Artikel: The Low Arousal Approach: Reducing Stress and Enhancing Well-Being of autistic pupils

Working titles:
The Low Arousal Approach: Reducing Stress and Enhancing Well-Being of autistic pupils
Understanding and Applying the Low Arousal Approach in Educational Settings: A Focus on Autism Spectrum

Melika Ahmetovic, Ludwig-Maximilian University Munich
Andrew McDonnell Director, Studio3 and Professor of autism studies, Birmingham City University, England

Abstract
Autistic children and adolescents often face significant challenges in everyday school life. Their unique ways of perceiving and processing information result not only in distinct learning and interaction styles but also in an increased risk of stress and emotional overload. Consequently, many autistic pupils exhibit behaviours that are perceived as “challenging” or “problematic” in educational settings – ranging from withdrawal and refusal to comply, to outbursts of anger and self- or other-injurious actions. However, these behaviours are rarely expressions of defiance or disorder. Rather, they are indicators of emotional distress, sensory overload, or limited coping mechanisms. Traditional behavioural interventions in schools frequently aim to exert control through rules, limits, and reinforcement of desirable behaviours. These approaches often fall short because they isolate behaviour from its contextual roots, particularly the child’s stress and arousal levels. The Low Arousal Approach (LAA), developed by Andrew McDonnell in the 1990s, offers an alternative. It shifts focus away from modifying the child and toward creating a supportive, low-stress environment managed by caregivers and educators. Central to this model is the idea that if heightened physiological arousal contributes to challenging behaviour, then reducing that arousal can significantly enhance well-being and de-escalation. This paper presents a comprehensive understanding of the Low Arousal Approach, incorporating psychological, neurological, and pedagogical insights. It explores its theoretical foundation, principles, and practical implementation in educational settings, particularly for autistic individuals. The paper also evaluates current research on its effectiveness and concludes with implications for future practice.
Keywords: Autism; Low Arousal Approach; Trauma-informed practice

Introduction
From a medical perspective, autism is defined as a neurodevelopmental condition characterized by persistent differences in information processing, sensory perception, social communication, and interaction. These differences are often accompanied by repetitive behaviours and narrowly focused interests (Ahmetovic & Schubert, 2025). With a global prevalence estimated at approximately 1% (Zeidan et al., 2022), autism is increasingly recognised as encompassing a broad and heterogeneous spectrum of cognitive, emotional, motor, and adaptive profiles.
Many autistic children and adolescents – regardless of whether they have co-occurring learning difficulties – may exhibit what is commonly described as “challenging” or “highly distressed” behaviour, such as aggression, self-injury, or repetitive actions (McDonnell, 2025). Historically, such behaviours have been interpreted through a pathologising lens, framed using terms like “abnormal,” “maladaptive,” or “dysfunctional” (NICE, 2015; Jorgensen et al., 2023). However, this language often neglects the broader context in which these behaviours arise. Increasing evidence suggests that, in the absence of acute medical causes, such expressions are frequently meaningful responses to distress, unmet needs, or adverse environments (ibid).
The term “challenging behaviour,” introduced by Emerson and Bromley (1995), was originally intended to shift the focus away from individual blame and instead highlight the challenges these behaviours pose for care services. Although later expanded by Emerson and Einfeld (2011), the framework often retains a service-centred perspective – one that includes not only healthcare and disability services but also educational settings. In this framing, behaviour is frequently portrayed as disruptive to others, rather than as a potential indicator of environmental misfit or unmet support needs. As a result, the individual is often positioned as the problem – even when their behaviour may be a rational response to a hostile, overstimulating, or non-inclusive context (Swaffer, 2018).
Offering a transformative perspective, Ramcharan et al. (2009) propose that what is typically termed “challenging behaviour” might be better understood as adaptive behaviour in response to harmful or unsupportive environments – what they describe as “challenging environments.” These are settings characterised by high demands, limited autonomy, sensory overload, poor communication, or social exclusion. From this perspective, behaviours often deemed disruptive are not irrational but rather attempts to resist, escape, or communicate the unlivability of these environments.
This shift in framing demands that professionals – including educators – critically examine the socio-environmental structures surrounding the individual. Key questions arise: Are expectations developmentally appropriate? Does the individual experience emotional and sensory safety? Do they have autonomy and meaningful choice?
When the environment is the root cause of distress, efforts to “fix” the individual can inadvertently perpetuate harm.
This perspective aligns with a broader movement advocating for less stigmatising, more person-centred language – especially within care and educational contexts. Terms such as “responsive behaviour” (Markwell, 2016) and “behaviours of concern” (Chan et al., 2012) attempt to reframe behaviour in a more compassionate and context-sensitive manner. However, as Cunningham et al. (2019) caution, without corresponding changes in attitudes and practices, new terminology risks becoming superficial rebranding that continues to pathologise (e.g., referring to “his challenging behaviour”) (Jorgensen et al., 2023).
