Nearly half a billion people suffer from a neurological, mental or behavioral disorder (National Library of Medicine). Patients with many neurological disorders struggle with light sensitivity, so lighting design is a key concern for this population.
To learn more about the impact of lighting and lighting design on populations that are light sensitive, we went straight to two experts who work with these patients every day. Gretchen Hunter, Ph.D., is a clinical neuropsychologist and clinical supervisor at Child and Family Development in Charlotte, North Carolina. Her colleague, Marion Wilm, OTR/L, C/NDT, is an occupational therapist. Hunter and Wilm often follow their patients for many years. Here's what they had to say about lighting for ADHD, migraines, autism and many other neurological conditions.
What are examples of neurological conditions that can make people more sensitive to light?
GH: Many patients with a neurological disorder are highly sensitive to sensory stimuli such as flashing lights or loud noises. I can think of a number of conditions that include significant light sensitivity issues. We work at a pediatric clinic, so many of our cases are referrals from pediatric neurologists for things like ADHD, autism spectrum disorder, concussion, epilepsy, specific learning disabilities or intellectual disabilities, traumatic brain injury (TBI) and even migraines. Patients with a concussion, mild TBI or migraines are perhaps the most light sensitive among those we serve.
MW: I see a lot of children on the autism spectrum as well as children with Down syndrome, mitochondrial disease, cerebral palsy and birth injuries. A lot of my patients look completely normal on the outside, yet they’re struggling.
What are some of the problems associated with light sensitivity?
GH: Poor or harsh lighting can cause fatigue. It can inhibit exercise or social interaction. Light sensitivity can also lead to general agitation, migraines or even seizures.
MW: Many of our patients are struggling with facets of everyday life, like dressing. Poor lighting can agitate or distract them, making things worse.
One of the little boys I see has nystagmus, which causes constant eye movements. His visual system is in total disorganization at all times, and he’s one of those kids who walks into my office and immediately turns out the lights. If we leave the lights on, I’ll notice his eyes drifting to the ceiling or to different areas in the room. The lights kill his attention and focus.
With other kids, we have to be careful about contrast and glare so they can stay focused on the task in front of them. I have toys that light up to help kids work on their focus. These lights are just one tool I use to help reset and reorganize my patients’ nervous systems.
Some of the issues associated with lighting are a result of the way our world is changing. A lot of kids with autism are interested in technology. They might look at an iPad for hours. But light and glare from screens — tablets, computers and phones — can be harmful for anyone, not just our patients.
How do children and adults respond differently to things that bother them?
GH: Adults are often able to verbalize something that’s bothering them. But many kids with disabilities, especially those that are elementary school age or younger, have a hard time forming their thoughts, feelings and experiences into something coherent. For example, a child with autism might be struggling with the flicker from fluorescent lighting in the classroom, but he might not be able to tell the teacher what’s bothering him. Showing kids how to recognize stimuli and verbalize what’s unpleasant is a big part of my psychotherapy practice.
Ideally, most adults have developed tools to help articulate their feelings. But many adults with disabilities still become agitated or overwhelmed in certain environments, and bad lighting is sometimes the culprit.
MW: I think kids are generally more vocal about their feelings. They’re not always able to pinpoint what’s bothering them, but if I watch their behavior, I can often tell if they’re disorganized or distracted. It’s always a good idea to start by looking at the environment and determining whether you can change something in that environment, such as lighting, to help the child be successful.
Most adults are better at acclimating to things. They aren’t as likely to say that the lighting is hurting their eyes. Instead, they might move to a different spot or wear glasses. In a perfect world, we’d reduce or remove problematic lighting in the environment.
What are some of the biggest lighting mistakes that can hurt this population?
GH: Flickering lights are a common problem. Bright lights can also cause issues. Fluorescent lights are often too harsh for our patients.
MW: Some colors can be a big problem, whether they’re in lighting or on surfaces. Yellow is one of those colors, and a lot of lights are yellow. Some kids will say, “That color hurts” or “I don’t like yellow.”
Overhead lighting can be tough, because it’s more intense than task lighting. At Child and Family Development, most of us have table lamps or floor lamps in our areas to help kids who struggle with overhead lighting. If we have enough natural light or can work in dim conditions, we can also just turn out the lights.
