Understanding the Low Arousal Approach
The Low Arousal Approach was first established in the late 1980’s in the UK. Its philosophy emphasises a non-confrontational approach in crisis situations. In 1992 Professor McDonnell established a training company called Studio 3 Training Systems Ltd. Over the last 25 years, Studio 3 has expanded and now provides its services across Europe.
Studio 3: What does the Low Arousal Approach mean, what does it have to do with stress and why is it relevant to autistic people?
Prof. Andrew McDonnell: The Low Arousal Approach is a collection of behaviour management strategies which focus on effective crisis management. As a young psychologist trained in Positive Behaviour Supports, I was always asked to produce plans but was also asked to give advice about what to do in a crisis situation. Autistic people in my experience are often ‘highly aroused’ and good stress management needs to be applied in these circumstances.
The phrase I like to use is ‘when you are drowning, that is not the best time to learn how to swim’. The people we support can accumulate stress to the point that they experience ‘shutdowns’ and ‘meltdowns’. So teaching supporters how to behave in these circumstances is vital in my opinion.
S3: Can the Low Arousal Approach be applied in the family home and in schools? Can the Low Arousal Approach be used by parents and families?
AM: Yes! We are proud of the fact that parents can be trained in Low Arousal Approaches. Indeed a good number of parents and family members have completed training and have successfully implemented it into their family home. Linda Woodcock, a parent of an autistic person, has written an excellent book on Low Arousal called ‘Managing Family Meltdown’. On a personal note, it is a priority for me and Studio 3 that families receive training in Low Arousal Approaches.
S3: Within the approach you discuss minimal use of physical intervention only when imminent risk of harm is apparent. Why?
AM: Too much training in this field contains physical interventions as a way of managing behaviours of concern. At Studio3 we have always reduced the number of physical interventions taught on our training courses. This is because we are quite radical in our perspective as we have banned many methods of physical restraint for our international programmes. This is because many methods of restraint are quite frankly dangerous.
In addition to our training differing from other companies due to our philosophy, our method of training also differs. Often people forget what they have learnt in the classroom in stressful situations, our training is not limited to the classroom. Instead we are able to provide specialist on-the-ground training and support.
S3: Is there any advice that can be given to parents/carers who support people who self-injure?
AM: Self-injurious behaviour is a very common problem, however this is nonetheless extremely distressing for the individual and those who support them. In my experience, self-injurious behaviour is often triggered due to the individuals’ sensory differences.
Therefore the use of proactive sensory strategies can often be very successful in reducing occurrences of self-injurious behaviours. In addition, designing relaxation programmes from a sensory perspective can also be beneficial. To give you an example, an individual will nearly always have smells which will relax them. Using this strategy can not only relax the individuals in times of stress, but can also reduce this person’s heart rate. Self-injurious behaviour is highly complex and can have many functions for the individual.
Nonetheless in addition to using proactive strategies, in times of extreme stress, parents will also need to use reactive strategies. For example, parents may benefit from being taught how to physically distract a person when their self-harm is causing significant physical damage to themselves.
S3: How long does it take to learn your method and what preliminary qualifications are required to participate in the training?
AM: We routinely train supporters (including families, carers and staff teams) on a core three day training course. This course is delivered in over 14 countries including Sweden, Denmark, Germany, the UK, Ireland and Canada. We also provide Train the Trainer courses to organisations to enable their employees to become Studio 3 affiliated trainers. I do need to stress however that potential trainers must have completed the core three day training course regardless of their experience. We additionally set very high standards for our trainers and in some cases people have failed to complete our training courses.
S3: What does the future hold for the Low Arousal Approach and Studio 3?
AM: Whilst the Low Arousal Approach is conceptually very strong, there is still a need for a stronger empirical evidence base. This is becoming even more relevant as training programmes are appearing to be increasingly popular. In addition, the specific behaviour needs of autistic people needs a much stronger emphasis within future Low Arousal work. This would certainly include a stronger voice for the people we support within the training we provide. Finally our main goal at Studio 3 is still to support restriction and restraint-free lives for the people we support.
Written by Tarendeep Kaur Johal and Simone Kendall, Assistant Clinical Psychologists at Studio 3 Clinical Services Ltd on February 2018.