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Low arousal approach

Within the study of human behavior, the Low Arousal Approach was developed by Professor Andrew McDonnell in the 1990s, and is now an internationally recognized model of behavior support. A low arousal approach to managing behavior of concern or challenging behavior focuses on stress and well-being, as well as how care givers respond in moments of crisis. Arousal refers to physiological arousal (e.g. heart rate) in response to stress, as opposed to sexual arousal. A low arousal approach to supporting individuals with additional needs aims to avoid confrontational situations and instead walk the path of least resistance.[1]

Philosophy edit

With strong roots in humanism, low arousal approaches have a philosophy of non-confrontation and 'do no harm'. In situations which may be stressful, responses that reduce levels of physiological arousal and stress are adopted by carers and staff, especially when supporting distressed individuals, who are more likely to perceive situations as stressful or threatening. These approaches became popular in services for people with intellectual disabilities and autism in the UK in the mid-1990s. This humanistic and person-centered approach to crisis management was developed by the organisation Studio 3 Training Systems and Clinical Services in response to the use of restrictive practices to manage crises such as physical restraint, seclusion, and chemical restraint. The avoidance of sanctions and consequence-based punishment strategies is an implicit part of the approach.

Strategies edit

A number of different strategies are employed in healthcare settings for the management of challenging behavior. A theoretical rationale for a collection of short-term non-aversive behavior management strategies described as low arousal approaches is to avoid the use of punishing consequences to behavior.[2]

The approach acknowledges the potential role of cognitive behavioral frameworks in shaping staff behavior.

Components edit

There are four key components considered central to low arousal approaches identified by McDonnell (2010) in 'Managing Aggressive Behavior in Care Settings: Understanding and Applying Low Arousal Approaches'.[3] Those include both cognitive and behavioral elements:

  1. Decreasing staff demands and requests to reduce potential points of conflict around an individual
  2. Avoiding potentially arousing triggers, such as direct eye contact, touch, and removal of spectators to the incident
  3. Avoidance of non-verbal behaviors that may lead to conflict, such as aggressive postures and stances
  4. Challenging staff beliefs about the short-term management of challenging behaviors

Evidence edit

This approach is based on the link between autism and arousal, which also applies to a number of other conditions such as intellectual disabilities, dementia, and acquired brain injury.[4][5] In theory, the approach is based on the link between stress and arousal, such that individuals who are highly stressed are more likely to engage in behaviors of concern, such as aggression and self-injurious behavior (SIB). As evidence has shown that individuals with autism and other additional support needs are easily aroused by stressful environments,[6] low arousal approaches seek to reduce environmental stress before crisis situations arise.

Academic research into the effect of levels of arousal on instances of challenging behavior have proposed that sensory reactivity is associated with hyper-arousal, and that hypo-arousal can lead to catatonic-type behaviors.[6] Low arousal approaches are hypothesized as a generalized strategy to managing behaviors of concern associated with over and under arousal.

Studies have been published that directly examine the application of these approaches. In a case study, there was a significant reduction in verbal and physical aggression following the application of low arousal approaches with an adult with an intellectual disability in a hospital setting.[1]

Autism and arousal edit

Arousal is not a new construct and was originally proposed as an explanatory theory for autism spectrum disorders.[7] Two implications of this theory are that children and adults with an autism spectrum disorder (ASD) would be more reactive to sensory stimuli than the standard population, and they may be slower to habituate to stimuli. There is some laboratory evidence of differences in physiological responses of individuals with ASD compared to non-autistic controls.[8][9][10]

There have been studies comparing autistic children to non-autistic controls, one studying the baseline heart rates of each,[11] and another comparing their baseline skin conductance responses.[12]

Hyper- or hypo-arousal? edit

Hyper-arousal is not universally accepted by all researchers. A recent review of sensory difficulties in autism concluded that the experimental evidence or hyper-arousal was at best mixed.[13] There are a number of problems with this view. First, ASD is a heterogeneous condition and the assumption that hyper-arousal should be a general explanatory theory of autism was too broad. Second, sensitivity to arousing stimuli may be intermittently presenting in individuals with ASD. Third, the stimuli employed in habituation paradigms cannot easily mimic real life non-laboratory-based events. Animal research on arousal has attempted to link deficiencies to conditions such as attention-deficit hyperactivity disorder, Alzheimer's disease, and autism.[14]