Language plays a central role in shaping perceptions and practices. As Culkin (1967) observed, “we shape our tools and thereafter they shape us.” The terminology used to describe the behaviours of disabled individuals influences how they are treated – often in dehumanising ways. Everyday actions become medicalised: eating is labelled “feeding,” and going out becomes “community access,” reinforcing a sense of separation from ordinary life (Hayes & Hannold, 2007). This process of “othering” undermines autonomy, increases vulnerability, and perpetuates social exclusion. Kitwood’s (1997) concept of “malignant social psychology” captures how depersonalisation through language and care practices can erode individuals’ well-being and identity (Jorgensen et al., 2023).
A significant consequence of such pathologisation is the continued overuse of psychotropic medications and restrictive interventions, including physical restraint and exclusion. Despite growing awareness of their harmful effects and efforts toward regulation, these practices remain widespread in disability services (Branford et al., 2019) and educational settings (Brede et al., 2017; Cho, 2020; Guldberg et al., 2021). Framing behaviour as a medical pathology can often justify the use of coercive practices. In contrast, understanding it as a form of distress or protest in response to harmful conditions calls for a more compassionate, contextual, and systemic approach.

Autism and Stress Regulation: Foundations for Understanding Behaviour
Arousal – the physiological response to external stimuli – plays a central role in human behaviour. Emotional arousal is intricately linked to cognitive and social functioning, influencing attention, decision-making, and interpersonal interactions. According to the Yerkes-Dodson law (1908), there is an optimal arousal level that supports performance and engagement; both excessive and insufficient arousal can impair functioning (McDonnell, 2010).
What is Arousal?
Physiological arousal refers to a state of heightened activity within the autonomic nervous system (ANS). Elevated arousal is associated with the activation of the “fight or flight” response—an evolutionarily conserved reaction to perceived threat or stress, rooted in mammalian survival mechanisms.
Despite its foundational role in psychology and neuroscience, arousal remains a complex and debated construct. Researchers have variously conceptualised it as either a unitary or multifaceted phenomenon. Recent neurobiological research suggests the presence of a generalised arousal system in the brain that modulates cortical functioning (Pfaff, 2005). According to Pfaff, generalised arousal is characterised by increased sensory alertness, motor activity, and emotional responsiveness: “Generalised arousal is higher in an animal or human being who is (S) more alert to sensory stimuli of all sorts, and (M) more motorically active, and (E) more reactive emotionally” (Pfaff, 2005, p. 5).
Importantly, physiological arousal has significant implications for behaviours of concern, particularly in individuals with neurodevelopmental conditions such as autism (McDonnell et al., 2015).
Polyvagal Theory and Arousal Regulation
Polyvagal Theory (Porges, 2011) offers a nuanced framework for understanding arousal and its relationship to behaviour. The theory is grounded in three core principles: the hierarchical organisation of the autonomic nervous system (ANS), the concept of neuroception (the unconscious detection of safety or threat), and the process of co-regulation through social interaction.
According to Porges (2022), “By placing autonomic state at the core of feelings of safety or threat, the pragmatic survival behaviours of fight and flight, as well as complex problem-solving strategies that would lead to escape, are consequential and dependent on the facilitatory function of the ANS in optimizing these strategies.”
In this context, arousal dysregulation becomes a key construct, referring to fluctuations between hypoarousal (marked by diminished responsiveness and reactivity) and hyperarousal (characterised by heightened emotional and physiological reactivity). Most individuals strive for an optimal level of arousal—a form of arousal homeostasis—to maintain effective functioning and emotional stability.
The concept of an optimal arousal range is often illustrated by the Goldilocks Effect, which refers to the “just right” zone where arousal and performance are in balance. In educational and behavioural contexts, recognising this „sweet spot“ has practical implications for supporting learning, attention, and regulation (McDonnell et al., 2014).
This analogy is useful for practitioners aiming to tailor environments to individual needs. Just as Earth’s position in the solar system allows for conditions that sustain life—neither too hot nor too cold—the “Goldilocks zone” in human functioning is the arousal level that is neither too low (understimulating) nor too high (overstimulating). In this optimal state, individuals are better able to engage, learn, and regulate their emotions effectively.
Understanding and supporting each individual’s unique arousal profile, and working to promote co-regulation, is central to relational and trauma-informed practices. By doing so, we move toward environments that support not only behavioural stability but also emotional safety and wellbeing.
Complementing the neurophysiological insights of Polyvagal Theory, the Vulnerability–Stress–Coping Model provides a psychosocial framework for understanding how internal sensitivities interact with environmental demands to shape behaviour.
The Vulnerability – Stress – Coping Model offers a comprehensive framework for understanding behaviour in autistic individuals, particularly those labelled as exhibiting “challenging behaviour” (Theunissen, 2017). Rather than viewing such behaviour as deliberate or dysfunctional, the model conceptualises it as a meaningful response to the dynamic interaction between an individual’s intrinsic vulnerabilities, external stressors, and available coping mechanisms. This perspective reframes behaviour not as a problem to be corrected, but as a signal – communicating unmet needs, sensory overload, or attempts at self-regulation.
