Section 2Evidence on Triple-A

Evidence on Triple-A

This section focuses on evidence on Triple-A issues from the research team at the Centre for Neurodiversity and Development, Durham University. This section should take approximately 20-30 minutes to complete.


Learning Outcomes

Understand research that shows Triple-A factors can impact on learning for autistic pupils specifically.

Understand how different research methods have been used to study Triple-A difficulties

Understand what may underlie the link between Triple-A difficulties.

What is the evidence?

Study 1 – Attention, Learning and Classroom Displays

The first example to look at is a study we published in 2017 [20], which was aimed at understanding how sensory aspects of the classroom environment can impact on attention and subsequent learning. In this study, we wanted to understand the impact of classroom displays on attention and learning for autistic and non-autistic children.

To do this, we designed an experiment. Experiments can give powerful evidence that shows the effect of one thing (e.g. classroom displays) on another thing (attention, learning), because they are designed carefully to test these effects while taking in to account other important factors. In this experiment,  we made a series of video mini-lessons. We had two groups of children watch the lessons and answer questions to test their learning afterwards. Crucially, we manipulated the presence of displays in the background of the videos. In half of the videos there were no displays, and in the other half there were lots of classroom displays (see images on the left).


How did we measure what the children paid attention to? We used technology called ‘eye-tracking’. Eye-tracking technology provides a precise and accurate way of measuring what a person looks at, when and for how long. It uses infra-red technology to track the movement of the eyes in relation to a computer screen, but is completely non-invasive. This means that for children, the experience is the same as watching a movie on a computer screen. For the research team, it gave a very accurate measure of what the children paid attention to when watching the videos. The image on the left illustrates an eye-tracking setup.

Word of explanation – looking at something does not necessarily mean you are paying attention to it. We can look at one thing (a computer screen) but be thinking about something else (food). That being said, what we look at closely corresponds to what we are thinking about most of the time, and therefore eye-tracking is a good (but not perfect) measure of visual attention.


What did we find?

The graph on the right shows the percentage of time each group spent looking at the background. The blue bars show looking at the background when there were no displays present.

The first thing to note is that when there were no displays, autistic and neurotypical children spent a similar percentage of time looking at the background – roughly around 10% (i.e. not that much).

How did children pay attention?

Here, we have a video that shows a part of a lesson with no displays, and eye-tracking data from some of the children who took part. Here you can see ‘heatmaps’ from eight participants from the autistic group. The more ‘red’ colour that you can see, the more children are looking at the same place at the same time.

Using videos like these, we can see the lesson through the eyes of the participants and how they attended to it– in this case, by focussing mostly on the ‘teacher’ and what she was explaining.

Attention and classroom displays

Now let’s take an example from a lesson where displays were present. Here, you will see ‘heatmaps’ from nine autistic participants.

It should be clear from this clip that attention patterns were quite different when displays were present.

Was this difference just at the beginning of the lessons, you might ask? On the next slide we will look at the overall pattern of results to find out.

Overall results

You might be thinking – “that is really interesting, but how can we know if this has relevance for what happens in a real classroom?”

Replication in real situation

It is important to say this is something we have replicated recently in a more realistic scenario – in a pop-up classroom [21], and with another experiment and with different groups of children. In our most recent study, we had children with and without autism complete classroom work in a mini classroom that we designed. In this experiment, we measured the amount of time children spent on or off-task. In our mini-classroom, we manipulated visual and auditory sensory information, such as displays on walls and classroom noise in the background.

We found a very similar pattern to that in our eye-tracking study – when classroom displays were present on the walls,  we found much more off-task behaviour than in any other condition.  This was true for both groups of children, but especially for the autistic children.

Replicating this finding with different children and using different methods gives us confidence to say that classroom displays have some negative impacts for children, but especially for autistic children.

Displays are a sensory feature of classrooms that we can easily adapt and change, and this may have positive benefits for many children. In Section 3, we will suggest some ways of thinking differently about use of displays.


Mollie (autistic young person) shares her experience of the classroom environment

Study 2 - Arousal, Learning and School Life

Study 2 – Results

The first finding of note was that parents and teachers believed that sensory differences affected learning either frequently or all of the time. This was not unexpected and highlights how sensory differences are such an important thing to understand in terms of learning for autistic pupils.

Icon showing that 71% of teachers believed that sensory differences affected learning frequently or all or the time and 81% of parents believed sensory differences affected life at school frequently or all of the time

Study 2 – Results

A further key question asked was how parents and teachers recognise sensory issues. Both groups reported recognizing sensory issues by virtue of observable behavioural reactions.

