What are flow states and can they be applied to autism and other conditions? Flow is a concept developed by Professor Mihaly Csikszentmihalyi. Flow occurs when people are engaged in controllable but challenging tasks. Usually these activities require a considerable amount of skill, for example running, sailing, and stimulating conversation. Csikszentmihalyi (2002) refers to the impact of flow states on a person’s mental wellbeing, stating that whilst in a flow state 'people are so involved in an activity that nothing else seems to matter' (p. 4). Flow uses the concept of optimal experience as an approach to help people feel happy and to develop a sense of positive wellbeing. He also focused on the power of experience, stating that 'optimal experience depends on the ability to control what happens in consciousness moment by moment. Each person has to achieve it on the basis of his own individual efforts and creativity' (p. 5). According to Csikszentmihalyi (2002), the four key characteristics of ‘flow’ are: 1) People become absorbed in an activity. 2) Individuals have a heightened sense of control which reduces their anxiety. 3) Flow tasks can become "autotelic" (that is they become self-motivating). 4) Flow activities can be viewed as coping strategies in that they help a person 'tune out'. Many people with autism are stressed individuals who find the world a confusing place (Vermeulen, 2013). So how does someone with autism achieve a sense of flow? McDonnell & Milton (2014) have argued that many repetitive activities may achieve a flow state. One obvious area where flow can be achieved is when engaging in special interests. Special interests allow people to become absorbed in an area that gives them specialist knowledge and a sense of achievement. In addition, certain repetitive tasks can help people achieve a flow like state of mind. These tasks can become absorbing and are an important part of people’s lives. The next time you see an individual with autism engaging in a repetitive task (like stacking Lego or playing a computer game), remember that these are not in themselves negative activities, they may well be reducing stress. If you want to improve your supports to people with autism from a stress perspective, a useful tool is to identify flow states for that person and try to develop a flow plan. Remember, the next time you see a person repeating seemingly meaningless behaviours, do not assume that this is always unpleasant for them - it might be a flow state, and beneficial for reducing stress. References Csikszentmihalyi M. (2002) Flow: The Psychology of Happiness, The Classic Work on How to Achieve Happiness, Random House Books. McDonnell, A. and Milton, D. (2014) Going with the flow: reconsidering ‘repetitive behaviour’ through the concept of ‘flow states’. In G. Jones and E. Hurley (Eds): Good Autism Practice: Autism, Happiness and Wellbeing, pp. 38-47 Vermeulen P. (2013) Autism as Context Blindness. EDS Publications: Kansas.

Changing cultures with Studio 3 As soon as a person leaves a classroom the real process of learning begins. we focus on implementation on the ground not just theory. To do this we provide training systems not just training courses. Since our founding as an organisation supporting people in crises across many sectors our approach has developed into a focus on 'culture change', the development of well-being using low arousal approaches. Our approaches challenge people and cultures to develop a systemic approach to supporting people. Here are seven key components of our approaches to supporting people and their supporters. 1) We provide a 'systems' approach to all of our work. We work at a number of levels. With individuals conducting direct training to staff, using tailor made. Interventions, supervision and clinical supports, development of a clear organisational message. 2) We support organisations to develop a clear and coherent approach to reducing restrictive practices. A good training approach has to be embedded in an organisations culture or ethos. We routinely audit practice in services. 3) We aim to develop a reflective approach to learning: reflective learners can help to develop 'learning organisations' 4) Our staff focus on implementation of positive practices on the ground not just in the classroom. We are practitioners who are not afraid to role model best practice. 5) We passionately support the human rights of individuals. All of our work is driven by these values. 6) We are driven by evidence based approaches and as such our training and other models of supports adapt to the latest research. 7) Studio 3 training in physical interventions focuses on teaching as few physical interventions as possible. There are methods such as prone and supine holds that we never teach. Indeed, we are regularly involved with organisations to eradicate such methods. If you are interested in any of our training courses please call 01225 334 111 or visit our training pages for more information.