Vulnerability, in this model, refers to enduring traits that increase susceptibility to being overwhelmed. In the context of autism, these traits often stem from neurodevelopmental differences, shaped by genetic, epigenetic, and prenatal factors. While sometimes perceived as weaknesses, these sensitivities can also be sources of strength, such as intense focus or heightened perceptual acuity (Theunissen, 2017). However, in overstimulating or unsupportive environments, these same sensitivities may contribute to distress.
Stress denotes any internal or external demand that exceeds an individual’s capacity to cope. For autistic individuals, stressors can include sensory stimuli (e.g., noise, light), unpredictable routines, social demands, or subtle emotional cues. Although stress can be constructive in moderation, chronic or overwhelming stress – particularly when unbuffered by effective coping strategies – can provoke behaviours often perceived as disruptive. These behaviours, however, are not arbitrary; they are communicative and regulatory responses to internal discomfort (Theunissen, 2017; Elvén, 2019).
Coping involves the strategies individuals use to manage stress. For autistic people, these may include behaviours that seem unusual or disruptive to neurotypical observers – such as repetitive movements, withdrawal, or vocal expressions – but serve essential regulatory functions. These actions often emerge due to limited access to socially normative or verbal strategies, particularly under stress or sensory overload. When such behaviours are misunderstood or met with punitive responses, it can escalate distress and reinforce cycles of dysregulation (Elvén, 2019; Delahooke, 2019; McDonnell, 2025; Wilczek, 2024).
In school environments, everyday situations – such as loud corridors, unpredictable social dynamics, or rapid transitions – can be acutely stressful for autistic students. These experiences may provoke heightened physiological arousal, characterised by increased heart rate, muscle tension, and vigilance, all of which impair self-regulation. Research shows that autistic individuals often require longer recovery times following stressful events, underscoring the importance of proactive strategies to reduce stress before it escalates (Groden et al., 1994; Green et al., 2010).
Due to communication differences – especially among non-verbal or minimally verbal individuals – distress is frequently expressed through behaviour rather than language. In these cases, behaviour should be interpreted as a form of emotional communication, not as deliberate opposition or misbehaviour.
Understanding the interconnection between arousal, stress, and behaviour is essential for educators and caregivers. These behaviours rarely occur in isolation; they are typically triggered by cumulative stressors. When environments are not attuned to an individual’s sensory and emotional needs, they become sources of ongoing dysregulation (Theunissen, 2017).
The first step is recognising the types of situations autistic individuals experience as overwhelming, under-stimulating, distressing, or anxiety-inducing. Behaviour is then seen as a coping mechanism – an effort to manage or express internal tension. Such behaviours are often personally meaningful and functional but may be perceived by others as disruptive or inappropriate. Examples include emotional outbursts, crying, screaming, aggression, self-injury, or refusal to participate. Other responses, like fleeing, object destruction, or repetitive behaviours, may reflect an effort to regain control. These are often classified as externalising behaviours. In contrast, internalising behaviours may manifest as withdrawal, reduced social engagement, or a flat affect (ibid).
Regardless of form, behaviours that fall outside social norms are often interpreted as problematic and targeted for correction by educators, caregivers, or peers (McDonnell, 2010; Theunissen, 2017). Traditional behavioural interventions tend to view such behaviour as symptomatic of a deficit and focus on elimination through compliance-based strategies.
In contrast, alternative frameworks urge practitioners to look beyond the behaviour (Delahooke, 2019), emphasising the need to understand the underlying stress and the person’s overall well-being. From this perspective, behaviours are not symptoms to suppress but signals of unmet needs.
The Low Arousal Approach exemplifies this shift. By reducing environmental triggers and prioritising relational and sensory safety, it creates conditions that support emotional regulation and affirm the person’s dignity and autonomy (McDonnell, 2025).

Understanding the Low Arousal Approach
The Low Arousal Approach (LAA), developed by Dr. Andrew McDonnell in the early 1990s, represents a significant paradigm shift in managing stress, behaviour, and crisis – particularly within educational and therapeutic settings. In contrast to medical or behaviourist models that focus on modifying the individual, LAA centres on the responses and behaviours of professionals, caregivers, and family members in high-stress interactions.
The core principle is both straightforward and impactful: if challenging behaviour is driven, at least in part, by heightened physiological arousal, then reducing arousal levels can help de-escalate behaviour – especially in the short term (McDonnell, 2019). This idea is supported by broader psychological and neuroscientific literature highlighting the central role of arousal in behavioural regulation (Kahneman, 1973; Fowler, 1977).
Although the concept of arousal itself is not new, the application of LAA in contexts involving autism and intellectual disability marked a transformative development. It reinterprets crisis behaviour not as something to be suppressed or punished, but as a communicative act – one that calls for empathy, co-regulation, and non-confrontational support (McDonnell, 2025).
