Contained below are answers to some of the most common questions we are asked regarding The Low Arousal Approach.
What do we mean by the term arousal?
We are describing that state of both physiological and psychological alertness and reaction to stimuli, which causes the brain to activates the nervous and hormone systems of the body and increases heart rate, blood pressure and the persons readiness to respond.
The link between arousal and information processing was originally described by Yerkes and Dodson (1908), known as the Yerkes Dodson Law. This law maintains that performance and arousal are linked in a classic inverted U shape and proposes that high levels of arousal lead to decreases in human performance. The original study examined the performance of mice in a learning task. Electric shocks were delivered for incorrect responses. This has been used as an analogy to show arousal reducing information processing has an optimum level (Easterbrook, 1959).
Critics of the Yerkes Dodson law argue that high levels of arousal have survival value (Zajonc, 1980) and in some circumstances may increase performance in specific situations (Hanoch&Vitouch, 2004).
Can arousal lead to ‘shut downs’?
Deborah Lipsky in her book From Anxiety to Meltdown: How Individuals on the Autism Spectrum Deal with Anxiety, Experience Meltdowns, Manifest Tantrums, and How You Can Intervene Effectively does refer to individuals with autism literally “shutting down”.
If we think about arousal and its behavioural impacts there are a number of areas where behaviours may be explained by this model. In constant states of hyperarousal the body may literally ’shut down’. Extreme levels of hyperarousal may lead to a person becoming less responsive to environmental stimuli and literally appearing to “shut down”. there are studies which appear to show unusual responses to sensory stimulation and arousal. Goodwin et al. (2006) reported lower sensitivity to environmental stimulation in five individuals with ASD compared to their controls; these individuals also had higher baseline heart rates than their controls. It is possible that higher levels of internal arousal may make some individuals less responsive to environmental stimuli. In this instance the internal arousal state becomes more dominant; this may provide an explanatory framework for some forms of catatonic type behaviors observed in some individuals with autism. Other forms of catatonia may be a result of low levels of physiological arousal which has a similar effect on movement effect on movement.
How easy is it to use reflective practice?
It can be difficult to reflect but, it can also be liberating?
All incidents of challenging behaviours do not occur in a “behavioural vacuum”. It is our experience that staff frequently do not view their behaviour as impacting on the behaviour of people with autism. The following is anonymised example of a real situation where a staff member analysed a challenging situation.
“I was working with Hans (a young man with autism) in a day centre. he walked into the room and paced around. To me he seemed very calm and relaxed. I asked him to come and sit with other members in the group and h said “no”. I very politely asked him a second and third time. About 5 minutes later he came up behind me and slapped me in the back, there was no apparent reason for this.”
This is a very typical example where the observer is not really interpreting behaviour in a manner which suggest that they are involved in the situation. A simple repeated request is not the problem, but, the response of the person with autism for them is the real issue.
The cornerstone of reflective practice is to view yourself as contributor to interactions with people. More positively there is a focus on active learning. In the above example a more reflective practitioner might focus on their own potential contribution to the situatio with Hans. they could ask questions such as “Did I trigger the situation with my requests?” or “Did I repeat the requests too many times?” Even morepositively “how can I change the situation in the future?”
Are we trying to manage or change behaviour?
Changing behaviours is a central focus of practitioners in this field. Attempting to change behaviours should be a major goal the rationale for positive behaviour supports. There have been major progress in the whole field of behaviour change using positive approaches. That is approaches which avoid the use of punishment or negative consequences to behaviour. But, in this book we have described a way of viewing the world which is literally a difference in viewing the world. Distinguishing goals can make a difference. In a recent article the dilemma was described.
Behaviour change should always be a desirable outcome, but for some individuals behaviour management may be sufficient per se. Consider the example of a young man with autism who repeatedly asks the same question to staff. Changing this behaviour may involve a range of strategies such as long term redirection plans, teaching a functionally equivalent response, altering a response chain all with a view of eliminating the above described behaviour. From a behaviour management perspective if the young man repeats the question 20 or 30 times before he can continue with an activity, does that really require an intervention? (McDonnell & Anker, 2009 pp).
Are we reinforcing negative behaviours?
There is almost an obsession with the idea that we have to be careful about reinforcing behaviours when a person is in crisis. The media also bombards us with messages that tell us about child rearing practices. A -good example of this is our exposure to the so called ’Super Nanny’ culture where distressed children are often managed in a manner that suggest that their behaviours are wilful. We find it interesting that people are often told by professionals to ignore behaviours, but this is really difficult to do in practice. ’You need to tough!’ can almost sound like a battle cry. Perhaps the most negative statements surround phrases such as ’dont let himher manipulate you’. It would be possible to believe that people are engaged in battles.What makes this sound difficult is that we do know that many behaviours are not always wilful and deliberate, but, they can feel like they are. When we are trying to manage situations it can begin to feel like a person is controlling us. This battle is at the centre of the low arousal approach.
Is it giving in?
People often perceive the low arousal approach as ‘giving in’.
In a crisis our goal is to reduce stress and not to teach a person.
The more stressed people become the less they process.
Consider the following example of a little boy called Charlie:
‘Charlie is seven years old and attends a main stream school. Charlie was diagnosed with autism when he was five. He has some spoken language and he has many rituals and routines. Three to four lessons a week Charlie will begin to scream and shout and bite staff. In contrast he has many good days where none of these behaviours occur. His teaching staff have restrained him and prevented him from leaving the classroom as he ’need to learn that his behaviour is inappropriate’
In a low arousal approach we would stress to these staff that Charlie is in meltdown and that they should facilitate his escape from that situation. The restraint used no matter how well intentioned will only serve to ‘traumatise ‘ him (and vicariously traumatise his teaching staff).