Here is a quote from a teacher as an example

“They try to protect themselves by covering their ears, closing their eyes, pulling their shirts over their noses to block out the smells”

This is important as it likely indicates that the sensory differences being picked up and noticed  at a point when sensory input is difficult to tolerate. It probably means we are more tuned into hyper-sensitivities rather than hypo-sensitivities.

Jayne (Mum to Danny, aged 8) discusses hyper-sensitivities at school

Opportunity for self-reflection

Can you think of what behaviours you notice in a child you support that suggests sensory issues?

Do you think these reflect hyper-sensitivities, or hypo-sensitivities?

What sensory differences most impacted learning?

Next, we asked parents and teachers to tell us about what kinds of sensory inputs had the most impact on learning. Parents and teachers were largely in agreement about the most to least impactful sensory inputs, with the most impactful being auditory (which is related to hearing), followed by tactile (which is related to touch and feel), then visual, with the least impactful being smell and taste.

Let’s look at examples of what parents and teachers said were impactful.

Auditory inputs

For auditory inputs, it was things like loud unpredictable noises such as fire alarms, hand dryers, or noise from other pupils; but also more specific noises such as a pencil on paper or a marker on a whiteboard.

Tactile inputs

For tactile inputs it was being touched by others in assemblies, during groupwork or in corridors. Similar to the auditory examples, we can see the element of ‘unpredictability’ coming through as an important aspect as to why these sensory inputs can be problematic. We also found evidence of tactile sensory behaviour that were positive for children, such as tactile seeking behaviours like repeated tapping, touching or squeezing.

Visual sensory inputs

For visual sensory inputs, parents and teachers reported negative experiences linked to fluorescent lights, strip lights and a high level of classroom displays. However, negative experiences with these stimuli were not specific to the classroom, and could be experienced in different parts of the schools (e.g. corridors).

Smell and taste

For smell and taste, the experiences reported by parents and teachers largely indirectly impacted learning and school life through, for example, distress at lunchtime in the canteen or in the PE changing room. Also reported were difficulties with incidental smells such as perfume worn by staff or the smell of cleaning products.

How do they impact learning?

How did the kinds of sensory experiences reported impact on learning?

Our analysis of this data suggested two major impacts – distraction and distress – albeit it with considerable diversity!

The best way to illustrate these points is with parents and teachers own words


Inability to “tune out the noises they don’t need affecting their ability to listen to instructions/input”

Quote from Teacher


Because if a child is more focussed on what they are wearing it distracts them from their work

Quote from Teacher


…meltdowns, tears, screaming…

Quote from Teacher


Corridors, open halls where sounds can be echoed, my child will self-harm and try to cover his ears.

Quote from Parent


she either appears anxious or angry. How can you possibly learn with all that adrenaline rushing through you? It’s like asking someone to do long division when they’re free falling from a plane. Not going to happen.

Quote from Parent, Pupil in Mainstream

Significant impact

This really clearly illustrates that what might look like angry or anxious behaviour can be the result of negative sensory experiences, and how that can render everyday tasks impossible.

This study emphasises why we need to do more to understand and support sensory needs in school.

In section 3, we will pick up on tips and strategies to support these needs.

Study 3 - Anxiety as a barrier to learning

In this final study example, we will describe a published study of barriers and facilitators to learning that we conducted, involving interviews with teachers from a range of different educational provisions [23].

Barriers and facilitators to learning in the classroom for autistic pupils

In this study [23], we wanted to explore what teachers felt were the barriers and facilitators to learning in the classroom for autistic pupils. The aim was to gain rich and detailed information on real experiences in the classroom from teachers who had supported many autistic pupils across a number of years.

We conducted semi-structured interviews with 10 primary school teachers of autistic pupils. Three of these teachers were from mainstream primary schools, 3 were from mainstream primary schools with Special Educational Needs provision, and 4 were from Special Educational Needs schools.

Teachers were asked two main questions:

 “Thinking about children with autism, can you tell me a little bit about the most important factors that you feel negatively affects a child’s ability to learn in the classroom?”

 “Thinking about children with autism, can you tell me a little bit about the most important factors for supporting a child’s ability to learn in the classroom?”

The purpose of asking about both barriers and facilitators was to encourage participants to discuss factors that both positively and negatively impact on behaviour and learning.

What did we find?