From this perspective, the Low Arousal Approach provides a valuable framework for responding to “behaviours of concern” in autistic individuals, particularly where verbal communication is limited. Importantly, it encourages what Damian Milton (2012) describes as “imagining otherwise”: moving beyond conventional intervention paradigms and adopting autistic-informed, person-centred perspectives.
The approach emerged from a large-scale study on incidents of aggression among individuals with intellectual disabilities (McDonnell, Waters, & Jones, 2002). The findings revealed that staff responses – rather than the actions of the individuals themselves – often escalated situations. These insights challenged traditional consequence-based models and inspired an alternative strategy focused on reducing external stress and preventing escalation through caregiver behaviour.
The LAA acknowledges that elevated arousal can impair behavioural control. For autistic individuals – many of whom experience co-occurring sensory processing differences – this is particularly relevant. Accordingly, the approach offers a compassionate, relational framework for understanding behaviour in context. As McDonnell, McEvoy, and Dearden (1994) describe, Low Arousal Approaches comprise “a range of behaviour management strategies which focus on the reduction of stress, fear and frustration and seek to avoid confrontations with service users.”
LAA strategies are both proactive and reactive.
• Proactive strategies include reducing unnecessary demands, adapting the environment, and recognising early signs of distress. For example, in the pre-crisis phase, professionals might observe pacing, self-injurious gestures, or social withdrawal. Effective responses may involve minimising sensory overload, offering calming alternatives, or modifying expectations (McDonnell, 2010).
• Reactive strategies focus on de-escalation during crises and supporting recovery afterward. In the crisis phase, communication should be calm, minimal, and non-confrontational. Practices such as eye contact or physical touch – often considered soothing in neurotypical contexts – may increase arousal and are typically avoided. Staff are encouraged to maintain emotional regulation and neutrality.
• During the post-crisis phase, recovery is prioritised: stressors are not reintroduced until the individual is fully regulated, and discussions about the incident are deferred. Staff debriefings centre on emotional reflection and learning rather than assigning blame (McDonnell, 2010).
LAA aligns closely with trauma-informed care principles (Harris & Fallot, 2001; Delahooke, 2019), which emphasise the creation of environments that prioritise emotional safety, agency, and relational trust in order to avoid retraumatisation. This is particularly crucial when supporting autistic individuals, who are disproportionately affected by trauma, not only due to overt incidents of harm, but also through cumulative, everyday experiences of being misunderstood, invalidated, or pressured to conform within systems that prioritise compliance over consent.
In many institutional and educational contexts, trauma can result from repeated exposure to overwhelming sensory environments (Rumball et al., 2020), social exclusion, or the use of behavioural interventions that emphasise control rather than connection (Kuferstein, 2018; McGill& Robinson, 2021). Autistic individuals may also experience trauma through persistent masking – the suppression of authentic behaviours (e.g., stimming, avoidance of eye contact, or direct communication) in order to meet neurotypical expectations (Miller et al., 2021). While masking can enable temporary social acceptance, it often comes at the cost of emotional and psychological well-being. Over time, this internalised stress can lead to anxiety, depression, identity confusion, and autistic burnout – a state of physical, mental, and emotional exhaustion linked to prolonged social and sensory strain (Raymaker et al., 2020; Cage & Troxell-Whitman, 2019; Ng-Cordell et al., 2022)).
Furthermore, traditional interventions such as restraint and seclusion – still in use in some educational and care settings – can reinforce feelings of powerlessness and fear (Kelly et al., 2021; Perry et al., 2021). As Pitonyak (2005) insightfully notes, such measures often reflect the emotional regulation needs of staff, rather than a compassionate response to the distress of the individual. In contrast, LAA seeks to de-escalate through relational safety, emotional attunement, and minimal demand environments, recognising that the path to regulation lies in co-regulation, not coercion (McDonnell, 2025).
Fundamentally, the Low Arousal Approach calls for a broader cultural shift within organisations. It encourages critical reflection on institutional policies, rigid rules, and staff attitudes that may inadvertently escalate distress. Central to this shift is the practice of self-reflection – caregivers and educators are urged to examine their own emotional triggers, assumptions, and beliefs about control and authority.
This reflective stance echoes Milton’s (2012) concept of the “double empathy problem,” which reframes social misunderstandings between autistic and non-autistic people as mutual and relational, rather than deficits located solely in the autistic person. LAA thus challenges professionals to adopt more nuanced, empathetic, and collaborative responses – imagining otherwise, and doing differently.
Practical Implementation of the Low Arousal Approach
Implementing the Low Arousal Approach (LAA) in educational settings involves a multi-layered strategy (Image 1) encompassing: reducing stress and arousal by adapting the environment – for example, by minimizing sensory input, providing predictable structure, and creating safe retreat spaces. Importantly, LAA does not aim to “extinguish” challenging behaviours, but to prevent their escalation by fostering emotional safety, co-regulation, and mutual respect. It emphasizes proactive emotional support through early recognition of distress, co-regulation, and reducing pressure with flexible, supportive strategies. A key element is staff self-regulation, where calm voice, open body language, and respectful positioning help de-escalate situations and prevent emotional contagion (McDonnell, 2025).