Historically, hypo-arousal in people with an ASD has also been proposed as a factor to specific stimuli,[15] although with limited laboratory evidence.[13] Repetitive movements may serve a dearousing function.[16] Unusual sensory experiences have been reported in autobiographical accounts of people with an ASD.[17] Sensory over-activity has been explained as a possible response to hyper-arousal.[18] An understanding of arousal and sensory experiences may have great explanatory significance for some forms of challenging behaviors.

Stress and arousal edit

Stress and anxiety has been proposed as a factor in challenging behaviors of people with ASD.[19] There is a transactional model of stress and coping that emphasizes the interaction between an individual and his or her environment. In this model, stress occurs when the demands of stressors outweigh coping responses.[20] There is a clear interaction between environmental and physiological events. Implicit in this model is the cognitive appraisal of threat. Some individuals with an ASD have difficulties in regulating their emotional responses and even communicating this to carers.[21] To help account for challenging behaviors, such as aggression and self-injury, arousal may mediate stress. There is a strong association between arousal and sensory experiences of people with ASD.[18]

Arousal curve and information processing edit

The majority of individuals spend time in a state of arousal equilibrium. In the case of people with an ASD, two distinct arousal groupings have an effect on behavior. A group of individuals will be hyper-aroused and highly reactive to environmental sensory stimuli.[18] At the opposite end of the distribution, a proportion of people are hypo-aroused. A number of people with ASD, who present with challenging behaviors, may experience either constant or intermittent states of hyper-arousal.

See also edit

References edit

Notes edit

  1. ^ a b McDonnell, Reeves, Johnson & Lane, 1998, p. 164
  2. ^ McDonnell, McEvoy & Dearden, (1994)
  3. ^ McDonnell, (2010)
  4. ^ Corbett, B.A. and Simon, D. (2013)
  5. ^ Richetin, J. and Richardson, D.S. (2007)
  6. ^ a b McDonnell et al., (2015)
  7. ^ Hutt, Hutt, Lee and Ounsted, 1964
  8. ^ Althaus, van Roon, Mulder, Mulder, Aarnoudse and Minderaa 2004
  9. ^ Hirstein Iversen and Ramachandran 2001
  10. ^ van Engeland, Roelofs, Verbaten and Slangen, 1991
  11. ^ Goodwin, et al., (2006)
  12. ^ Hirstein, et al., (2001)
  13. ^ a b Rogers and Ozonoff, 2005
  14. ^ Garey, Goodwillie, Frohlich, Morgan, Gustafsson, Smithies, Korach, Ogawa and Pfaff, 2003
  15. ^ Rimland, 1964; DesLauriers and Carlson, 1969
  16. ^ Kinsbourne, 1980
  17. ^ Shore, 2003; O'Neill and Jones, 1997
  18. ^ a b c Liss, Saulnier, Fein and Kinsbourne, 2006
  19. ^ Howlin, 1998; Groden, Cautela, Prince and Berryman, 1994
  20. ^ Lazarus and Folkman (1984)
  21. ^ Frith, 2003