3 key areas

Summary: Anxiety as a barrier

The following quotes illustrate this:

“their anxiety levels go so up so high they can’t think” – (Teacher 1)

“[Some of our]… autistic children have the highest levels of anxiety … it can be little things like they want a drink but the drink’s near the sink … so that stops them from doing any of the learning because they’re so focused on getting their water bottle” – (Teacher 9)

The consensus from teachers in this study was that anxiety was so high in so many of the autistic pupils that they had taught, that it became all-encompassing, to the point where pupils could not focus on their work and missed out on many learning opportunities. The fact that anxiety can be such an overwhelming and significant issue for many autistic people is something that has been shown in many other research studies (as discussed in Section 1). This teacher interview study really shows its impact for learning and school life for autistic pupils, regardless of educational provision. It shows that when all the possible barriers and facilitators to learning for autistic pupils are considered, anxiety comes out strongly as a significant barrier and one which should take priority for support and intervention.

Jayne (Mum to Danny, aged 8) discusses anxiety at school

Well Done!

Continue on to the next slide

What underlies Triple-A?

What underlies Triple-A?

To illustrate this point, here is a quote from a teacher

“My experience is that children can be reactive to sensory inputs before they actually occur, i.e. a child may become anxious an hour before lunch time as they anticipate the sensory overload. I work with a child who is extremely anxious coming back into school after half terms/holidays as they were anticipating fire drills that we usually practice in the first couple of weeks back. The shrill alarm, sudden change in routine, bodies brushing past as children form lines etc. were all very overwhelming.”

Understanding the link between each aspect of the Triple-A framework as well as the role of intolerance of uncertainty can help us to focus our support strategies in the right place. For example – that avoidance, as a strategy is not going to get a person very far, and ultimately helping to manage uncertainty and build tolerance is a better way forward.

Pulling everything together…Triple-A

On the basis of the evidence we have shared here, we have put forward our ‘Triple-A’ framework – to raise understanding and awareness of how each of these factors can be influential for learning for autistic pupils.  We have used examples from our research to explain why each factor is important in its own right, but crucially how they interact together.

Model depicting link between attention, arousal, anxiety and the classroom environment, and how these further link with engagement and then learning


Pulling everything together…Triple-A

Triple-A impacts will apply differently for each individual child – for some children anxiety may be by far the most prominent difficulty. For some, it may be arousal and sensory issues. For some, it may be attention skills. For many, there will be links and overlaps between all three. Our research has focussed on autistic pupils, but we know these issues are highly relevant for many neurodivergent children without an autism diagnosis.

Although the research we have focussed on in this section has mostly involved primary school aged children, our work with autistic adolescents and autistic university students echoes many of the same issues. The quotes on the following slides from autistic young people really illustrate this.

“What I do, like, is not just for like attention, it’s because I actually can’t really cope if there’s like a fly or something or something smells bad.”

Quote from Autistic Adolescent

“Often things like when, when other kids are being quite unpredictable and when instructions are made unclear and, and also like being made, when we have to queue at lunchtime. I’m not very good with that.”

Quote from Autistic Adolescent

“I think mainly, it’s worth understanding that for people like me…… are our senses……… and we get sensory overload much faster than [neurotypical] people. I can only handle so much noise or something, other kids can cope, but being in a noisy classroom, I can’t”

Quote from Autistic Adolescent

Broad impact


Triple-A issues don’t just occur in primary school and can continue to impact throughout schooling. Indeed, they don’t just occur in the classroom, and can be experienced in various aspects of school life (e.g. the playground, the corridors, the dining hall, the PE hall).

“The pupils in my classes were very noisy and it could cause me to experience panic attacks and sensory overload. It would also distract me from what my teachers were saying as I couldn’t focus when two people were speaking at once. I also struggled in places that were too crowded or where the lights were too bright.”


Quote from Autistic University Student

“[I] struggled doing tests with a full class without noise cancelling headphones due to pen tapping and clock ticking, often found corridors and fire alarms overwhelming, shirt collar and cuffs of uniform were uncomfortable and scratchy so made it hard to focus”.

Quote from Autistic University Student

Triple-A Summary

In this section, we summarised 3 key studies from the research team at the Centre for Neurodiversity and Development at Durham University, which provided evidence on Triple-A issues for autistic children. We hope that you now have a better understanding of:

  • How sensory features of a classroom can be distracting.
  • How sensory processing differences impact learning for autistic pupils.
  • Why anxiety may be problematic for learning.
  • How different research methods have been used to study Triple-A difficulties.
  • What may underlie Triple-A difficulties.

In the next section we will map the key research findings  to practical support strategies for you to develop and use in practice.

Section 2

Incorrect answers are shown in red, correct answers in green.

Does looking at something mean a person is paying attention to it?

From the research presented, what effect did classroom displays have on attention and learning?

From our research on sensory issues at school, what types of inputs did parents and teachers indicate were the most problematic?

Can you give examples from your experience of other sensory stimuli that can pose problems for autistic and neurodivergent people?

