Managing acute dysregulation and risk in Scottish Autism’s Services
Position statement on Low Arousal and Positive Behaviour Support
Autistic people who are supported in social care and education settings can sometimes experience acute levels of stress, distress and dysregulation. In some instances, this will present risk of harm or injury to supported people and practitioners. Such moments of risk are sometimes labelled as ‘behaviours of concern’ or, in the past were labelled ‘challenging behaviour’. However, our practice framework – with its emphasis on wellbeing – focuses less on changing the outward behaviour than reducing the stress or distress that underlies such incidents.
Low Arousal: The Studio III approach
The Low Arousal approach developed by Studio III offers insights, techniques and skills that allow us to prevent and reduce incidence of risk. Where such incidents do occur, Studio III training offers physical skills to de-escalate and manage such situations as safely as possible, while respecting the rights and of supported people and practitioners.
The approach does not sit outside of our practice framework, rather the Studio III focus on reducing stress, understanding autistic thinking, and safe management of physical harm sits within our wellbeing and rights-based approach.
Scottish Autism adopted Studio III training in 2020 as we believe it is consistent with our ethical approach and our commitment to eradicating restrictive practices.
Scottish Autism’s position on Positive Behaviour Support
We are often asked why Scottish Autism does not use Positive Behaviour Support in our services. Here we outline some of the reasons that we feel our own practice framework, underpinned by the insights of Low Arousal approaches, provides a more contemporary and ethical approach.
Behaviourism, trauma and community voice
At Scottish Autism we are committed to listening to what the autistic community tell us. Autistic advocates have spoken out for many years expressing the harm and distress that they feel comes from support rooted in behaviourist psychology (e.g. AMASE 2021, Dawson 2004, McGill and Robinson 2021). Many autistic people have recounted trauma from being pushed to act in ways that followed socially expected norms and did not allow them to follow their own ways of expressing themselves or self-regulating. At the same time, these approaches have often failed to address the sources of stress in their environment. We take these concerns seriously.
Whose preferred behaviour?
Positive Behaviour Support (PBS) has its basis in Applied Behaviour Analysis (ABA) developed in the United States in the 1960’s. In the 1980’s and 1990s, early PBS practitioners in the UK drew explicitly on this behaviourist paradigm, adapting the principles of Applied Behaviour Analysis for UK social care and education settings (Dunlap et al 2008; Gore et al, 2022:9).
At Scottish Autism we start with the premise of accepting different ways of being in the world. Historically behaviourist approaches fundamentally started from a person’s outward presentation and the premise of reinforcing ‘desirable’ behaviour and sanctioning undesirable behaviour. This poses an ethical problem – who decides what is desirable and undesirable? Too often, interventions have been based on normative judgements about socially ‘appropriate’ behaviour’ rather than acceptance of difference. For example, autistic people have, in the past, been stopped from following ‘stereotyped’ or ‘restricted and repetitive’ behaviours which can often be a source of comfort and self-regulation – known today as ‘stimming’. While we would hope that such instances are no longer the case, the ethical question remains – who decides what means of acting or communicating are desirable?
Often PBS is used in instances labelled as ‘challenging behaviour’ or ‘behaviours of concern’. Because autistic people do not always express stress or distress in ways that practitioners initially recognise, being steered to behave in a socially normative way may, in fact, create greater internal stress, masking of distress and emotion, and prevent access to activities that may help to regulate someone.
At Scottish Autism our starting point for support is to consider how someone may be feeling and how they may be experiencing their environments and interactions. We feel it is more ethical to understand behaviour that may present physical risk and harm as dysregulation, stress and distress and seek to ameliorate sources of that stress, rather to seek to modify a person’s outward behaviour. Such an approach has been advocated by autistic professionals and researchers in our sector (National Autistic Taskforce 2024).
Advocates of Positive Behaviour Support assert that contemporary practice is more focussed on wellbeing than normative ideas about behaviour, and we recognise that there will be PBS practitioners doing work today whose work is informed by more person-centred approaches and considerations of wellbeing (Gore et al 2013, Gore et al 2022). However, we prefer to follow a model that starts from this ethical premise, rather than try and retrofit it onto a practice model that has its roots in behaviourism. We feel that our own Practice Framework, underpinned by Studio III Low Arousal approaches, does so – with wellbeing and human rights as our fundamental principles.
Evidence and the “gold standard”
Positive Behaviour Support has sometimes been cited as the ’gold standard’ of evidence-based practice. There is indeed a large corpus of literature on PBS. Most of it is published by PBS practitioners evaluating work with small case studies in the authors’ own services. Though this work can share important and useful insights on supporting people with high support needs, most would not reach a ‘gold standard’ of evidence’. To our knowledge there is one ‘gold standard’ study of Positive Behaviour Support which employed a large-scale randomised controlled trial of PBS approaches. The study found staff training in PBS “did not reduce challenging behaviour” as a primary outcome when applied over a twelve-month period, nor did it improve ‘secondary outcomes’ of participants’ mental health, or family and carer wellbeing (Hassiotis et al, 2018).
We have often heard objections that where Positive Behaviour Support is not effective it must be because of imperfect implementation. Response to ethical critiques often stress that objections describe an old model and that PBS has changed and evolved. In the first instance, it could be argued that if an approach cannot be understood and applied with fidelity by social care practitioners, the approach itself may be problematic. More pertinently, if PBS can be applied so variously, or adapted and changed so much that it no longer looks as it once did, it is hard to see how a strong argument for evidence-based fidelity or methodological rigour can be asserted.
Who is PBS for?
The leading PBS body in the UK has acknowledged in recent years that Positive Behaviour Support is not appropriate for autistic people who do not have a learning disability (Gore et al, 2021). It is not clear to why PBS is inappropriate for someone who does not have a learning disability, but is appropriate for a person who does, and who may find it more difficult to self-advocate. We find it hard to see an ethical reason for differentiating between the needs of different autistic people on this basis.
References
Autistic Mutual Aid Society Edinburgh (2021, revised 202), On ‘Positive Behaviour Support’ (https://amase.org.uk/pbs/) accessed 23/12/25)
Dawson, M. (2004). The misbehaviour of behaviourists. Ethical challenges to the autism-ABA industry, 18. (accessed at https://www.sentex.net/~nexus23/naa_aba.html 23/12/25)
Dunlap, G. et al. (2008). Positive behaviour support and applied behaviour analysis: A familial alliance. Behaviour Modification, 32(5), 682-698.
Gore, NJ, et al. (2013) ‘Definition and scope for positive behaviour support’, International Journal of Positive Behavioural Support, 3(2), 14–23.
Gore, n. et al (2022) Positive Behavioural Support in the UK: A State of the Nation Report International Journal of Positive Behavioural Support, 12, Supplement 1, 2022
Hassiotis. A. et al (2018) “Clinical outcomes of staff training in positive behaviour support to reduce challenging behaviour in adults with intellectual disability: cluster randomised controlled trial” The British Journal of Psychiatry (2018)121, 161-168.
McGill, O., and Robinson, A. ““Recalling hidden harms”: Autistic experiences of childhood applied behavioural analysis (ABA).” Advances in Autism 7, no. 4 (2021): 269-282.
The National Autistic Taskforce (2024) Recognising Behaviour as Distress in Practice – a discussion paper. (https://nationalautistictaskforce.org.uk/wp-content/uploads/2023/06/NAT-SfC-Discussion-Paper-Final.pdf accessed 23/12/25)
February 2026