Resources edit

  • Althaus, M.; van Roon, A.M.; Mulder, L.J.M.; Mulder, G.; Aarnoudse, C.C.; Minderaa, R.B. (2000). Autonomic Response Patterns Observed during the Performance of an attention Demanding Task in two groups of Children with Autistic-Type Difficulties in Social Adjustment. Psychophysiology, 41, 893–904.
  • Corbett, B.A.; Simon, D. (2013). Adolescence, Stress and Cortisol in Autism Spectrum Disorders. Open Access Autism, 1(1), 2.
  • Deslauriers, A.M.; Carlson, C.F. (1969). Your child is asleep: Early infantile autism. Homewood, IL: Dorsey Press;
  • Frith, U. (2003). Autism Explaining the Enigma. (2nd Edition) Oxford: Blackwell.
  • Garey, J.; Goodwillie, A.; Frohlich, J.; Morgan, M.; Gustaffson, J.A.; Smithies, O.; Korach, K.S.; Ogawa, S.; Pfaff, D.W. (2003) Genetic Contributions to Generalized Arousal of Brain and Behavior. Proceedings of the National Academy of Sciences of the United States of America, 100, 11019–11022.
  • Goodwin, M.S.; Groden, J.; Velicer, W.F.; Lipsitt, L.P.; Grace Baron, M.; Hofmann, S.G.; Groden, G. (2006). Cardiovascular Arousal in Individuals With Autism. Focus on Autism and Other Developmental Disabilities, 21, 100–123.
  • Groden, J.; Cautela, J.; Prince, S.; Berryman, J. (1994). The Impact of Stress and Anxiety on Individuals with Autism and other Developmental Disabilities. In E. Schopler and G. Mesibov (Eds.) Behavior Issues and Autism. New York, Plenum Publishing.
  • Hirstein, W.; Iversen, P.; Ramachandran, V.S. (2001). Autonomic Responses of Autistic Children to People and Objects. Proceedings: Biological Sciences
  • Howlin, P. (1998). Children with Autism and Aspergers Syndrome: A Guide for Practitioners and Carers. Chichester: Wiley.
  • Hutt, C.; Hutt, S.J.; Lee, D.; Ounstead, C. (1964). Arousal and Childhood Autism. Nature, 204, 908–909.
  • Kinsbourne, M. (1980). Do Repetitive Movement Patterns in Children and Animals Serve a Dearousing Function? Developmental and Behavioral Paediatrics, 1, 39–42.
  • Lazarus, R.S.; Folkman, S. (1984). Stress, Appraisal, and Coping. New York: Springer.
  • Liss, M.; Saulnier, C.; Fein, D; Kinsbourne, M. (2006). Sensory and Attention Abnormalities in Autistic Spectrum disorders. Autism, 10, 155–172
  • McDonnell, A.A.; Waters, T.; Jones D. (2002). Low Arousal Approaches in the Management of Challenging Behaviours. In D. Allen (Ed) Ethical approaches to physical interventions: Responding to Challenging behaviours in people with Intellectual Disabilities. Plymouth: BILD, pp. 104–113.
  • McDonnell, A.A.; McEvoy, J.; Dearden, R.L. (1994). Coping with Violent Situations in the Caring Environment. In T. Wykes (Ed) Violence and health care professionals. London: Chapman and Hall, pp. 189–206.
  • McDonnell, A.A.; Reeves, S.; Johnson, A.; Lane, A. (1998). Management Challenging Behaviours in an Adult with Learning Disabilities: the Use of Low Arousal. Behavioural and Cognitive Psychotherapy, 26, 163–171.
  • McDonnell, A.A. (2010). Managing Aggressive Behaviour in Care Settings: Understanding and Applying Low Arousal Approaches. Chichester: Wiley-Blackwell.
  • McDonnell, A.A.; McCreadie, M.; Mills, R.; Deveau, R.; Anker, R.; Hayden, J. (2015). The Role of Physiological Arousal in the Management of Challenging Behaviours in Individuals with Autism Spectrum Disorders. Research in Developmental Disabilities, 36C, 311-322.
  • McDonnell, A.A. (2019). The Reflective Journey: A Practitioner's Guide to the Low Arousal Approach. UK: Studio 3 Publications.
  • O'Neill, M.; Jones, R.S.P. (1997). Sensory Perceptual Abnormalities in Autism: A Case for More Research. Journal of Autism and Developmental Disorders, 27(3), 283–293.
  • Richetin, J.; Richardson, D.S. (2007). Automatic Processes and Individual Differences in Aggressive Behaviour. Aggression and Violent Behaviour, 13, 423-430.
  • Rimland, B. (1964). Infantile autism, New York: Appleton Century Crofts.
  • Rogers, S.J.; Ozonoff, S. (2005). What Do We Know About Sensory Dysfunction in Autism? A Critical Review of the Empirical Evidence. Journal of Child Psychology and Psychiatry, 46, 1255–1268.
  • Shore S. (2003). Beyond the Wall: Personal Experiences with Autism and Asperger Syndrome: Autism Asperger publishing company.
  • Van Engeland, H.; Roelofs, J.W.; Verbaten, M.N.; Slangen, J.L. (1991). Abnormal Electrodermal Reactivity to Novel Visual Stimuli in Autistic Children. Psychiatry Research, 38, 27–38.

