In conjunction with Gareth D. Morewood, Studio 3 are delivering training in low arousal, education and emotional regulation as of January 2019. It has been a very busy start to the year for Studio 3’s new Education Project. Since January, our Educational Advisor has worked with schools and families in Dubai, Lisbon, the Netherlands and, most recently, Denmark, as well as numerous U.K. schools and settings, delivering training and working directly with young people, supporting them, their families and professionals. In February, Studio 3’s low arousal and emotional regulation training made it all the way to Dubai, where it was delivered for the first time by Educational Adviser Gareth D. Morewood. Gareth delivered multiple sessions at Optimus Education’s first event in the Middle East. You can read more about this exciting two-day conference and the developing context in Dubai here. Whilst there, Gareth had the opportunity to talk with Dr. Pooky Knightsmith about the Studio 3 education project, and what inclusion means on a whole-school level using the low arousal approach. At Studio 3, we believe that children with additional needs should be supported in educational settings in an inclusive way, by creating a low arousal environment across the whole school. This not only facilitates learning for pupils who may have difficulty regulating their emotional states, but also benefits children who do not have additional needs or behaviours of concern. Gareth, who is a practicing teacher at Priestnall School in Stockport as well as the Special Education Needs Coordinator (SENCo) there, has for many years demonstrated through research and practice that it is possible to support children with special education needs within a mainstream school environment. His work with Studio 3 focuses on providing training to staff, teachers and families on methods they can implement in educational settings to make them calmer, more positive and stress-free environments for all children and young people involved. Recent months have seen the delivery of the first one-day low arousal course, developed by Gareth, on Autism, Education and Emotional Regulation. Most recently, Gareth and Professor Andrew McDonnell collaborated in The Hague, working in partnership with a British School in the Netherlands. The pair delivered Studio 3’s innovative training to 25 inaugural delegates, resulting in a really powerful day, with follow up sessions planned for June and a growing interest in implementing Studio 3’s work in educational settings in the Netherlands. Gareth was also able to deliver a keynote address at the impressive SIKON event in Odense. With 900 delegates present, this was a very significant opportunity to spread Studio 3’s message, which was well received by the enthusiastic audience at the event. View the slides from his presentation here There are many more exciting developments ahead for the Studio 3’s education project, which you can follow more closely on our website, facebook and twitter. Studio 3's Twitter: @studioiii Studio 3's Facebook Gareth's Twitter: @gdmorewood Further Reading Morewood, G. D. (2019) Understanding Emotional Regulation in the Context of Whole School Inclusive Systems. INCLUVISION Magazine, published by JSS Private School, Dubai. Autism, Education and Emotional Regulation flyer SENCology blog, hosted by Optimus Education

by Dr Catriona A. Stewart Autistic girls and women have been described as being like swans – appearing to glide across the surface of life but paddling furiously under the surface just to keep afloat! Until recently, it was believed there were substantially more autistic males than females, with a ratio of approx 4:1, and the gap widened in autism with no co-occuring Learning or Intellectual Disability to approx 9:1. It is now becoming widely accepted that females with average to high intelligence, those who might have, in the past, attracted a diagnosis of Asperger syndrome, may especially be misdiagnosed or overlooked. There is a range of possible reasons for why this might be the case, including that most previous research has involved male participants and therefore expectations are that autism is a ‘male thing’ are perpetuated. It has been suggested the tools used to assess females may not be not appropriate, but an alternative interpretation might well be that clinicians applying the available assessment tools for autism must use their professional and clinical judgment with few trained in, or knowledgeable of, autism in girls and women. It’s important to note that some of the aspects of autism presentation identified as being specific to girls and women are not necessarily so. It’s possibly more that our awareness and improved understanding of what autism means in females has helped to challenge some of the stereotypical ideas of autism in a general sense. For example, the often-cited abilities of girls to ‘mask’ their autism (to glide like swans…) is also reportedly experienced by some boys and men. It’s believed that some of these characteristics are at least more common in women but it’s also important to remember that the expectations on individuals - the social pressures, the strategies and tools available for managing day-to-day life - are not gender neutral in a gendered society, and much will depend on the life circumstances of the individual autistic person, their family, their personality, the resources and opportunities available to them and also of course, any co-occuring conditions. Despite our increased awareness of autism in girls and women, professionals working in the field of autism and other general practitioners including teachers, GPs, social workers, health visitors, police... may not always have had access to the kind of training or experience that would support their work effectively when they come into contact with autistic women or girls. They may not recognise the possibly ‘atypical’ presentations of autism or be aware of some of the specific needs of this population. There is very little in the way of female-informed service provision or even strategy, in terms of specific educational needs, health-care, including maternity and post-natal services, mental health support and so on. When women begin to identify either their daughter or themselves as having autism traits it may be difficult to have family or friends understand, as there is so little available information and the general understanding is still of autism as mainly affecting boys and men. Underpinning all my work is a commitment to retrieving the authentic autistic voice and lived experience not just as valid but essential; those experiences and voices are increasingly signposting academic and clinical research directions and adding to a richer, more helpful narrative around autism, which has historically been presented in stereotypical and very negative terms. That negative language and stereotyping can cause a great deal of damage to the sense of self, mental health and well-being for the individual young person or adult. I have worked passionately for years to change the language and perceptions of autism, especially as effects females and their families and to create a positive form of visibility, identity and relational community for autistic girls and women. By Dr Catriona A. Stewart, chair of Scottish Women's Autism Network (SWAN) (@CatrionaSScot)

