatient visits routinely involve waiting, yet the design of waiting rooms often creates crowding, noise, and uncertain wayfinding that can heighten stress for autistic children and their families. These conditions can undermine regulation, safety, and cooperation before care even begins. Prior work highlights sensory sensitivity and anxiety among autistic patients, but fewer studies examine how the physical environment of waiting specifically shapes stress and coping or translate those insights into actionable design guidance for architects and design professionals. This mixed-methods study investigates how outpatient waiting environments influence autistic children and caregivers and develops evidence-informed design recommendations. The study combined observations of two pediatric waiting rooms, a parent survey focused on environmental variables, and semi-structured interviews with parents, autistic children, clinical staff, and healthcare design professionals. The Transactional Model of Stress and Coping and the Theory of Supportive Design guided study design and analysis. Findings show recurring environmental stressors including continuous visual exposure to doors, elevators, and corridors, dense seating without clear boundaries, stressful thresholds at arrival and check-in, unclear restroom access, and limited awareness of queue status. Observations found that anxiety-related behaviors clustered near thresholds and high-flow paths, while survey responses reflected the lack of supportive space for privacy and the challenge of crowding impacting user’s comfort. Based on analysis of observations, surveys, and interviews, the dissertation proposes evidence-informed design guidelines that prioritize: (1) autonomy and sense of control (choice of zones and seats); (2) social support and visibility (balanced supervision without exposure); (3) comfort and sensory modulation (small, dimmable/tunable zones); (4) proximity and access to key features (quiet/refuge pods beside check-in; short, clearly signed paths to restrooms); (5) positive distraction with cultural and individual relevance; (6) flexibility and adaptability of seating clusters; (7) clear boundaries and semi-enclosed seats (e.g., cocoon chairs); (8) safety (layouts that reduce elopement risk, no sharp edges, trip hazards, or backless/unstable furniture); (9) clear wayfinding and real-time queue awareness; (10) privacy needs at the seat (armrests/side panels) and zone level (frosted bands/low partitions); (11) seamless transitions and graded thresholds from curb-to-room; and (12) continuity of engagement tools that travel with the child. By shaping the waiting area as a supportive and comfortable place, these design recommendations turn research into practical guidelines. Implementing these elements can potentially help reduce distress, support families, and make the waiting period a more dignified and supportive part of pediatric outpatient care for autistic individuals and their care partners.
Recommended Citation
Shokrollahi Ardekani, Mina, "Understanding Expert and Stakeholder Perspectives for Designing Autism Supportive Outpatient Waiting Environments" (2025). All Dissertations. 4123.
https://open.clemson.edu/all_dissertations/4123
Author ORCID Identifier
0000-0002-5281-452X