External links edit

  • Research Article 1
  • Research Article 2
  • [1]
  • [2]
  • [3]

arousal, approach, other, uses, arousal, within, study, human, behavior, arousal, approach, developed, professor, andrew, mcdonnell, 1990s, internationally, recognized, model, behavior, support, arousal, approach, managing, behavior, concern, challenging, beha. For other uses see Low arousal Within the study of human behavior the Low Arousal Approach was developed by Professor Andrew McDonnell in the 1990s and is now an internationally recognized model of behavior support A low arousal approach to managing behavior of concern or challenging behavior focuses on stress and well being as well as how care givers respond in moments of crisis Arousal refers to physiological arousal e g heart rate in response to stress as opposed to sexual arousal A low arousal approach to supporting individuals with additional needs aims to avoid confrontational situations and instead walk the path of least resistance 1 Contents 1 Philosophy 2 Strategies 2 1 Components 3 Evidence 3 1 Autism and arousal 3 2 Hyper or hypo arousal 3 3 Stress and arousal 4 Arousal curve and information processing 5 See also 6 References 6 1 Notes 6 2 Resources 7 External linksPhilosophy editWith strong roots in humanism low arousal approaches have a philosophy of non confrontation and do no harm In situations which may be stressful responses that reduce levels of physiological arousal and stress are adopted by carers and staff especially when supporting distressed individuals who are more likely to perceive situations as stressful or threatening These approaches became popular in services for people with intellectual disabilities and autism in the UK in the mid 1990s This humanistic and person centered approach to crisis management was developed by the organisation Studio 3 Training Systems and Clinical Services in response to the use of restrictive practices to manage crises such as physical restraint seclusion and chemical restraint The avoidance of sanctions and consequence based punishment strategies is an implicit part of the approach Strategies editA number of different strategies are employed in healthcare settings for the management of challenging behavior A theoretical rationale for a collection of short term non aversive behavior management strategies described as low arousal approaches is to avoid the use of punishing consequences to behavior 2 The approach acknowledges the potential role of cognitive behavioral frameworks in shaping staff behavior Components edit There are four key components considered central to low arousal approaches identified by McDonnell 2010 in Managing Aggressive Behavior in Care Settings Understanding and Applying Low Arousal Approaches 3 Those include both cognitive and behavioral elements Decreasing staff demands and requests to reduce potential points of conflict around an individual Avoiding potentially arousing triggers such as direct eye contact touch and removal of spectators to the incident Avoidance of non verbal behaviors that may lead to conflict such as aggressive postures and stances Challenging staff beliefs about the short term management of challenging behaviorsEvidence editThis approach is based on the link between autism and arousal which also applies to a number of other conditions such as intellectual disabilities dementia and acquired brain injury 4 5 In theory the approach is based on the link between stress and arousal such that individuals who are highly stressed are more likely to engage in behaviors of concern such as aggression and self injurious behavior SIB As evidence has shown that individuals with autism and other additional support needs are easily aroused by stressful environments 6 low arousal approaches seek to reduce environmental stress before crisis situations arise Academic research into the effect of levels of arousal on instances of challenging behavior have proposed that sensory reactivity is associated with hyper arousal and that hypo arousal can lead to catatonic type behaviors 6 Low arousal approaches are hypothesized as a generalized strategy to managing behaviors of concern associated with over and under arousal Studies have been published that directly