Staff news, developments from across the globe, and recent events from Studio 3. Our educational lead, Gareth D. Morewood, presented at the SIKON 2019 conference on the 29th and 30th April in Odense. He delivered a keynote speech titled, ‘Effectively Supporting Student Behaviour by Understanding the Link Between Emotional Regulation and Low Arousal’. Paul Dickenson, a consulting clinical psychologist providing advice around behaviours of concern, will also have an internal stress and well-being role for Studio 3 staff as of this month. Congratulations to Amy O’Quinn and Adam Gardiner at Breton Ability Center in Nova Scotia for commencing their next Studio 3 training trainers programme. It is nice to see our work thriving in their capable hands. Congratulations to Martin Galvin and Paul Phillips (principal trainers in Studio 3) for passing the 100 In-House Trained Trainers threshold. Our work in Ireland is broadening from the learning intellectual disability sectors to schools and mental health. Congratulations to our colleagues at Pindstrupskolen near Aarhus in Denmark who are leading the way in applying a stress and well-being framework to their pupils. For more staff news and recent events, follow us on Twitter @studioiii or connect with us on Facebook and Linkedin!

A practitioner’s handbook to the low arousal approach, written by Studio 3 CEO Professor Andrew McDonnell, is now available to pre-order from our website. Professor Andrew McDonnell’s new practitioner guide really is a reflective journey. A strong theme throughout all of the chapters is that we must look at our own behaviour first in order to manage highly stressful situations. We spoke to him about what to expect from the upcoming publication, and the meaning behind the book’s title. INTERVIEWER: Tell us a little bit about why you wanted to write this book. ANDY: The book is actually something I’ve wanted to write for years. I’ve written an academic book on the low arousal approach and actually a lot of my colleagues - Bo Hejlskov Elvén, Linda Woodcock, Andrea Page – they’ve all written excellent practitioner books on low arousal and I kind of felt a bit left out. My hope is that this book will be there for frontline workers. It’s really focused on parents, staff in schools – anyone who supports a distressed individual. It also applies to a whole range of different areas, not just people on the autism spectrum. It’s really about how we apply low arousal in practice. INTERVIEWER: Who is the book for? ANDY: I think it’s for quite a wide audience. I mean, certainly, professionals will be able to read it. I don’t believe in this concept of saying a book has been ‘dumbed down’ because I think it’s really insulting, but it is written to have a broad audience, including family members who may not have a professional background in behaviour management. Professionals should be able to pick it up and say, hopefully, ‘There are some quite useful things in here I can do around crises management, and also look at how I can apply these things in my work’. Certainly, family members should find it useful, for example people with siblings who are distressed in some kind of way, who experience these kind of high arousal cycles. I’d also look at it for some of our trainers, in their own organisations and in-house, as a kind of practice guide for them. They often ask us questions such as, since low arousal was developed as a concept, where is it now? What I have told people over the years is that low arousal is as much more about reflective practice, i.e. US, than it is about them, the people we are supporting or working with. INTERVIEWER: What is the meaning behind the title of the book? ANDY: The idea behind the term ‘reflective journey’ is that it should be a book that people can dip in and out of. They can do self-assessment reflective exercises, and it should make them think a little bit more about how they can become an even better practitioner. For some people, they may need to be thinking that maybe there are some skills they need to develop further. The Reflective Journey: A Practitioner’s Guide to the Low Arousal Approach is now available to pre-order on our website! Deliveries expected to start in June.