Many public places rely on overhead fluorescent lighting. But fluorescent lights can flicker. They can also produce glare and a humming sound that is too soft for most people to hear but is upsetting for highly sensitive people. When I walk into a room, I don’t always notice that a light is flickering. But to some of my patients, it may be like a strobe light, because they don’t know how to filter out a harmful stimulus.
We talk a lot about the benefits of natural light, but we have to be careful there, too. If the sun is too bright, our kids can struggle.
What are some lighting strategies that help your patients?
GH: When I work with patients who are still healing from an acute disease, I often recommend rest to allow the brain to heal. For people suffering from migraines, this might include going to lie down in a darkened room. For extremely acute conditions or highly sensitive patients, I might prescribe total avoidance of light. As these patients are returning to daily activities, they may request changes to the lighting in their school or at home. They may want to use lamps instead of overhead lights. They may wear sunglasses indoors. They may choose to sit by a window to do their homework rather than relying on artificial lighting. Here at Child and Family Development, we’re fortunate to have an office with lots of large windows and natural light in our primary treatment spaces.
It’s important for therapists, teachers, parents and others to maintain an open dialogue with kids who are sensitive to light, so they can modify the environment to control symptoms.
MW: Our patients with neurological conditions are more sensitive than neurotypical people, but when the lighting is right, it’s better for everyone. In fact, if we designed environments for people with autism, I think we’d find that we’d be more comfortable. We wouldn’t have to acclimate to intense stimuli nearly as often. Our nervous systems would be calmer. And we’d be in a better place for learning and problem solving. We’d be freer to use our brains for their real purpose instead of dealing with distractions.
Why are lighting controls important for people with neurological conditions?
GH: Lighting controls are beneficial for anyone, because lighting preferences are highly individual. I’ve even watched my patients’ lighting needs change throughout the course of their treatment here. For example, kids who are overly sensitive to sensory stimuli in the beginning may become less sensitive after a course of occupational therapy to address the issue. Lighting controls also make it possible to downgrade the amount or intensity of lighting, which is helpful.
In our office, we have rooms that have multiple uses. Lighting controls could help define the spaces in those rooms so staff can easily type reports, work with children on coping strategies or talk with parents.
General protocols provide a great starting point, but lighting controls provide a great way to fine-tune the environment for each person. This is a big deal for kids with disabilities.
MW: Our nervous systems react to stimuli based on our previous experiences, so the more we can fulfill individual preference, the better. Lighting controls would give our patients some autonomy. A lot of these kids don’t have the luxury of independence. I can only imagine the benefits if they were able to eliminate or dim lights without an adult yelling at them. I’ve also seen fabric covers designed to cover fluorescent lighting, suppressing the light’s intensity and adding colors to the space. They’re a great option if it isn’t possible to do a full lighting overhaul.
I’d love to be able to add color-changing lights or to control artificial lighting to mimic sunshine throughout the day. Both moves would help boost kids’ productivity in work and school environments.
Most lighting controls would be really helpful for the patients we serve, but occupancy sensors might actually be harmful in some cases, because they remove an element of control from the user. Many kids with autism have behavior meltdowns when they feel like the world’s coming at them too fast, too bright and too loud. If they walk into a dark room and the lights come on, they might be caught off guard.
What is a sensory room, and why does it help people relax?
GH: A sensory room is a special room that uses different stimuli to help people build and engage their senses in a safe environment. Stimuli include special lights, colors, soft objects and smells. They may have soft, colorful lights in floating tubes or comfortable chairs and a whooshing sound in the background, like white noise.
Sensory rooms are nice, calming places for neurotypicals, not just people with the conditions we treat. In fact, I toured a local sensory room and thought I could probably spend a day inside. Once you experience a sensory room, it’s easy to understand why it works for kids with ADHD, autism and other disorders.
What’s the best way to ensure proper lighting for neurological conditions?
GH: Above all, sharing information empowers patients and their families to make healthy choices or ask for an adjustment if something in the environment isn’t quite right. This is important, because everything we do should be patient-driven.