Keep up to date with Studio 3's projects in Ireland, Canada, Denmark, Sweden, Germany and the UK 1) Ireland: We are continuing to grow and expand both our training and behaviour consultancy services. In June we had a highly successful conference in Tralee organised by Studio 3 Kerry. There is also an increase in applications for our Atlass autism and stress programmes. We continue to provide clinical support and training to 20 different organisations in the Irish Republic, and we now have over 80 operational trainers in the Irish Republic delivering managing challenging behaviour training. 2) Denmark: Low arousal is very much embedded into the Danish psyche. Whilst we continue to grow in areas such as intellectual disabilities and autism organisations, we are also providing crisis management training in psychiatric facilities and services for older adults. One area of note is the collaboration between Pindstrupskolen and Professor Andy McDonnell in developing a wellbeing-based ethos. 3) Sweden: Bo Heilskov Elvén continues with his doctoral research applying low arousal approaches with families in Southern Sweden. Training in managing challenging behaviour continues to grow all over Sweden. We also note that an interest to develop Swedish-based Atlass trainers is very strong. 4) Germany: Our colleagues at Autea continue to expand Studio 3’s training programme. We particularly note that they are now also delivering our training in Austria. 5) Canada: There are approximately 12 train trainers in Canada (based in Nova Scotia and Alberta). In 2019, we anticipate this number increasing to between 44-48. Thank you to Debbie Pugh for organising a low arousal training day in August 2018 in Vancouver. In September, Andy McDonnell attended the Atlantic Abilities conference in Halifax. Harman Singh from the Breton Ability Centre in Sydney Nova Scotia presented about successful restraint reduction. This four-year project has demonstrated the effectiveness of our training in reducing restrictive practices. Finally, special mention must be given to Maureen Bennie and the Autism Awareness Centre in Calgary for partnering with Studio 3 to bring the low arousal message to Canada. 6) UK: There are many notable projects underway, but we would like to give particular mention to the work of our colleague Gareth Morewood of Priestnall School, who is helping our colleagues to develop a range of training options for schools and young people. Congratulations also to Daniel Rippon at the University of Northumbria, who has submitted his doctoral thesis on carer stress! In partnership with Studio 3, Daniel and his colleagues are developing a ‘stress tool kit’ for organisations. His work is going to be developed and applied across the Studio 3 organisation.

by Signe Lo Scott Larsen “The vast majority of challenging situations are inadvertently triggered by supporters, and we are often unaware that we can trigger situations.” (McDonnell, 2010) This is one of the messages that is present when working with Low Arousal, a behaviour management approach that seeks to reduce the points of conflict that lead to challenging behaviour when working with people with autism. But what can this statement tell us? First of all, it tells us to explore our own behaviour and the emotional responses that arise during intense, complex and developing work with children and adults with additional needs. Therefore, if we can recognise that we are part of the problem, it also leaves plenty of opportunities to be part of the solution. ​ Elevated Stress At Pindstrup School, we support highly stressed children, where emotional meltdowns and distressed behaviour are undeniably a part of the everyday life in any school for children with additional needs. This is why crisis management is a significant focus here at Pindstrup School, and it is also the reason why Low Arousal was implemented at the school five years ago. If you ask Vice-principal Lone Bridal Hansen about the effects of Low Arousal, one of the things she mentions is a decrease in the number of physical restraints at the school. As Lone Bridal puts it: “When you can better understand why children sometimes enter high states of arousal, you are also better able to act in a different way.” ​ Low Arousal is therefore the conceptual framework that we use for early identification and management of distressed behaviour. Low Arousal was developed by Professor Andrew McDonnell, director of Studio 3, and is used in services for people with autism spectrum disorders, emotional/behavioural difficulties, mental health issues and intellectual disabilities. The approach emphasises a range of behaviour management strategies that focus on stress reduction, and the rights of people being cared for in the least restrictive environment available. ​ The Low Arousal Approach enables practitioners to avoid punitive consequences and seek solutions that reduce high levels of arousal in the individual – i.e. strategies that regulate the person’s aggression or agitation in high-risk situations. It is argued that such an approach can improve functional assessment and positive behaviour support strategies in care settings for people with autism. ​ Theoretically, the Low Arousal Approach points out the importance of sensory differences and physiological arousal in correlation with aggression and challenging behaviour. The knowledge about sensory differences in autism has increased a great deal and it is now thought that people with ASD have various levels of information processing issues that affect the person's stress level. ​ When a person has sensory difficulties, normal everyday impact from the environment can seem very stressful. As an outcome of this, people with ASD will easily experience sensory overload in a world full of stimuli. So you can say that there is a great deal of “sensory noise” in the school environment that stresses the child, which is invisible to teachers and pedagogues. What we can observe are the stress reactions that are a result of the sensory differences. ​ This approach describes how stress arises in the transaction between physiological stress response and the environment. It is suggested that a reduction of environmental arousal should decrease stress and anxiety, and therefore reduce the frequency and intensity of distressed behaviour. In other words, caregivers need to understand their contribution to the crisis, as crisis situations occur when our demands to the stressed-out child outweigh the child’s functional coping strategies. “Low Arousal is a way to understand why a child can have a meltdown just because he for example drops his lunch on the floor,” as Lone Bridal says. ​ “It might not just be one thing that starts the meltdown, but rather a combination of different