Support for individuals struggling to cope with stress and additional issues Working with Individuals ​ Here at Studio 3 we have an experienced team of staff who have a diverse range of skills (including CBT, PBT, psychotherapy and systemic working). We provide individual therapeutic programmes on a case-by-case basis, and tend to work primarily with highly complex situations and people. Much of our work focuses on extreme anger, physical and verbal aggression, self-injurious behaviour and self-harm. In addition, we employ trauma-informed approaches in our work with individuals who suffer with trauma or abuse across the lifespan. ​ This includes working with adults and young people who: - Have experienced trauma and difficulties in attachment - Have a developmental condition, mental health problem or intellectual disability - Present significant levels of self injury and behaviours of concern - Have patterns of eating disorder - Obsessive behaviours - Have been in trouble with the police - Have significantly aggressive and violent behaviours - Have issues with drugs and alcohol - Have been victims or perpetrators of sexual abuse or present sexually inappropriate and harmful behaviour Studio 3 will often work with both the individual and carers trusted by them to ensure that therapeutic support is continued outside of therapy sessions.  Additional support and training is also provided on a regular basis to these carers to promote consistency and continuity. ​ We provide therapeutic support by developing a  programme which includes long term objectives that are informed by clinical assessment. The frequency of support sessions are dependent on the needs of the young person, and can therefore be long-term or on-going. Learn more about our clinical support services here, or get in touch with us directly to discuss individualised support by calling 01225 334 111 or emailing info@studo3.org

Celebrating the achievements of our consultants and associates across the globe Firstly we would like to congratulate Professor Mark Wetherall upon becoming a Professor in Health Psychology at the University of Northumbria. We look forward to his future collaborations with Studio 3, particularly in terms of ways to reduce carer stress. Best wishes to Daniel Rippon who has just submitted his PHD thesis at Northumbria University on hair cortisol concentration and work related stress in carers who deal with challenging behaviour. His collaborative work with us is only just beginning with this Studio 3 funded project, and we are excited about what the future holds! We are delighted to welcome Camille Trueman to the team as our new assistant psychologist. Millie has previously worked in both NHS and private sectors, and has a vested interest in supporting those with mental health difficulties. She will be working closely with our clinical services team In addition, we would like to congratulate Martin Galvin on receiving Principle Trainer status in Ireland, working alongside Paul Phillips and our colleagues in Ireland to deliver Studio 3's training courses in Dublin and Tralee. And finally, we acknowledge Scottish Autism who this year celebrate their 50 year anniversary! They provide a vital service in Scotland, enabling people living with autism and supporting them at all stages of their lives. For more information on the work they do, visit their website here.