examine the application of these approaches In a case study there was a significant reduction in verbal and physical aggression following the application of low arousal approaches with an adult with an intellectual disability in a hospital setting 1 Autism and arousal edit Arousal is not a new construct and was originally proposed as an explanatory theory for autism spectrum disorders 7 Two implications of this theory are that children and adults with an autism spectrum disorder ASD would be more reactive to sensory stimuli than the standard population and they may be slower to habituate to stimuli There is some laboratory evidence of differences in physiological responses of individuals with ASD compared to non autistic controls 8 9 10 There have been studies comparing autistic children to non autistic controls one studying the baseline heart rates of each 11 and another comparing their baseline skin conductance responses 12 Hyper or hypo arousal edit Hyper arousal is not universally accepted by all researchers A recent review of sensory difficulties in autism concluded that the experimental evidence or hyper arousal was at best mixed 13 There are a number of problems with this view First ASD is a heterogeneous condition and the assumption that hyper arousal should be a general explanatory theory of autism was too broad Second sensitivity to arousing stimuli may be intermittently presenting in individuals with ASD Third the stimuli employed in habituation paradigms cannot easily mimic real life non laboratory based events Animal research on arousal has attempted to link deficiencies to conditions such as attention deficit hyperactivity disorder Alzheimer s disease and autism 14 Historically hypo arousal in people with an ASD has also been proposed as a factor to specific stimuli 15 although with limited laboratory evidence 13 Repetitive movements may serve a dearousing function 16 Unusual sensory experiences have been reported in autobiographical accounts of people with an ASD 17 Sensory over activity has been explained as a possible response to hyper arousal 18 An understanding of arousal and sensory experiences may have great explanatory significance for some forms of challenging behaviors Stress and arousal edit Stress and anxiety has been proposed as a factor in challenging behaviors of people with ASD 19 There is a transactional model of stress and coping that emphasizes the interaction between an individual and his or her environment In this model stress occurs when the demands of stressors outweigh coping responses 20 There is a clear interaction between environmental and physiological events Implicit in this model is the cognitive appraisal of threat Some individuals with an ASD have difficulties in regulating their emotional responses and even communicating this to carers 21 To help account for challenging behaviors such as aggression and self injury arousal may mediate stress There is a strong association between arousal and sensory experiences of people with ASD 18 Arousal curve and information processing editThe majority of individuals spend time in a state of arousal equilibrium In the case of people with an ASD two distinct arousal groupings have an effect on behavior A group of individuals will be hyper aroused and highly reactive to environmental sensory stimuli 18 At the opposite end of the distribution a proportion of people are hypo aroused A number of people with ASD who present with challenging behaviors may experience either constant or intermittent states of hyper arousal See also editLow arousal theoryReferences editNotes edit a b McDonnell Reeves Johnson amp Lane 1998 p 164 McDonnell McEvoy amp Dearden 1994 McDonnell 2010 Corbett B A and Simon D 2013 Richetin J and Richardson D S 2007 a b McDonnell et al 2015 Hutt Hutt Lee and Ounsted 1964 Althaus van Roon Mulder Mulder Aarnoudse and Minderaa 2004 Hirstein Iversen and Ramachandran 2001 van Engeland Roelofs Verbaten and Slangen 1991 Goodwin et al 2006 Hirstein et al 2001 a b Rogers and Ozonoff 2005 Garey Goodwillie Frohlich Morgan Gustafsson Smithies Korach Ogawa and Pfaff 2003 Rimland 1964 DesLauriers and Carlson 1969 Kinsbourne 1980 Shore 2003 O Neill and Jones 1997 a b c Liss Saulnier Fein and Kinsbourne 2006 