stressors prior to the incident that triggers the situation. And another thing is that you learn to understand yourself as a person, and the interaction between yourself and the child, when the child is entering a state of high arousal.” ​ The fact that the interaction between the child’s stress and our response to the situation is central in Low Arousal opens up a world of possibilities. It’s all about spotting it, and this is where the approach, both theoretically and in practice, deals with behaviour of concern. ​ ​ Let go of demands until the waters have subsided ​ A teacher described an episode with a highly stressed child one afternoon at the school. During the break a boy got very frustrated, and had a meltdown when class started. He kept repeatedly kicking a door into the wall. The teacher tried to shield the door by putting a foot between the door and wall, but that just angered him further, and his aggression increased. The teacher decided to rethink the situation, and chose two other strategies. ​ The first one was to keep herself at a distance in order to give the boy an opportunity to escape from the situation if he needed to. ​ The other strategy was to be aware of her own body language throughout the incident. She found that it was important that she stayed in the same room as the boy in case he needed her help, but she deliberately avoided direct eye contact and movements, which could be interpreted as attempts to try and stop the boy from kicking the door. ​ After a while he calmed down, and she was able put her hand on his shoulder and rub his back, until he was ready to go to back to his seat. The incident lasted more than half an hour, but there was no scolding and no restraints. But why was it the low intensity strategy that ultimately stopped the incident? The answer might be that the boy, for a shorter or longer time, had been unable to get away from various stressful stimuli and communicate his needs, both during and prior to the incident, and his behaviour was a functional strategy to cope with the situation. The Low Arousal Approach argues that challenging behaviour is mediated by a heightened state of physiological arousal, and that the reduction of this physiological arousal state should reduce challenging behaviours. This means that the teacher did right in trying to understand the role of the situation by identifying arousal triggers. In this case, the teacher's attempt to stop him from kicking the door was an arousal trigger, and it was the use of a low intensity strategy that ultimately calmed him down. ​ The reduction of staff demands in a crisis situation is a key element in Low Arousal. The term 'strategic capitulation' is an example of a strategy that refers to demand reduction in crisis situations. The avoidance strategy should not be seen as a long-term solution, but in the crisis situations, it has proven to be the most effective staff response. ​ Although Low Arousal has mostly been used in the field of disability, the approach can also serve a purpose in a broader context. As an example of this, Pindstrup employ the Low Arousal approach when we give supervision in public schools. ​ “If you take a look at a lesson in a public school from the children’s perspective, the children are exposed to an enormous amount of information in the classroom. And some of the children can get very confused, and find it difficult to sort out all that information throughout the day. This is where Low Arousal can help teachers understand them as children who need help to sort through all the impressions and make more appropriate choices”, Lone Bridal says. ​ ​ Peace of mind is contagious ​ Many of the core principles of the Low Arousal approach can be distilled into a single phrase: “Before you attempt to change or manage another person, you need to reflect on your own behavior.” And it is precisely in this tension that teachers and support staff can connect themselves with the fact that we are part of the problem, but also a part of the solution. So, how is Low Arousal implemented in practice? Andrew McDonnell has defined four key elements that need to be considered in crisis situations: The first is to reduce staff demands and potential conflict triggers around the child – for example, that we take into account the child’s sensory differences or different cognitive functions that can affect the child’s experience of the situation. Secondly, avoidance of arousal triggers. This could for example be direct eye contact, touch or audience to the event that can potentially elevate the child’s arousal. Thirdly, that the staff are aware of their own attitudes and body language. In the example with the highly stressed boy, it was important to avoid a confrontational posture, and this is an example of how body language can mediate further stress – and conversely, how appropriate postures can lead to a reduction of the child´s level of arousal. Fourth, that staff beliefs about short-term management of distressed behaviour are challenged and discussed, e.g., when and why we choose confrontational approaches such as physical restraints – and not avoidance strategies. In short, the message is that peace of mind is contagious! Staff working with stressed children need to be centred and emotionally aware when working with vulnerable groups of people, and able to reflect on how we respond to someone in a crisis situation. ​ It may sound simple, but conflict situations in practice are, not surprisingly, multifaceted and complex. This is also why the school regularly have training courses on the subject, in order to learn more and to keep the principles fresh in our minds. Over the years, the approach has become an implicit part of the school culture. ​ Lone Bridal has also observed changes in staff beliefs. “I can see and hear that staff beliefs and narratives have changed. Today, we talk about children who have difficulties. You would very often hear a teacher say: ‘I think this child seem a little more stressed at the moment, we need to take very good care of him right now’. Earlier on, you would hear different narratives about challenging behaviour, and you would see children who were constantly fighting the world, because they were being met in inappropriate ways. At this stage, the narratives within the school signal that we understand that these are children with difficulties who need help and support.” ​ Pindstrup School is a special needs school for children with autism, ADHD, moderate learning difficulties and associated behavioral difficulties. Low Arousal is an approach we use within all these areas – as well as when the school’s consulting team at various occasions offer supervision on crisis management and inclusion in public schools. Written by Signe Lo Scott Larsen July 2016