The low arousal approach, a concept founded at Studio 3, is now widely practised across the globe. Here's why. Low arousal approaches have been adopted and taught in many services both in the UK and throughout Europe. This article will provide a brief background to the approach, as well explaining the principles of the approach, including reflective practice and identifying behaviour triggers. Given that stress is an ever-present part of the lives of people with autism, how should we manage crisis situations where the individuals we support may be experiencing 'meltdown'? The term 'low arousal' was first used in 1994 (McDonnell, McEvoy & Dearden, 1994). McDonnell (2010) identified four key components considered central to low arousal approaches. These include both cognitive and behavioural elements: 1. Decreasing staff to client demands and requests so as to reduce potential points of conflict around that individual. 2. Avoidance of potentially arousing triggers (e.g. direct eye contact, touch and removal of spectators to the incident). 3. Avoidance of staff's non-verbal behaviours that may lead to conflict (e.g. aggressive postures and stances). 4. Challenging staff beliefs about the short-term management of challenging behaviours. Implicit in the approach are two key guiding principles. The first principle is that the approach concentrates on altering our own behaviour in crisis situations. There is now very good evidence which indicates that many challenging behaviours are inadvertently triggered by carers (McDonnell, 2010). A key element is reflective practice (Schon, 1987; McDonnell, 2010). This literally means that a person needs to examine their own contribution to a situation and modify their behaviour accordingly. The second principle involves the concept of trauma-informed behaviour management (McDonnell, 2010). If we view a person as traumatised, it has an impact on how we manage their behaviour. Quite often people who are stressed and traumatised experience panic and need to escape from situations. In terms of physical interventions, a minimalist approach has been adopted by Studio3 staff. Learn about our low arousal approach training courses here. For more information on low arousal in general, visit www.lowarousal.com.

A review of Bo HejlskovElvén and Tina Wiman's 'Sulky, Rowdy and Rude?: Why Kids Really Act Out and What to Do About It' (2017) Yet again Bo Heilskov Elvén and his colleague Tina Wiman have produced a wonderfully reflective book that can be read by families to help them to focus on the behaviour of their child. In our view, this book can also be read by front-line carers and other professionals working with children. There are a series of easy to read chapters which focus on how to understand the behaviour of young children. There are also very simple chapters which concentrate on the work of Ross Green, who focuses the behaviours family members. The low arousal approach permeates the entire book. In a user friendly way there are many themes that focus on how we perceive behaviours. Chapters include: 'Children Behave Well If They Can' and, our personal favourite, 'Conflicts Consist of Solutions'. The authors tailor the book well to their main audience, and we would recommend this book widely. Purchase from Amazon here or see more from our colleague Bo here.

A review of Martin Seligman's 'Flourish: A New Understanding of Happiness and Well-being - and How to Achieve them' (2011), written by Professor Andrew McDonnell Martin Seligman's book is a real triumph. It builds on his earlier book on authentic happiness. I must admit that when the original book was published I felt that happiness was too narrow a focus and, in true Seligman style, he opens his book by accepting this and broadening his definition of well-being. A key part of this book is the narrative that Seligman uses to describe his own journey from an animal researcher who quite literally electrocuted dogs to the premier world leader in positive psychology. This of course is a major transformation and represents a really interesting journey. Seligman is willing to share personal reflection and insights with his readers. I also like the fact that Seligman is not afraid to be blunt in his views about research. For example, when he talks about science he dismisses the armchair theorising and logic of Wittgenstein and presents a more scientific approach in the spirit of Popper (1959). His comments about basic research without purpose were robust and humorous and I am afraid even I would not print! Seligman argues that well-being is "a construct and happiness is a thing" (pp14). In this book, Seligman elaborates on his 5 component model of well-being (or flourishing) using the accronym PERMA. This stands for: Positive emotions, Engagement, Relationships, Meaning and Accomplishment. The book describes applications of this work ranging from schools to the US military. I particularly liked the emphasis on building psychological resilience rather than on "fixing things". It is a personal opinion, but I do believe that somewhere along the line psychologists become taxonomists and fixers/repairers rather than architects. Unusually for me, I must admit that I did find this book very inspirational. Initially, I had thought about writing a review with the usual minor critiques of terminology. However, in reality. this book contains a narrative that I feel that all professionals should read and reflect. I have spent my career working with people with intellectual disabilities and/or autism and it has become increasingly clear to me that the PERMA model fits very well with not only my own philosophy, but that of my colleagues in both Studio 3 and Atlass autism. This book is now set reading on all our training on autism stress. Purchase from Amazon here or find out more about how we utilise Seligman's PERMA model in our Atlass training courses here.