Image 1. Practical application of Low Arousal Approach (original illustration by the authors)

Implementation begins with careful observation. Educators and support staff must identify early indicators of rising arousal, which vary between individuals. For some pupils, this may present as restlessness, verbal protest, or irritability; for others, signs may be more internalised, such as withdrawal, silence, or dissociation.
In the pre-crisis phase (Image 2), non-confrontational and supportive strategies are key. These may include reducing task demands, offering choices, and providing calming sensory supports – such as quiet spaces, weighted items, or visual schedules. These interventions align with Dunn’s sensory processing model (2001), which highlights individual differences in sensory thresholds and responses (McDonnell, 2010). Flexibility within a predictable classroom structure is essential; routines should be consistent but adaptable, transitions clearly signposted, and expectations communicated in accessible formats (Elvén & Sjölund, 2022).
During the crisis phase, the primary goal is immediate de-escalation. Staff must regulate their own emotional responses and avoid escalating behaviours such as raised voices, authoritative commands, or excessive proximity. Eye contact, gestures, and spatial positioning should be tailored to the student’s sensory and communicative preferences. Often, a calm, quiet presence – characterised by minimal verbal input and slow, deliberate movements – can be more effective than direct intervention (ibid). As McDonnell (2019) note: “When people are in crisis, they are not thinking rationally. Our job is to remain calm when others cannot.”

Image 2. Modell der Affektregulation (Elvén & Sjölund, 2022, S.38)
In the post-crisis phase, the focus shifts to recovery. Demands should remain low, with opportunities provided for rest and self-regulation. Only once the student is fully calm should reflection or discussion be introduced – and even then, the emphasis should be on restoring emotional safety, not enforcing apologies or consequences. Staff debriefings serve a crucial function in this phase, enabling teams to examine their own emotional triggers, interactions, and responses in a non-judgemental context (Elvén & Sjölund, 2022).
Empirical reports and case studies highlight the positive impact of LAA on school environments. For example, one secondary school that implemented sensory retreat rooms and staff training in low arousal communication saw an 80% reduction in the use of restraint over a year, alongside improved staff well-being and pupil-staff relationships (McDonnell, 2010).
Crucially, successful implementation requires ongoing training, reflection, and institutional commitment. Staff must be equipped not only with practical strategies but also with a deep understanding of the theoretical underpinnings of LAA. The approach should be embedded into the school’s ethos and policies – not viewed merely as a response to behavioural incidents. Effective implementation involves consistent practice of these principles across daily interactions – in classrooms, therapy settings, and family environments alike. This demands a systemic cultural shift, where emotional regulation and relational safety are prioritised across all levels of care and education.
Evidence and Effectiveness of the Low Arousal Approach
Although the research base for the Low Arousal Approach (LAA) is still developing, existing evidence indicates promising outcomes across educational, residential, and therapeutic contexts. Early findings by McDonnell et al. (2002) reported significant reductions in the use of physical interventions and incidents of aggression following LAA implementation in residential and special education settings. These results have been echoed in subsequent studies, which highlight improvements in staff confidence, reductions in service-user distress, and enhanced quality of life for individuals with complex support needs (McDonnell et al., 2015).
Further research (Larsen, 2018; McDonnell et al., 2024; Anderson et al., 2018) found that incorporating LAA strategies not only reduced the frequency of challenging behaviour but also contributed to greater staff confidence, with reductions in burnout and moral injury. These findings suggest that LAA benefits both service users and professionals, fostering emotionally safer environments conducive to long-term stability and development.
Moreover, qualitative evaluations and pilot projects in countries such as Sweden and Australia have yielded similarly positive outcomes. Case reports indicate that LAA contributes to reductions in behavioural incidents, improved relational dynamics, and more responsive, respectful support for autistic individuals and those with intellectual disabilities (Elvén & Sjölund, 2022).
The effectiveness of the Low Arousal Approach can be better understood through the lens of contemporary neuropsychological research, particularly concerning the stress response in autistic individuals. Research indicates that autistic people often experience heightened sensory sensitivities, increased physiological reactivity to stress, and slower recovery following arousal (Anderson et al., 2018). In these contexts, traditional behavioural interventions that depend on confrontation or demand compliance may inadvertently intensify distress, resulting in escalation or shutdown (McDonnell, 2025). In contrast, the LAA aims to reduce these responses by minimising sensory and social stimuli that can trigger hyperactivation of the amygdala, promoting co-regulation strategies to help downshift sympathetic nervous system arousal, and avoiding coercive interactions that risk emotional overload or the development of learned helplessness.
These strategies are congruent with trauma-informed care models and Polyvagal Theory (Porges, 2011; Delahook, 2019), both of which underscore the role of safe, attuned relationships in promoting emotional regulation. By foregrounding calm presence, flexibility, and relational safety, LAA creates conditions where individuals are more likely to return to a regulated state without punitive intervention.
