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.

The Low Arousal approach emphasises a range of behaviour management strategies that focus on the reduction of stress, fear and frustration and seeks to prevent aggression and crisis situations. The low arousal approach seeks to understand the role of the ‘situation’ by identifying triggers and using low intensity strategies and solutions to avoid punitive consequences for distressed individuals.

The Low Arousal approach enables practitioners to avoid the use of punitive consequences, such as physical restraint, for individuals from a variety of settings through early identification and intervention using low intensity strategies and solutions right the way through to managing meltdowns. The essential core principle is that many people inadvertently trigger behaviours, therefore it is often our behaviour which needs to change.

The Low Arousal approach has evolved from its original definition (McDonnell, McEvoy & Dearden1994) to a cognitive re-conceptualisation (McDonnell, Waters & Jones 2002). In his recent book titled “Managing Aggressive Behaviour In Care Settings: Understanding And Applying Low Arousal Approaches,” the definition has been further redefined (McDonnell 2011).

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’?

McDonnell (2010) identified four key components considered central to Low Arousal approaches, which include both cognitive and behavioural elements:

1. Decreasing staff demands and requests to reduce potential points of conflict around an individual.
2. Avoidance of potentially arousing triggers e.g., avoiding direct eye contact, touch and removing spectators to the incident.
3. Avoidance of 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.

These seemingly simple behaviour management strategies are often difficult to apply in practice, as they involve changing and moderating our own levels of arousal. This means that each practitioner must reflect on their own behaviour and how it may contribute towards instances of challenging behaviour in the people they support. If we are part of the solution, we can also be part of the problem.

In essence, the Low Arousal approach is not just a behaviour management strategy, but a holistic philosophy towards caring for vulnerable people which acknowledges that challenging behaviour is not a choice.

A Death of One Thousand Subtractions

Alzheimer's is the cleverest thief, because she not only steals from you, but she steals the very thing you need to remember what's been stolen - Jarod Kintz, This Book Has No Title.

It'll become an epidemic once the baby boomer generation starts getting over 65 years of age. It's the revenge of longevity. 65 to 70% of Dementia is Alzheimer's. It always begins in the hippocampus, thus the loss of short term memory at the beginning of the illness. Short term memory (STM) just gets worse and worse at first, followed by the person's analytical abilities. Frustration can lead to aggression and even violent outbursts, muscle and movement loss progressively follow and the inability to swallow, then you're more or less looking at it really beginning to kill the person.

You can't converse with Alzheimer's sufferers in the way you do with others; the dialogue tends to go round in circles - Kevin Whately.
 

The care givers are also the heroes in this disease, along with the scientists. A death of 1000 subtractions, bit by bit, day by day, week by week, month by month, year by year. A slow death sentence. However, not everyone who lives to an old age gets Alzheimer's. No one is immune to the disease. Yes there is a genetic component, but inheritance is only about 5%, so you're far more likely to be in the 95th percentile.

People think it's just forgetting your keys. Or the words for things. But there are the personality changes. The mood swings. The hostility and even violence. Even from the gentlest person in the world. You lose the person you love. And you are left with the shell... And you are expected to go on loving them even when they are no longer there. You are supposed to be loyal. It's not that other people expect it. It's that you expect it of yourself. And you long for it to be over soon - Alice LaPlante, Turn of Mind.

Another Pint of Commotion Lotion Please...

An interesting read from Christian Jarrett for the BPS Research Digest, titled 'My drunkenness means you did it deliberately' (2010).

With our brains gently soaked in alcohol we’re generally more sociable and relaxed – it’s a sedative after all. So why do drunk people seem so prone to aggravation and argument? One reason, say Laurent Bègue and colleagues, is that alcohol exacerbates the ‘intentionality bias‘, our natural tendency to assume that other people intended their actions. So when that guy jolts you at the bar and you’re drunk, you’re more likely to think he did it on purpose.

 

Bègue’s team recruited 92 men (aged 20 to 46) to take part in what they were told was a taste-testing study. They were given three glasses to taste, each containing a cocktail of grapefruit and grenadine cordial, mint and lemon concentrate. For half the participants, the drinks also contained alcohol – approximately the same amount found in five to six shots of vodka. To control for expectancy effects, half the participants with the alcoholic drinks and half the non-alcohol participants were told the drinks were alcoholic. Next, the participants spent 20 to 30 minutes on filler tasks, in keeping with the cover story that this was a taste-test study, and to allow the alcohol to kick-in. Finally and most importantly, the participants read 50 sentences about various actions (e.g. ‘He deleted the email’) and gave their verdict on whether the actions were intentional or not.

 

The intoxicated and sober men alike said that obviously intentionally actions (e.g. ‘she looked for her keys’) were intentional, and that blatantly unintentional actions (e.g. ‘she caught a cold’) were unintentional. But crucially, when it came to more ambiguous actions, like the email deletion example, the intoxicated men were significantly more likely (43 per cent) than the sober men (36 per cent) to say the action was intentional. Whether participants were told they’d had alcohol or not made no difference.

 

Why should alcohol have this effect? Bègue’s team think that it takes cognitive effort and control to overcome the intentionality bias, especially so as to take in all the information necessary to consider alternative explanations. Alcohol’s well-known disinhibitory and myopic (the ‘narrowing of attention’) effects would clearly undermine these faculties.

 

‘In summary,’ the researchers concluded, ‘alcohol magnifies the intentionality bias. Napoleon said, “There is no such thing as accident.” Our findings suggest that drunk people are more likely to believe Napoleon’s statement than are sober people.’

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Begue, L., Bushman, B., Giancola, P., Subra, B., and Rosset, E. (2010). “There Is No Such Thing as an Accident,” Especially When People Are Drunk. Personality and Social Psychology Bulletin, 36 (10), 1301-1304 DOI: 10.1177/0146167210383044