What is happiness, and why is it important? "Most folks are as happy as they make up their minds to be." - Abraham Lincoln We often speak about quality of life but, the term happiness is often avoided as it is considered to be subjective. However, when thinking about people with autism who sometimes become very stressed, happiness and well-being are meaningful goals. Happiness is defined as the overall appreciation of one’s life-as-a-whole; in short, how much one likes the life one lives (Veenhoven, 2006). Studies have indicated that 40% of happiness may be determined by intentional activities, 50% by genetics and 10% by life circumstances (Lyubomirsky, Sheldon & Schkade, 2005). Happiness is associated with many positive effects on physical health and is essential for people who wish to work with others who are highly stressed. It is our view that happiness should be an area of increasing interest for researchers. In the Atlass programme, we place the happiness of carers and people with autism at the core of our approach. Consider the following approach; the next time you see a person with autism who presents with challenging behaviours, focus on what gives them momentary happiness and do more of it. This of course also applies to their carers. Find more information on happiness here.

Available for purchase from January 2019, 'The Reflective Journey' is a practitioner guide to the low arousal approach and reflective practice. The following excerpt is from the chapter titled 'Positive Psychology' The Emergence of Positive Psychology There is an emerging influence of positive psychology within the field of autism and behavioural supports, which is currently at quite an early stage of development. Analysing the impact of positive interactions can be an extremely powerful tool. The modern use of the term positive psychology emerged from the growing literature on wellbeing and happiness. A focus on strengths rather than deficits is the basis of the approach. Seligman and Csikzentmihayli (2000) argued that the ‘old’ psychological thinking was mostly focused on negative characteristics: "It concentrates on repairing damage within a ‘disease model’ of human functioning. This almost exclusive attention to pathology neglects the fulfilled individual and the thriving community. The aim of positive psychology is to begin to catalyse a change in the focus of psychology from preoccupation only with repairing the worst things in life to also building positive qualities” (Seligman and Csikszentmihalyi, 2000, p.5). A good working definition of positive psychology was proposed by the Irish Psychologist Alan Carr: "Positive psychology is concerned with the pleasant life, the engaged life and the meaningful life" (Carr, 2011, p.2). In terms of behaviours of concern, this may represent a stronger focus on skill acquisition and building resilience through developing better coping strategies for people with autism and their supporters. This approach entails a more holistic overview of the person rather than focusing on a collection of behaviours that require ‘fixing’ or ‘repairing’. Such a holistic view inherently considers the interaction of the person with their environment and accepts that other people, including staff and carers, are part of that environment. In education research, there has been an emphasis on the development of resilience-based programmes to target primarily childhood mental health issues, including depression (Seligman et al., 2009; Norrish et al., 2013). The authors can find little research however that includes children with autism. Notwithstanding the current paucity of research, the potential usefulness of Positive Psychology in supporting autistic children and young people has been embraced by some authors. In the last six years, Groden et al (2011) published a book dedicated to this approach that explores the use of Positive Psychology informed strategies to build resilience, increase optimism and self-efficacy (among other areas of functioning). The authors contend that there are many potential areas of application for positive psychological thinking to behaviour supports. These areas could include focusing on understanding individuals with autism who appear to manage their own behaviour, and a placing greater emphasis on resilience. There is a clear need for the development of what has been loosely described as positive psychological techniques for supporting children with autism. One key implication of adopting a positive psychology approach could be in the way behaviours of concern are recorded. Carers or supporters are often expected to record incidents. This can be a negative process where there is a strong emphasis on risk and reactive behaviours. A focus on positive recording of data (what has gone well, and why that might have been) rather than an overemphasis on recording negative behaviours can be achieved by using the same recording systems, but intermittently targeting positive behaviours. Monitoring positive emotions such as moments of happiness, or positive interactions may help to enhance interventions. The full book will be available to purchase from the Studio 3 website in January!