Howlin 1998 Groden Cautela Prince and Berryman 1994 Lazarus and Folkman 1984 Frith 2003 Resources edit Althaus M van Roon A M Mulder L J M Mulder G Aarnoudse C C Minderaa R B 2000 Autonomic Response Patterns Observed during the Performance of an attention Demanding Task in two groups of Children with Autistic Type Difficulties in Social Adjustment Psychophysiology 41 893 904 Corbett B A Simon D 2013 Adolescence Stress and Cortisol in Autism Spectrum Disorders Open Access Autism 1 1 2 Deslauriers A M Carlson C F 1969 Your child is asleep Early infantile autism Homewood IL Dorsey Press Frith U 2003 Autism Explaining the Enigma 2nd Edition Oxford Blackwell Garey J Goodwillie A Frohlich J Morgan M Gustaffson J A Smithies O Korach K S Ogawa S Pfaff D W 2003 Genetic Contributions to Generalized Arousal of Brain and Behavior Proceedings of the National Academy of Sciences of the United States of America 100 11019 11022 Goodwin M S Groden J Velicer W F Lipsitt L P Grace Baron M Hofmann S G Groden G 2006 Cardiovascular Arousal in Individuals With Autism Focus on Autism and Other Developmental Disabilities 21 100 123 Groden J Cautela J Prince S Berryman J 1994 The Impact of Stress and Anxiety on Individuals with Autism and other Developmental Disabilities In E Schopler and G Mesibov Eds Behavior Issues and Autism New York Plenum Publishing Hirstein W Iversen P Ramachandran V S 2001 Autonomic Responses of Autistic Children to People and Objects Proceedings Biological Sciences Howlin P 1998 Children with Autism and Aspergers Syndrome A Guide for Practitioners and Carers Chichester Wiley Hutt C Hutt S J Lee D Ounstead C 1964 Arousal and Childhood Autism Nature 204 908 909 Kinsbourne M 1980 Do Repetitive Movement Patterns in Children and Animals Serve a Dearousing Function Developmental and Behavioral Paediatrics 1 39 42 Lazarus R S Folkman S 1984 Stress Appraisal and Coping New York Springer Liss M Saulnier C Fein D Kinsbourne M 2006 Sensory and Attention Abnormalities in Autistic Spectrum disorders Autism 10 155 172 McDonnell A A Waters T Jones D 2002 Low Arousal Approaches in the Management of Challenging Behaviours In D Allen Ed Ethical approaches to physical interventions Responding to Challenging behaviours in people with Intellectual Disabilities Plymouth BILD pp 104 113 McDonnell A A McEvoy J Dearden R L 1994 Coping with Violent Situations in the Caring Environment In T Wykes Ed Violence and health care professionals London Chapman and Hall pp 189 206 McDonnell A A Reeves S Johnson A Lane A 1998 Management Challenging Behaviours in an Adult with Learning Disabilities the Use of Low Arousal Behavioural and Cognitive Psychotherapy 26 163 171 McDonnell A A 2010 Managing Aggressive Behaviour in Care Settings Understanding and Applying Low Arousal Approaches Chichester Wiley Blackwell McDonnell A A McCreadie M Mills R Deveau R Anker R Hayden J 2015 The Role of Physiological Arousal in the Management of Challenging Behaviours in Individuals with Autism Spectrum Disorders Research in Developmental Disabilities 36C 311 322 McDonnell A A 2019 The Reflective Journey A Practitioner s Guide to the Low Arousal Approach UK Studio 3 Publications O Neill M Jones R S P 1997 Sensory Perceptual Abnormalities in Autism A Case for More Research Journal of Autism and Developmental Disorders 27 3 283 293 Richetin J Richardson D S 2007 Automatic Processes and Individual Differences in Aggressive Behaviour Aggression and Violent Behaviour 13 423 430 Rimland B 1964 Infantile autism New York Appleton Century Crofts Rogers S J Ozonoff S 2005 What Do We Know About Sensory Dysfunction in Autism A Critical Review of the Empirical Evidence Journal of Child Psychology and Psychiatry 46 1255 1268 Shore S 2003 Beyond the Wall Personal Experiences with Autism and Asperger Syndrome Autism Asperger publishing company Van Engeland H Roelofs J W Verbaten M N Slangen J L 1991 Abnormal Electrodermal Reactivity to Novel Visual Stimuli in Autistic Children Psychiatry Research 38 27 38 External links editResearch Article 1 Research Article 2 1 2 3 Retrieved from https en wikipedia org w index php title Low arousal approach amp oldid 1101536297, wikipedia, wiki, book, books, library,

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