Additionally, LAA aligns with neurodiversity-affirmative perspectives, which conceptualise autism as a difference in neurodevelopment rather than a disorder to be corrected. It challenges the traditional focus on compliance and instead fosters autonomy, consent, and mutual respect. Milton (2012) highlights that autistic people often experience breakdowns in mutual understanding with neurotypical individuals – a dynamic that LAA seeks to redress through relational empathy and flexible support.
Limitations and Critical Considerations
Despite encouraging findings, the current evidence base for the Low Arousal Approach (LAA) presents several limitations. One significant concern is the lack of large-scale, controlled studies. Much of the existing research is grounded in qualitative methodologies, case studies, or service evaluations. While these offer valuable insights into real-world application, they fall short of providing the empirical rigor, which is needed to establish broader validation. Another challenge lies in the variability of implementation. As a principle-based rather than protocol-driven model, the application of LAA can differ considerably across settings, making it difficult to assess outcomes consistently. Additionally, there is occasional misinterpretation of its non-confrontational strategies. Some critics suggest that avoiding confrontation may unintentionally reinforce avoidance behaviours or impede appropriate boundary-setting. However, such concerns often arise from misunderstandings of the approach, which prioritises emotional safety and relational attunement without advocating permissiveness. As McDonnell (2019) clarifies, LAA is not synonymous with permissiveness. Rather, it embodies relational authority – a model of leadership grounded in emotional containment, respect, and attunement. It prioritises safety, regulation, and trust as preconditions for any meaningful behavioural change.
The effective implementation of the Low Arousal Approach depends not solely on individual practitioner competence, but on sustained organisational commitment. This necessitates strategic investment in leadership engagement, ongoing staff training, access to structured reflective supervision, and alignment with inclusive institutional policies. In the absence of these systemic supports, there is a significant risk that the approach will be fragmented into isolated techniques rather than adopted as an integrated, paradigm-shifting framework for practice.
As Pitonyak (2005) emphasises, true culture change is foundational as it requires ongoing reflection, not just procedural revision. In this way, LAA offers more than a strategy for behaviour support; it represents a paradigm shift toward ethical, relational, and rights-based practice.
Crucially, LAA should not be mischaracterised as passive or inactive. On the contrary, it requires highly skilled, proactive emotional regulation, supported by thoughtful planning and a commitment to long-term relational engagement. Implementing LAA effectively means investing in reflective team culture, professional wellbeing, and environments that honour dignity, autonomy, and neurodiversity (McDonnell, 2025).
Conclusion
The Low Arousal Approach (LAA) offers a compelling and ethically grounded alternative to traditional behaviour management strategies, particularly in supporting autistic children and adolescents. It reframes behaviours often labelled as “challenging” not as deliberate opposition, but as expressions of unmet needs or distress – calling for attuned, relational, and trauma-informed responses. Rooted in contemporary neuroscience, sensory integration theory, and principles of humanistic and inclusive education, LAA urges educators to look beyond surface behaviours and engage with the emotional, sensory, and contextual realities shaping them.
Critically, successful implementation of LAA demands more than the application of specific techniques; it calls for a systemic shift in educational culture – toward empathy, reflective practice, and relational safety. For schools, this means integrating LAA principles into institutional policies, training frameworks, and daily interactions. For individual practitioners, it entails the cultivation of emotional self-regulation, the capacity to tolerate ambiguity, and a commitment to meet pupils with respect, curiosity, and patience rather than control.
The broader ethical imperative underpinning LAA resonates with the foundational question of pedagogy: how can we shape educational practices in ways that are not only effective, but also responsible, meaningful, and rights-affirming – particularly under conditions of pressure or complexity? In this context, the seven principles of pedagogical ethics articulated by Prengel (2020), grounded in the UN Convention on the Rights of the Child, provide a valuable lens for reflection and action. These principles – ranging from self-care and nonmaleficence to autonomy, justice, and the cultivation of caring communities – create a moral compass for educators striving to uphold dignity and inclusion in their practice.
While further empirical research is needed to robustly establish the efficacy of LAA across diverse educational contexts, current findings, case evidence, and practitioner reports consistently highlight its potential to reduce crises, build trust, and promote wellbeing. Ultimately, the Low Arousal Approach invites a reimagining of educational environments -not merely as sites of behavioural compliance, but as spaces of connection, co-regulation, and shared humanity.

References
Ahmetovic, M., & Schubert, L. (2025). Autismus. In R. Markowetz, T. Hennemann, D. Hövel, & G. Casale (Eds.), Handbuch Förderschwerpunkt emotionale und soziale Entwicklung. Beltz Verlag.
Anderson, C., Lupfer, A., and Shattuck, P. T. (2018). Barriers to receipt of services for young adults with autism. Paediatrics, 141, S300–S305. doi: 10.1542/peds.2016-4300G
Branford, D., Gerrard, D., Saleem, N., Shaw, C., & Webster, A. (2019). Stopping over-medication of people with intellectual disability, autism or both (STOMP) in England Part 1 – History and background of STOMP. Advances in Mental Health and Intellectual Disabilities, 13(1), 31–40.