A Review of Roy Deveau and Sarah Leitch's 'Person centred restraint reduction: planning and action' (May 1 2018), Written by CEO Professor Andrew McDonnell In our experience, the subject matter of this book can often be viewed by people in the field as an area in which great progress has been made in the UK. Sadly, there remains a real need for this type of material in Britain. Restraint and other restrictive practices are an emotive subject within the field of care giving. The Winterbourne View experience in 2011 placed these issues at the forefront of professional practice, demonstrating the continuing need to review and reassess the ways in which vulnerable people are cared for. It is debatable how much learning occurs after our living rooms are invaded by the sight of substandard practices. Views on restrictive practices can range from zero tolerance to a frightening acceptance of the need to restrict and control. Across the globe people can often view physical interventions as a 'necessary evil’, and other European countries have their own equivalents of the Winterbourne View experience. For example, in the Republic of Ireland, an RTE Undercover documentary focusing on the abuse of adults at Aras Attracta demonstrated that issues of restraint and the need for restraint reduction literally transcends cultures. It is often easy to be overwhelmed by rhetoric about restraint reduction, especially without a strong enough focus on how to achieve, as far as possible, restriction-free lives for the people we support. Initially, I was a little alarmed to read the expression 'person centred' in the title. However, in my view the authors have provided a guide that focuses on auditing practice and in effect encouraging staff teams to be solution-focused in their work. The authors provide a menu-based approach to supporting people to reduce restraint in their practice. The book also illustrates the still relative paucity of data driven approaches to restraint reduction. The first two chapters provide a guide for practice leaders to focus on when developing a strategy towards tackling restrictive practices and auditing practice. It is a very simple message, namely; make your approach 'data driven'. In Chapter Three, the authors focus on strategies ranging from Active Support and Periodic Service Review, to Practice Leadership and Organisational Approaches. For me, there is a slight danger that some cultures may decide that they are doing OK and stop here. Chapter Four goes on to discuss a key range of reactive strategies, from the work of Gary LaVigna to my own. These include many useful strategies that people may try, although I stress that such approaches should be data driven and, where possible, systematically applied. Chapter Five focuses on restrictive responses with a small number of evidence-based approaches. When reading this chapter, it reminded me how difficult it can be for practice leaders to effect change in environments with 'restrictive cultures'. What we do know is that practice can change if people are motivated to effect that change. The structure of this book should be a guide to create solution-focused, empathic and reflective approaches to a problem. The title for Chapter Six, 'Turning Ideas into Action', allows the reader to reflect on their 'Plan of Action'. The seven guidance points for plans are both simple and easy to understand. It is quite difficult to write a forward to a book such as this without offering some additional guidance. Practice leaders must focus on simple strategies and encourage real change. However, where restrictive practices present a high risk of harm, solutions may need to be more rapid; effectively, 'Deeds Not Words'. In Chapter Seven there is a useful case study presented, which provides a helpful learning framework for the reader. I would actively encourage more case examples to illustrate the many useful strategies described in this book. In addition, I particularly like the idea of Practice Leaders coaching their colleagues. The authors mention the EDDY approach (Explain, Demonstrate, Do under Supervision, You have a go). If there is a weakness in the field of staff training (especially in physical interventions), it is that too much teaching takes place in classrooms with insufficient emphasis on coaching. Role modelling best practice must be an essential component of the approach. The values we apply to these situations also help us to reflect on solutions. In many cases a simple focus on Human Rights can be enough to reduce restrictive practices. If there is an over-arching theme of the book for me it is a positive message to empower people to focus on solutions to restrictions. In effect, the goal is to create cultures where restrictions can be lessened. My own personal experience is that even in poor quality environments, much can be done to create restriction free services. In addition, training in crisis management is necessary, but not sufficient to achieve success. Many contributing factors influence the reduction of restrictive practices; for example, organisational factors such as practice leadership, which combine with other elements ranging from low arousal approaches to PBS and mindfulness. This book is a very useful stepping stone towards a more scientific approach to what still can be described as a 'Cinderella Area', long neglected by clinicians. This book is a useful resource for service providers who wish to focus on restraint and restrictive practice reduction. I hope that it is the first of many guides that provide attention to detail on this important subject. Moving from 'rhetoric to reality' is the goal. If there has been a lesson in the poor practice exposed in the last 30 years, it is that we ignore restrictive practices at our peril. In my opinion, the vast majority of organisations should use this guide to reflect on their organisational culture. Andrew McDonnell, PhD CEO Studio3, Visiting Professor of Autism Studies, Birmingham City University. Available from MyBookSource.