Which of these factors were indicated as barriers/facilitators to learning at school by teachers in Study 3?

In the teacher interview study, what did teachers indicate was one of the most significant barriers to learning for autistic pupils?

What is the name of the theoretical model that can help us understand what connects Triple-A factors?

True or False: Triple-A issues impact every autistic child in the same way?

Well Done!

Continue on to the next slide

Section 2


Jayne Sayers

Advisory team member

Jayne is the parent of an autistic 8 yr old son, and has 22 years experience in the NHS as a nuclear medicine technologist, working with patients of all ages and capabilities.

Mollie Preece

Advisory team member

In her own words, Mollie describes herself as “12 years old and I’m different in a good way. Change is difficult but with the right support I can manage it. If I feel people understand me, I can work well with them and not shut down. A loud noisy environment is just not helpful. It really helps me to learn when I have a calm and productive environment in the classroom.”

Marie Preece

Advisory team member

Marie is the parent of an autistic daughter and was diagnosed as autistic herself at the age of 45. She runs a successful business and in her spare time she is involved in various projects which aim to bring awareness and understanding of the challenges of autism in girls and women.

Sharon Minikin

Advisory team member

Sharon has taught children with Autism for 18 years and is currently SENDCO and Provision Manager of a Local Authority commissioned Resource Base for children with social communication needs.

Prof Sue Leekam

Advisory team member

Sue is an Emeritus Professor in psychology at Cardiff University and holds a Leverhulme Trust Emeritus Fellowship. She is an expert in neurodevelopment and especially in the areas of attention, anxiety, sensory and social differences.She is also passionate about building strong research-community relations in areas of health and education. She serves on the NHS Wales Steering Committee for Neurodevelopmental Service Improvement, and was also an advisor to the Welsh Government’s Autism Strategy.  She has been invovled in the development of training tools to improve public and professional understanding of autism [See here for free training film for front line professions on the signs of autism: see ]

Charlie Hookway

Advisory team member

Charlie was diagnosed with autism in year 4 and he is now in his final couple of weeks of A levels. He loves photography and is due to start a degree at university in September

Amanda Hookway

Advisory team member

Amanda is a mum to 3 boys. Her eldest son is on the autistic spectrum. She has worked in schools supporting students who have additional needs and learning difficulties for many years. 

Emily @21andsensory

Advisory team member

Emily has Sensory Processing Disorder (diagnosed aged 8) and is Autistic (diagnosed aged 25). She is an Illustrator, Graphic Designer and Podcaster. She enjoys discussing and drawing about her life as a sensory-being across social media at @21andsensory. Emily hosts and runs the 21andsensory Podcast where she chats to neurodiverse people from all walks of life

Helen Sellars

Advisory Teacher, Commuication & Interactin Team

Helen is an Advisory Inclusion Teacher from the Communication and Interaction Team which is part of Specialist Inclusion Services at Durham County Council. Prior to working in SEND and Inclusion, Helen was an Assistant Head Teacher and SENDCo.

Elizabeth Mulholland

Team Leader, Communication & Interaction Team

Liz is the Team Leader for the Communication and Interaction Team which is part of the SEND and Inclusion Service at Durham County Council. Prior to this Liz worked as an Advisory Inclusion Teacher within the same service having spent several years previously as a senior leader and SENDCo in a primary school.

Dr Janet Crawford

Principal Educational Psychologist

Janet is the Strategic Manager for Specialist Inclusion Support and Principal Educational Psychologist in Durham with a long standing interest in autism and neurodiversity. Janet is the current Chair of County Durham Think Autism Strategy Steering group

Rosie Johnson

Research Assistant

Rosie is a Research Assistant on this Triple-A project. Prior to this Rosie has worked as an Assistant Psychologist, including previously working in CAMHS with children and young people who are neurodivergent.

Dr Liz Jones

Project Collaborator

Liz is a mixed-method researcher with an interest in understanding the experiences of children and young people with sensory differences at school. During her PhD she explored the impact of sensory processing differences on learning and school life for autistic pupils.

Dr Emily McDougal

Project Collaborator

Emily is a researcher with an interest in understanding neurodivergent children in the context of the primary school classroom. During her PhD, she investigated the role of attention in learning for autistic pupils.

Jessica Hirst

Lead Research Assistant

Jess is the lead research assistant on this Triple-A project, having worked on it from the beginning. Indeed, some of the research Jess completed for her Masters in Developmental Psychopathology has contributed to the evidence for this training. Jess is really interested in understanding and supporting engagement and learning at school for autistic and neurodivergent pupils, and having now begun a PhD, she is focusing on developing a holistic model for learning and engagement at school for autistic and neurodivegent pupils.