Brede, J., Remington, A., Kenny, L., Warren, K., & Pellicano, E. (2017). Excluded from school: Autistic students’ experiences of school exclusion and subsequent re-integration into school. Autism & Developmental Language Impairments, 2, 2396941517737511.
Cage, E., & Troxell-Whitman, Z. (2019). Understanding the reasons, contexts and costs of camouflaging for autistic adults. Journal of Autism and Developmental Disorders, 49(5), 1899–1911. https://doi.org/10.1007/s10803-018-03878-x
Chan, J., Arnold, S. R. C., Webber, L., Riches, V. C., Parmenter, T. R., & Stancliffe, R. J. (2012). Is it time to drop the term ‘challenging behaviour’? Learning Disability Practice, 15(9), 36–38.
Cho, V. (2020). Restraint and seclusion in schools and the IDEA struggle. Connecticut Public Interest Law Journal, 20, 289–321.
Culkin, J. M. (1967). A schoolman’s guide to Marshall McLuhan. Saturday Review, 18(Mar), 51–53.
Cunningham, C., Macfarlane, S., & Brodaty, H. (2019). Language paradigms when behaviour changes with dementia: #BanBPSD. International Journal of Geriatric Psychiatry, 34(8), 1109–1113.
Delahooke, M. (2019). Mehr als Verhalten. Neurozeption, Neurodiversität und die Wirkung früher Traumata auf die Gehirnentwicklung. Probstverlag: Lichtenau
Elvén, B. H., & Sjölund, A. (2022). Handeln, Auswerten, Verändern: Vom unaufgeregten Umgang mit Menschen mit einer Autismus-Diagnose und einer an Autonomie orientierten Pädagogik. dgvt Verlag.
Emerson, E., & Bromley, J. (1995). The form and function of challenging behaviours. Journal of Intellectual Disability Research, 39(5), 388–398. https://doi.org/10.1111/j.1365-2788.1995.tb00543.x
Emerson, E., & Einfeld, S. (2011). Challenging behaviour: Analysis and intervention in people with intellectual disabilities (3rd ed.). Cambridge University Press.
Fowler, CJH. (1977). The role of arousal in memory and attention. University of London, Bedford College (United Kingdom).
Green, J., Charman, T., McConachie, H., Aldred, C., Slonims, V., Howlin, P., … & the PACT Consortium (2010). Parent-mediated communication-focused treatment in children with autism (PACT): A randomised controlled trial. The Lancet, 375, 2152–2160
Groden, J., Cautela, J., Prince, S., & Berryman, J. (1994). The impact of stress and anxiety on individuals with autism and developmental disabilities. In Behavioral issues in autism (pp. 177-194). Boston, MA: Springer US.
Guldberg, K., Wallace, S., Bradley, R., Perepa, P., Ellis, L., & MacLeod, A. (2021). Investigation of the causes and implications of exclusion for autistic children and young people.
Harris, M., & Fallot, R. D. (2001). Envisioning a trauma‐informed service system: A vital paradigm shift. New directions for mental health services, 2001(89), 3-22.

Jorgensen, M. Nankervis, K. & Chan, J. (2023) ‘Environments of concern’: reframing challenging behaviour within a human rights approach, International Journal of Developmental Disabilities, 69:1, 95-100, DOI: 10.1080/20473869.2022.2118513
Kahneman, D. (1973). Attention and effort (Vol. 1063, pp. 218-226). Englewood Cliffs, NJ: Prentice-Hall.
Kelly, P., Saab, M. M., Hurley, E. J., Heffernan, S., Goodwin, J., Mulud, Z. A., … & O’Donovan, A. (2023). Trauma informed interventions to reduce seclusion, restraint and restrictive practices amongst staff caring for children and adolescents with challenging behaviours: A systematic review. Journal of Child & Adolescent Trauma, 16(3), 629–647. https://doi.org/10.1007/s40653-023-00524-2
Kitwood, T. (1997). Dementia reconsidered: The person comes first. Open University Press.
Kupferstein, H. (2018). Evidence of increased PTSD symptoms in autistics exposed to applied behavior analysis. Advances in Autism, 4(1), 19–29. https://doi.org/10.1108/AIA-08-2017-0016
Larsen, J. (2018). Research and Development project: Implementation and power measurement of the conflict management method low arousal. Special Area Children and Young People. Region Mitte Denmark.
Markwell, H. (2016). Loaded meanings: The narrative of behaviour. Australian Journal of Dementia Care, 5(4), 12–16.
McDonnell, A. A. (2010). Managing aggressive behaviour in care settings: Understanding and applying low arousal approaches. Oxford: Wiley- Blackwell.
McDonnell, A. A. (2019). The reflective journey: A practitioner’s guide tot he low arousal aproach. Peterborough: Studio 3 Publication
McDonnell, A. A. (2025). Working with parents and carers: An empathic Low arousal approach to distressed behaviour. In Improving Mental Health Therapies for Autistic Children and Young People (pp. 105-114). London and New York: Routledge.
McDonnell, A. A., Page, A., Bews-Pugh, S., Morgalla, K. A., Kaur-Johal, T., & Maher, M. (2024). Families’ experiences of the Low Arousal Approach: a qualitative study. Frontiers in Psychology, 15, 1328825.
McDonnell, 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 autistic spectrum disorders. Research in Developmental Disabilities, 36, 311-322.
McDonnell, A., McEvoy, J., & Dearden, R. L. (1994). Coping with violent situations in the caring environment. In T. Wykes (Ed.), Violence and health care professionals (pp. 189–206). Springer. https://doi.org/10.1007/978-1-4899-2863-4_11
McDonnell, A., Waters, T., & Jones, D. (2002). Low arousal approaches in the management of challenging behavior. In D. Allen (Ed.), Training carers in physical interventions: Research towards evidence-based practice (pp. 104–113). BILD.
McGill, O., & Robinson, A. (2021). “Recalling hidden harms”: Autistic experiences of childhood applied behavioural analysis (ABA). Advances in Autism, 7(4), 269–282. https://doi.org/10.1108/AIA-04-2020-0025
Miller, D., Rees, J., & Pearson, A. (2021). “Masking is life”: Experiences of masking in autistic and nonautistic adults. Autism in Adulthood, 3(4), 330–338. https://doi.org/10.1089/aut.2020.0083
Milton, D. E. (2012). On the ontological status of autism: The ‘double empathy problem’. Disability & society, 27(6), 883-887.
Ng-Cordell, E., Wardell, V., Stewardson, C., et al. (2022). Anxiety and trauma-related disorders in children on the autism spectrum. Current Psychiatry Reports, 24, 171–180. https://doi.org/10.1007/s11920-022-01331-6
Perry, E., Mandy, W., Hull, L., & Cage, E. (2022). Understanding camouflaging as a response to autism-related stigma: A social identity theory approach. Journal of Autism and Developmental Disorders, 52(2), 800–810. https://doi.org/10.1007/s10803-021-04987-w
Pitonyak, D. (2005). Supporting a person who is experiencing post traumatic stress disorder (PTSD). Health, 30, 1.
Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation (Norton series on interpersonal neurobiology). WW Norton & Company.
Prengel, A. (2020). Ethische Pädagogik in Kitas und Schulen. Weinheim:Beltz
Ramcharan, P., Nankervis, K., Strong, M., & Robertson, A. (2009). Experiences of restrictive practices: A view from people with disabilities and family carers (Final research report). Office of the Senior Practitioner. https://apo.org.au/sites/default/files/resource-files/2009-05/apo-nid27281.pdf
Raymaker, D. M., Teo, A. R., Steckler, N. A., Lentz, B., Scharer, M., Delos Santos, A., … & Nicolaidis, C. (2020). “Having all of your internal resources exhausted beyond measure and being left with no clean-up crew”: Defining autistic burnout. Autism in adulthood, 2(2), 132-143.
Rumball, F., Happé, F., & Grey, N. (2020). Experience of trauma and PTSD symptoms in autistic adults: Risk of PTSD development following DSM‐5 and non‐DSM‐5 traumatic life events. Autism Research, 13(12), 2122-2132.
Swaffer, K. 2018. Rethinking dementia: 30 Normal human responses (Blog post), [online] Available at: https://kateswaffer.com/2018/09/02/rethinking-dementia-normal-human-responses/ [Accessed 15 April 2025]

Theunissen, G. (2017). Autismus und herausforderndes Verhalten: Praxisleitfaden Positive Verhaltensunterstützung. Lambertus-Verlag.
Wilczek, B. (2024). Autismus, Trauma und Bewältigung. Grundlage für die psychotherapeutische Praxis. Stuttgart: Kohlhammer
Yerkes, R. M., & Dodson, J. D. (1908). The relation of strength of stimulus to rapidity of habit-formation. Journal of Comparative Neurology and Psychology, 18(5), 459–482. https://doi.org/10.1002/cne.920180503
Zeidan, J., Shikako-Thomas, K., Ehsan, A., Maioni, A., & Elsabbagh, M. (2022). Global prevalence of autism: A systematic review update. Autism Research, 15(5), 778–790. https://doi.org/10.1002/aur.2696

Autor*innen:
Melika Ahmetovic, MPhil
ORCID: https://orcid.org/0000-0003-0774-6561
Hochschule/Institution: Ludwig-Maximilians-Universität München
Arbeits- und Forschungsschwerpunkte: Pädagogik bei Autismus-Spektrum; Bildungsbiographien von autistischen Schuler*innen; Schulexklusion; Netzwerkforschung
Anschrift: Leopoldstraße, 13, 80802 München
E-Mail-Adresse: melika.ahmetovic@edu.lmu.de

Prof. Dr. Andrew McDonnell
ORCID:
University/Institution:
Work and research interests:
Address:
E-Mail: